This looks at a story on blood pressure medications and why do I bring this is up? We don’t prescribe medications, at least general nurses don’t, nurse practitioners do but why do we need to know the differences between generic and brand name medications? This is an ongoing issue and as every nation in the world struggles with dealing with the increased cost of providing high quality medical care to our patients. Why aren’t we looking more closely at previous treatment modalities? Medications that are very inexpensive and are inexpensive to duplicate, to replicate, to provides, easy for the patients to manage with a well-known profile of side effects and issues that we can document and keep track of very easily rather than new medications that have a less proven track record that may or may not cause and extended life of the patient.
So, why do we- we need to look at those kinds of studies and do that kind of research and this particular study that I found here over at medicine net.com looks at dealing with patients with a history of hypertension and dividing that patient group up and giving some of them a standard, easily available generic diuretic medication that has been used for years to treat high blood pressure and also another group of patients giving them a rather new ACE inhibitor or rather new calcium channel blocker and looking at how that high blood pressure is being treated using those particular medications.
So, they had 33,000 people in this study and they looked at these patients and how they responded overtime. This study came out- began in 2002 and they followed up with these patients over 4 and 8 years and discovered that the diuretic was better than the calcium channel blocker in preventing heart failure and better than the ACE inhibitor in preventing onsets of stroke, heart failure and overall cardiovascular disease and that’s significant. We’re talking about a 20% higher death rate for tyhe ACE inhibitor group and a 12% higher rate of hospitalization and death in the calcium channel blocker group. Significant changes are differences in how these patients were managed when they were put on just a diuretic versus the more expensive, newer, brand-name medications.
So, we should be doing more studies like this because if the old medication is working fine, either similar effect in this or in this caase had a better patient morbidity and mortality profile then we should probably be doing more studies like this much more frequently because it just doesn’t make sense to go ahead and continually make new drugs that overtime were shown not to be that effective in treating the patients and yet caused increased expense to the entire health care system.
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This article has been featured in the news segment of the Nursing Show podcast episode Psychological Assessment and Episode 145.
Filed under nursing news by on Sep 3rd, 2010. Comment.
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Welcome to Episode 146 of the Nursing Show
The Nursing Show is a proud member of the ProMed Podcast Network.
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News–
Nursing Credit Linked to Political Activity
Concussions Send More Young Athletes
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Tip of The Week- Defense Mechanisms
The idea of defense mechanisms originally came from Sigmund Freud. Basically, it is defines as the ego’s response to to protect against anxiety. Defense mechanisms are thought to safeguard the mind against feelings and thoughts that are too difficult for the conscious mind to cope with.
A common defense mechanism is denial. Patients tend to convince themselves that everything will be okay. This type of defense mechanism is displayed by patients who have just been diagnosed with a terminal illness, or loved of patients who are near death. Another is displacement. It is diverting one’s emotions to something or someone less threatening to them instead of dealing with the original problem directly. An example of this is a person who had just been reprimanded at work by their boss throws everything they get their hands on when they get back to the office.
There are more defense mechanisms displayed not only by psychological patients but also for people who are in a high level of anxiety. The key to dealing with this is to identify the defense mechanisms displayed by the patient through listening and understanding carefully what the patient tells the nurse during the interview process and using the appropriate therapeutic communication techniques.
Identifying Defense Mechanisms Practice Test
Common Defense Mechanisms Hand out
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Don’t miss an episode! You can receive the Nursing Show Newsletter in your email inbox.
Other Podcasts from Jamie Davis:
- The MedicCast (for EMTs, Paramedics, EMS field work)
- MedicCast News (Weekly short medical news program)
- MedicCast Live (Monthly live call-in show with a single EMS topic)
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Song this week: Alyssa Hendrix with “Good Summer Rain”
Click here to get Songs from the MedicCast at the iTunes Store.
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This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.
Filed under nursing show podcasts, nursing show tv, podcast studio video by on Sep 3rd, 2010. Comment.
Now, stem cells have been out there for a while in research. Most recently, people have been holding stem cells as the eventual cure for many problems including spinal cord injury, neurological disorders, patients with any kind of permanent damage to their bodies; we could regrow portions or segments of organs, whatever the case may be. Well, a study that was recently done undertaken by the Mayo clinic and also researchers in Belgium concurrently, they used a mouse study to study mice with cardiac- induced cardiac problems. They then used the mouse’s own stem cells to change them using a recombinant DNA technique to go ahead and change those stem cells. They were targeted to become cardiac cells. The goal of course was to see if they can regrow dead cardiac muscle.
