Showing posts with label pediatrics. Show all posts
Showing posts with label pediatrics. Show all posts

Sunday, March 13, 2011

Colds teach the immune system how to fight future viruses

by Michael Gonzalez, MD

Viral upper respiratory illnesses, or common colds, are by far the most frequent illness I see in my office.

It is called the common cold because it is, well, common. I typically can make the diagnosis with a high degree of certainty based on the pattern and the timing of the symptoms. Deciphering cold symptoms and knowing when to worry is what a pediatrician does more often than anything else, and I believe parents can learn how to do this as well. If a parent can get a handle on what a common cold looks like, they can certainly save some co-pays and visits to the doctor. You see, there is no real treatment for the common cold. I know, I know, this is the great failure of modern medicine

Click on the "via" link for the rest of the article.

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Andrew Lopez, RN
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Saturday, February 5, 2011

Kids with allergies can die in school, responding to criticism, KevinMD.com

Like many other parents of kids with allergies, I was very dismayed to see this article, titled, Allergic boy, 7, suffers two heart attacks after teacher hands him chocolate nut in class, last week.   It seems a boy of 7 was accidentally given a chocolate candy containing a hazelnut, to which he is allergic.  After biting into the candy, he realized immediately that he shouldn’t have it and spit it out.  Despite quick treatment with an EpiPen after symptoms started, he ended up in pretty bad shape on life support after suffering a couple of cardiac arrests.

I read with interest the comments that the public left on that article.  As I’ve seen before with other peanut allergy articles (namely those that discuss banning peanuts on airplanes), this issue was very polarizing.  The teacher and child were equally blamed.  People even blamed the mother, who wasn’t even there until right afterward and did exactly what she was supposed to do.

I am almost positive that I would be one of those people saying, “What’s the big deal?  Just don’t eat peanuts” if peanut allergies didn’t affect my life in a huge way – my 4 year old son is severely allergic to peanuts.  He’s had 3 exposures, all accidental.  The last one saw us end up in the Emergency Room needing IV’s, oxygen, and several medications to treat his anaphylactic reaction.

L
Click on kevinmd.com link for the full article:

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Andrew Lopez, RN
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Wednesday, February 2, 2011

Fewer pediatricians, higher risk for kids’ appendix ruptures | Johns Hopkins University - The Gazette

Children who live in areas with fewer pediatricians are more likely to suffer life-threatening ruptures of the appendix than those in areas with more pediatricians, even when accounting for other factors such as the number of hospitals, imaging technology, insurance coverage and the number of surgeons in an area, according to a study from the Johns Hopkins Children’s Center.

The study’s findings, based on an analysis of nearly 250,000 hospital records of children with appendicitis, are published online in the December issue of JAMA–Archives of Surgery.

“Our analysis shows that the most potent predictor of outcome in children with appendicitis was the number of pediatricians available in an area, emphasizing the pivotal role they play as the point of first contact in the care of a sick child,” said lead investigator Fizan Abdullah, a pediatric surgeon at the Johns Hopkins Children’s Center and an associate professor in the Johns Hopkins School of Medicine.

The appendix is a small tube extending from the large intestine, and infections and inflammation of the organ can be dangerous. Each year, 77,000 children develop appendicitis, and an estimated one-third of them suffer a ruptured appendix, a serious complication that often results from delays in diagnosis and surgery to remove the inflamed or infected organ.

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Andrew Lopez, RN
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Tuesday, February 1, 2011

Campaign for a Commercial-Free Childhood Home

Screen-Free Week

Order Your Organizer's Kit Today!
Go Screen-Free with CCFC: April 18-24, 2011

This April, children and families around the world will turn off their TVs, video games, and computers and turn on life. Will you organize a Screen-Free Week in your school or community?  It's easy and fun and we'll walk you through the process with our brand-new Organizer Kit.  Organize your own Screen-Free Week > | Visit the Screen-Free Week store > | Become a Facebook fan >

Take Action
Shape Up, Scholastic!

