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 action.” […]

2017-07-27T14:40:37-04:00June 12th, 2015|Nursing|0 Comments
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Family Caregivers Increasing in Age, Numbers: How Can Nurses Help?

By Shawn Kennedy, MA, RN, AJN editor-in-chief

AJNFamilyCaregiverSupplementLast week, a new report from the National Alliance for Caregiving and AARP detailed the landscape of family caregiving in the United States. The majority (60%) of caregivers remain female (40% are men, a percentage that continues to rise). They average 49 years of age. In most cases, they are caring for a relative (typically, a 69-year-old female). On average, the caregiver spends 24 hours each week helping with daily activities and has been doing so for four years; one-third of caregivers still maintain a full-time job.

An estimated 34.2 million adults provided unpaid care to an adult 50 years or older in the previous 12 months; nearly one in 10 caregivers is 75 years or older—a typical example given in the report was a 79-year-old female caring for a 77-year-old spouse with Alzheimer’s disease, aging issues, or heart disease. Half of caregivers were thrust into caregiving and felt that they had no choice about taking on the responsibility of a loved one’s care; 22% of caregivers feel that their own health has suffered.

To raise awareness of their needs, in recent years AARP has championed the plight of family caregivers, collaborating with government and consumer organizations, and health care professionals. AJN, too, has worked with AARP on several projects to provide nurses with information to support family caregivers, […]

2016-11-21T13:02:26-05:00June 10th, 2015|Nursing, nursing perspective, Patients, Public health|0 Comments
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A Program of Mindfulness Practice for Nurses at a Boston Cancer Center

By Jacob Molyneux, senior editor

The Thea and James Stoneman Healing Garden at the Dana-Farber Cancer Institute is a source of tranquility and relaxation for nurses, patients, and families. Photo by Sam Ogden, Dana-Farber Cancer Institute. The Thea and James Stoneman Healing Garden at the Dana-Farber Cancer Institute is a source of tranquility and relaxation for nurses, patients, and families. Photo by Sam Ogden, Dana-Farber Cancer Institute.

Maybe you already practice some version of meditation or mindfulness in your daily life. If not, you may at least have read or watched a news story recently about mindfulness and its various uses with or by everyone from elementary school students to professional athletes to drug addicts in recovery to CEOs looking to improve their focus, as well as many of the rest of us.

Or maybe you saw the final episode of the television series Mad Men a few weeks ago, with the advertising man Don Draper sitting cross-legged at a California coastal retreat, deep in meditation.

Some critics of a […]

2016-11-21T13:02:26-05:00June 8th, 2015|career, Nursing, nursing perspective, personal health practices|0 Comments
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A Nurse Epidemiologist’s Notes on Issues Raised by a Recent Death from Lassa Fever

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

Lassa fever is most often diagnosed by using enzyme-linked immunosorbent serologic assays (ELISA), which detect IgM and IgG antibodies as well as Lassa antigen. Reverse transcription-polymerase chain reaction (RT-PCR) can be used in the early stage of disease. The virus itself may be cultured in 7 to 10 days, but this procedure should only be done in a high containment laboratory with good laboratory practices. Immunohistochemistry, performed on formalin-fixed tissue specimens, can be used to make a post-mortem diagnosis.

Some aspects of last month’s case of Lassa fever in New Jersey seemed to parallel the story of Thomas Duncan, who died last October in Dallas after contracting Ebola virus disease in Liberia.

A man arrived in the U.S. from Western Africa. He was screened for Ebola at the airport and instructed to monitor his temperature […]

2016-11-21T13:02:27-05:00June 5th, 2015|infectious diseases, Nursing, nursing perspective|0 Comments
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Nurses Aren’t Just Healers, They’re Teachers Too: A Patient’s View

Illustration by Jennifer Rodgers. All rights reserved. Illustration by Jennifer Rodgers. All rights reserved.

A teeny red bump had mysteriously appeared on my left index finger. It hurt when I pressed on it. I figured it was nothing. . . .

That’s the start of the June Reflections essay in AJN, “Ms. Lisa and Ms. MRSA,” a patient experience narrative by freelance writer Shannon Harris. As luck would have it, the bump on her finger, it turns out, is not nothing. It’s MRSA.

The diagnosis takes a while. Finally the situation worsens, and surgery is needed. The author takes it all in stride, at least in retrospect:

The third physician stood out to me most. He asked to take a picture of my green and black, staph-infected finger with his iPhone. “Sure. Look at it! I thought this only happened to pirates,” I told him as he snapped away. He glanced at the young, button-nosed nurse standing beside him. “Don’t you want a picture? For your records?” he asked.

She shook her head, squinting and gritting her teeth. “I know. Yuck,” I said. I later shared photos of my infection journey online, to the great wonder and disgust of my friends and family. Before that, though, came surgery.

The author’s tone is light, but the situation is a […]

2016-11-21T13:02:27-05:00June 3rd, 2015|Nursing, patient engagement, patient experience, Patients|1 Comment
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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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