Now, this is a problem. If you have a patient with a heart attack, they have cardiac ischemia and then eventually death of the cardiac cells; they have that portion of their heart as non-functioning and it will not be getting any better. Patients that begin the downward slide of heart failure because of cardiac events or a series of cardiac events over time causing deaths of portions of the cardiac muscle, how do you regrow that cardiac muscle? You can’t, it won’t regenerate itself. But, if we are able to target stem cells to actually go in there- you have a patient with a significant cardiac event, you could put them on a cardiac bypass device to hold them momentarily to keep them on that bypass device, allowing the heart time to heal itself and regenerate cardiac tissue.
That’s a long way off. This type of study is still on the animal study stages so we’re looking at 10-15 years ‘til something like this might reach the patient population but it does hold out hope that stem cells do seem to be providing the tools needed to take care of patients with a whole host of injuries, whether it’s a medically related injury such as a cardiac event or if its perhaps a spinal cord injury because if we can regrow and regenerate cardiac cells, we should be able to do something similar for other types of cells and eventually perhaps even neurological cells. You may have patients coming in asking you questions because they see news headlines about things like this occurring and you should be able to talk to them about it and let them know that there’s a lot of great research going on out there. In may not help in the immediate near term but down the road, it could save a patient from otherwise be neither a life of disability or a life that would be extremely shortened and death following closely along.
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This article has been featured in the news segment of the Nursing Show podcast episode Psychological Assessment and Episode 145.
Filed under nursing news by on Sep 2nd, 2010. Comment.
This news story is looking at treatment of atrial fibrillation and its associated risk factors. Now, we’ve covered a-fib here on the show before. You can look back in past episodes and find those episode links and listen to that show or watc h that episode. In any case, a-fib comes associated with some risk factors including increased risk for stroke, pulmonary embolism, cardiac events and heart failure. So, what do we do when we have patients with atrial fibrillation to assess their risk for those events?
Well, there are all kinds of scoring and screening scales out there. We use them to assess patients’ fall risk, we use them to assess patients for many different things and there is an assessment scale for atrial fibrillation called the CHADS 2 score and its used to assess patients and see whether or not they have an increased risk for things like stroke. So if you use this score and you assess your atrial fibrillation patient, it was found in this recent study coming out of Sweden that patients with a higher CHADS 2 score were found to be at increased risk for stroke, other cardiac events and actually, the CHADS 2 score was found to score well for other cardiac issues. So not even patients with atrial fibrillation but patients with any onset of acute coronary syndrome using the CHDS 2 score was predictive of their risk other problems to occur such as stroke and other associated issues.
That’s what this particular news item I found over at medical news today is talking about and you should keep in mind that there are a host of assessment tools available for taking care of our patients and we should utilize those tools, we should also continually assess those tools for their effectiveness in predicting problems with our patients. Just because we’ve used a tool forever in a day doesn’t mean that it can’t be tweaked or made a little bit better to better cause us to look more carefully at our patients and predict future outcomes and try to avoid negative outcomes. So, I like studies like this and I’ll continue to bring those out as I find them.
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This article has been featured in the news segment of the Nursing Show podcast episode Psychological Assessment and Episode 145.
Filed under nursing news by on Sep 2nd, 2010. Comment.
Podcast: Play in new window | Download
Podcast (studio_video): Play in new window | Download
Welcome to Episode 145 of the Nursing Show
The Nursing Show is a proud member of the ProMed Podcast Network.
Subscribe to the Podcast MP3 Audio Version
iTunes |
Zune |
Podcast |
Blog
—-
Subscribe to the Podcast Studio Video Version
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Podcast |
Blog
———————————–
Sponsors
NursingTopStudent.com all of the tools student nurses need for less than $1 a day. Audio and video study aids plus a whole lot more! More than 200 files and counting!
Sponsor: Hold your meetings online for just $49 a month Try GoToMeeting free.
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News–
Better Treatment for A-fib and Risks
Smart Stem Cells Repair Hearts
Cheaper Generics Just as Good as Branded BP Meds
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Tip of The Week- Psychological Assessment Review
Psychological assessment is basically gathering information or testing a person to evaluate a mental health complaint. It explores the patient’s personal history including the presenting problem, when it started, medical and psychological history, substance abuse, mental status evaluation, and more. In assessing behavioral or psychological patients, nurses should keep in mind the communication techniques for these types of patients watch out for defense mechanisms displayed by the person interviewed and be able to get through those barriers for a more effective assessment.