Are you tired of Scholastic exploiting its unique access to schoolchildren and marketing everything from sugary beverages to television programs to cleaning products and medications in classrooms?  Are you fed-up with “book” fairs and “book” clubs that are chock-full-of toys, videogames, and other commercialized fare? We created this page to help you communicate your concerns directly with Scholastic's CEO. Take action>

 

Take Action
Tell the FCC: Sneaky New Nick Toon is Nothing but a Skechers Ad

The FCC has opened an inquiry into CCFC's petition urging the the Commission to rule that the upcoming broadcast of Zevo-3 on Nicktoons is not in the public interest.  Developed by Skechers, Zevo-3 is the first kids' program to feature characters known to children only as commercial spokescharacters and will violate longstanding policies designed to protect children from overcommercialization. But the FCC will only act if there is signification public pressure, so please submit a comment in support of our petition today. Submit a Comment to the FCC> |  Read the Petition> | Read the Press Release> | Read the AP Story>

How much television and computer time have your kids had this week?

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Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
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Tuesday, January 18, 2011

Helping a Child Who Is Afraid of Shots

When your young child whimpers at the mention of the word "shot," you probably have mixed feelings. You want your son to be protected by his vaccinations; you just wish that the procedure was pain-free.

"Vaccines protect the health and well-being of children, but children don't understand that," says Deborah Wexler, MD, executive director of the Immunization Action Coalition, a national organization based in St. Paul, Minn. "It can be really hard for them to come in for their shots."

Fortunately, you can have an active role in changing your child's attitude. What a parent says and does before, during, and after the doctor's appointment can help to calm a child, reduce her fears, and ensure that she develops a healthy attitude toward seeing the pediatrician.

If you struggle with what to say or have trouble putting on a brave face, read on for expert advice.

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Sincerely,

Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
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856-415-9617, (fax) 415-9618

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Thursday, January 13, 2011

Saving Grace (Emergency Department Nurses)- LA Times Magazine

“I heard a guttural scream,” Rich says, “and a man was handing me his lifeless son.”

“How old?” I ask.

“Nine months. We worked on him for over an hour.”

Rich moves his chair, coughs. It’s freezing in the conference room. [Note: For privacy, nurses are mentioned only by first name.] The muffled din of the emergency room is audible through closed metal doors. It’s 7 a.m., and Rich’s 12-hour shift has just ended. “I flashed to something I heard once about how a casket doesn’t weigh very much—just enough to break a father’s heart,” he says, “and I lost it. I’m standing there, between beds one and two holding that dead baby, and I’m sobbing. I am in charge, and I’m crying.”

As an 11-year volunteer in Cedars-Sinai Medical Center’s emergency room, I’ve seen close up what ER nurses deal with. It takes rare emotional courage not to burn out when you know that every time those doors open—whether you are working triage in front, where a guy may stumble in with a heart attack, or in back, where paramedics may race in with a girl who has been knifed or shot—it’s bad news. Then there’s the physical strength required to survive 12-hour shifts with two half-hour breaks and 45 minutes for lunch. ER nurses never sit. But it’s the children—every ER nurse will tell you—who take the biggest toll

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Andrew Lopez, RN
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Asthma On The Rise: 25 Million In The U.S. Affected : Shots - Health News Blog : NPR

If asthma sometimes seems to be everywhere, it's not exactly your imagination.

Federal health officials estimate nearly 1 in 12 Americans, or nearly 25 million people have the respiratory disorder. That works out to 8.2 percent of the population in 2009, the latest year covered by the research.

 

The results from the Centers for Disease Control and Prevention appear in this report.

The prevalence of asthma is up a little lately, from 7.7 percent in 2005.  How come? One reason is that doctors are looking for it more and are better at detecting it. The biggest increases in diagnosed asthma occurred in the '80s and '90s.

Asthma attacks, the severe breathing problems that can land someone in the hospital, affected 12.8 million people in the United States, or 4.2 percent of the population, in 2009. Attacks have held pretty steady for more than a decade.

