Two Readings Are Better Than One: Why You Should Insist That Your Blood Pressure Be Taken in Both Arms

A recent health alert from John Hopkins summarizes a newly published study in Lancet that recommends routinely having your blood pressure measured in both arms.

For years, the American Heart Association recommended that bilateral blood pressure readings be done at your initial visit with your physician. Now recent evidence supports that this is not enough. When differences in readings from arm to arm are identified, your cardiovascular health can be in jeopardy.

 Just a difference of 15 mm Hg or more between arms shows increased risk to your health and well-being in the following ways:

1. you have two times the risk of developing PAD (peripheral arterial disease) which poses a threat to the health of your lower extremities.

2. you have a 60% increased risk of developing dementia or having a stroke because the 15 mm Hg or more difference suggests that you may already have the beginnings of cerebrovascular disease

3. you have a greater likelihood of dying from premature heart disease.

4. you may hypertension and not even know it because your blood pressure was always done in the arm that has the lower blood pressure.

At the least, have your blood pressure checked in both arms at the time of your annual physical. Better than that, have it done that way every time you see the doctor. It is an easy, non-invasive way to detect problems with your arterial and vascular health.  When a difference between arms is found, it signals to your doctor and you that you must begin aggressive steps to reduce your risks of developing the catastrophic effects of arterial and vascular disease.

Photo image from Photobucket.com (lengtarang)

Forced to Say Good-Bye

    

 

 

 

 

 

 

Four weeks ago the visiting nurse agency I work at announced it was closing. Since it was a job that I absolutely loved, this was devastating news. After the shock, the anger flared and the “what ifs” nearly drove me crazy. Now I have three more days to go until my last day. I’ve accepted the inevitable but I am very sad and it hurts to say good-bye.

My patients have had a hard time too. Some of my patients I have seen at least weekly for over four years. There is the ninety year old that stands by the window watching for me to arrive. One of my patients tells me that she talks to me more than she talks to her son and daughter. She makes it clear that she doesn’t want any other nurse ever taking care of her. There’s also that new Alzheimer’s patient that is just beginning to get used to me coming to see her. There is still so much more I want to do to help her.

This week, however, is not about implementing new plans of care, getting my patients through the lonely holiday season, or recertifying them for another 60 days of care under Medicare. Instead I am saying my good-byes.

Today there was one hard good-bye. The wife of a man with advanced parkinson’s disease started crying when she walked me to the door. When I first started seeing her husband, she was uneasy about people coming in to their home to help her care for her husband. That was two years ago. Over time, she became comfortable with the visits and told me that she thought of me as their friend. I walked away from their house in tears.

This was all getting to be too much until I remembered one thing: I may be saying good-bye to some very special people which greatly saddens me but I know that in my next job there will also be the opportunity to make those incredible human connections that touch my heart. That is one of the best reasons to be a nurse!

The Four Year Plan

     

 

    

 

 

 

 

 

My nursing career seems to be on a four year plan. I work four years at a job then get laid off. This has now happened to me three times in the past twelve years. There’s definitely a pattern going on here.

First there was the geriatric internal medicine office where I worked as a manager. Restructuring took place and I was left without a job. I was traumatized, an emotional wreck. “Since when do nurses get laid off?” I asked myself over and over.

I recovered from this devastating experience by taking a job in the medical review department at Medicare. Not my favorite job but it was less stressful than what I had experienced in the office setting. Salary and benefits were good. Four years passed and word was out that the office would be closing if the contract was lost. The contract was lost but I jumped ship before it was a done deal. The good news was that I found the perfect job. I became a visiting nurse.

The next four years working for a small visiting nurse agency in the town where I lived were incredibly fulfilling. I was back to taking care of patients and was loving every minute of it. The salary was so-so, the benefits decent. I had good supervisors. For the first time I worked as a union employee which gave me a feeling of being protected. I could see myself doing this work until I retired. But I forgot…four years had passed and it was time for all good things to come to an end. And it did last week when it was announced that the agency was closing.

