Food or Meds? The Lose-Lose Choice Facing Some Older Americans

Food insecurity was already common in older adults before the pandemic.

image by congerdesign from Pixabay

Years ago, when I worked as an ED nurse at Bellevue Hospital, one patient who became a favorite was a charming octogenarian named Sam. He would frequently present in congestive heart failure or pulmonary edema. He always responded quickly to treatment and often just needed a bit of furosemide to get rid of excess fluid.

After one of his almost monthly admissions, we found out that Sam relied on canned soup for much of his diet. The high salt content would cause him to retain too much fluid. He knew the salt wasn’t good for him, but soup was cheap and sometimes all he could afford.

What is food insecurity?

The United States is one of the world’s richest countries, yet we know that hunger is a common problem for many people. Older adults, especially those over 65 with multiple chronic conditions and who take multiple medications, are especially at risk for food insecurity—the inability to afford healthy and nutritious food.

Hard choices for elderly on a fixed income.

Many older adults live on fixed incomes and many don’t have supplemental insurance to cover medications. Some may have to choose between paying for medication or paying for other necessities like housing and food.

Many rely on programs like Meals on Wheels or food banks, but a number of these programs were suspended, at least for a time, during the early days of […]

Racism, Social Justice, and Nurses

By Karen Roush, PhD, RN, FNP-BC

The murder of George Floyd under the knee of a police officer, following so quickly on the murders of Ahmaud Arbery, shot down while jogging in February, and Breonna Tayler, an EMT with plans of becoming a nurse who was killed by police in her own home in March, coalesced years of anger, fear, and despair into an extraordinary outcry for racial justice that has not been seen since the civil rights movement.

Black Lives Matter.

Credit: National Nurses United

The chilling casualness with which Derek Chauvin ended George Floyd’s life over nearly nine agonizing minutes exposed more dramatically than anything else why we need to insist that black lives matter. The fact that it took four days for any charges to be brought against Chauvin, and over two months for the murderers of Mr. Arbery to be charged, only serves to reinforce what many have been saying for a long time, that all lives do not matter equally.

People have filled the streets of large cities and small to march in solidarity for racial justice and the end of police brutality. (Looters and rioters are not part of the protests and unwelcome by those marching for justice.) Not everyone may agree on how to achieve […]

2020-06-12T13:22:12-04:00June 11th, 2020|Nursing, Public health|4 Comments

Are You on Top of Your Patient’s Lab Values?

“Alterations in potassium, chloride, BUN, and creatinine provide important information about patients’ renal function, volume status, and acid-base balance… [and] demonstrate the importance of the nurse’s ability to integrate laboratory results with patient history, hospital course, physical examination findings, and underlying physiological mechanisms.”

Years ago, I monitored my patients’ labs by checking to see which results had been flagged by the lab as abnormal and making sure the physician was aware of these. I was on top of glucose and PTT’s, and knew well the steps we had to take in order to correct abnormal glucose or coagulation levels.

But I was fuzzy on the significance of many other changes in blood chemistry or hematology, and rarely connected any lab values with the larger picture of the patient’s overall health trajectory—nor, for that matter, was I expected to, back in the 1980s.

Today, nurses are more intimately involved in monitoring and managing lab abnormalities. […]

2020-06-09T06:35:53-04:00June 9th, 2020|Nursing|0 Comments

Environmentally Sustainable Nursing Practices: Small Changes Make a Big Difference

“The decisions nurses make about waste and efficiency on the front lines of clinical care matter, and the potential impact on health and the environment should not be underestimated.”

These days, most nurses have little time for anything that isn’t COVID related. Either we’re inundated with patients, changing work flow and physical spaces to accommodate long-term social distancing, or trying to home-school our kids or plan the next trip to the grocery store. Inevitably, though, our attention will return to other urgent issues in health care. The impact of our everyday work practices on the health of the planet is one of these issues.

How often do you toss unused linen into a laundry hamper after a patient is discharged, or discard leftover but unopened supplies that have been in a patient’s room, or hurriedly throw away soiled “chux” in a “red-bagged waste” container because that’s the nearest receptacle? In “Reducing Waste in the Clinical Setting” in this month’s issue, Sara Wohlford and colleagues at Carilion Roanoke Memorial Hospital in Roanoke, Virginia, share how increased attention to wasteful practices and modest changes in workflow can impact the environment and save money.

Small changes in three areas can make a big difference.

The authors looked at three facets […]

Cast Into the Shadows: COVID-19’s Power Over Non-COVID Cases

As a pediatric ICU nurse in a hospital that has not experienced an overwhelming surge of COVID-19 patients, it has taken me some time to register the ways this pandemic has affected my perspective and practice.

Non-COVID diagnoses left in the shadows.

Photo by Unjay Markiewicz/ Unsplash

I recently took care of two young patients, each with acute and unexpected conditions. One was under post-operative care after a brain tumor had been removed the day before. The other had been newly diagnosed with acute lymphoblastic leukemia. What stood out to me as I interacted with their families was that these were some of the only people I would interact with in this period who did not have COVID foregrounded in their mental and emotional space. This feeling was followed by the sobering realization that this was only because they found themselves dealing with something just as insidious, if not more so.

In both cases, the families observed confusing symptoms in their children and had to wrestle with whether or not to go to the ED in the midst of a pandemic. Only when the symptoms became so severe and concerning did these families decide they could no longer avoid the ED. Now facing an inpatient hospital stay and […]

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