Click on the npr.org link to read the rest of the article.
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Sincerely,

Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
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856-415-9617, (fax) 415-9618

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Tuesday, January 11, 2011

Children's Health Products, Nursing Entrepreneurs, Nurse-Owned Businesses

Mary Ann Bernard, RN, CIC, Healthy Attitudes:"Provide options for health and wellness through use of a Wholefood Nutritional Supplement. A children's research study currently in progress and children 6-15 can get on free for up to a year if parent or grandparent, etc. setting the example of health for them. Capsules, chewables and gummie form available. Also provide a protein/carb drink mix, plant based for a meal replacement, pre and post workout drink or healthy snack."
http://www.nursingentrepreneurs.com/bernard/

Children's Health Council:"Mission: to make a measurable difference in the lives of children who face severe or complex behavioral and developmental challenges by providing interdisciplinary educational, assessment, and treatment services and professional training."
Children's Health Council
650 Clark Way, Palo Alto, CA 94304
(650) 617-3820
http://www.chconline.org/

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Children's Health Development Foundation (Australia):"The Children's Health Development Foundation was established by the South Australian Government in 1983 as a result of community concerns about children's fitness and eating habits, and increasing levels of childhood obesity. It followed a series of successful research studies which showed that school based intervention strategies through the health and physical education curriculum could positively impact on children's physical and emotional health."
Children's Health Development Foundation
8th Floor, Samuel Way Building Women's and Children's Hospital
72 King William Road North Adelaide, South Australia, 5006
Phone: +61 8 8161 7777 Fax: +61 8 8161 7778 Email: chdf@wch.sa.gov.au
http://www.chdf.org.au/

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Children's Health Systems:
1600 7th Avenue South Birmingham, Alabama 35233
(205) 939-9100
http://www.chsys.org/

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Harvard Center for Children's Health:"The Harvard Center for Children's Health was created in 1995 to translate what we know about children's health into what we do to improve children's health and well-being. The Center serves as a vehicle through which knowledge, gained through research, can be communicated to larger audiences. Our mission is use this information to influence policy and practice in order to improve the lives of children. The Center also promotes interdisciplinary research and community collaboration."
(617) 432-3222 / fax (617) 432-3755
http://www.hsph.harvard.edu/children/

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KidsHealth!:"KidsHealth is the largest and most visited site on the Web providing doctor-approved health information about children from before birth through adolescence. Created by The Nemours Foundation's Center for Children's Health Media, the award-winning KidsHealth provides families with accurate, up-to-date, and jargon-free health information they can use. KidsHealth has been on the Web since 1995."
http://kidshealth.org/

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Children's Health, MEDLINEplus:"Welcome to MEDLINEplus, a goldmine of good health information from the world's largest medical library, the National Library of Medicine. Health professionals and consumers alike can depend on it for information that is authoritative and up to date. MEDLINEplus has extensive information from the National Institutes of Health and other trusted sources on over 500 diseases and conditions. There are also lists of hospitals and physicians, a medical encyclopedia and dictionaries, health information in Spanish, extensive information on prescription and nonprescription drugs, health information from the media, and links to thousands of clinical trials. MEDLINEplus is updated daily and can be bookmarked at the URL: medlineplus.gov. There is no advertising on this site, nor does MEDLINEplus endorse any company or product."
U.S. National Library of Medicine
8600 Rockville Pike, Bethesda, MD 20894
http://www.nlm.nih.gov/medlineplus/childrenshealth.html

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My Baby And Me Exercise:"Corinne L. Becker, R.N., B.S.N., certified by the Aerobics and Fitness Association of America, is the prenatal and postnatal exercise specialist at Memorial Hospital West Fitness and Rehab Center in Pembroke Pines, Florida. Since 1992, over ten thousand moms and babies have graduated from her "Mommy and Me" Fitness Program. Corinne also teaches "Daddy and Me" and "Grandparent and Baby" classes along with her husband Scott."
My Baby And Me Exercise
1689 N. Hiatus Rd. PMB 173
Pembroke Pines, FL 33026
1-888-741-BABY (2229), corinne@mybabyandme.com
http://mybabyandme.com/

