NursingCenter’s In the Round

A dialog by nurses, for nurses

Fighting the Obesity Epidemic

clock March 11, 2013 03:46 by author Lisa Bonsall, MSN, RN, CRNP

In 2010, more than one-third of adults in the United States were obese, according to the Centers for Disease Control.

It’s safe to call the issue of obesity an epidemic at this point, and it can lead to other complications like heart disease, Type 2 diabetes, stroke and certain types of cancer. The health problems caused by obesity are some of the leading causes of preventable death.

A new infographic from Nursing@Georgetown outlines some important statistics about this issue, aimed at increasing awareness and educating the public about the positive effects of a proper diet and exercise.

Things like eating whole grains, switching to low-fat milk, and increasing your intake of fruits and vegetables can help turn things around and lead to a healthier body. In addition, the USDA has developed a nutrition guide called MyPlate that outlines recommended food portions.

Exercise also helps, and all adults should set a long-term goal to accumulate at least 30 minutes of moderate-intensity physical activity on most days. Check out the infographic below for information, and ways we can all work to improve our health behaviors.

Obesity in the U.S.: Fighting the Epidemic with Proper Diet & Exercise

Via Nursing License Map and Nursing@Georgetown

This post is written by Erica Moss, who is the community manager for the online nursing programs at Georgetown University School of Nursing & Health Studies.

Lab Values and DKA

clock August 15, 2012 03:25 by author Lisa Bonsall, MSN, RN, CRNP

Changes in laboratory values often give us clues to what is happening with our patients. I came across the following resource this morning and thought it was worth sharing. Here’s a handy table to help you identify diabetic ketoacidosis (DKA).

The following equation can be used to calculate an anion gap:

Anion gap = Na+(mEq/L) – [Cl-(mEq/L) + HCO3-(mEq/L)] 

You have an important role when caring for a patient with DKA.  Thorough physical assessments, careful monitoring of laboratory values, and critical thinking are essential to avoid complications of this complex disorder. Have you cared for a patient with DKA? What are the common presenting signs and symptoms?

Donahey, E., Folse, S., Weant, K. (2012). Management of Diabetic Ketoacidosis. Advanced Emergency Nursing Journal, 34(3).

Pneumococcal pneumonia in the house

clock January 12, 2012 08:15 by author Lisa Bonsall, MSN, RN, CRNP

The holidays were not without incident at our house this year. Illness reared its head as it usually does when excitement builds and holiday events and preparations keep us too busy to get adequate rest and eat right. This year, however, it was my husband who was down-and-out, not one of our kids.

He had a cough for about a week and was fatigued, but, despite my clinical judgment that he should rest, I “encouraged” him to help out with all that still needed to be done before Christmas. On Christmas day, he really wasn’t looking so well – high fever, chills, productive cough that seemed constant. He spent the evening in bed taking ibuprofen around the clock to help alleviate his symptoms.

By late morning the next day, we called our primary care office and found that they were closed for the holiday. We ended up heading over to the emergency department (ED) at our local hospital. In triage, he was found to be febrile, tachycardic, and hypoxic. He got a stat dose of albuterol and was quickly taken back to a room in the ED. As we went through his medical and surgical history with the ED nurse, we both paused and looked at each other when he told her that he had a splenectomy when he was younger. 

Oops – did we forget the implications of being without a spleen and the need to seek care quickly when he gets sick? And hadn’t I just read something about the risks associated with splenectomy?

Shortly after, labs came back and his white blood cell count was 43,000. So, he spent 4 days in the hospital on I.V. antibiotics. His diagnosis? Pneumococcal pneumonia.

Yes, I had read “something” recently and even put in on our recommended reading list a few weeks prior. Needless to say, I did go back and read this one again: A close up view of Pneumococcal disease.

“Risk factors for acquisition of the disease are alcohol abuse, splenectomy, immunocompromised status, smoking, and asthma.”


All is well now. And next time, I’ll ease up on my “encouragement” and do a better job with my assessment!

Headlines from the ADA

clock July 8, 2011 01:39 by author Lisa Bonsall, MSN, RN, CRNP

The American Diabetes Association's 71st Scientific Sessions took place at the end of June and several headlines have come across our newsfeed .  Here are some highlights that you might be interested in:

Access more information from this meeting, including video highlights, webcasts of select presentations, and links to abstracts, at DiabetesPro: Professional Resources Online.

Building Skills and Celebrating the NP of the Year at NCNP

The National Conference for Nurse Practitioners (NCNP), sponsored by Lippincott Williams & Wilkins, the publisher of The Nurse Practitioner Journal, is well under way at the Las Vegas Hilton. NCNP began on Wednesday, May 11 with a keynote address on The Implication of Health Care Reform for Nurse Practitioners by Eileen T. O'Grady, PhD, RN. Dr. O'Grady is a visiting professor at Pace University's Graduate School of Nursing in New York City where she teaches health policy. Her energizing presentation outlined the many opportunities that nurse practitioners have in the Patient Protection and Affordable Care Act of 2010 including funding for education and nurse managed clinics.

Also at NCNP, the conference chairperson, Margaret A. Fitzgerald, DNP, FNP-BC, FAANP presented the Nurse Practitioner of theYear Award to Margaret L. Campbell, PhD, RN, FAAN, Assistant Professor at Wayne State University. Dr. Campbell is noteworthy for her contributions, not only to nursing, but to health care for her pioneering work in the palliative care specialty.