To get the most out of the interview, nurses should start with open ended questions and proceed with leading questions focusing on the patient’s feelings. Since the mental and emotional stability of the patient can not be ensured, it is best to conduct the assessment process in a safe environment such as the nurse will not be in a cornered area and the objects that can pose physical threat are not within the patient’s reach.
For more tips and interview techniques for psychological patients, nurses and nursing students can follow the links below.
History and Mental Status Examination
Defense Barriers to Communication
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Don’t miss an episode! You can receive the Nursing Show Newsletter in your email inbox.
Other Podcasts from Jamie Davis:
- The MedicCast (for EMTs, Paramedics, EMS field work)
- MedicCast News (Weekly short medical news program)
- MedicCast Live (Monthly live call-in show with a single EMS topic)
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Song this week: Brakelazy with “Tricks”
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Click here to get Songs from the MedicCast at the iTunes Store.
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This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.
Filed under nursing show podcasts by on Aug 27th, 2010. 1 Comment.
An article study that recently came out, showing that Acetaminophen may be a trigger for teen asthma attacks. Now, why do I bring this up? Anytime I see an article like this that gets out into the public I am constantly reminded that as medical professionals, we need to understand what these studies are saying and we need to be able to speak intelligently about them should we receive a question from one of our patients. It’s important because the news media will go out there and put something like this out on the internet or out on the websites or on their health pages in the newspapers and what happens is that patients hear this and change the way that they’re medicating themselves. We should always always be educating our patients that if you read some article, you need to check with you healthcare professional. The person who told you to take a certain medication, to use a certain nutritional supplement, whatever the case may be, don’t just stop taking something until you’ve contacted the medical professional who told you to take it.
This is true for something as inane as Tylenol. It is not a dangerous drug when used appropriately and even though this study showed that there was an increased asthma risk for some patients, that asthmas risk is still not that great. I mean, it’s an increased risk for an existing patient that has asthma but it may not be necessarily an indication that you should stop taking Tylenol. So, we need to be able to educate our patients whenever studies that talk about medications come out and reach news headlines because ultimately, a lot of our patient just go “Oh, we can’t use Tylenol anymore”, and they might switch to something else that is not as appropriate to treat the problem at hand that may cause other side effects and switching from one analgesic to another over the counter, probably not too much of an issue but if you have patients that were put on Tylenol because they have GI issues and the family of NSAIDs, the anti inflammatories out there cause these patients typically to have more risk of GI bleeds, well an isolated lower risk of a possible asthma attack might be just the less significant problem to deal with than a patient developing a slow GI bleed by taking too much of an Ibuprofen or some other over the counter anti inflammatory medication for pain management.
So we need to be able to speak intelligently about what we’re seeing and be able to educate our patients about “hey, when you read something, don’t just read the headline, read the whole article”, because as for instance, and I’ll just slide down here at the very bottom of this article, the authors of the study say that it is a safe drug and there’s no imminent threat to patients but for some people at high risk, it might be important for their prescribers to advise them appropriately about whether this drug would be a good choice for them. This is the standard disclaimer but it’s all the way at the bottom of the article so we need to go ahead and educate our patients that don’t just read the headlines. The headlines are out there to freak you out, they are used to cause a little bit of a fear reaction so you’ll read the article, that’s how headlines are written. patients should understand that and not have a knee-jerk reaction to just reading a headline because of course the headline doesn’t tell the whole story and you need to have the whole story and then talk to a medical professional like your nurse to go ahead and find out what exactly this particular article means.
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This article has been featured in the news segment of the Nursing Show podcast episode Acetaminophen Medication Review for Nurses and Episode 144.
Filed under nursing news by on Aug 26th, 2010. Comment.
There’s been continual evidence that violence in the workplace for healthcare professionals at all levels is under reported. If a patient combative because of a head injury, because of sedation and they take a swing at you, it’s violence but does that mean- does that get reported necessarily? If a patient’s combative and you have to wrestle him, technically that’s violence but its not- you know, it doesn’t get reported very frequently.
So there is going to be some new guidance for the UK on how violence is recorded in the workplace and this is part of the National Health Service security and management service and they have launched a guidance on different ways to mark patient records so that if a patient has been violent with health care professionals in the past or there’s some indication that they tend to lash out and become combative under certain situations, wouldn’t it be nice if there was something in the chart to warn you about this? So there are going to be procedures in place, that are going to be put in place by the National Health Service in the UK to pt violence markers on electronic and paper records.
