BonnieRN Blog

A Reader Asks: About West Nile Virus ( WNV )

by Bonnie Kavanagh RN · - Place a Comment

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West Nile Virus (WNV) is a single stranded RNA virus and a member of a strain of encephalitic (inflammation of the brain) antigen complexes. The lack of the presence of the protein CCR5 in humans makes one more susceptible to this virus but less susceptible to HIV (Human Immunodeficiency Virus). According to the National Institute of Health (NIH) this lack of protein is present in approximately 1% of the population. WNV is transmitted, primarily, through infected mosquitoes. WNV cross contaminates from a cycle of birds and mosquitoes.

At highest risk to develop symptoms of WNV are individuals over the age of 50. According to the Center for Disease Control (CDC) approximately 80% of individuals, who contract WNV, do not demonstrate symptoms. The common symptoms for WNV range from fever, headache (the prominent feature), fatigue, skin rash, swollen lymph glands, and eye pain.

Mosquito season for most of the United States, starts in spring and may end in September. Once bitten by an infected mosquito, the incubation period for WNV is two to 14 days; longer periods of incubation have been documented in immuno-suppressed people. The most efficient diagnosis of WNV is by a blood test that detects the antibody IgM after eight days of the illness. This test is often done when severe symptoms of the disease, that involve WNV such as: Encephalitis, Meningitis (specific tissues of the brain), and Poliomyelitis (severe weakness of the body). Fortunately, severe WNV cases are uncommon and are associated with additional symptoms of gastrointestinal (stomach distress) symptoms, optic neuritis, seizures, weakness, change in mental status changes, seizures, flaccid paralysis (rare), and inflammation of the heart and pancreas.

Immunity of WNV develops through our white blood cells of T-lymphocytes or memory cells. This production of immune cells produces, through exposure to the virus, stays within our body for long periods of time and will likely last throughout our life span. There is currently not a vaccine for the virus.

The best preventative steps, to minimize transmission of WNV, are in avoiding mosquito bites. A nationwide “Fighting the Bite” campaign, promoted by the CDC, includes:
• Applying insect repellent containing DEET.
• Wearing clothing that covers the skin and is sprayed with DEET or Permethrin.
• Drain standing water in the home and outdoors whenever possible.
• Clean clutter and litter in yards and fields that may hold water.
• Use screens on windows and doors whenever possible.
• Report dead birds to local authorities and do not handle.
• You may obtain, through your local Public Health Department, community education & handouts to support a neighborhood campaign to “Fight the Bite”.

Thank you for asking this important and timely question.

More mosquitoes found in Boston with West Nile virus (boston.com)
Dead Birds With West Nile Jump to 18 in Cerritos! a Los Cerritos Community News Alert! (economy4abc.blogspot.com)
Health department wants help spotting dead crows (pnwlocalnews.com)

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Posted on: August 3, 2011

A Reader Asks BonnieRN: My mother was recently told by her physician that she has precancerous lesions that were cause by sun exposure. What are they and what can I do to help her keep her skin protected from sun exposure?

by Bonnie Kavanagh RN · - Place a Comment

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A precancerous lesion is a change in the skin; it carries the risk of turning into skin cancer. In your mother’s case, according to her physician, they were from the UV radiation; they may also generate due to her genetics, exposure to cancer-causing substances (carcinogens) such as arsenic, tar or x-ray radiation.

Skin protectants, from the sun’s harmful UVA and UVB rays, can range from specially treated clothing such as Solartex to sun block lotions. According to the NIH, the Food and Drug Administration (FDA) is taking steps to help protect consumers from skin damage caused by excessive sun exposure. This recent FDA ruling put demands that the sunblock lotions provide consistency in labeling. Claims such as “waterproof’ will also disappear according to the FDA ruling which begins next year in 2012.

Most labeling of skin lotions has been on SPF (Skin Protective Factor) advertising. SPF numbering has nothing to do with UVA protection. The FDA has proposed a rule limiting the maximum SPF value on sunscreen labels to “50 +”, because there is no proof that products with SPF values higher than 50 provide greater protection than products with SPF values of 50.

Many sunscreens today only address UVB rays which cause sunburn and skin cancer. But UVA rays are just as bad if not worse. The UVA rays do everything bad UVB does more harm. It can cause skin cancer and aging of the skin. Scientific studies have suggested UVA rays contribute more to development of melanoma than UVB rays.