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Office of Children's Health Protection:"EPA established the Office of Children's Health Protection (OCHP) in May 1997 to make the protection of children's health a fundamental goal of public health and environmental protection in the United States. OCHP supports and facilitates Agency efforts to protect children's health from environmental threats. Learn more about OCHP by selecting from the topics below."
Office of Children's Health Protection
U.S. Environmental Protecton Agency Office of the Administrator
1200 Pennsylvania Ave, N.W. Mail Code 1107A
Room 2512 Ariel Rios North Washington, DC 20004
Fax (202) 564-2733 Telephone (202 564-2188
http://yosemite.epa.gov/ochp/ochpweb.nsf/

Nursingentrepreneurs.com is a networking and resource directory for Nurse-Owned businesses and nurses looking for an alternative to working at the bedside.

If you explore the site a bit, you'll find profiles of hundreds of nurse entrepreneurs around the country. We encourage you to browse around, find a business category you are interested in, then contact the nurse directly. We're available for questions as well. This website is Owned-Operated by Andrew Lopez, RN a Medical/Surgical/Telemetry nurse.

Has your Nurse-owned business been written up in the news? Do you send out a newsletter or regular press releases? We'd like to hear about it!

Our Newest article is from an Arizona Nurse Entrepreneur:

Should You Incorporate Your Registry Business? By Joseph Caracci, RN:"The short answer is yes! When starting a new nurse registry business, you are entering into a legal business environment that requires you to take steps to protect your personal assets, such as your home, your savings, and your retirement. With this in mind, you need to determine which legal form you are going to take for your new registry. Some of the common choices are a sole proprietorship, a partnership, a limited liability partnership (LLP), a limited liability company (LLC), and a corporation."
http://www.nursingentrepreneurs.com/incorporate

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The #1 question, we've been receiving lately is about Starting A Nursing Agency, resource sites & manuals

Please choose from the following:

Interesting Reading For Nurse Entrepreneurs, Actual or Soon To Be:

Nurse Entrepreneurs: Tales of Nurses in Business:"This book is vey inspiring! Learn how 50 different nurses brought their vision to reality! Learn some great tips on starting your own business. Nurses don't have to just work at the bedside. Read this book and you will be thinking of how you can make your dream a reality!"

Own Your Own Corporation: Why the Rich Own Their Own Companies and Everyone Else Works for Them:"Rich Dad's-"Own your Own Corporation" is a must read for anyone comtemplating a new business-or someone who already owns their own business. Garrett's direct yet simplistic explanations of the different business entities,the proper and best suited entity for your business-is followed by real-life scenarios which helps drive home the importance of corporate ownership in today's business world. Use Garrett's legal expertise to establish a successful, legally responsible and fiscally protected business...And understand the why's and how's of that ownership."

21 Success Secrets, Success Secret #4- "Do What You Love to Do." Get your FREE CD and find out the other 20 secrets of self-made millionaires.:"Order your FREE CD ($4.95 S&H) from Brian Tracy's acclaimed 21 Success Secrets series. Start with 21 Success Secrets of $elf-Made Millionaires - full of techniques practiced by all men and women who go from rags to riches in one generation. Brian Tracy is a noted success expert. He's trained over 2 million people in 23 countries how to achieve their financial goals faster than ever before."

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    • Site Build It :"Site Build It! is the complete, all-in-one traffic-building system. It builds income by giving you all the software, tools and techniques that you need to build targeted traffic... all tied together into a terrific, time-saving, step-by-step process."

