Western Nurse Magazine July August 2017

July – August 2017

incorporating western midwife

ESCAPE WINTER:

Kalbarri + ANF Holiday Units = Perfect PAGE 12

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Secretary's Report July-August 2017

State Secretary, Mark Olson

on the

cover

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FEATURED 4

ANF Humanitarian Fund

10 Anniversary: St John of God Geraldton Hospital 12 Winter Getaway: ANF Kalbarri 24 ANF Prize Winners Kalbarri Winter Break

FAVOURITES 8

4

Internet Watch

18 ANF Out ‘N’ About 20 Across the Nation 26 Around the Globe 30 Research Roundup 31 ANF Contact Details

ANF Humanitarian Fund

10

HOLIDAY ANF 15 ANF Super Deal Margaret River 32 ANF Student Deal Margaret River

WIN! St John’s Geraldton Anniversary

The Cranial Nerves Filaments of olfactory nerve (I) Olfactory bulb

Frontal lobe

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Olfactory tract

Temporal lobe Optic nerve (II) Optic chiasma Optic tract Oculomotor nerve (III)

Infundibulum

Facial nerve (VII)

Trochlear nerve (IV)

Vestibulocochlear nerve (VIII)

Trigeminal nerve (V)

Glossopharyngeal nerve (IX)

Abducens nerve (VI)

Vagus nerve (X)

Cerebellum

Accessory nerve (XI)

Medulla oblongata

Hypoglossal nerve (XII)

It has two divisions: the cochlear nerve and the vestibular nerve. The cochlear nerve transmits sound through a complex pathway that begins in the cochlea of the inner ear and extends to the auditory cortex of the temporal lobe.3 The vestibular nerve transmits signals to neural structures in order to maintain the eye movements and muscles required to keep us upright.3 Hearing acuity is assessed through one’s ability to hear normal and whispered voices, and with the use of a tuning fork.2 Abnormal hearing may occur as a result of inflammation, local occlusions, otosclerosis, drug toxicity, or the presence of a tumour.2

and larynx, maintains talking and swallowing, and transmits sensation from the carotid body, carotid sinus, pharynx, and viscera.2 Through the parasympathetic nervous system, these nerves also maintain the parotid gland and carotid reflex, which slows the heart rate and lowers blood pressure in response to pressure and chemical related changes in the body.1,2 Assessment of the glossopharyngeal and vagus nerves is focused on motor function and the presence of a gag reflex as impairments may result in airway compromise. Identification of abnormal signs including poor voice quality, impaired cough or gag reflex, or inadequate swallowing may help prevent life-threatening complications.2

CRANIAL NERVE XII: HYPOGLOSSAL NERVE The hypoglossal nerve controls motor movement of the tongue. Clinical examination includes inspection, movement of the tongue, and assessment of speech. Abnormal findings, including incomprehensible speech, tongue wasting, tremors, wiggling, or deviations in forward protrusion (away from the midline) may indicate an upper or lower motor neuron lesion.2

Cranial Nerves

CRANIAL NERVE IX AND X: GLOSSOPHARYNGEAL NERVE AND THE VAGUS NERVE The glossopharyngeal and vagus nerves are both mixed motor and sensory nerves.1,2 The glossopharyngeal nerve is responsible for taste on the posterior third of the tongue, as well as the gag reflex, and movement of the pharynx for phonation and swallowing.2 The vagus nerve also controls movement of the pharynx

CRANIAL NERVE XI: SPINAL ACCESSORY NERVE The spinal accessory nerve is a motor nerve, which innervates the sternocleidomastoid muscle and the trapezius.1 Strength and symmetry are assessed through the application of resistance. Normal movements are smooth and equal on both sides.2

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CLINICAL UPDATES 14 Seasonal Influenza Vaccine 2017 16 Cranial Nerves

Now we have a new State Government, I find the ANF is being approached repeatedly by senior nurses and midwives requesting we lobby the recently appointed Health Minister about one deserving cause or another.

