PAIN MANAGEMENT
Tackle pain with Pilates?
Studies have shown that arthritis is the leading cause of pain in nursing home residents. At a nursing home near Denver, Colo., a different approach to pain management in these patients is catching on: Pilates exercises.
A Pilates instructor leads about 30 nursing home residents with arthritis through a routine of modified Pilates exercises. Residents can do the modified exercises while seated, even in a wheelchair.
Pilates isn't just a trendy choice to help get patients moving; it's a way to focus on overall fitness. In fact, the benefits of Pilates and other forms of exercise extend beyond arthritis. Exercises like Pilates that promote balance and stretching may also help reduce pain in patients with neuropathy, cancer, old fractures, or prosthetic joints.
If you'd like to try this approach at your facility, keep in mind that it may take you some time to find a Pilates instructor who's willing to modify an exercise program for your residents. But it may very well be worth the effort.
PERTUSSIS
Booster vaccine shows promise
Your adolescent and adult patients may benefit from a new combination vaccine that appears to provide a booster for immunity against tetanus, diphtheria, and pertussis.
The overall safety profile for the combination tetanus-diphtheria-5-component acellular pertussis vaccine (Tdap) was similar to that of the currently licensed tetanus-diphtheria vaccine, according to a study published in the Journal of the American Medical Association.
What's significant is the addition of pertussis protection to the mix. More and more cases of pertussis, also known as whooping cough, are being reported in the United States. In 2004, in fact, the Centers for Disease Control and Prevention received reports of more cases of whooping cough in adolescents and adults than in infants, the first time that's ever been documented.
The authors said that widespread use of an adolescent and adult pertussis booster vaccine could reduce the number of cases of pertussis disease. Currently, booster vaccination with tetanus and diphtheria toxoids every 10 years is the standard of care in the United States. The authors' data indicate that the Tdap vaccine (which isn't yet available on the market) could be used to protect against tetanus and diphtheria as recommended while providing added protection against pertussis.
PROSTATE CANCER
Risk of fracture may outweigh benefit of treatment
Older men who are taking hormone-suppressing drugs to treat early prostate cancer may become dangerously prone to broken bones. In older patients, a broken bone may be deadly, beginning a downhill slide of slow-healing infections, serious complications, and becoming bedridden. Prostate cancer, on the other hand, is slow growing, and most patients die of other causes before the prostate cancer becomes life threatening.
Advise patients with early prostate cancer who are on hormone-suppressing therapy that they may be at increased risk of bone fracture. Urge them to have a careful discussion with their health care provider about benefits versus risks of their treatment. Adding a bone-resorption inhibitor like alendronate sodium (Fosamax) may help to slow or reverse bone loss.
RESPIRATORY FUNCTION
Flying can affect O2 levels
Even if you're not a nervous flyer, air travel can literally take your breath away. A study of 84 airline passengers published in the May 2005 issue of Anaesthesia suggests that flying can significantly decrease the blood's oxygen content.
More than one-half of the study's participants had oxygen saturation levels at or below 94% while flying at maximum altitude. The length of the flight didn't make a difference.
A drop in oxygen saturation could be a problem for passengers with lung or heart disease. Someone with lung disease could experience shortness of breath from reduced oxygen saturation. A person with heart disease may suffer angina or be at greater risk for a myocardial infarction or an arrhythmia while flying. Any passenger could be at increased risk of deep vein thrombosis, especially on long flights.
Encourage patients with lung or heart disease who are planning to fly to first visit their primary care providers and have their oxygen saturation level checked. If it's a little low, they may need to alert the airline that they could need supplemental oxygen during the flight.
CPR
Even the pros don't get it right
Insufficient or outdated training and overly complicated instructions for administering cardiopulmonary resuscitation (CPR) may cause paramedics, nurses, and physicians to perform it incorrectly and fail to restart a stopped heart. Problem areas include frequency and force of chest compressions and application of breaths.
Take the time to brush up on your CPR skills by reviewing guidelines for administering CPR from the American Heart Association and your institution. Ask questions if you're not sure you understand the steps. You'll be more confident when called on to perform the procedure if you're familiar with the latest recommendations.
COLONOSCOPY
Still the best
Tell your patients who may balk at having a colonoscopy that a recent study showed that it's the most effective method for detecting colonic polyps and cancers.
In a recent study, colonoscopy was substantially better at detecting polyps and cancers in patients at increased risk for developing colorectal cancer than computed tomography colonoscopy (often referred to as a "virtual colonoscopy") and air contrast barium enema. All individuals age 50 and older should be screened for colorectal cancer.
CHOLESTEROL CONTROL
Two's better than one
At the American Heart Association's annual conference, researchers reported that patients on therapy to control cholesterol levels get an added benefit from a two-drug approach: one drug to boost "good" cholesterol and another to lower "bad" cholesterol.
Study participants were given niacin, one of the B vitamins, in addition to a statin like atorvastatin calcium (Lipitor) or simvastatin (Zocor). High levels of low-denisity lipoprotein cholesterol are major risk factors for heart disease and stroke.
Advise your patient on statin therapy that he may want to discuss with his health care provider the benefit of adding niacin to his management plan.
SMOKING CESSATION
Help patients kick the habit
More then 440,000 deaths in the United States each year are caused by smoking. You can help your patients kick the smoking habit by following the five A's to a cessation intervention-Ask, Advise, Assess, Assist, and Arrange-as outlined in a new pocket guide, "Helping Smokers Quit: A Guide for Nurses." This free booklet, available from the U.S. Department of Health and Human Services, includes a table of Food and Drug Administration-approved medications for smoking cessation, online resources for nurses, and a new toll-free national hotline (1-800-QUIT-NOW) for smokers who want to quit.
Get your free copy of the smoking cessation guide by calling 1-800-358-9295, or by visiting http://www.ahrq.gov/path/tobacco.htm.
DID YOU KNOW?
In a recent study, colonoscopy was found to be substantially better at detecting colonic polyps and cancers in patients at increased risk for colorectal cancer than computed tomography colonoscopy and air contrast barium enema.