    • Please select from the following, see also Doing Business Resources:

      Make Money From Any Type of Website! Webmasters will want to check out our Paid Link Affiliate Programs Directory

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      4nursinguniforms.com

      Nurses' Station:"The idea for the Nurses' Station Catalog was conceived in 1989. After searching the marketplace in response to customer inquiries, it became obvious that there were no catalogs of this type serving the nursing profession. To be sure, there were several catalogs offering nurse's uniforms and a smattering of professional items. But there weren't any catalogs at the time offering a range of gifts, clothing, professional items, name badges, shoes and scrubs for nurses. It took two years of hard work to gather samples and put a together a catalog of the most unique and high-quality items for nurses."
      Nurses Station P.O. Box 388 Centerbrook, CT 06409-03881
      http://www.nursefriendly.com/station/

      Choose Nursing Uniforms, Shoes, Scrubs, Accessories By Brand:

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    Sincerely,

    Andrew Lopez, RN
    Nursefriendly, Inc. A New Jersey Corporation.
    38 Tattersall Drive, Mantua New Jersey 08051
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    Monday, January 10, 2011

    Preventing Heart Ailments at Their Roots - Childhood - NYTimes.com

    Two studies published Monday suggest that the road to hypertension and heart disease starts in childhood and that prevention should start there, too.

    Related

    One analysis found that parental smoking increases the risk for high blood pressure in preschoolers, and the other that excessive sugar consumption in teenagers is associated with multiple factors known to increase the risk for cardiovascular disease. Both reports appear in the February issue of the journal Circulation.

    The first study looked at 4,236 children in Germany, where 5-year-olds undergo a compulsory physical and cognitive assessment before starting school. During the period of the study, 2007-8, more than 28 percent had at least one parent who smoked. Even after correcting for body mass index and parental hypertension, having a smoker as a parent substantially increased the likelihood that a child would have blood pressure readings in the top 15 percent of the sample.

    Parental smoking was not the only association, or even the strongest. Being overweight and having a parent with hypertension were also associated with high blood pressure in the children. But the lead author, Dr. Giacomo D. Simonetti, said smoking was probably the easiest risk to modify.

    Click on the link above to read the rest of the article:

    See also: Cardiac Resources:
    http://www.nursefriendly.com/nursing/directpatientcare/cardiac.htm

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    Tuesday, December 14, 2010

    Organ Donation Informed Consent, Is A Single Parent's Sufficient?

    See also: Medical, Legal Nurse Consultants, Clinical Nursing Case of the Week, Clinical Charting and Documentation, Nurses Notes, Courtrooms, Disability, Discrimination, Employment, Expert Witnesses, Informed Consent, Medical Malpractice, Nursing Practice Acts, Pensions, Search Engines, Torts and Personal Injury, Unemployment, Workers Compensation, Workplace Safety:

    Each week a case will be reviewed and supplemented with clinical and legal resources from the web. Attorneys, Legal Nurse Consultants and nursing professionals are welcome to submit relevant articles. Please contact us if you'd like to reproduce our material.

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    Summary:  Organ donors are in high demand.  Frequently intended recipients can wait a lifetime for the critical matching organ.  In this case, two nurses obtained a consent from a child's mother.  When the father later expressed his disagreement, the child's corneas had been harvested and it was too late.

    The patient was an 11-year-old child that had died soon after an Asthma attack.

    "By condition (excluding pregnancy), the five leading causes of hospitalization among children are: bronchitis/asthma, digestive disease, pneumonia and respiratory infection, otitis media and mental disorders."1

    The parents were approached for the purpose of donating the child's corneas under the Uniform Anatomical Gift Act.

    "What is a Corneal Transplant?

    The cornea is a dime-sized clear tissue covering the front of the eye. Light rays pass through the cornea and then through the lens. The lens forms an image on the retina in the back of the eye where the optic nerve is located. Sight is controlled by the optic nerve, the only nerve of vision. This nerve activates the retina to pick up the image in view."2

    The mother alone was present at this time when it was first discussed.