The irony is a number of these same senior staff who say they want innovation in public health, are the ones now struggling to preserve the useless, outdated annual performance appraisals that have been dumped by many big companies, and which the vast majority of nurses and midwives want gone.

Clearly, such appraisals at best duplicate what’s already occurring in every day hospital safety protocols and within national nurses’ board regulations, and at worst are time-consuming tools for bullying that take frontline health staff away from patients.

But coming back to the goals of these senior people, I cannot understand how they do not see these appraisals are chewing up valuable cash that could be used for the very projects they want me to spruik to the Minister.

The Government has time and time again made the point that the State’s finances are a mess, and there is an extremely limited pot of public cash, and that for new investment to occur, savings have to be found.

Appraisals are not just low hanging fruit in a tough economic climate, they are rotten apples that are hindering the valuable work of frontline staff.

And the money wasted on them is not small change, it’s millions of dollars yearly that could be spent on the types of projects these senior people want implemented, and that I agree are needed – such as ward-based patient care initiatives and the employment of more graduates.

The Minister and the vast majority of our members have recognised appraisals waste time, money and resources – our members have asked they be abolished, and WA Labor has promised this will happen.

And despite these senior people telling our frontline members at work that appraisals are here to stay, the Minister has told us repeatedly that he is keeping his promise, and he is actively working with us to get rid of them.

If those senior people holding out in support of these useless appraisals instead pitch in with the rest of us to scrap them, they can also identify the meaningful areas where we could be redirecting the savings we’ll have when they’re gone. In the meantime, if you have areas of crucial concern where funds are lacking, I want to hear from you.

22 Interpreting ABGs 29 Doppler Ultrasound

For DVT - Radiology

REFERENCES

1. Damodaran O, Rizk E, Rodriguez J, Lee G. Cranial nerve assessment: a concise guide to clinical examination. Clin Anat. 2014;27:25-30.

2. Forbes H, Watt E, editors. Jarvis’s physical examination & health assessment. Australian and New Zealand Edition. Chatswood, NSW: Elsevier Australia; 2012. 914p.

3. Rhoades RA, Bell DR, editors. Medical Physiology: Principles for Clinical Medicine. 4th edition.

Baltimore, MD: Lippincott Williams & Wilkins; 2013. 820p.

July–August 2017 western nurse |

3

ANF Humanitarian Aid Sandra Guzzi during her volunteering program in a cardiac hospital in Tanzania.

GLOBAL CARE

The ANF’s humanitarian fund empowers our members to help people worldwide – a life-changing experience for all involved.

Sandra Guzzi always dreamed of volunteering as a nurse overseas – and when it finally happened, she was sent to stop heart patients dying in an African hospital that services 40 million people.

Institute, in the nation’s biggest city, Dar es Salaam, on the Indian Ocean coast. “Our team was sent there to help out with the more complex cases and help reduce the high mortality attributed to the postoperative care.

In November 2016, the intensive care registered nurse was accepted to work as a cardiac nurse for Open Heart International’s trip to Tanzania, which provides free open heart surgery to adults and children.

“I was assigned to work on the ward which was a 40 bedded ward. All rooms had four beds, no curtains between them and one shared bathroom. There were limited basic medical supplies, as well as (limited) linen, gloves and hand soap.

Sandra told western nurse she will never forget the experience of aiding people in such dire need. The Joondalup Health Campus RN feels fortunate to subsequently have received an ANF Humanitarian Aid Volunteers Fund grant, which will finance her trip back to Tanzania this year, because she wants to keep helping. And she hopes others will also apply for the funding and go volunteering.

“We were based at the only cardiac hospital in Tanzania, serving 40 million people,” she said of her time at Jakaya Kikwete Cardiac

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western nurse July–August 2017

“The hospital does not provide food or water to the patients. But I found every patient and their families to care for each other, always ensuring that their neighbour had something to eat and drink. The patients warmed your heart, especially the children whose smiles melted you and constantly wanted to hug and play with you.”