Through Saturday, May 14 nurse practitioners will engage in hands-on workshops to build skills in common office procedures, orthopedic procedures, dermatology procedures, and suturing. Participants will also update their practice at numerous sessions on the latest evidence-based diagnostic and treatment recommendations for acute and chronic care for patient populations from children through older adults. For more information about the National Conference for Nurse Practitioners, visit

Universal principles for culturally sensitive care

clock September 28, 2010 07:49 by author Lisa Bonsall, MSN, RN, CRNP

In the latest issue of the Journal of Christian Nursing, Anthony Hoffman BSN, RN, describes his experiences as a diabetic educator in Nouakchott, Mauritania (located on the west coast of Africa). In his article, Universal Principles for Culturally Sensitive Diabetic Education, we are reminded of the importance of cultural awareness.  While most of us might not travel abroad to work, we care for and will continue to care for patients from other countries or with different faiths and traditions that impact how they manage illness. Mr. Hoffman shares the following “universal principles” which truly can apply to any patient in any setting:

"1. Patients own their culture. A patient needs to be allowed and encouraged to describe his or her culture. I found travel guides and documentaries useful as a starting point in understanding culture, but quickly learned the danger of stereotyping. Having an inquisitive attitude helps us be students of our patients' cultures and avoid stereotyping.

2. Patients own their bodies. In every culture, patients have the right to make their care decisions. Sometimes cultural mores and values will make adherence to the plan of care more challenging, but the final course of action belongs to the patient. We must continue to respect and offer the best to our patients regardless of their healthcare decisions.

3. Patients own their care plans. We need to help patients design their own care plans. Let them suggest ideas for how to follow the recommended plan of care. Set small and incremental goals with the patient for lifestyle modifications and celebrate the achievement of goals. In this way, nurse and patient become teammates working together.

4. Patients are their own best advocates. Teach patients the hows and whys of diabetic care, not just the "shoulds" and "musts." A patient who understands the basic physiology of diabetes is empowered to make informed decisions regarding his or her care plan and to adhere to that care plan.

5. Honesty is always the best policy. We are sometimes tempted to tell less than the "whole truth" in the name of cultural sensitivity. For example, I didn't like telling patients that dates have a high glycemic index or that fasting and binging during Ramadan can wreak havoc on their blood glucose. Withholding unpleasant information does not honor our patients or empower them to make wise decisions about their health."

You can read Mr. Hoffman’s article in its entirety here. Let us know what you think!

One thing is certain...diabetes care is constantly changing

It's amazing to me how quickly best practices change in how we manage some of the most common diagnoses today. For years we've been placing type 2 diabetics on insulin sensitizers like Avandia or Actos to help normalize their blood glucose levels. We did it because the evidence pointed us in that direction.  But now the Food and Drug Administration (FDA) is currently reviewing the insulin sensitizer, Avandia manufactured by Glaxo SmithKline. Avandia has recently been linked to an increase risk of heart attack as compared with other antidiabetic drugs however, the research is not sufficient to indicate that Avandia increases the chance of death. For many of us who have used Avandia for years to help control our patient's diabetes, this information may come as a surprise.  So what are healthcare professionals to do? For many patients, this class of drug works well for them. Do we take our patients off this drug due to this latest information?  

As with all areas of healthcare, we need to be careful that one study does not change the way we practice. Instead we need to make sure that a rigorous systematic review was done to develop the practice recommendations that drive our care.   For starters, we can follow the recommendations from the American Diabetes Association, the Endocrine Society, and other well known and respected diabetes associations in addition to the FDA. It's important we stay up to date with latest advances in evidence-based care and bring those interventions to our our patients, not interventions based on  anecdotal findings. We need to view this issue with Avandia as an opportunity to take another look at the evidence and then decide what we should do with our patients.   

One thing is certain - diabetes care is constantly changing.

My patient is a little too sweet...

According to a recent article published in the American Journal of Nursing, "Diabetes under control; improving hospital care for patients with diabetes", "the American Diabetes Association estimates that people with diabetes account for 22% of hospital inpatient days, and in 2007 their in-hospital care accounted for an estimated half of the $174 billion spent in the United States on diabetes care."  These statistics are staggering; however, when you consider the number of people diagnosed with diabetes, they are not surprising.  Every day we manage patients with hyperglycemia, some are diabetics and some are not. The article in AJN points out that hyperglycemia in the acute care setting can be indicative of  a diagnosis of diabetes, undiagnosed diabetes or prediabetes, or transient stress hyperglycemia, which can result from the stress of illness.  As we all know, a fingerstick glucose reading is a snap-shot in time of the blood glucose.  In no way is it indicative of the glycemic control of the patient. 

Hemoglobin A1C gives clinicians a more accurate picture of the patient's blood glucose control over the past 60 to 90 days. In people without diabetes, the A1C is around 5%.  The American Diabetes Association recommends that diabetics have an A1C of 7% or less as a goal for good glycemic control.  So why is the A1C an important lab value in acute care?  Research has shown that patients who maintain glycemic control have better outcomes than those who don't. Knowing the A1C will help you manage the patient's blood glucose more effectively and efficiently and can aid in discharge planning.  Research has shown you can't maintain glycemic control in diabetics by just using short acting insulin to cover meals.  The patient must have an oral agent or a long acting insulin in addition to the short acting insulin.

Does your institution have a policy to to identify elevated blood glucose in all hospitalized patients, not just the ones who have the diagnosis of diabetes?  Is your standard of care to control hyperglycemia in all patients?  If you want more information on how to implement this standard at your hospital, read the June issue of AJN, "Diabetes under control, improivng hospital care for patients with diabetes".

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