Smoking, Orthopedic Surgery, and Bone Healing

When assessing a smoker who is scheduled for surgery, most of us will quickly zero in on their potential for complications from anesthesia. But what if the upcoming procedure is orthopedic?

Smoking is a well-known risk factor for osteoporosis and bone fracture, so it makes sense that it can be an issue in bone surgery healing.

In “The Effects of Smoking on Bone Health and Healing” in this month’s AJN, authors Stephanie Niu and Fidelindo Lim review the effects of smoking on bone health and healing and offer suggestions on how nurses might use this information to help people facing orthopedic surgery to quit.

“In addition to posing surgical and postsurgical risks for orthopedic patients, tobacco, nicotine, and other byproducts contained in traditional and electronic cigarettes (e-cigarettes or vaping products) adversely affect overall bone health and impede bone healing.”

Smoking associated with poor postsurgical outcomes.

Research has shown that smoking is associated with postop infection and poor bone fusion. It significantly increases time to union and risk of nonunion, and is significantly associated with poor clinical outcomes after surgery. […]

2020-07-20T09:16:45-04:00July 20th, 2020|Nursing|0 Comments
Read More

The Baby with Tetralogy of Flow

It is a good day so far—none of the 16 critically ill babies in the neonatal intensive care unit has coded or died. So far, the shrill electronic alarms for dying babies have been silent.

As the neonatologist on call, this gives me the opportunity to talk to Anna and Jake, Baby Milo’s parents. Milo peers up at them with big brown eyes as Anna leans over his crib and whispers to him. A small transparent plastic mask covers Milo’s tiny nose to help him breathe, and a cluster of saliva bubbles percolate between his lips. Despite a sleeve of tape securing his right hand, his tiny fingers tug the orange orogastric tube taped to his cheek.

Milo’s father, a brawny man wearing scuffed brown shoes, ripped blue jeans, a T-shirt, and a tattered Green Bay Packers cap, sits in a chair and nervously taps his knee while he stares with bloodshot eyes at the vital signs on Milo’s bedside monitor.

“Milo is adorable,” I say from the doorway. His parents look over to me as I step into the room.

“We think so,” Anna says with a smile.

“How are you both doing?” I ask. “Being in the NICU can be pretty stressful.”

Milo’s parents glance at each other and nod. Anna takes a seat next to Jake, who touches her shoulder.

I pull up a chair. “Can you tell me Milo’s story? How did you end up in the NICU?” I say.

“We were celebrating my birthday at a steakhouse,” Jake says. “Right after they brought […]

2020-07-15T11:23:21-04:00July 15th, 2020|family, family experience, pediatrics|0 Comments
Read More

Magnet Status Is Generally Better for Nurses and Patients

Discussed in this post: “Original Research: How Magnet Hospital Status Affects Nurses, Patients, and Organizations: A Systematic Review” (July, AJN)

Is the work it takes to become a Magnet hospital worth it?

The Magnet award recognizing excellence in nursing has been around for decades. It’s not an easy process, nor an inexpensive one—hospitals that apply invest a lot of time, effort, and money. There’s a considerable fee plus the expenses for the site visit appraisers, and many institutions designate or hire a Magnet coordinator whose job it is to ensure policies throughout the organization comply with Magnet requirements. It’s a huge undertaking. And while administrators may groan over the prospect of going through it, many hospitals do pursue it—there are over 500 Magnet-designated hospitals worldwide.

No institution is perfect, but Magnet does mean improved visibility for nursing.

I’ve had experiences, with friends or family, in both Magnet and non-Magnet hospitals. While I felt that overall patient care and responsiveness to patients and families was better at the Magnet facilities, there were also instances where things didn’t go quite the way they should. But in the harried hospital setting, I don’t expect 100% smooth sailing with every encounter with every nurse. What I have heard from several nurses who participated in their hospitals’ Magnet journey […]

2020-07-13T12:40:55-04:00July 13th, 2020|Nursing|1 Comment
Read More

Leaving WHO? Now?

Vital global health needs.

The July cover of AJN shows a nurse-midwife counseling a new mother in Ghana. We obtained this photograph from Jhpiego, a U.S.-based nonprofit organization that has been providing health services for women and families in developing countries since 1974. Not only does this image pay tribute to the Year of the Nurse and Midwife, but it’s a reminder that though the world’s attention is focused on the mounting cases of COVID-19, other vital global health care needs deserve our attention and our support. Infant and maternal mortality; communicable diseases like TB, Ebola, and malaria; and health crises arising from disasters, poverty, and war don’t pause while we deal with this outbreak.

A stunning departure.

I’m still in disbelief that the United States has given the World Health Organization (WHO) notice that it is pulling out of the organization. In May, the White House threatened to cut funding and leave, claiming that the WHO favored China and thus mishandled the COVID-19 outbreak (this was after praising them in April). This week, the United States confirmed it will leave the WHO. A global pandemic hardly seems the time to stop collaborating with other countries as the whole planet seeks solutions to combat this new and deadly coronavirus. […]

2020-07-09T11:32:24-04:00July 9th, 2020|climate change, infectious diseases, Public health|7 Comments
Read More

Falls in Behavioral Health: Different Population, Different Risk Factors

“I need help in 230A! Mr. Johnson is on the floor!”

(click image to enlarge)

Does your heart still sink when you hear a patient has fallen? We’ve gotten better at preventing falls, but we haven’t eliminated them. They remain one of the most common “incident” reports in hospitals. And did you know that adult behavioral health inpatients have more falls and fall-related injuries than patients on medical-surgical units?

In this month’s Cultivating Quality article, “Preventing Falls Among Behavioral Health Patients,” free until July 20, Stephanie Ocker and colleagues discuss their very successful falls-related interventions on an inpatient behavioral health unit. As they proceeded with their root cause analyses of recent falls, an unusual risk factor stood out:

“Patients frequently walked in the unit’s common area with bath blankets hanging around them and often trailing under their feet. When nurses would ask patients not to walk around with blankets to reduce the risk of tripping, patients would say they were cold.”

[…]

2020-07-06T10:53:28-04:00July 6th, 2020|Nursing|1 Comment
Read More

Comment ground rules

1. Please be respectful.
2. We moderate all comments.

Content disclaimer

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.
Go to Top