Sandra, who has since been chosen as Curtin University's ambassador for their new nursing campaign, said part of the

Volunteers Fund volunteers’ role was to ensure local nurses were providing adequate postoperative care to the patients. “One of my colleagues introduced the shift planner to the nurses which they now use,” she said. “We educated nurses on abnormal vital signs, basic wound care and management of chest drains.” She said the volunteers’ presence was well received, and she is proud to have been invited back in 2017, as part of the Intensive Care Team.

“It all makes sense now why I am a nurse … I want to continue working in a voluntary capacity for the rest of my life”

“You can’t put a price on this truly life changing experience,” Sandra said. “The parents of the sick children told us how unwell their children were prior to surgery. They cried as the saw their children improve postoperatively. Adult patients were so thankful they were no longer breathless, and could look forward to a normal, functional life. The children's smiles and laughter will always stay with me and made the journey a little easier.

“On our last day, one of our little baby patient’s mother sang us a goodbye song, reducing us to tears, and made us promise her we would return to help save other children like her baby girl.”

Sandra still gets teary thinking of that moment. “It all makes sense now why I am a nurse,” she said. “It is more than a job. I love what I do, and I want to continue working in a voluntary capacity for the rest of my life. I am proud to be a nurse today more than ever.”

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July–August 2017 western nurse |

5

ANF Humanitarian Aid HELPING THEM TO SEE

A project that recently provided thousands of free spectacles to people who normally can’t even access an eye checkup, will benefit because one of our members applied for the ANF Humanitarian Aid Volunteers Fund.

Regina Lau will be using her ANF humanitarian fund grant to continue participating in a project that earlier this year provided 2750 pairs of free spectacles to children, adults and the elderly in Sri Lanka.

Fitting a Laotian Buddhist monk with a pair of recycled prescription sun glasses, graded by Acacia prisoners.

The registered nurse/registered midwife, who is Team Leader of the Eye Care Outreach project and Medical Coordinator of Global Hand Charity, said mobile eye care camps were conducted in three regional areas and two orphanages in January 2017.

“As a result of the intervention, 3000 people were screened and beneficiaries included school children, mature adults and elderly people,” Regina said of the project that was first launched in Northern Laos three years ago, and runs annually.

“We gave out 2750 pairs of free spectacles (in Sri Lanka) to people identified with impaired vision, with many more special prescriptions organised for children and adults with very low vision. Many older adults were also given assistance with cataract follow-up. The glasses came from four sources – reconditioned ones sorted

by Acacia Prison prisoners, as part of their rehabilitation program; and contributions from Essilor Vision Foundation, Rotary Australia World Community Services, and Global Hand Charity Inc. “Although this mission is only a small step towards the aim of helping the 2.5 billion people in the world who suffer from uncorrected poor vision – for those who benefited from this project, the pair of eyeglasses they received was a reallife changer.

Regina Lau (kneeling) and the optometry team of volunteers at the eye care trip in Sri Lanka, January 2017.

She said the team of 11 volunteers consisted mostly of optometrists and optometry students from University of Melbourne, who self-funded their trips.

“Together we managed to see an average of 550 to 600 Sri Lankans a day, focusing on children in orphanages and on tea-pickers in the tea plantation territories, many of whom were hit by poverty and social problems,” she said. “It has been so humbling to see so many people travel from far away villages to get their sight checked, for example a young mother of two who was continuously bumping into walls at the clinics, due to bad vision, whom we were able to help with glasses.

"... the pair of eyeglasses they received was a real-life changer – in measurable terms their quality of life improves with greater employment opportunities, young children could optimise their potential in educational pursuits, and the elderly could help with general house chores with better eye sight”

Regina Lau performing eye checks on a Laotian girl, as part of an earlier screening program.