    "The child's mother maintains that she told the nurse it "did not matter" to her."3

    "The Uniform Anatomical Gift Act (UAGA) of 1968 provided for the first time that an individual could donate his or her organs at death to another for medical purposes. It was adopted in all 50 states and the District of Columbia, and was a major step toward solving the organ donation problem. But new medical technologies have now made many transplant operations commonplace, and a shortage of donor organs remains."4

    With this, the harvesting center was contacted and the patient's information left.  A consent form was faxed over to the hospital.  Two nurses then spoke to the mother by telephone and signed off on the form that consent had been obtained.

    Individual state laws may vary in procedure for who can consent to an anatomical gift.  In Alaska for instance:

    "(a) A competent person who is 18 or more years of age may make a gift to take effect upon death of all or a part of the person's body for a purpose specified in AS 13.50.020.

    (b) When persons in prior classes are not available at the time of death, and in the absence of actual notice of contrary indications by the decedent or actual notice of opposition by a member of the same or a prior class, any of the following persons, in order of priority listed, may give all or a part of the decedent's body for a purpose specified in AS 13.50.020:

    (1) the spouse;
    (2) an adult son or daughter;
    (3) either parent;
    (4) an adult brother or sister;
    (5) a guardian of the decedent at the time of death;
    (6) any other person authorized or under obligation to dispose of the body.
    (c) The persons authorized by (b) of this section may make the gift after or immediately before death."5

    The agent for the organ center came and harvested the child's corneas and returned to the center.  He had looked over the consent form obtained, initialed it to verify it had been obtained by phone and was satisfied.

    "When the cornea, a thin tissue that covers the front of the eye, becomes cloudy or damaged due to disease, injury or hereditary conditions, the result is vision loss or even blindness.

    To clear this window, the damaged cornea is removed surgically and replaced with healthy, transplanted eye tissue-a donated cornea. This transplant operation is successful in more than 90 percent of cases in the US. After a successful transplant, patients have renewed vision or see for the first time."6

    Each individual facility must generate protocols on organ procurement and obtaining informed consent:

    "Each hospital in the state shall develop procedures for identifying potential donors of gifts, requesting gifts, notifying and coordinating with eye banks, tissue banks, and organ procurement agencies, and assisting in the procurement, removal, storage, and transportation of gifts."7
     

    The child's father would arrive on the scene soon after.  When approached and informed of the harvesting, he was perturbed.  He would not sign the consent after the fact and chose to take legal action against the hospital and the donor center.

    In court, summary judgement was entered for the defense:

    The parent's appealed.

    Questions to be answered:

    1. Under the Uniform Anatomical Gift Act (UAGA), is the consent of a parent sufficient to proceed with harvesting of a child's organs.

    2. Were the nurses negligent in their explanation of the procedure or in not waiting till the father was available?

    The applicable laws stated that as long as a consent from a legally "responsible" and informed party is obtained, no liability or negligence can be assigned.  It was clear from the testimony of the nurses that they spoke to the mother and informed her of what was to happen.

    In obtaining organs, time is typically of the essence.  The longer an organ or tissues remains in a body, the less likely it will be useful for the purposes of transplantation.

    There was no evidence that the mother was either "coerced" or "rushed" into making a decision.  There was no documentation that she "wished to speak to her husband" before making the decision.  If more time had been needed or another family member needed to be consulted, the mother could have clearly stated this.

    On the part of the nurses, a single adult guardian consent only was needed and obtained.

    When the agent of the eye bank looked over the informed consent, he as satisfied that it was legitimate.  In harvesting the child's corneas, he acted in good faith and had no reason to believe a proper consent had not been obtained.

    The court dismissed the plaintiff's argument that the "good faith" actions of the hospital or eyebank were "subject to interpretation."  The court was satisfied that under the conditions, the actions of the employees were reasonable and within the boundaries of existing law.

    This case does point out the need for judgement and clear documentation when a consent for organ donation is obtained.  The nurses were wise to obtain not one but two witness signatures on the consent form.  The agent of the eye bank was wise to make sure the notation was made of a "telephone" consent.

    Regardless of these precautions, the nurses, hospital and eyebank were still sued.  Had this lawsuit been initiated after either of the employees involved had left, the hospital may or may not have covered or defended them.

