Candis Morrison

Identification and Management of Delirium in the Critically Ill Patient With Cancer

Rather than a specific entity, delirium is at the midpoint on a spectrum of potential mental status changes that ranges from full consciousness to deep coma. The extremes are relatively easy to recognize, but other points along the spectrum may go unrecognized or be misdiagnosed. If recognized and treated expeditiously, delirium may be reversed in some patients. It is imperative that those caring for critically ill patients with cancer have the knowledge and tools necessary to identify and manage delirium appropriately. Although all critically ill patients are at risk for delirium, cancer presents additional assaults to the central nervous system via direct tumor invasion or iatrogenic provocations. This article describes delirium in cancer, and addresses diagnostic and management issues across the course of the disease.

Interrelationships of Violence and Psychiatric Symptoms in Women with Substance Use Disorders

&NA; Womens issues of violence, mental health problems, and substance abuse have been noted to cooccur, but few studies have examined the interrelationship among the three. A chart review of 198 women (primarily African American) at an inner city substance abuse treatment center was performed to collect data related to physical and sexual abuse experiences before and after age 13. There were significant associations among all forms of physical and sexual abuse before and after age 13 and most of the types of substances abused and almost all of the presenting mental health problems, but most of the independent relationships became nonsignificant in multivariate analyses. However, the experience of both physical and sexual assault increased the risk of suicide attempts by a factor of 6.04. Physical assault was a borderline (p= .07) predictor of depression, while sedative use was significantly predictive of depression, anxiety, and suicide attempts.

A centralized, computerized, and relational data base for student clinical placements

Quality clinical experiences are a critical component of advanced practice nursing (APN) curricula. Historically, nursing instructors coordinated both the didactic and clinical components of a course. Increasingly, course coordinators organize the didactic component, and external preceptors working in the clinical setting function as practicum teachers. Both scenarios involve labor-intensive processes, and neither facilitate the scheduling of clinical experiences that build on progressive learning across the students curriculum. A centralized, computerized, relational data base for efficient management of APN preceptors and students across the curriculum was designed. One masters-prepared clinical coordinator maintains the data base and performs all related functions. This system offers numerous benefits to students, preceptors, ] faculty, and nursing school, including balanced and progressively complex clinical learning experiences for students from competent preceptors: consistent interface with students and preceptors; faculty relief from time-consuming tasks; rapid generation of a variety of tables, rosters, and reports; consistent tracking of preceptor evaluations; timely acknowledgment of preceptor assistance; and efficient communication among students, preceptors, faculty, and school administration.

A Missed Opportunity: Master's Education for Certified Nurse Practitioners.

Many nurse practitioners were prepared in nondegree certificate programs and lack academic credentials desired in todays marketplace. The history of nurse practitioner education is reviewed, and a masters completion program for certified nurse practitioners is presented.

Hodgkinʼs Disease in Primary Care

Hodgkins disease is a common hematologic malignancy in young adults. The typical patient is a young adult male presenting with painless cervical adenopathy or a mediastinal mass on chest X-ray. If diagnosed early and aggressively treated, long-term survival rates are excellent. The subtypes of Hodgkins disease are differentiated by pathologic examination of an affected lymph node. Chemotherapy, with or without adjuvant radiation, is the favored therapeutic regimen for most patients. A comprehensive approach to care, which incorporates psychosocial implications, can improve quality of life for Hodgkins disease patients.