“For many of the beneficiaries who are living below the poverty line, a pair of glasses – although available for a very low price – still means an investment that they can’t afford without receiving financial support. The lack of accessibility to eye care facilities is also an issue for the people living in rural areas.”

Regina said although the initiative was a huge success, they had to turn away Nearly 3000 pairs of spectacles dispensed “another couple of hundred people who in the 2017 Sri Lanka trip. had made such long journeys”, due to a lack of time, and “In measurable terms their quality of life improves with because optometrists were under tremendous strain to cope greater employment opportunities, young children could with the influx. optimise their potential in educational pursuits, and the But Regina plans to return to Sri Lanka in December to elderly could help with general house chores with better eye sight.” continue the work, with help from the ANF Humanitarian

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western nurse July–August 2017

Volunteers Fund Aid Volunteers Fund. “A big thank you to the ANF for the financial help and support,” she said. “It is a tremendous boost. The money kindly received from the ANF will be used to purchase more eye wear, to cover specialised prescriptions for people in exceptional circumstances, for eye charts and eye care equipment.

Preparing clients for glasses dispensing, with their prescriptions.

"By collaborating with various organisations and other aligned health professionals to achieve a common goal, projects such as this remind me that as nurses, we are ideally placed to influence health outcomes globally.”

The ANF fund is open to members who have done, or are about to undertake humanitarian volunteer work in Australia or overseas.

A record 1000 people turned up for eye screening in Katana, Sri Lanka to be seen by the Global Hand Charity team.

Applications close on December 15. See page 28 for more detail.

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July–August 2017 western nurse |

7

InternetWatch AMAZING APPS + ONLINE NEWS

AFL LIVE It’s well and truly footy season! Watch the games or listen in radio format. Access live scores, highlights, player profiles and stats. Filter matches according to your team or check out what the opposition is up to. Free

First Responder Calling qualified first aiders!

Sign up as a first responder and be notified when someone has called 000 for an ambulance in a nearby public place. Not looking to sign up as a first responder? No problems. Anyone can access the first aid guides, triple zero (000) calling with automatic GPS location and a defibrillator locator. Free

Human-to-Cat Translator Got communication issues with your cat? Consider translating your voice into meows.

With over 175 samples, the translator dares to connect with the resident puss. Your voice is analysed and it plays personalised meows to your cat. The creators assure us no cats were harmed in the development of this app. Free

PAC-MAN Come on, relive PACMAN, the retro arcade classic. Earn high scores as you eat fruit and run away from the ghosts. Or gobble a Power Pellet and get the ghosts before they get you. Check out the new mazes, and as always, reaction time and reflexes are key as you chomp towards the best score. Free

PANTONE Studio Here’s one for the creatives out there. It contains the entire 10,000+ colour collection. Build palettes to test on materials and designs. All tools, features, and content are free with a selection of available PANTONE colours. $5 per month for the complete colour collection.

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western nurse July–August 2017

Kidsafe WA Child Safety This is a useful one for parents and carers. Enter basic information about the child(ren) in your life and then users will be provided with personalised weekly tips and information on child injury prevention – all based on the child’s specific stage of development. Free

FIVESuperSites LastPass…

Modern life comes with heaps of online accounts that demand passwords to ensure the safety of your personal details. At LastPass you set the master password and they do the rest. Passwords are auto-filled, differently each time. Keep those hackers guessing! https://www.lastpass.com/

AQWA Visit the Aquarium of Western Australia app and create your own undersea adventure.

Follow Sweep through caves and crevices, open ocean and coral reefs as you decide where he goes during his journey under the sea. Check out the Great Southern Ocean and even the Busselton jetty! Free

Bored Panda Bored Panda is seriously addictive and a treasure trove of interesting stories on the Internet. Simply cruise around or join to add or vote on new stories. Join discussions with other bored pandas if you’re so inclined. It’s surfing the web in one place. Free

Airvo2 This is a must for those that use the AIRVO 2 device. It simulates the screen to help you learn how it works. The manufacturer says you can change settings, oxygen levels and simulate warnings. There are tutorials to help out with the basics, as well as short videos. Free

Scattegories It’s just like the board game. Quick! Name an animal that starts with the letter P. The more creative your answers, the more points you collect.