In this long awaited ruling by the FDA, sunscreens must provide labeling information about their protection from both UVA and UVB radiation in order to earn the label “broad spectrum.” By 2012. Companies providing this broad spectrum formula already on the market include: Neutrogena and Johnson and Johnson products.
The best approach to help your mother is to keep her out of the sun whenever possible and fully screened from the sun. Activity and socializing is important to keep up, so when she is out in the sun you may protect her skin by wearing specialized clothing or by applying the broad spectrum lotions with an SPF between 30 to 50.

Providing sun protection with specially treated clothing that is tightly woven to block out the UVA and UVB rays would include: a hat that shades the face, ears, and nose, and long sleeved clothing and long sleeved pants. Sunglasses will protect her eyes from UV rays and will help reduce her risk of cataracts. When using a broad spectrum sunscreen it must be applied to sun exposed areas of the skin then reapplied every two hours to be affective, according to the FDA research.

Regular appointments to her family physician or dermatologist for skin assessments remain important. Follow her health care practitioner’s recommendations for follow up. These regular appointments for skin assessments must continue until she is released from further follow up by her health care practitioner.

Thank you for asking this important and timely question.

FDA Sheds Light on Sunscreens (nlm.nih.gov)
Crack Down on Sunscreen Labeling (+Some Great Ones!) (blogs.smarter.com)

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Posted on: June 24, 2011

An Aha Moment of a Nurse Care Manager Making a Difference

by Bonnie Kavanagh RN · - Place a Comment

Image by The Library of Virginia via Flickr

Last year, when the mobile unit for Mutual of Omaha toured the country, I was able to share with them my aha moment. This particular interaction involved a story I shared with them about a dear client of mine.

During my career in nursing, I have been fortunate to have opportunities to make a difference in the lives of others.

Allow me to share this video with you, my loyal readers.

Your questions, comments and suggestions are appreciated and encouraged. Namaste’

Mutual of Omaha discontinues Medicare Supplement Plan N (supplementalinsuranceadvisorsblog.mysenioradvisorsgroup.com)

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Posted on: May 31, 2011

A Reader Asks BonnieRN: My Mother Recently Turned 65. What Immunizations Is She Supposed To Have?

by Bonnie Kavanagh RN · - Place a Comment

Image by edgeplot via Flickr

Turning 65 is an important milestone to review her immunization records. Ask her physician or healthcare professional to review this with her healthcare records for pneumonia, annual flu, Tdap, Shingles, and other immunizations that are specific to her life style choices and overall health status. The CDC has an excellent guide that outlines elder immunizations, along with other specific groups, the suggested schedule. The guide is found HERE.

Sensitivity and intolerance to immunizations and all components of all vaccines will be reviewed by her physician such as an egg allergy or a component in the vaccine. The flu vaccine, recommended annually and usually starting in September, is made from an inactive virus. The flu vaccine takes approximate two weeks to develop the antibodies to those included in the serum. A full month is needed to have immunity from the strains in the vaccine. Additionally, getting the flu vaccination will help her to avoid complications of the flu should your mother get the flu.

Pneumonia, and its’ complications, is one of the top ten leading causes of death in elders. The pneumonia shot is recommended once in a lifetime but may be recommended again, with your mother reaching 65, according to the Center for Disease Control (CDC). Her physician will review this with her and the family at the annual exam. The pneumonia vaccine, she may qualify to receive, is call Pneumococcal polysaccharide vaccine (PPSV). This vaccine will also aid in preventing complications of pneumonia such as bacteremia and meningitis.

The Tdap, known as Tetanus (lockjaw), Diphtheria, and Pertussis vaccine, may also be indicated. Her physician will review her records thoroughly and determine whether she is a candidate for this immunization. Her physician may also recommend the Tetanus vaccine (Td), usually at ten year intervals, is often recommended by the physician with an open wound or deep cut injury.

The Shingles vaccination, available since 2006, was found, through clinical trials, to reduce the incidence of Shingles by 50%. The vaccine will also reduce the severity of pain if you do contract Shingles. The incident of Shingles is more common to populations over 50 than younger individuals. According to the CDC, about 1 in 5 people who contract Shingles, have long lasting post-herpetic neuralgia, a painful condition affecting the nerve fibers and skin at the site affected by Shingles.

An excellent grid, for documenting your mother’s immunization records and retaining in her files, can be found HERE. My experience has been the majority of patients benefit from a through immunization review during all annual exams, particularly when reaching this important milestone of turning 65. If there are not specific allergies or issues with the components used in the various vaccines, and the family physician or health care practitioner agrees, than the above immunizations deserve consideration.

