Stoma siting: what the community nurse needs to know

Stoma siting is often regarded as the most important part of preoperative preparation. Marking the abdominal skin at the proposed stoma site takes place after a period of assessment, discussion, observation, consideration and evaluation that will have begun on the first meeting between the patient and the nurse. The siting procedure is a joint decision made between the patient and the nurse about the most suitable place for their stoma. The position of the stoma should allow the patient to manage it independently and to resume their normal activities after recovery. The success of the stoma can depend on the site and its condition. The purpose of this article is to describe and discuss the siting process and how it benefits the patient. Community nurses should gain a greater understanding of the issues involved, as well as the considerations for both the nurse and the patient. This article is intended to help the community nurse feel more aware of the issues involved in siting, and feel more prepared to assist the patient to prepare for and begin their life with the stoma. The outcome and effects of a 'poorly' or 'less than ideally' sited stoma (e.g. formed during emergency surgery), and its care and management will also be discussed. Illustrations have been included to assist the reader through the process of siting.     

Seasonal influenza: what every nurse needs to know

Professor Alan Glasper discusses this year's seasonal influenza advice from the Department of Health in preparation for winter, and the increasing importance of influenza vaccination by nurses, for nurses.     

Cancer genetics and nursing practice: what every gastroenterology nurse needs to know.

Most nurses will care for and provide health information about cancer to a patient at some point in their careers. Cancer care will change dramatically in the coming years as a result of the translation of information gained from the Human Genome Project into clinical practice and the enhanced understanding of cancer at a molecular level. A select group of cancers, known as hereditary cancers, result from mutations in the germline that confer a greatly increased lifetime risk of developing cancer. Advances in technology and discoveries stemming from the Human Genome Project now provide the means to test individuals for the presence of mutations associated with some known hereditary cancer syndromes. Of particular importance to gastroenterology nurses are hereditary colorectal cancer syndromes. Although many ethical, legal, and psychosocial issues associated with testing remain unresolved, predisposition genetic testing is having a significant impact on health care. Nurses will have vital roles in the future assessing patients and their family members for increased cancer risk, educating them about the availability of testing, making referrals for cancer genetic counseling and risk assessment, and providing follow-up care in the community for patients found to be at increased risk.     

Home care: what a physician needs to know

When elderly patients might benefit from home care, a key question is whether Medicare will pay for it. We describe what physicians can do to avoid the pitfalls in qualifying appropriate patients for Medicare's Home Health Services and hospice programs, and the basic features of these two programs. We also describe the experience and methods used in prototype programs that provide home-based hospital-level care, and that revive a supposedly lost art: physician house calls.     

Insulin pumps: what every school nurse needs to know.

The results of the Diabetes Control and Complications Trial revolutionized the care of people with Type 1 diabetes mellitus (DM). The era of "tight control" of blood sugars to decrease microvascular complications dawned. The subsequent technological development of insulin pumps has made it possible for individuals with Type 1 DM, as well as those with Type 2 who are insulin dependent, to keep their blood sugars in a more normal range. Children of all ages with Type 1 DM have been switching from multiple daily injections of insulin to insulin pumps. School nurses who have not had a child with a pump certainly will in the near future. It is important for school nurses to understand the function and possible complications of using an insulin pump to assist and support children in their transition to pump therapy. School nurses need to be aware of available technical support resources for insulin pumps should problems arise at school with pump management.     

Injury in women who are raped: what every critical care nurse needs to know.

Sexual assault is considered the silent, violent epidemic. However, many critical care nurses are unaware of the injury patterns that may indicate that their patient has been sexually assaulted. In addition, critical care nurses are often uncertain how to proceed when caring for someone with a suspected sexual assault. This article provides both background information about sexual assault and guidance to critical care nurses on how to manage this difficult situation.     