Challenge a random opponent or connect to Facebook and play with your mates. Free

Kids Health WA

Head here to access paediatric calculators for emergency drugs, antibiotics, fluids and more. The calculators simplify dosing – type in the child’s age, weight or other required information and the selected medication or fluid doses are displayed. http://kidshealthwa.com/resources/

James Fridman

James Fridman is a British graphic designer who is famous for taking requests for alterations to photographs, but responds with an image edited to slightly different specifications, to hilarious effect. Do not submit any personal photos that you do not want to be made public! http://jamesfridman.com/

Have I been pwned?

Pwning is the name given to the act by unscrupulous people trying to access our personal data on the Internet. This website is so cool. Simply enter your email address to check if your personal data has been compromised by data breaches. Sign up to be notified if you get pwned in the future. https://haveibeenpwned.com/

Photo Ark

The folks at National Geographic are trying to save species through the photography of Joel Sartore. So far over 6000 species from 40 countries have been captured on film, with the aim of inspiring people to get involved in caring for and protecting these animals. Have a look, they are stunning. https://www.nationalgeographic. org/projects/photo-ark/

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July–August 2017 western nurse |

9

HAPPY BIRTHDAY The original 1935 St John's Geraldton building.

St John of God Geraldton Hospital has been a part of WA’s Mid West community for the lion’s share of the past 100 years. But this year marks an important milestone – a quarter of a century since that community banded together to build the modern hospital that now services this city of nearly 40,000 people and its outlying areas.

When St John’s Geraldton first opened its doors as a 28-bed hospital on October 19, 1935, there’d still be another two years before the port town would significantly move towards becoming a city – with the construction of bulk wheat export facilities.

In 1969, a major remodel of the hospital had increased bed capacity to 70, but by the late 1980’s, the design was no longer appropriate for the needs of the growing region. Groups within Geraldton and the Mid West worked to raise $1.6 million so a new hospital could be built.

On April 12, 1992, the new 60-bed single-storey hospital opened, which continues to operate with some additions until today. This year St John of God Geraldton Hospital is celebrating the 25th anniversary of when

Enrolled nurse Amy Davis, and registered nurses Stacey Williamson and Jasmine Causer working in Geraldton St John's.

the efforts of community members culminated to create the modern hospital that now accommodates a city of nearly 40,000 people, and its outlying areas.

SJG Geraldton Hospital CEO Paul Dyer said the local community raised $1.8 million towards the cost of constructing the new building for the hospital.

Mr Dyer said at the time the buildings were ageing and needed to be replaced with newer, bigger facilities that would serve the future needs of the community.

“As a not for profit, the organisation did not have the ability to provide all the funding which put the project at risk, but the organisation went to the local community for help and they happily stepped in to assist,” he said of the effort that included many individuals, and the donations of both small and large businesses and medical practitioners in the area.

“To this day, that engagement continues, with many people thinking of St John of God Geraldton Hospital as ‘their’ hospital.”

Registered nurse Stacey Williamson, who works in the chemotherapy area, agreed that community spirit continues. “I enjoy working at SJG Geraldton Hospital because of the good community environment, where good people care about each other, and care about the patients,” Stacey said. “I enjoy the variety of roles from coordinating, to working on the wards, working in chemo and working in day surgery."

Leonie Mogridge said being a registered midwife in this community is such a rewarding career. “To be able to share in the lives of so many people beginning or expanding their precious family, is so rewarding,” she said. “Even after 36 years, 25 of them at St John’s Geraldton, I am still amazed by the sight of birth and the joy of family.”