    Related Link Sections:

    Clinical Charting and Documentation, Nurses Notes
    http://www.nursefriendly.com/nursing/linksections/directpatientcarelinks.htm

    Informed Consent
    http://www.legalnursingconsultant.org/legal.nurse.consultants.lnc/informed.co...

    Medical Legal Consulting Nurse Entrepreneurs
    http://www.nursefriendly.com/nursing/ymedlegal.htm

    Organ Donation:
    http://www.nursefriendly.com/nursing/directpatientcare/organ.tissue.donation.htm
     

    Sources:

    1. National Association of Children's Hospitals and Related Institutions.  No date given. About Childrens Hospitals - Facts on Children's Health - Illness and Injury.  Retrieved June 20, 1999 from the World Wide Web: http://www.nachri.org/abouth/facts/hlth_illness.html

    2. Old Dominion Eyebank.  No date given.  Corneal Transplant. Retrieved June 20, 1999 from the World Wide Web: http://www.odeb.org/html/cornealtransplant.htm

    3. RRNL 39 May 12 (1999)

    4. National Conference of Commissioners on Uniform State Laws.  No date given.  Why All States Should Adopt The Revised Uniform Anatomical Gift Act (1987). Retrieved June 20, 1999 from the World Wide Web: http://www.nccusl.org/whystate/uagawhy.html

    5. The Alaska Legal Resource Center. No date given.  Persons Who May Execute An Anatomical Gift.  Retrieved June 20, 1999 from the World Wide Web:  http://www.touchngo.com/lglcntr/akstats/Statutes/Title13/Chapter50/Section010...

    6. Medical Eye Bank of Florida.  No date given.  Anatomy of the Eye. Retrieved June 20, 1999 from the World Wide Web: http://www.castlegate.net/mebfl/anatomy.htm

    7. The Alaska Legal Resource Center. No date given. Requests By Hospitals For Anatomical Gifts. Retrieved June 20, 1999 from the World Wide Web: http://www.touchngo.com/lglcntr/akstats/Statutes/Title13/Chapter50/Section014...
     

    The Uniform Resource Locator (URL) or Internet Street Address of this page is
    http://www.nursefriendly.com/nursing/clinical.cases/062099.htm

    Send comments and mail to Andrew Lopez, RN

    Created on Saturday May 23, 1999

    Last updated by Andrew Lopez, RN on Monday, January 25, 2010

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    How adult smoking affects behavior in children, KevinMD.com

    by Nancy Walsh

    Both maternal and paternal cigarette smoking can contribute to adverse chronic conditions — physical and psychological — in children, two large studies found.

    Writing in the July issue of Pediatrics, Marie-Jo Brion, PhD, of the University of Bristol in England, and colleagues reported that children in two cohorts whose mothers smoked were more likely to have conduct/externalizing behavior problems than were those who had no prenatal tobacco exposure:

    * British cohort, OR 1.24 (95% CI 1.07 to 1.46, P=0.005)
    * Brazilian cohort, OR 1.82 (95% CI 1.19 to 2.78, P=0.005)

    In a second study in the same issue, Chinese researchers found that daily paternal pre- or postnatal smoking was associated with increased mean body mass index (BMI) Z-scores in offspring at seven years, with a mean difference of 0.10 (95% CI 0.02 to 0.19) and also at 11 years, when the mean difference was 0.16 (95% CI 0.07 to 0.26).

    These studies “tighten the evidence around tobacco smoke exposure and chronic conditions of childhood,” observed Jonathan P. Winickoff, MD, of Massachusetts General Hospital for Children in Boston, and colleagues in an editorial accompanying the studies.

    Winickoff and colleagues wrote that these studies contribute to a growing body of research findings linking tobacco smoke exposure and multiple childhood morbidities and mortality, ranging from miscarriage, stillbirth, and sudden infant death syndrome to decreased lung function and obesity.

    Brion and colleagues sought to determine if maternal smoking also could be causally related to the widely reported psychological problems seen in offspring.