Is this something we’re already doing here? Again, it’s under reported, how often do you place in the chart that the patient was combative and it took three of us to hold him down? You may have put something in there but did it get marked anywhere else? Did a flag get put on that when a patient is found to be repeatedly combative whenever they’re sedated? This is something that we need to look at in our facilities. It’s easy for the UK to do this kind of thing; they have a National Health Service so they can have a national standard. It’s more difficult here in the United States and I think this is one of those things that different nursing organizations, professional organizations, perhaps the emergency nurses, the critical care nurses, the American Nursing Association should look into and propose a series of standardized language, standardized ways of noting potentially patient in the care record so that future professionals dealing with them will be forewarned and be able to be on the lookout, be extra prepared.
In my other line as a paramedic, in my other show the MedicCast, I end every episode with the words Scene Safety, BSI, scene safety and body substance isolation. Its something that new emergency medical services professionals have to learn about because we’re going into the field so frequently and having to protect ourselves and be aware of our surroundings. Situational awareness is just as important in the hospital setting especially because you might often let your guard down, thinking that “hey, I’m at work, I’ve got my friends and co-workers around me, I’m not necessarily a potential victim of violence in the workplace”, and yet we find that’s really not the case and different levels and aspects of violence are inflicted upon healthcare professionals in facilities all the time. So, hopefully we can come up with a way to document this and do so more appropriately and I’m looking forward to finding out more about what’s going on in the UK and how they’re going to be doing this and perhaps we can bring some of those procedures and policies here at the United States.
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This article has been featured in the news segment of the Nursing Show podcast episode Acetaminophen Medication Review for Nurses and Episode 144.
Filed under nursing news by on Aug 25th, 2010. Comment.
This is a recent story I found over at medicalnewstoday.com and this is a study from the University Of Maryland School Of Nursing and they were looking at workplace conditions in magnet hospitals. Now, those of you that know probably already know this but magnet hospitals are facilities that have raised certain departments or perhaps the whole facility to a certain level of care expectation. Most often, they require nurses that work there to have BSNs in those departments that have the magnet status and they are constantly reviewing and raising educational concerns and information for increased and better patient care and patient outcomes. Great for the patients, but by just working at a magnet hospital, does that mean that your work conditions as a nurse are better? Is nurse staffing better? You’re working with a higher educated caliber of nurse, I want to say higher caliber in general because a Bachelor’s degree does not a fantastic nurse make automatically, but certainly a nurse with a higher level of education, higher understanding and perhaps a higher base of critical thinking. So, you have good patient care outcomes but what about good work environment?
What this study found was that just coz you work in a magnet hospital doesn’t mean that your working conditions are necessarily better, that this is really a separate management concern. Focusing on patient outcomes is all well and good but there are other things, other factors that contribute to workplace satisfaction and that’s what this particular article found out. Really, actually when you think about under those concerns, it’s not really that much of a surprise. Yes, you have a higher requirement for the nursing staff educationally but that doesn’t necessarily mean that you will also have better workplace conditions or better staffing. It doesn’t mean that its worse, doesn’t mean it’s better but definitely is not an indicator that if you work in a magnet facility that you’re going to enjoy your job better. You should look at all aspects of any employer. as we run into the beginning of the new fall semester, we have a lot of new nursing students coming in here and perhaps this is their final year, they’re going to be looking at jobs, perhaps you just passed your nursing boards, you’re a recent graduate and you’re looking at different facilities and where you’d like to work.
You should always ask some questions. I’ve done this in the past, you check over at nursingshow.com and search for nurse interview tips or tips for new nurses. You will find some articles and other segments over there that I’ve put together in the past, talking about the fact that no matter where you are in your nursing career when you go to interview for a job, one of the things you should bring with you is your list of questions that you have for your perspective employer. You know, it doesn’t hurt you to ask good questions about the workplace. It shows you’re interested, it shows you’re engaged and it lets them know that those types of questions are on the minds of their prospective applicants and so you should ask questions about other services available to the facility. Go online, look at you hospital’s websites, look at your perspective employer’s website and find out a little bit more about their background and jot down a few questions to bring to the interview yourself and this will help you find the right fit for you. What is a good fit for some people in some facilities is not necessarily true for everyone and so you need to find the right job that’s going to fit your perspective style in workplace, style in patient care and so magnet hospitals may not be the perfect job for you.
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This article has been featured in the news segment of the Nursing Show podcast episode Acetaminophen Medication Review for Nurses and Episode 144.
