Polypharmacy in the Elderly: The Risks Often Outweigh the Benefits

“…the single greatest adverse drug event risk factor is the number of medications a patient takes.”

Lessons from speaking to elders about their medications.

Early in my career, I taught groups of seniors about common medications as part of a hospital-based community health program. I traveled around the Chicago area, speaking to groups at senior centers, apartment buildings, and places of worship about their health and medications.

As part of our program’s mandate to educate physicians and nurses as well, we interviewed many elders on film, asking them to tell us about their medications. I will always remember one lady, relating a friend’s problems with adverse drug effects. “He’s dead now,” she stated with finality. She made it clear that she blamed his demise on the drugs his doctor had prescribed.

My experience in the Chicago medication education program influenced my pharmacology lectures to nursing students. Students may remember me most for the many times I repeated this statement: “The first sign of an adverse drug reaction in an older person is often a change in mental function.” This is a central reality of drug effects on the elderly.

Paying attention to unexplained cognitive changes.

Yet even today, the default response of […]

2020-02-03T08:54:32-05:00February 3rd, 2020|Nursing|0 Comments

April Issue: Delirium in Hospitalized Children, Lyme Disease Basics, Ostomy Care, More

The April issue of AJN is now live. Here are some of the articles we’re pleased to have a chance to publish this month.

CE: Original Research: Recognizing Delirium in Hospitalized Children: A Systemic Review of the Evidence on Risk Factors and Characteristics

Among the key findings of this review was that delirium is multifactorial,
related to treatment (such as mechanical ventilation) and to a hospital
environment (such as the pediatric ICU) that deprives patients of normal
sleep–wake cycles and familiar routines.

CE: Lyme Disease: Diagnosis, Treatment, and Prevention

The authors describe the clinical features of Lyme disease, the appropriate use of diagnostic tests, the recommended treatment, and evidence-based strategies for preventing tick-borne diseases nurses can share with patients.

Environments and Health: The Great London Smog of 1952

Over five days in December 1952, smog engulfed London, killing up to 12,000 people. This article discusses the disaster’s impact on human health and subsequent pollution legislation—including the U.S. Clean Air Act—and its implications for nurses today, as dangerous air quality events continue and environmental regulations are increasingly under threat.

Supporting Family Caregivers: No Longer Home Alone: Ostomy Care at Home

The authors offer practical guidance, including an informational tear sheet and an instructional

2018-04-02T09:22:34-04:00April 2nd, 2018|Nursing|0 Comments

Night Watch

Editor’s note: In this tightly observed guest post, a nurse visiting a sick family member experiences the hospital as a kind of foreign country.

Eileen McGorry, MSN, RN, worked as a registered nurse in community mental health for over 30 years. She currently lives in Olympia, Washington, with her husband Ron.

The walkway is hard, the concrete cold, and I am immersed in darkness. Then there is the swish of the hospital doors and whispery stillness. The light over the reception desk shines on a lone head, bent over a book. A clipboard is pushed toward me. The paper on it is lined with names, some boldly printed, others scribbled, the letters unrecognizable. The spacious lobby is filled with individual groups of soft stuffed chairs and love seats. All of it quiet and empty. Over the chairs and sofas, the black of the midnight hour is changed into twilight.

I remember the bustle of the area at midday. Families gathered together, eyes searching the crowd for the green scrubs of surgeons. “She will live,” they say to some, and to others, “We will wait and see.” The frenzy of the day over, the empty chairs wait for tomorrow.

I sign my name in script. I use the old Catholic school script. The script preached by my mother, who is upstairs recovering from heart surgery. I walk past the chairs along walls so […]

Preventing Delirium, The Luxury of Time, Things We Get Right, More: Nursing Blog Roundup

By Jacob Molyneux, senior editor

Here are a few recent posts of interest at various nursing blogs:

karindalziel/ via Flickr Creative Commons karindalziel/ via Flickr Creative Commons

In the throes of nursing school: An intriguing little pastiche of a poem (does it qualify as a ‘found word’ poem?) can be found at a newish blog, adrienne, {student} nurse, in a short post called anatomy of a bath. In another post, she makes the following observations: “In nursing school, you are not driving the train…You absolutely must keep telling yourself that there is nothing wrong with you.”

Preventing delirium in the ICU: At the INQRI blog (the blog of the Interdisciplinary Nursing Quality Research Institute), a post summarizes some recent research on implementing a “bundle” of practices to increase mobility and reduce sedation in the ICU, all in order to prevent patient delirium, which is known to have many short- and long-term negative effects.

The luxury of time. At Love and Ladybits, the author gets a tantalizing glimpse of the quality of care she’d be able to provide if she had more time to spend with each patient. Of course, this “alternative reality” can’t last, but perhaps it can serve as a touchstone of sorts during […]

Fecal Impaction and Dementia: Knowing What to Look For Could Save Lives

By Amy M. Collins, associate editor

Last October, I wrote a blog post about my grandmother, who is 85 and suffering from the first stages of Alzheimer’s disease, and about the failure of many providers to assess and treat the underlying cause of a sudden and extreme acceleration of her dementia symptoms (mania, agitation, and violence, along with nonstop, nonsensical talking).

The post generated a slew of comments on both the blog and Facebook, with over 20 nurses suggesting the probable cause for her symptoms to be fecal impaction or urinary tract infection. They were right. But several physicians and specialists had been shockingly wrong, diagnosing her with everything from closet alcoholism to VERY-late-onset bipolar disorder.

My grandmother did, in fact, have a severe fecal impaction, finally diagnosed—after several weeks of family turmoil—by a nurse in an ED. She was treated, and within a few weeks her symptoms slowly dissipated. I’m happy to say that she’s now back to her sweet and gentle self, with no memory of the episodes she herself would have deemed crazy.

Although her Alzheimer’s symptoms are still heartbreaking (she recently introduced me to a fellow assisted-living resident as her ‘special friend’ instead of her granddaughter), she isn’t agitated, hallucinating, accusing people of […]

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