The hospital now includes a chapel, two birthing suites, day and overnight ward areas, hospice, two operating suites, medical imaging, pathology services and administration offices.

In 1994 a laundry was added, in 1997 a dedicated hospice unit was introduced, and the hospital auxiliary and local Variety Club helped

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western nurse July–August 2017

raise money to build a children’s playground which opened in 2002. The following year, the specialist centre was extended to accommodate increased demand for specialist services. Then two family rooms were later added to the maternity unit through Commonwealth Government funding.

The modern buildings were opened in 1992 by then-Deputy Premier Ian Taylor, and then-newly-appointed Bishop Justin Bianchini, who blessed the new facilities at his first official event for the area, and who is now retiring. 

The opening of the new St John's Geraldton on July 23, 1992.

Registered midwife Leonie Mogridge, with Dr Nikee Msuo (left) at St John's Geraldton.

St John's Geraldton today.

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July–August 2017 western nurse |

11

WARM WINTER GETAWAY

Don't wait till summer to have a beach holiday – Kalbarri awaits.

.........

There’s always a rush to book holidays for summer – but what if you could take a break during winter instead and enjoy sunshine and world class beaches.

Kalbarri weather makes it possible to get away from the cold, rainy city, without having to go through the hassle of flying to Bali or Europe – and the ANF has quality accommodation right near the water, to help you achieve a real beach holiday ASAP at a terrific price.

It takes mere minutes to book your holiday on iFolio, and from less than $50 a night you can have resort accommodation in the ANF apartments right in the heart of this seaside paradise - beach next to beach, pretty inlets and multiple stunning coastal views.

ANF State Secretary Mark Olson said he and the ANF Holiday Unit Team had also worked more flexibility into existing systems to offer even more choice. “You don’t have to stay a week, you can now arrive Friday and leave

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western nurse July–August 2017

Monday, or stay Monday to Friday,” Mark said. “We’re always working on options to help you have exactly the holiday you want. For instance, some members were also telling us they wanted something other than the bring-your-own system, so we made sure the provision of linen and bath towels became available.”

What hasn’t changed is the brilliant location of your accommodation. Take a few short steps out of your ANF apartment in the Kalbarri Beach Resort and enjoy the views over the water, because you’ll be living only metres from one of those terrific beaches. And a brief scenic drive gets you easily to other local attractions.

Once you’ve had enough of lying poolside in the resort, lazily paddling around in the pool, and relaxing in the spa baths, you can choose from open water swimming, surfing, canoeing, sailing, relaxing on the beach, whale watching, bush walks, hiking, rock climbing, enjoying stunning scenery at various lookouts, watching pelican

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Enjoy the pool at the ANF Holiday Units Plenty of room for the family in the ANF Holiday Units

Kalbarri .......

feedings, horseback riding, or chartering a boat – and those are just some of the activities possible in this beautiful region.

Food-wise, the general area is known for its sumptuous seafood. Later this year, there are also Kalbarri Community Markets held on September 25, October 2, and December 19.

“And at the end of a day in and around Kalbarri, you can come home to a poolside barbecue in your private resort, right near your two-bedroom ANF apartment,” Mark said. “Inside your accommodation, you have a full kitchen and room for all the family, with all sorts of extras, including a 55 inch big screen TV and DVD/Blu-ray player, with games capacity.”

You can find all ANF accommodation details and options on your iFolio. 

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July–August 2017 western nurse |

13

update: 2017 Seasonal influenza vaccine RECOMMENDATIONS The 2017 flu vaccine is recommended for all Australians over the age of six months. It is free for individuals at risk including:

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Generic name Influenza vaccine Brand name FluQuadri Junior, FluQuadri (Sanofi Pasteur), Fluarix Tetra (GSK), Afluria Quad (Seqirus)1 Drug class Vaccines

INDICATIONS The seasonal influenza vaccine is used to protect against seasonal influenza (see Table 1).