Thank you for this important and timely question. Your questions and comments are appreciated and encouraged. Namaste’

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Posted on: May 22, 2011

Bloom Where You Are Planted

by Bonnie Kavanagh RN · - Place a Comment

Image by cobalt123 via Flickr

When I was studying nursing, I read an article with this title, “Bloom Where You Are Planted”. I pondered that article for quite some time. I than embraced the philosophy that has shaped my passion for nursing where I would (in essence) give it my all wherever I landed in my career and location. I have done just that and it has worked for me. I am fortunate to love what I do in nursing and in making a difference in the lives of those we serve in nursing. Nurses do, make a difference. I am grateful to be a part of the cycle.

Education programs are an important component of providing support for patients and families; looking at who the teachers are in those programs is important. Viewing the thoroughness of what is being taught cannot be understated. I find, locally, many of the programs being taught by non-professionals. Does a six week-program in education and certification make you an expert? Some do think so and act upon that. As for me and my many years of college and advanced courses, I am proud of my achievements and thoroughness in teaching and educating my patients and their families. Unless we see changes in programs of teaching, the public will not (and does not) know the difference in qualitative education and learning models of practice. Unless families are exposed to thorough programs and options, they simply will never learn what is needed; skimming the surface of health care teaching is NOT enough. I find myself wanting more for myself and my personal growth as a teacher (and forever student) and I wonder where that will take me. I must remember a phrase a good friend told me once, “Growth is painful but stagnation is death”.

Reflections, assessments, and gr0wth are an important tool we must focus upon to be better people. To bloom we must have good earth filled with nutrition and plenty of water to grow. I am thirsty for more and hope you are too. Do you think of how you can best position yourself to grow, learn, and nurture your growth? I hope so. Until we can participate in education in its’ truest form, based on trialed learning from accurate resources that originate in colleges and universities than we are settling for information not education.

I found this Johnson and Johnson You Tube of interest:

I find it amazing (and sad) that much of health care is taught by non-medical people. This is NOT the case where I come from but is here in Grand Junction. Certainly, it is not always true but predominant. Coming soon, there will be some workshops offered via the college of nursing; I am honored to have been an instrumental part of that process. I hope this becomes a trend. It is what is needed in this community to grow in education to consumers, health care workers, and families who care for people in the home and elsewhere.

Yes, nurses do make a difference in the lives of others and in the quality of the education we provide.

Your questions, comments, and suggestions are appreciated and encouraged… Namaste’

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Posted on: May 12, 2011

My New Good Companion ~ GPS

by Bonnie Kavanagh RN · - Place a Comment

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I have succumbed to yet another technological marvel, the GPS. Many friends, especially close friends who know me have suggested purchasing this product. My closest friends have insisted that I do so and I am happy to say “I have a new good companion on the road, the GPS”.

You will want to know that I purchased a Garmen Product 1350LMT. I get free lifetime downloads of maps. Apparently, this can cost as much as $ 80 a download (shudder). The product cost was under $200.00. While I ordered this on Amazon.com, I will be sending it back (if it ever does get delivered) because of the delay in arrival (UPS claims the address was wrong). So, like any other realistic consumer, I ran down to Best Buy and got one locally at a higher price.

My business trips will normally be to destinations that are pretty easy. This weekend, I decided to tag on some stops to see a close friend (at a new residence), and my duo who are working hard in college. I planned several visits to distant colleagues along with stops to facilities to assess their arrangements when I do transfer clients to this part of Colorado. My good companion, the GPS, never failed me.

You could say we had to “connect” as I did have to learn more technical lingo and programming skill with this very user friendly device. Once I figured out how to find the streets in the various communities, it was impressively easy. The only glitch was finding a colleagues location that was in a new neighborhood. Once I got to this destination (after having to read the driving directions she gave me), I was able to program her coordinates via my GPS and set into a favorite location to my GPS for my next trip to her location.

I am hooked on GPS and while I hesitate to call it a best friend, I am willing to call it an appreciated and long lost companion.

Your questions, comments and feedback are appreciated and encouraged.

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Posted on: May 8, 2011

VA Aid and Attendance and The DD Form 214 or Report of Separation Form

by Bonnie Kavanagh RN · - Place a Comment

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Almost every VA Aid and Attendance set up I have facilitated, or started, has needed a DD Form 214 or Report of Separation . You do not always find this out immediately but the documentation and reimbursement of funds may get delayed if you do not have this form.