Filed under nursing news by on Aug 25th, 2010. Comment.
Podcast: Play in new window | Download
Podcast (studio_video): Play in new window | Download
Welcome to Episode 144 of the Nursing Show
The Nursing Show is a proud member of the ProMed Podcast Network.
Subscribe to the Podcast MP3 Audio Version
iTunes |
Zune |
Podcast |
Blog
—-
Subscribe to the Podcast Studio Video Version
iTunes |
Zune |
Podcast |
Blog
———————————–
Sponsors
NursingTopStudent.com all of the tools student nurses need for less than $1 a day. Audio and video study aids plus a whole lot more! More than 200 files and counting!
Sponsor: Hold your meetings online for just $49 a month Try GoToMeeting free.
———————————–
News–
Acetaminophen: Teen Asthma Trigger?
New Guidance on Care Record Violence Markers
Working Conditions Less Better for Nurses in Magnet Hospitals
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Tip of The Week- Acetaminophen (Tylenol) Medication Review
Acetaminophen, more popularly known as Tylenol is one of the over the counter drugs that can be found in most American households. This medication is mainly used for minor pain and aches and for fever reduction. Since this is a common drug taken by most people, nurses should be aware of the basics of this drug to be able to provide the correct information to patients and avoid overdosing or under dosing on the drug.
Knowing information like how it works, its interactions with other drugs, and contraindications is also necessary to avoid unwanted side effects that can arise. For more information on the medication Tylenol, nurses and nursing students can follow the links below.
Medicine Net.com on Acetaminophen (Tylenol)
Nursing Show Episode on Acetaminophen Overdose
———————————–
Don’t miss an episode! You can receive the Nursing Show Newsletter in your email inbox.
Other Podcasts from Jamie Davis:
- The MedicCast (for EMTs, Paramedics, EMS field work)
- MedicCast News (Weekly short medical news program)
- MedicCast Live (Monthly live call-in show with a single EMS topic)
——————————–
Song this week: Johanna Stahley with “I’m Not Perfect”
![]()
Click here to get Songs from the MedicCast at the iTunes Store.
————————————

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.
Filed under nursing show podcasts by on Aug 20th, 2010. 2 Comments.
Up til now, insurance companies have been reluctant to get into the technology game where we have something that maybe can provide an option for our patients but their insurance company isn’t going to cover it and so they end up falling into the same-old, same-old whereas we could have a patient that could be safely and effectively managed much less expensively in the long term, but because of the upfront cost of putting in some kind of technological solution in the near-term, the insurance companies have bulked. That seems to be shifting according to this article I found over at medical news today.com, there is a shift and they’re starting to look at some monitoring technologies that will wirelessly let a monitoring center, physician’s office, a telenurisng program, hospital center, whatever the case may be, let them know about daily updates for for instance Congestive Heart Failure patients, COPD patients, patients that are at risk for being hospitalized with complications related to their medications, management of their disease.
Think about it, if we can monitor I’s and O’s remotely, we could catch an early weight gain that shows signs of Congestive Heart Failure exacerbation,. The benefit of that of course is we can adjust the patient’s diuretic medication, we can adjust the patient’s beta blockers and other cardiac meds and by doing that remotely by having a nurse- because it’ll be a nurse that calls, by having a nurse call in and verify the information, talk with the patient a little bit, get the assessment and then provide the update and information from their prescriber, we could give this patient an opportunity to not have a long-term hospital visit with all of the concurrent issues, risk for infection and other illnesses and expense and time away from home and all of those things that come into play when we have to hospitalize a patient. Managing this patient remotely, keeping them at home, keeping them from having and exacerbated situation occur is of course part of what nurses do and part of our focus on health management and return to optimal health and so I think that this is just right up nursing’s alley. This is what we do, it’s what we do really really well. So I’m looking forward to opportunities to do more of this. Imagine that at risk diabetes patient, that patient who for whatever reason is having difficulty managing their illness. If we could monitor their diabetes with them and catch some early shifts and some changes; maybe their diet is not where it needs to be, maybe they need some encouragement, all of these things can be done remotely and we provide this patient upfront care that staves off years of complications simply by making a quick phone call. So I’m looking forward to really having some of our insurers be more forward thinking about the uses of technology and actually reducing health care cost.
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This article has been featured in the news segment of the Nursing Show episode Johnson & Johnson Campaign for Nursing’s Future Campaign and Episode 143
Filed under nursing news by on Aug 13th, 2010. Comment.






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