Don't overlook palliative care
Although the challenges encountered by patients with Huntington disease (HD) were clearly addressed in "Adult-onset Huntington Disease: An update" (July 2019), the article had one major omission: Palliative care was never mentioned as a component in the care of this patient population. Additionally, the author made no mention of hospice utilization toward the end of life.
Palliative care is intended to help patients and families dealing with life-threatening illnesses, which clearly includes HD. I am concerned that someone reading this article might not consider utilizing palliative care early in this diagnosis and throughout the course of the disease. I thank the author for writing on such an important topic, but I firmly believe that the critical role of palliative care should have been incorporated.
-PATRICK J. COYNE, MSN, ACHPN, ACNS-BC, FAAN, FPCN
PALLIATIVE CARE DIRECTOR, MEDICAL UNIVERSITY OF SOUTH CAROLINA
CHARLESTON, S.C.
The author responds: Encouraging palliative care strategies and hospice programs for patients with end-stage HD is appropriate. I agree that case managers should implement referrals and suggest care strategies to practitioners to help manage signs and symptoms at end of life. The scope of this article did not include end-of-life care because its main focus was patient care throughout the stages of HD. Additional articles focusing solely on the needs of patients and families at end of life (including those with HD) would be an exemplary focus for future authors.
-NANCY L. URRUTIA, EdD, MSN, RN, CNE
Caring for undocumented immigrants
"Deportation and Health: Implications for Nurses" (Student Voices, June 2019) was a great article about the ethical issues surrounding healthcare for undocumented immigrants. However, are the authors aware of the financial implications of the problems they addressed? No doubt, we as nurses should advocate for our patients' needs regardless of their social or economic status. But who is going to pay for healthcare services provided to undocumented, uninsured immigrants? Would those medical bills be another burden of the hardworking middle class? We all know nothing is free. Somebody has to pay.
-ELENA OCHAKOVSKI, MSN, RN, CCM
CHICAGO, ILL.
Folic acid intake for women
In "Gestational Diabetes: Folic Acid Intake Lowers Maternal Risk" (Drug News, July 2019), the US Preventive Services Task Force recommendation was misstated. The recommended daily intake for women of reproductive age is 400 to 800 mcg. This is important information for nurses like me who work with women who want to become pregnant, and I share it with patients on a daily basis.
-JENNIFER BALLARD CARPENTER, BSN, RN
LINCOLNTON, N.C.