So once again, I am going through the emotional experience of being laid off. This time is pretty tough since there are patients that I have become very close to and I can’t seem to reconcile myself to saying good-bye to them.

Early in my career, I worked at a place until I decided to leave. I lasted sixteen years at my very first job, thirteen at the next. It was a time when nurses didn’t get laid off, contracts weren’t lost, health facilities didn’t close.

Funny thing is that now I am just four years away from retirement so if my next job plays out right it should take me right to the end of my career. But who knows in today’s job market if my career will suddenly shift to a two year plan or even a one year plan. No job, not even a nurse’s, is secure. I can attest to that.

What Gets Me Upset

“When I think about all the patients and their loved ones that I have worked with over the years, I know most of them don’t remember me nor I them.  But I do know that I gave a little piece of myself to each of them and they to me and those threads make up the beautiful tapestry in my mind that is my career in nursing. ” ~Donna Wilk Cardillo, A Daybook for Beginning Nurses

As a home-care nurse, it upsets me…..

 to see an elderly woman living alone abandoned by her family with only the intermittent visits of a home health care professional to brighten her day and tend to her needs.

 to see a vibrant, energetic man felled by parkinson’s disease be no longer able to walk safely across the room or dress himself.

 to see a man whose only words are “yes”, “no”, and “there, there”. Who knows what he really wants to say?

 to see a ninety-five year old lady living on her own frustrated by a system that suddenly takes away seventeen dollars of her food stamp money due to state budget cuts.

 to hear that my elderly patient’s doctor didn’t listen to her when she told him about her pain. “That’s just old age” is her doctor’s usual reply.

 to hear my senior patients say that every day is the same for them now. Not like the old days when they played cards with friends, cooked for family, or went dancing.

 to hear that some children won’t spend a dime or lift a finger to help their elderly parents.

 to hear an arthritic old lady with congestive heart failure say that she wishes God would just take her because there is no good reason for her to be still here.

Paperwork-It Will Only Get Worse!

 

Two hours working on paper work and I am beat!

Visiting patients is the easy part of my day. The part that gives me the greatest satisfaction and reaffirms my choice of career. The paperwork doesn’t. I’ve read that paperwork is one of the top four reasons nurses leave the clinical setting. Is that surprising?

Connecticut’s Public Act 09-5 Section 66

I am outraged that as of January 1, 2010 some of my elderly patients here in Connecticut will be forced to pay a 15% copay for services they receive in their homes. These are my non-Medicaid patients who are on the Connecticut Homecare Program for the Elderly. This program provides services such as home health aides, homemakers, and nurses to the elderly who meet the financial requirements of the program. Apparently, the legislature wanted to put a financial cap on the monies spent for individual services but decided instead to go for a cost-sharing program.

 Public Act 09-5 Section 66 is the statute that mandates the 15% copay. Here is how it works:

 The client has 30 days from the date of the bill to remit a payment. If the next month’s bill is ready to go out and no payment has been received on the previous bill, the client will get a notice informing them that the bill is past due and must be paid within 10 days or services will be discontinued. If there is no payment made in the 10 day period, the Alternate Care will issue a discontinuance notice and give the client an additional 10 days to remit payment. If the client pays the past due amount, they can stay on the program unless they fall behind by more than one month. Clients who go off the program for non-compliance with the cost sharing requirements may reapply for the program but services may not be initiated until they remit the full amount past due. Per the statute, clients are not entitled to a Fair Hearing for a discontinuance related to non-compliance with the cost sharing requirements. The statute does not allow for any hardship exceptions under the cost sharing requirement.

 So it seems that the senior pays the copay or they are out of the program with no appeal rights or hardship exceptions. Outrageous!