Contemporary pacemakers: what the primary care physician needs to know

Pacemaker therapy is most commonly initiated because of symptomatic bradycardia, usually resulting from sinus node disease. Randomized multicenter trials assessing the relative benefits of different pacing modes have made possible an evidence-based approach to the treatment of bradyarrhythmias. During the past several decades, major advances in technology and in our understanding of cardiac pathophysiology have led to the development of new pacing techniques for the treatment of heart failure in the absence of bradycardia. Left ventricular or biventricular pacing may improve symptoms of heart failure and objective measurements of left ventricular systolic dysfunction by resynchronizing cardiac contraction. However, emerging clinical data suggest that long-term right ventricular apical pacing may have harmful effects. As the complexity of cardiac pacing devices continues to grow, physicians need to have a basic understanding of device indications, device function, and common problems encountered by patients with devices in the medical and home environment.     

Emergency preparedness: what every health care worker needs to know

Canada is moving forward quickly with plans to ensure that it is prepared to deal with emergencies. The National Framework for Health Emergency Management, released Nov. 26, 2004, recommends that a National Health Incident Management System (IMS) be developed. However, although most communities have successfully implemented IMS in the emergency services sector, many are still struggling with the integration of IMS into their health care systems. It is essential that all health care workers, regardless of profession or position, understand at least the basic concepts of emergency preparedness because of the wide variety of roles they may be asked to fulfill in an emergency situation. This article will review the basic concepts in emergency preparedness and management with a specific focus on IMS in health care.     

Delirium in the critical care patient: what the professional staff needs to know

Delirium has been recognized in the literature as a significant problem in the care and treatment of the critical care patient. Delirium, a medical disorder that results in the morbidity and mortality of the patients, especially in the elderly, is often misdiagnosed and inappropriately treated. Nurses and other health care professionals need in-depth education about delirium, validated and understandable assessment tools, and astute clinical observational skills. A comprehensive and aggressive clinical management plan that incorporates appropriate pharmacological agents will result in less morbidity and improved long-term outcomes.     

Electroconvulsive therapy: what the internist needs to know

Although electroconvulsive therapy (ECT) is widely used to treat a number of psychiatric disorders, many physicians are still unfamiliar with the procedure, its indications, and its contraindications. This article is an internist's guide to ECT, with particular focus on how commonly prescribed medications and medical conditions affect ECT.     

Ezetimibe-associated adverse effects: what the clinician needs to know

OBJECTIVE: Ezetimibe is a relatively new lipid lowering agent, which is indicated for the treatment of primary hypercholesterolaemia, either as monotherapy or in combination with other hypolipidaemic drugs. The objective of the present article was to review the side effects attributed to ezetimibe administration and discuss their possible underlying mechanisms. Moreover, we aimed to comment on the possible drug interactions of ezetimibe and present current guidelines regarding its safe use. METHODS: Relevant articles were identified through a PubMed search (up to June 2007). RESULTS: Compelling evidence from the majority of the data reviewed here showed that adverse effects associated with ezetimibe use are few and mild without having been associated with serious clinical outcomes. In most studies ezetimibe has not been associated with increased rates of myopathy or rhabdomyolysis, whether used alone or in combination with statins, although there have been some case reports of myopathy attributed to this agent. Moreover, ezetimibe has been associated with mild elevations of liver transaminases, mainly in combination with a statin. Other side effects are extremely rare. It should be noted, however, there are no long-term safety data or outcome studies for ezetimibe yet. CONCLUSIONS: Ezetimibe is a safe alternative option for hyperlipidaemic patients intolerant to other lipid lowering drugs as well as a beneficial supplementary agent for patients who do not reach the recommended serum cholesterol level with their current hypolipidaemic treatment. However, as is the case with all new medications, physicians should be alert to recognise adverse effects associated with ezetimibe and report them to regulatory authorities.     

Body piercing: what nurse practitioners need to know

Body piercing is a growing trend among today's youth. Chances are, nurse practitioners will be in contact with someone who has a body piercing and/or complication relating to piercing. This article includes the history of body piercing, the environment of piercing parlors, the methods commonly used, site-specific explanations of select piercings, complications, treatment and practice implications. Nurse practitioners need to establish collaborative working relationships with their clients as well as those who do the piercings.