About Jacob Molyneux, senior editor/blog editor

Senior editor, American Journal of Nursing; editor of AJN Off the Charts.

Recent Study: Electrolyte Disorders Common in Thiazide Diuretic Users

  • Hyponatremia and hypokalemia occur in approximately 20% of patients who take thiazide diuretics.

Thiazide diuretics are widely used in the treatment of hypertension, yet their use is associated with electrolyte disorders. Researchers investigated the prevalence of and risk factors for hyponatremia and hypokalemia in patients taking thiazide diuretics, substance-specific risks for these electrolyte disorders, and whether the use of thiazides is associated with a higher risk of syncope and falls.

The cross-sectional analysis by Ravioli and colleagues published in the American Journal of Medicine included all adults admitted to the ED in a one-year period whose sodium and potassium levels were measured on admission. The researchers conducted detailed chart reviews for all patients and screened for a history of syncope or falls.

Of the 20,421 patients for whom sodium and potassium measurements were available, 1,604 were taking thiazide diuretics regularly.

Acute kidney injury was more common in thiazide users than in nonusers (21.4% versus 7.2%). Hyponatremia and hypokalemia were also significantly more common in patients taking thiazides versus nonusers (22.1% versus 9.8% and 19% versus 11%, respectively).

[…]

2022-01-12T11:02:34-05:00January 12th, 2022|Nursing|0 Comments
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Distinguishing Between Delirium and Dementia in a Mother’s Rapid Decline

We now know just how vulnerable older adults in long-term care have been during the pandemic. COVID-19, especially in the pandemic’s early months, cost many their lives far too early. Even today we are seeing the disease bring premature death to the elderly, especially at facilities with lower staff vaccination rates. Just two days ago, NBC news reported the following disheartening NEJM study results:

“People in nursing homes are much more likely to die of Covid-19 if the staff caring for them remains largely unvaccinated, a study published Wednesday in the New England Journal of Medicine found.”

Other forms of decline accelerated by the lockdown.

But the isolation from family members and other external contacts imposed by the many months of lockdown had other less easy to measure costs. This month’s Reflections essay, “Again in a Heartbeat,” by Jeanne Kessler, MSN, RN-BC, details her own dawning awareness that something had begun to change in her mother as time went by during the lockdown at her assisted living facility.

Suddenly her mother couldn’t talk on the phone any longer. This wasn’t like her at all. Her attention span had shortened drastically. There were other worrisome indications. While […]

2021-12-10T07:55:02-05:00December 10th, 2021|Nursing|0 Comments
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‘I Didn’t Think It Would Happen to Me’

A daughter notices cognitive changes in her mother, a former geriatrics nurse.

Illustration by Janet Hamlin for AJN.

This month’s Reflections essay, “In Full Bloom,” is a gentle, humane exploration of what it’s like when an aging parent shows signs of cognitive decline. Author Diane Fraser deftly weaves memory, incident, and reflection together in this bittersweet one-page essay.

She describes her mother’s dawning realization of the hard reality of her own aging. “I’m old,” she said. “I’m really old.”

And then later, perhaps also alluding to her worsening dementia:

“I didn’t think it would happen to me. . . Those were my patients. This is me.”

There’s a family birthday party. An annual visit to a lilac festival where the author begins to find certain aspects of her mother’s behavior puzzling.

This is all described with lightness and respect. It’s just how it is, the author seems to suggest. We might as well make the best of it.

She remembers the sometimes bawdy stories her […]

2021-11-01T10:19:57-04:00November 1st, 2021|Nursing|0 Comments
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FDA Revokes Authorizations for Certain Respirators, Decontamination Systems

Changes reflect replenished stockpiles of approved equipment.

The Food and Drug Administration (FDA) has revoked its emergency use authorization for disposable respirators that haven’t been approved by the National Institute for Occupational Safety and Health (NIOSH). Emergency use authorizations for decontamination and bioburden reduction systems were also revoked as of June 30.

The actions were taken to align with updated recommendations from the CDC and the Occupational Safety and Health Administration (OSHA) that reflect an increased domestic supply of approved respirators. This means facilities no longer need to rely on crisis strategies to cope with supply shortages, such as the reuse of disposable respirators.

The FDA ruling, which took effect July 6, allows for a transition period. The agency suggests that health care facilities consider redistributing unapproved respirators to countries in need as well as to nonmedical industries, such as construction.

Every employer must have plan to protect workers.

Also in June, OSHA issued an Emergency Temporary Standard to protect health care workers from exposure to COVID-19. The standard requires that every employer have a plan in place that identifies COVID-19 hazards in the workplace and lists additional requirements for reducing transmission of COVID-19, including the use of respirators and PPE. OSHA will continue to monitor […]

2021-10-18T09:52:28-04:00October 18th, 2021|Nursing|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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