The Ups and Downs of Lymphedema Care

I have found that patients with lymphedema of the lower extremities can be incredibly challenging but also very gratifying to take care of.  The challenges are:

• managing those leaking legs
• preventing cellulitis
• reducing edema
• encouraging compliance
• getting those compression stockings on

Is There A Way Elderly Women can Feel Useful Again? I Need Suggestions.

This week one of my patients, an elderly woman in her 80’s, told me how useless she feels. This isn’t the first time I heard someone tell me that. Usually it is a woman used to a lifetime of being very busy around the house. Now they can’t walk without a walker, they need someone to clean their house, and they get their meals from Meals-on-Wheels. Arthritis, balance problems, general debility keeps them from being able to do the kinds of things that were always part of their life.

Some of these women live with their children. They see their daughters rushing around trying to balance work life with home life, a home that includes an aging parent. The patient I talked with this week said she used to help out by often cooking dinner for her daughter and son-in-law. Now she can’t.

I honestly don’t know what to tell these women. I encourage them to do things like folding laundry but that just doesn’t seem like enough to them. My heart breaks for them. Everyone wants to feel useful. I did get one woman to crochet squares that she gave to a charity organization. The squares would be joined, made into an afghan, and be given to someone in need.

Does anyone have any suggestions on how incapacitated elderly women can still feel useful? What can they do to help their families? I’d especially be interested in hearing from anyone who has lived with an elderly parent or grandparent. I’d love to be able to compose a list of suggestions that I can give to the women or their families of activities they can participate in. So please help me out if you can.

Back From Vacation

 I was back on the road today after a week-and-a-half vacation. One of the nice things about vacation was not having to drive thirty or forty miles everyday. I drove when I wanted and stayed home when I felt like it. Very nice.

Today was a beautiful day and I was feeling well-rested and ready to get back into the swing of things. I passed a thermometer on a bank as I drove to work. It read 64 degrees. I wore a short sleeve top and didn’t bother to bring a sweater knowing it would warm up as the day passed.

Is an Assistant Needed to Drain a PleurX Catheter?

Carefully I opened the package that contained the equipment I needed to drain a PleurX catheter.  A PleurX catheter goes into the pleural cavity and remains there where it can be used intermittently to drain fluid out of the pleural space. I was going to do this in the rather cluttered and small bedroom of my patient’s apartment. My patient was dying of lung cancer after years of heavy smoking. Now he lay in his bed with the ornate mahogany headboard. Oxygen ran through a soft green tubing into his nose. Before I began I left the room to scrub my hands at his bathroom sink. When I returned to his bedside, I picked up the drainage kit that was packaged in a blue wrapper. The inside of the wrapper was sterile and became my sterile field. That means anything that came in touch with it must be sterile. On the field was already gauze for the dressing I would put over the catheter when I finished. There were alcohol wipe that I would use to clean the tip of the catheter. A new cap to cover the tip of the catheter was also part of the kit. I touched nothing with my bare hands.  My patient waited expectantly for the draining to begin. The trouble he was having breathing was caused by the build-up of fluid in his pleural space. Once I was done, his breathing would be slower and easier. I expected that at least 200cc of amber fluid would be drained off today. He held his flannel shirt up so I could remove his old bandage which I did with non-sterile gloves. I threw the bandage and my gloves into a plastic bag I had set out for garbage. I now turned to put on the sterile gloves that lay across the blue sterile field. I gingerly picked up one and using sterile technique I put first one and then the other on. I was ready to begin. Just then a flash of black crossed in front of me and landed in the middle of the blue sterile field! It was Nicky, my patient’s devoted and very fluffy cat who now sat grooming himself  oblivious to the fact that he just contaminated something that I had been so careful about maintaining sterility. But I now had a cat in front of me, one who wasn’t about to move. Of course now I would have to #1 get Nicky out of the room and #2 start all over again. Later when I told my clinical supervisor about my feline helper, she laughed and said “Welcome to Home Care! You just never know who in the household will want to assist you!!”