    Their study included 6,735 children residing in southwest England born between April 1991 and December 1992, as well as 509 children from the city of Pelotas in southern Brazil who were born during 1993.

    The prevalence of maternal smoking was almost twice as high in the Brazilian cohort (29.4% versus 15.9%), but consistency was observed otherwise in the two groups.

    In unadjusted models, maternal smoking was associated with behaviors in children at four years of age including inattention/hyperactivity, conduct/externalizing problems, and peer/social difficulties, but not with emotional/internalizing problems.

    After adjusting for multiple potential confounders, however, such as birth weight and gestational age, socioeconomic factors, and maternal-paternal smoking, only conduct/externalizing problems were seen in both cohorts.

    These findings support the concept that these children’s behavioral problems may be mediated by the influence of intrauterine tobacco exposure, and particular

    ly nicotine, on neurodevelopmental pathways, according to the investigators.

    They acknowledged that the study had shortcomings. Information about potentially important confounders, such as maternal antisocial behavior, was not available, and different instruments were used to assess child behavior in the two cohorts.

    Also, parental smoking was measured by self-report, which may represent an underestimation.

    In the second study, C. Mary Schooling, PhD, and colleagues from the University of Hong Kong, examined the effects of secondhand smoke on 6,790 children born during 1997 whose mothers did not smoke, stratifying them according to degree of paternal smoking.

    They found that children of daily paternal smokers were from lower socioeconomic backgrounds, had mothers not born in Hong Kong, and were less likely to be breastfed.

    Unlike BMI, the children’s height was not affected by paternal smoking.

    At age seven, the difference in height Z-scores was −0.01 (95% CI −0.08 to 0.06), and at age 11 the difference was 0.02 (95% CI −0.05 to 0.10).

    “To date, most of the evidence for the association between parental smoking and offspring overweight comes from Western or long-term developed settings, where smoking and childhood BMI are socially patterned and usually associated with low socioeconomic position,” the investigators wrote.

    They noted that in Hong Kong, few women smoke and about one-quarter of men do, and although the prevalence of overweight in childhood is comparable to that in Western countries, it may be less socially patterned.

    “Therefore, currently developed Hong Kong may serve as an ideal, non-Western social laboratory in which to verify associations from Western societies that are potentially confounded by [socioeconomic position],” they wrote.

    In this study, the data were collected prospectively but there still were limitations. Secondhand smoke exposure was determined by parental report, so underreporting was possible, and childhood adiposity was measured by proxy using BMI, which does not differentiate between body fat and lean mass.

    Nonetheless, the study suggests that paternal smoking may contribute to excess weight in offspring. Possible explanations for this include the fact that infants in households of smokers were less likely to be breastfed, and parents may have been generally less health-conscious.

    “Alternatively, our findings might reflect the physiologic effects of paternal smoking and perhaps prenatal [secondhand smoke] exposure,” they wrote.

    For example, while nicotine exposure from secondhand smoke might not be sufficient to cause intrauterine growth restriction, it might lead to restricted brain development and changes in appetite and metabolism.

    In the editorial, Winickoff and colleagues urged continuation of efforts to curb smoke exposure in workplaces, restaurants, homes, and cars, recommending that clinicians utilize office systems, family-centered approaches, and community outreach to further minimize exposures and improve the health of both parents and children.

    “Parental tobacco dependence, itself a chronic condition, begets other chronic conditions of childhood,” they wrote.

    Nancy Walsh is a MedPage Today contributing writer.

    Originally published in MedPage Today. Visit MedPageToday.com for more smoking news.

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    Wednesday, December 1, 2010

    CDC - Seasonal Influenza (Flu) - Flu Information for Parents

    Flu Information for Parents

    Flu is more dangerous than the common cold for children. Each year, flu places a large burden on the health and well-being of children and families. An influenza vaccination is the best method for preventing flu and its potentially severe complications in children. CDC recommends that all children 6 months and older get a flu vaccine.

    Other Materials

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