Wednesday, April 21, 2010
There are two kinds of people in this world, givers and takers. We nurses surely fit into the giver category. We literally pour ourselves out for others, in caring. How do we do this? How do we give and give and care and care, over and over again? What do we contribute to our community? In my opinion, our greatest “giving” contribution to our community is our children. You might feel this is irrelevant, but consider that most of us are parents or future parents. We realize that loving, teaching, and preparing our next generation of productive citizens is the GREATEST gift we can give to our community. We prepare our children for the joys and struggles that lie ahead for them. The giving and caring starts in our homes where we make parenting a priority and tremendous sacrifices for the family. Let us never forget the mighty work that dedicated parenting is for the community.
Beyond our homes, our attention and energy expands out to our studies and our work. We chose to be givers in this world when we answered that calling into nursing which we hear initially. We endure our rigorous studies and finally achieve that hard-earned goal, our nursing license. When we enter the profession, we are enchanted and enamored by the excitement and challenges, but all too soon the disillusionment sets in. We realize that things aren’t quite like the textbooks explain, and that maybe not every patient always gets the right amount of attention and effort devoted to them that they each deserves.
We realize that time and resources are finite, so we figure out ways to do more with less, and get more mileage out of our day. We learn to multi-task better, to streamline our processes better. We start to skip lunches, forget to drink and hydrate ourselves, and hardly ever make it to the bathroom. We put ourselves aside for the sake of the patients.
Throughout our careers, we CONTINUE to show that we are givers by not only living out our higher calling, but by choosing to stay and remain in our work. Even though we have our fair share of legitimate reasons to abandon ship, ALL of us here haven’t done that. We have CHOSEN NOT to. It’s our decision. It’s our decision to stay. It’s our decision to still care. It’s our decision to continue to endure the sometimes harsh conditions and situations we find ourselves in. The list of ways we show this determination and dedication to our patients is endless.(Christina Feist-Heilmeier, RN, MSN)
Nurse Telephone Triage Service is proud of our nurses, and appreciate the care they give to the patients we serve on a daily basis. For that, we say THANK YOU for your dedication, your hard work, your positive attitude, and your commitment to make NTTS the successful corporation that it is!
Wednesday, April 14, 2010
Most swallowed foreign bodies pass harmlessly through the GI tract. However, if it has a sharp edge, is greater than 1 inch in diameter, or batteries, the patient must be evaluated as soon as possible. Children with preexisting GI abnormalities (eg. tracheoesophageal fistula, stenosing lesions, previous GI surgery)are at increased risk of complications and are more likely to retain foreign bodies in the stomach.
Most complications of pediatric foreign body ingestion are due to esophageal impaction either at the thoracic inlet, cricopharyngeus sling or the mid esophagus. Once the foreign body reaches the stomach of a child with a normal GI tract, it is much less likely to lead to complications. Foreign bodies occasionally become lodged at the ileocecal valve. Foreign-body induced appendicitis has been reported. Besides sharp, pointed, toxic, or objects that are too long or wide, another important exception is the child who has swallowed more than one magnet. Reports exist of swallowed toy magnets attracting and adhering tightly to each other through the GI tract, leading to small bowel obstruction or necrosis of intervening tissues. Systemic reactions, such as a nickel allergy, are unusual but have been reported.
Retained foreign bodies may cause GI mucosal erosion, abrasion, local scarring or perforation. Foreign body migration may lead to peritonitis, mediastinitis, pneumothorax, pneumomediastinum, pneumonia or other respiratory disease. Migration into the aorta may produce an aortoenteric fistula, a horrific complication with a high mortality rate.
Esophageal foreign body symptoms may include dysphagia, food refusal or weight loss, drooling, emesis or hematemesis, foreign body sensation, chest pain, sore throat, stridor, cough, unexplained fever or altered mental status.
Stomach/lower GI tract foreign body symptoms may include abdominal distention/pain, vomiting, hematochezia, or unexplained fever.
Most children who have swallowed a foreign body do not need specialized care. Although a theoretical risk of spontaneously vomiting and then aspiration of a foreign body exists, this is unusual. Do not attempt to dislodge a foreign body from a spontaneously breathing patient by giving abdominal thrusts or syrup of ipecac.
If the child is not at increased risk, asymptomatic, and the object swallowed is not determined to be harmful, homecare advice can be given. Reassure the parent that most anything that can get to the stomach will pass through the intestines over the next 3-4 days without difficulty. Test the child's ability to swallow foods. If no symptoms are present and the object was small and smooth, ask the parent to give the child some water to drink. If the water is swallowed easily, the child should be able to eat some bread or other soft foods. Inform the parent that most foreign bodies are passed in a normal BM in 3-4 days, and there is nothing you can do to hurry the process. Have the parent call back if the foreign body was not passed in 3 days, abdominal pain, vomiting or bloody stools develop, or the child becomes worse.
With a looming shortage of primary care doctors, 28 states are considering expanding the authority of nurse practitioners. These nurses with advanced degrees want the right to practice without a doctor's watchful eye and to prescribe narcotics. And if they hold a doctorate, they want to be called "Doctor."
For years, nurse practitioners have been playing a bigger role. With 32 million Americans gaining health insurance within a few years, the health care overhaul is putting more money into nurse-managed clinics.
Newly insured patients will be looking for doctors and may find nurses instead.
The medical establishment is fighting to protect turf. In some statehouses, doctors have shown up in white coats to testify against nurse practitioner bills. The American Medical Association says a doctor shortage is no reason to put nurses in charge and endanger patients.