Off the Charts

When It’s Not Just Heavy Menses: A Nurse’s Guide to Recognizing von Willebrand Disease

By Sylvia Foley, AJN senior editor

Blood red sky by Micky Zlimen, via Flickr

Quick, what’s the most common inherited bleeding disorder? As you might have guessed from the giveaway title, it’s not hemophilia. It’s von Willebrand disease, and it affects about 1.3% of the U.S. population.

Yet many nurses and other clinicians, as well as the public, are unaware of this disease, its symptoms, and the associated risks. Sequelae can include complications during pregnancy and childbirth, chronic joint disease, even death. In girls and women, menorrhagia is the most common symptom; while the disease is equally prevalent in both sexes, it can be more problematic for menstruating females. In our June CE article, “Just Heavy Menses or Something More? Raising Awareness of von Willebrand Disease,” author Josie Weiss seeks to improve the odds that nurses will know when to suspect that a patient has the disorder and what to do once diagnosis is confirmed.

Simply put, von Willebrand disease is caused by “genetic defects in the concentration, structure, or function of von Willebrand factor,” which is a protein essential to blood clotting. These defects result in episodes of excessive or prolonged bleeding, which can be mild to severe in intensity. Weiss describes the three main types of […]

Guest Author2016-11-21T13:09:56-05:00June 11th, 2012|Nursing|0 Comments

A ‘Ruined Generation of Men,’ Plus a New Class Divide? Digital Adverse Effects in the News

By Michael Fergenson, AJN senior editorial coordinator

LAN Party NW, 2009/Chase N., via Flickr

There continue to be questions raised about the harmful effects of the excessive use of digital devices, mostly in the young but also in adults. Such ills as ADHD, violence, poor school performance, social isolation, and bullying have been attributed to the overuse of gaming, the Internet, and social media Web sites.

A ruined generation of men? Psychologist Phillip Zimbardo, well known for his ethically borderline 1971 Stanford Prison Experiment, contends that video games and digital media do have a detrimental effect on today’s youth, especially males. His recent article, “The Demise of Guys: How Video Games and Porn Are Ruining a Generation,” argues that addiction to video games and online porn “is creating a generation of risk-averse guys who are unable (and unwilling) to navigate the complexities and risks inherent to real-life relationships, school and employment.”

He refers to stories such as a South Korean man who went into cardiac arrest after playing a video game for 50 hours straight, a man whose wife kicked him out because he couldn’t stop watching porn, and a mass murder suspect who claims to have used video games to prepare for his crime of shooting 77 people. Zimbardo argues there may be a link between violent video games and real-life aggression.

Causation is hard to prove, but many studies have pointed to negative physiologic and psychosocial effects of such games over […]

Jacob Molyneux, senior editor/blog editor2017-03-27T12:15:49-04:00June 8th, 2012|Nursing|0 Comments

A Decidedly Female Focus: June Highlights

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

This month’s issue of AJN has a decidedly female focus, from the cover to the last page.

On the cover, we used an illustration of ancient Roman mosaics depicting women exercising.

The editorial focuses on the politicization of women’s health issues. (Read it and see if you agree—we’ve already received both pro and con letters.)

AJN Reports discusses safety issues connected with the often unregulated sharing of breast milk among women via Internet-enabled sale or donation.

The two CE offerings focus on women’s health: “Managing Menopausal Symptoms” is the third in our series on women’s health and provides an overview of managing a few of the more common and troublesome menopausal “changes”—for the sake of historical perspective, we included an archival piece from 1910, “Dangers of the Menopause” (abstract only; archival articles require a subscription).

The other CE, “Just Heavy Menses or Something More? Raising Awareness of von Willebrand Disease,” takes a detailed look at an inherited bleeding disorder that afflicts equal numbers of men and women. While much of the article’s information on the disorder and its recognition and management is relevant for both sexes, the article draws particular attention to women who are often not diagnosed because the disorder may present through symptoms associated with a woman’s menstruation pattern.

Lastly, “Seized,” our moving Reflections essay this month, tells the story of a mother’s feeling of powerlessness in the face of her daughter’s […]

Jacob Molyneux, senior editor/blog editor2016-11-21T13:09:57-05:00June 6th, 2012|Nursing|0 Comments

The Kiss: Hope in the ICU

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Love Song of Frank,” was published in the May issue of AJN.

by limegreeen9, via flickr creative commons

I always look forward to interdisciplinary rounds. I’ve worked with most of the team members for years and enjoy the differing perspectives and collaboration. Today is no exception; I know my patient very well, as he’s been in the ICU for months. As the interdisciplinary team moves through the ICU like a small mingling mob, pausing at each room for a brief nursing report and lingering for discussion, I stand in anticipation, ready to present my patient’s case.

My report, though, is politely cut short by the medical director.

“What’s changed?” he wants to know.

And I feel pressed to produce some crumb of improvement.

“Well…” I say. “He kisses his wife. His GCS* remains eight, but he kisses his wife.”

A few people smile, and I hear a few chuckles.

“It’s a reflex!” I hear someone say as they move away.

I know, of course, how little the kisses mean from a medical standpoint. His initial injury was neurologic, and his neuro status is quite compromised, but stable. His cardiovascular, gastrointestinal, and genitourinary systems are stable, as well. It’s respiratory insufficiency that keeps him in the unit. Puckering his lips in response to his wife leaning towards him is not significant […]

Marcy Phipps, BSN, RN, CCRN, CFRN2016-11-21T13:09:58-05:00June 4th, 2012|Nursing, nursing perspective, nursing stories, Patients|4 Comments

What to Do If the Nursing Board Takes Action Against You: A Lawyer and Former RN Advises

At 7 AM, when RN Michelle Flacco took over the care of 66-year-old Lester Scanlon, who had dementia and type 1 diabetes, she was notified that his blood glucose level was significantly elevated, at greater than 550 mg/dL. Ms. Flacco performed blood glucose tests three times during her shift, each time after Mr. Scanlon had eaten a meal, and each time his blood glucose level was elevated. However, Ms. Flacco didn’t notify Mr. Scanlon’s physician, nor did she administer insulin to the patient. The next shift, Mr. Scanlon was found unresponsive, with a very elevated blood glucose level. He was diagnosed with diabetic coma. The incident was reported to Ms. Flacco’s state board of nursing, and she was accused of professional incompetence. The board is seeking revocation of her RN license.

That’s the opening of “You’re Being Investigated by Your State Nursing Board” in the June issue of AJN. The case described is a composite, but it illustrates a situation that a nurse can find herself or himself in. The article, currently open access, is by Margaret E. Mangin, who practiced nursing for 12 years before becoming an attorney. For the past 26 years, she has practiced law in San Diego, primarily defending hospitals, nurses, and other health care providers. This is the latest installment of our Legal Clinic column. You might want to check it out. The table below gives the most frequent licensing violations, 1996 to 2006.