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
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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 […]

2020-06-04T10:11:36-04:00June 4th, 2020|environmental health, Nursing, nursing research|0 Comments
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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 […]

2020-06-02T09:32:44-04:00June 2nd, 2020|family experience, infectious diseases, Nursing, nursing stories, patient engagement, Public health|1 Comment
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Time Matters, Priorities Change: A Nurse and Cancer Survivor on Living with the Pandemic

Everything is different, and the same.

Michael Himbeault/Wikimedia Commons

It’s going to be a while before things get to normal, if they ever do. It’s more like the future will become the normal.

The only thing in my experience I can liken it to is my cancer survivorship: you start living your life again, but everything is different. Priorities change. Your sense of safety never fully returns, yet because of this you become more purposeful in living: time matters. It’s as though you go on living, but learn a new way to do it.

There’s actually a sense of freedom accompanying the realization that nothing/no one lasts forever.

Finding a middle ground.

After I completed treatment, I watched the Jeff Bridges film Fearless (1993). His character is a survivor of a horrendous airliner crash, and he develops a sense of invincibility as a way of coping. I understood his character really well. You either hide in fear, or you go forward as if you are invincible. Eventually, you discover a middle ground. […]

2020-05-27T10:26:29-04:00May 27th, 2020|infectious diseases, Nursing, patient experience, Public health, wellness|0 Comments
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June Issue Highlights: PPE Shortages, Opioid Use Disorder, More

“Nurses’ work has become powerfully visible.”—editor-in-chief Shawn Kennedy in her June editorial, “Nurses: Courageous, Committed, and Fed Up”

The cover image of our June issue is a watercolor painting, Human, by Ohio artist Jim Leitz. Created in March, the painting is a tribute to the experiences of frontline health care workers during the COVID-19 pandemic. The June issue is now live, and features continuing coverage of COVID-19, plus many articles on other topics in nursing and health care. Here’s what’s new:

Original Research: The Relationship Between Food Insecurity and Cost-Related Medication Nonadherence in Older Adults: A Systematic Review

The authors conducted a comprehensive review of the literature to explore the connection between these two significant public health issues. The evidence suggests a correlation and points to the need for more effective interventions.

Opioid Use Disorder: Pathophysiology, Assessment, and Effective Interventions

A review of the development of opioid use disorder, available screening tools, medical treatments, and behavioral interventions that have demonstrated efficacy in reducing substance use.

Back to Basics: Abnormal Basic Metabolic Panel Findings: Implications for Nursing

In this article in a new series designed to improve acute care nurses’ understanding of laboratory abnormalities, the author discusses important values in the basic metabolic panel, including the electrolytes potassium and chloride as well […]

2020-05-26T09:23:33-04:00May 26th, 2020|Nursing|0 Comments
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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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