I have learned to either help prepare the form for a client ahead of time or have the client or family take care of this. You may have the form filled out in may ways with different fees. You may fill one out online via the government website for FREE. Click here to either download a copy to submit or you may (directly) fill the request out and send to the appropriate department to obtain the information for your file. Click here for both of those options as well as instructions.

Your questions, comments, and feedback is appreciated and encouraged.

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Posted on: April 28, 2011

Guest Writer: How Generation Alzheimer’s Disease Is Affecting Boomers

by Bonnie Kavanagh RN · - Place a Comment

Drawing comparing how a brain of an Alzheimer ...

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This article was written by the team at The Alzheimer’s Association to inform and reflect upon the impact this disease is having on baby boomer’s.

This year, the first wave of baby boomers are turning 65 – and with increased age comes increased risk of developing Alzheimer’s disease.

Our new report, “Generation Alzheimer’s: The Defining Disease of the Baby Boomers,” sheds light on a crisis that is no longer emerging – but here. Many baby boomers will spend their retirement years either with Alzheimer’s or caring for someone who has it. An estimated 10 million baby boomers will develop Alzheimer’s.

Starting this year, more than 10,000 baby boomers a day will turn 65. As these baby boomers age, one of out of eight of them will develop Alzheimer’s – a devastating, costly, heartbreaking disease. Increasingly for these baby boomers, it will no longer be their grandparents and parents who have Alzheimer’s – it will be them.

“Alzheimer’s is a tragic epidemic that has no survivors. Not a single one,” said Harry Johns, president and CEO of the Alzheimer’s Association. “It is as much a thief as a killer. Alzheimer’s will darken the long-awaited retirement years of the one out of eight baby boomers who will develop it. Those who will care for these loved ones will witness, day by day, the progressive and relentless realities of this fatal disease. But we can still change that if we act now.”

According to the new Alzheimer’s Association report, “Generation Alzheimer’s,” it is expected that 10 million baby boomers will either die with or from Alzheimer’s, the only cause of death among the top 10 in America without a way to prevent, cure or even slow its progression. But, while Alzheimer’s kills, it does so only after taking everything away, slowly stripping an individual’s autonomy and independence. Even beyond the cruel impact Alzheimer’s has on the individuals with the disease, Generation Alzheimer’s also details the negative cascading effects the disease places on millions of caregivers. Caregivers and families go through the agony of losing a loved one twice: first to the ravaging effects of the disease and then, ultimately, to actual death.

“Most people survive an average of four to six years after a diagnosis of Alzheimer’s disease, but many can live as long as 20 years with the disease. As the disease progresses, the person with dementia requires more and more assistance with everyday tasks like bathing, dressing, eating and household activities,” said Beth Kallmyer, senior director of Constituent Relations for the Alzheimer’s Association. “This long duration often places increasingly intensive care demands on the nearly 15 million family members and friends who provide unpaid care, and it negatively affects their health, employment, income and financial security.”
In addition to the human toll, over the next 40 years Alzheimer’s will cost the nation $20 trillion, enough to pay off the national debt and still send a $20,000 check to every man, woman and child in America. And while every 69 seconds someone in America develops Alzheimer’s disease today, by 2050 someone will develop the disease every 33 seconds – unless the federal government commits to changing the Alzheimer’s trajectory.
“Alzheimer’s, with its broad ranging impact on individuals, families, Medicare and Medicaid – has the power to bring the country to its financial knees,” said Robert J. Egge, vice president of Public Policy of the Alzheimer’s Association. “But when the federal government has been focused, committed and willing to put the necessary resources to work to confront a disease that poses a real public health threat to the nation – there has been great success. In order to see the day where Alzheimer’s is no longer a death sentence, we need to see that type of commitment with Alzheimer’s.” The full text of the Alzheimer’s Association’s “Generation Alzheimer’s” report can be viewed by clicking on the blue hyperlink.

Alzheimer’s Disease Early Diagnosis (asourparentsage.net)
2011 Alzheimer’s Disease Facts and Figures (shoppingblog.com)

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Posted on: April 28, 2011

A Reader Asks BonnieRN: My Elder Mother Has Had A Couple of Falls This Winter. What Can I Do to Help Keep Her Safe?

by Bonnie Kavanagh RN · - Place a Comment

Tai Chi'

Falls are a common and serious problem for elders. Falls are associated with significant mortality, morbidity, and decreased independence. According to the Center for Disease Control (CDC) in 2007 , there were over 18,000 falls that resulted in unintentional deaths; fortunately, the CDC studies the issues related to falls and states that falls are mostly preventable. The website at the CDC has a lot of information, resource guides for people and the community that is very helpful. There is also a toll free number to talk with them directly, who can help you with resource material at 800-CDC-INFO; ask for information for this topic under “Fall Prevention”.

