Nurses disease reporting

MANAGING INFECTION. The nurse should report any slight rise in temperature, sore throat, or other signs of infection to the primary health care provider as soon as possible because of a possible decreased resistance to infection during glucocorticoid therapy. Nursing personnel and visitors with any type of infection or recent exposure to an infectious disease should avoid patient contact. 

MANAGING LACTIC ACIDOSIS. When taking metformin, the patient is at risk for lactic acidosis. The nurse monitors die patient for symptoms of lactic acidosis, which include unexplained hyperventilation, myalgia, malaise, gastrointestinal symptoms, or unusual somnolence If the patient experiences these symptoms, the nurse should contact the primary care provider at once. Elevated blood lactate levels of greater than 5 mmol/L are associated with lactic acidosis and should be reported immediately. Once a patient s diabetes is stabilized on metformin therapy, the adverse GI reactions that often occur at the beginning of such therapy are unlikely to be related to the drug therapy. A later occurrence of GI symptoms is more likely to be related to lactic acidosis or other serious disease. 

The nurse carefully observes patients with cardiovascular disease taking the thyroid hormones. The development of chest pain or worsening of cardiovascular disease should be reported to the primary health care provider immediately because the patient may require a reduction in the dosage of the thyroid hormone. 

Reversible hypothyroidism has been reported in nursing-home residents without a history of thyroid disease, who had been taking iodinated glycerol as an expectorant (443). Hypothyroidism has been reported after longterm treatment with iodinated glycerol (444). 

In the Lyon Diet Heart Study, survivors of myocardial infarctions on a Mediterranean style diet rich in ALA were less likey to experience a second episode (de Lorgeril et al., 1994). These researchers reported that nonfatal myocardial infarctions and total death in subjects on the experimental and control diets were reduced by 75% and 70%, respectively. Fewer nonfatal myocardial infarctions also were reported in subjects consuming an Indo-Mediterranean diet rich in ALA (Singh et al., 2002). The Nurse s Health Study (Albert et al., 2004) also showed that diets rich in ALA reduce the risk of dying from coronary heart disease. The study was a 16-year followup involving approximately 76,000 women. Women on the highest ALA (1.5 g/day) diet had a 21% and 46%, respectively, lower risk of dying from coronary heart disease or sudden cardiac death compared to women on a 0.7 g ALA/day diet. 

Several extensive human epidemiologic studies have also been published. For example, two U.S. studies, one involving 87,245 female nurses (S23) and the other 38,910 male physicians (R5), both concluded that vitamin E supplementation was directly associated with reduced risk for ischemic heart disease. In addition, Gey and associates (G6) reported on a large cross-cultural European population which differed sixfold in age-specific mortality from CAD. The data supported their conclusions that this highly significant difference in CAD was primarily due to increased plasma vitamin E levels in those with a relatively low incidence of... 

Case Example An outbreak of an infectious disease leads public health officials to believe that a bioterror attack has occurred. To avoid panic in the public, however, they have made no public announcement of their suspicions. They have requested, however, that nurses be on the alert for new cases of the infectious disease and to report it to them immediately, along with certain information about the patient. A nurse asks her supervisor if she can legally make such reports. 

Case Example Because public health officials suspect a stealth bioterror attack, they request that hospitals secretly test all of their new patients for the suspected contagious disease. The patient is to be notified only if he or she tests positively for the disease, and he/she will be offered standard medical treatment. Reports are to go directly to public health officials. Can a nurse legally or ethically participate in such a program ... 

A study on diet and colon cancer was reported by W. Willett s group (Willett et at., 1990) (Table 11.3). The study examined various components of the diet, such as fiber, fat, and meat. The fiber component was divid into cereal fiber and fruit fiber. The fat component was divided into meat fat, dairy fat, saturated fat, and unsaturated fat. The meat component was divided into beef, pork, and lamb, and into rare versus well-done Styles of cooking. The body mass index, as defined in the Obesity chapter, was also recorded. The study was part of the Nurses Health Study Cohort, which was inibated in 1976 and involved 121,700 female nurses. Every 2 years, the nurses filled in a questionnaire that asked about various risk factors for disease. The questionnaire asked, for example, about 61 foods and their frequency In the diet. The foods were chosen to allow epidemiologists to make broad statements regarding the component nutrients. 

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