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A Case of Early PEG Tube Dislodgment—What Can We Learn?

By Sylvia Foley, AJN senior editor

Figure 2. A PEG tube (or G-tube) is inserted through the skin, subcutaneous tissue, and abdominal wall into the stomach. Illustration courtesy of the StayWell Company, Yardley, PA. A PEG tube (or G-tube) is inserted through the skin, subcutaneous tissue, and abdominal wall into the stomach. Illustration courtesy of the StayWell Company, Yardley, PA.

Percutaneous endoscopic gastrostomy (PEG) tubes are widely regarded as “one of the most useful” means of delivering enteral nutrition—but when things go wrong, the results can be devastating.

Consider the following case, presented in one of June’s CE features, “Early Percutaneous Endoscopic Gastrostomy Tube Dislodgment”: Mr. J. B., a man in his fifties, was involved in a motor vehicle accident and developed an extending, chronic subdural hematoma. After undergoing an emergency craniotomy, he suffered neurologic deterioration and respiratory failure. Treatment included the placement of a PEG tube for nutritional support, but when Mr. B. later became confused and agitated, he forcibly dislodged the tube. The bedside nurse “inserted a Foley catheter to replace the PEG tube, drew an air bubble out of the catheter to confirm gastric placement, noted this, and then reported the event to the facility’s attending physician, who acknowledged and approved the […]

2017-07-27T14:40:37-04:00June 12th, 2015|Nursing|0 Comments

Atrial Fibrillation: What the Newest Guideline Means for Nurses

Figure 1. Normal Sinus Rhythm and Two Types of Atrial Fibrillation. Images courtesy of ECGGuru.com. Figure 1. Normal Sinus Rhythm and Two Types of Atrial Fibrillation. Images courtesy of ECGGuru.com.

By Sylvia Foley, AJN senior editor

Atrial fibrillation, the most common chronic cardiac arrhythmia, affects an estimated three to six million Americans and can profoundly diminish their quality of life. Treatment guidelines for atrial fibrillation are frequently updated—a fact that “speaks to both the prevalence and the serious health care implications of the condition,” says Christine Cutugno, an experienced critical care nurse and educator. It can take time to determine just what has changed. She offers nurses ample guidance in one of this month’s CEs, “Atrial Fibrillation: Updated Management Guidelines and Nursing Implications.” Here’s a brief overview.

Atrial fibrillation is frequently associated with advancing age, structural cardiac dysfunction, and preexisting comorbidities. The most common complications, stroke and heart failure, result in significant morbidity and mortality. Indeed, atrial fibrillation is responsible for over 450,000 hospitalizations and 99,000 deaths annually and adds up to $26 billion to U.S. health care costs each year. Given the aging of the U.S. population, the incidence of atrial fibrillation is expected to double within the next 50 years. There is evidence that nursing intervention in patient education and transition of care coordination can improve adherence to treatment plans and patient outcomes.

This article reviews the recently updated guideline for the management of atrial fibrillation, issued jointly by the American Heart […]

2017-07-27T14:41:02-04:00May 15th, 2015|Nursing|0 Comments

Florence Nightingale: The Crucial Skill We Forget to Mention

“Suppose Florence hadn’t been a writer? Think about it…”

Karen Roush, PhD, RN, is an assistant professor of nursing at Lehman College in the Bronx, New York, and founder of the Scholar’s Voice, which works to strengthen the voice of nursing through writing mentorship for nurses.

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

When we talk about the diversity of what nurses do, there is no better example than Florence Nightingale herself.

She was an expert clinician working in hospitals in Europe and London and caring for soldiers in military hospitals during the Crimean War. She was a quality improvement expert, implementing improvements in military hospitals that had a major impact on patient outcomes. Her work as an educator created the very foundation of nursing as a profession. She was a researcher and epidemiologist, using statistical arguments to support the changes she demanded. She was a public health advocate, campaigning for improvements that benefited the health of populations globally. She was our first nursing theorist, defining an environmental model of health care still used today.

But you are probably aware of all of this. Florence’s contributions to nursing and health are well known. What often gets left out though, and is of great importance to the history of nursing and how we practice today, is […]

2016-11-21T13:02:32-05:00May 13th, 2015|career, Nursing, nursing perspective|11 Comments

A Found Poem For Nurses Week

Badruddeen, via Flickr Badruddeen, via Flickr

The poem below, originally published in our May 2005 issue, is by Veneta Masson, MA, RN. It’s a “found poem,” a form of poetry in which the poet assembles phrases selected from a source or sources. The lines here come “from actual posts to an Internet bulletin board,” but they could as easily be comments on AJN‘s Facebook page! The author is a nurse and writer living in Washington, DC (more about her work can be found here).—Jacob Molyneux, senior editor

Nurses Week—What Did You Get?
Hi, everyone! Just curious to see what you received for Nurses Week.

Denim shirts with the company logo

Swiss Army–type knives with fourteen blades

Carnations in dollar-shop vases

One wilted rose

Soap on a rope

I think I’m worth more than this

A live band at the Holiday Inn

A potato bar luncheon

If you weren’t there, you got nada

Nothing

Not a thing

A PA announcement thanking the nurses

We dug out our caps & wore them all day
our VP of Nursing came to the unit and stayed for an hour
we sat with her & shared our stories of why we went into nursing

We got pizza one day (if you were there) and ice cream one day (if you were there)

Rolos, Skittles and M&Ms—give me the tools to do my […]

2016-11-21T13:02:32-05:00May 11th, 2015|career, Nursing, nursing perspective|2 Comments

Seeing Potential: The Joys of Teaching Nursing

By Ruth Smillie, MSN, RN, associate professor of nursing at Saint Josephs College, Standish, Maine.

"Buck Up," by zenera / via Flickr. by zenera / via Flickr.

The day I come to class pregnant is one of my favorites. I really hate to be pregnant; I’m 55, grey haired, and way too old to be pregnant. My students are obviously surprised when I waddle in swaybacked with my sudden eight-month pregnancy. They snicker and smile, and then the magic begins.

As each one brings up the “change” they were assigned, I acquire the mask of pregnancy: larger breasts (made from paper bowls), kidney stones and gallstones (collected from outside), more blood volume (once, in a soda bottle), varicose veins (pipe cleaners or string), and so on—all carefully attached to me by duct tape.

I look and feel ridiculous and we all laugh a lot, but that’s not the point. The point is that they remember the changes of pregnancy. Embarrassing as it is, I would do it every day if it helped them learn. I love to teach nursing and it has been an amazing experience.

Students have no idea how incredible they are. Most of mine are just out of high school, young and unaware of their potential. But they have it, and I can see […]

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