A thorough assessment to avoid future falls should be done by her health care provider. A physical therapist may be needed to evaluate her functional strengths, balance, vertigo, and weaknesses. A complete medical and should be done to evaluate her overall health status and medication management and how that may influence her potential for falls. Multi-focal assessments need to be done that will determine if hearing, vision, or environmental factors are adding to your mother’s risk for falling.

Initially, you may help her by making an an appointment with her primary care provider to start the process. Be sure to bring your mother’s health history information with you along with her medication and supplement (including teas) list.

Look around her home to see if there is any clutter you may be able to clear out for her. Be sure her walkways are completely clear of clutter and debris. You may want to help her clean her home and set up regular intervals of home cleaning to help her keep her home organized and free of clutter. Mothers Day is next month and that would make a useful surprise gift for a Mom who has everything they need. Be sure to pick up scatter rugs (if there are any) in her home that may become a hazard.; the unevenness or texture of a rug on a floor can set someone off balance or slip out easily and cause a fall.

A specially made chair or bench for the shower may add to her safety during showers. You will find a durable medical equipment company (DME) in the phone book within the yellow pages section under medical equipment. For shower safety, it may be necessary to have a family member or qualified care giver be with her, perhaps temporarily, during her shower time. showering for her less stressful. These safety features or medical items may be reimbursable under your insurance coverage; check with your professional DME provider to see if you qualify for reimbursement.

If your health-care provider team allows exercise, encourage your mother to exercise regularly. There are many exercises that would add strength and balance to your mothers abilities and minimize her fall risk. Have her health- care team make recommendations. Common programs for elders may include yoga, stretching, strengthening with bands, walking, or Tai Chi’; you will find many health clubs and facilities with programs that include an elder focus on exercising.

Thank you for asking this timely question on a very important topic. Your questions, comments, and suggestions are greatly appreciated and encouraged.

Exercise helps fight fear of falling (seattletimes.nwsource.com)
A ReaderAsks Bonnie RN: How Do I Best Choose An Assisted Living Facility For My Elder Parent. (bonniern.com)

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Posted on: April 22, 2011

Breast Cancer Self Examination and Screening

by Bonnie Kavanagh RN · - Place a Comment

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According the the CDC’s latest statistics (2007) breast cancer is the 2nd most common cancer among women in the United States; first place is non-melanoma skin cancer. Breast Cancer is also one of the leading causes of cancer death among women of all races. Here’s a You Tube of breast cancer survivors. While breast cancer is statistically higher in women than men, men do also get breast cancer. The data on men, according to The American Cancer Society is, men are 100 times less likely to contract breast cancer than women.

The mortality of breast cancer rates are highest in black women in the United States. Asian Americans, particularly Japanese Americans have the highest survivial rates among breast cancer survivors. American Indians and Alsakan Natives have the lowest incidence of breast cancer and one of the lowest mortality rates. This may be due to the rural setting of this population and their limited access to health care. Much of the data of breast cancer, is based on the white women population that is either under or over 50.

Risk factors of breast cancer of this complex disease is multi-focal. The two primary risk factors are being female and growing older. Included in key focuses of risk factors are: family history, primary genetic mutations, radiation exposure, reproductive history, and lifestyle factors such as weight gain, alcohol consumption, and wheter you exercise.

Detection and screening for breast cancer includes regular breast self-exams ~ BSE (the wedge method is demonstrated above) and clinical exams ~ CBE buy your health care practitioner. Mammography is the most widely used method of breast cancer screening. Mammography is also used for breast cancer diagnosing. Mammography is said to be most affective in screening women for breast cancer over the age of 50; the breast as more dense under age 50 and are therefore more difficult to detect with Mammography testing; screening recommendations for Mammography testing of breast cancer for women begins at age 40. Your family practitioner should be consulted for recommendations of when and how frequently to test for breast cancer contingent with your breast cancer review of risk versus benefit questions and answers.

When a breast abnormality has been detected by Mammography or during a BSE or a CBE, the next diagnostic is a biopsy. There are multiple methods of biopsies; this needs to be thoroughly discussed with your health care practitioner for the best form of testing.

Performing regular BSE and having adequate routine testing by following your health care practitioners recommendation should be reviewed, if it has not already been, with your practitioner on your next appointment.

Your questions, comments and suggestions are greatly appreciated and encouraged. Namaste’