It is the most important intervention to prevent influenza infections and reduce complications (including mortality) in individuals at risk.2 All 2017 flu vaccines in Australia are quadrivalent.1 They contain four strains of influenza: two type A and two type B. Type A and B influenza are commonly associated with major and minor epidemics, which often occur in the winter months.2 The composition of the annual vaccine is based on recommendations from the World Health Organization and the Australian Influenza Vaccine Committee and approved for use by the Australian Therapeutic Goods Administration (TGA).3 Table 1. Influenza virus strains in the 2017 seasonal influenza vaccine.1

Influenza virus strain Description A (H1N1)

A/Michigan/45/2015 (H1N1) pdm09 like virus

A (H3N2)

A/Hong Kong/4801/2014 (H3N2) like virus

B

B/Brisbane/60/2008 like virus

B

B/Phuket/3073/2013 like virus

MECHANISM OF ACTION All influenza vaccines available in Australia are split virion or subunit vaccines that contain purified inactivated influenza virus.2 The virus is cultivated in embryonated hens’ eggs, then divided and destroyed in order to ensure that particles in the vaccine cannot cause infection.2,4 Once administered, the body recognises the influenza particles as foreign and develops a lasting immune response.4

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western nurse July–August 2017

- People aged 65 years and over - Aboriginal and Torres Strait Islander people aged six months to less than five years - Aboriginal and Torres Strait Islander people aged 15 years and over - Pregnant women - People aged six months and over with a concurrent medical condition that may result in complications associated with influenza, including those with severe asthma, a chronic respiratory or neurological condition, heart disease, renal disease, an immunocompromising condition, or a metabolic disorder such as diabetes.2 Some states offer a free flu vaccine to all children aged six months to less than five years. For the most up-to-date recommendations regarding immunisations in Australia, please refer to The Australian Immunisation Handbook 10th edition and the specific state immunisation schedule.

Local complications at the injection site such as pain, swelling, and redness may also occur.

Allergic reactions including hives, angioedema, asthma, and anaphylaxis are rare.2

DOSAGE AND ADMINISTRATION Most people require a single dose of the influenza vaccine each year. Children under nine require two doses at least four weeks apart in the first year they receive the vaccine, and then a single dose in all subsequent years.

In 2017, children aged between six months and less than three years will have two doses of FluQuadri Junior, and children aged three to nine will have two doses of FluQuadri or Fluarix Tetra (if it is their first year of vaccination.)1 (see Table 2). Everyone else will require a single dose, as outlined in Table 2.

Evidence suggests that protection from influenza begins to diminish three to four months after vaccination. This must be considered when determining the optimal time to vaccinate. As long as there continues to be cases of influenza it is never too late to vaccinate.1,2

REFERENCES

PRECAUTIONS The only absolute contraindication to the influenza vaccine is previous anaphylaxis to the vaccine or a vaccine component.2,5 Influenza vaccines are safe for individuals who are allergic to eggs, including those with anaphylaxis.1,2 Individuals with a history of anaphylaxis to eggs should be vaccinated in a medical clinic, with experienced health professionals who are capable of managing a reaction should it occur.1,2 Caution should be taken prior to vaccinating a person with a history of Guillain-Barre syndrome; specialist advice may be required.2 Vaccination should be delayed in individuals with an acute febrile illness.2,4 The influenza vaccine is safe to use and recommended in pregnancy.1,2

ADVERSE EFFECTS Common adverse effects include fever, malaise, myalgia and/or headache which may last up to two days.2,5 Children under five may experience more severe symptoms than adults.2,5

1. Australian Government Department of Health.

Australian Technical Advisory Group on Immunisation (ATAGI) advice for immunisation providers regarding the administration of seasonal influenza vaccines in 2017. Canberra: Commonwealth of Australia; 2017 Feb. 2p.

2. Australian Government Department of Health and Ageing. The Australian immunisation handbook. 10th edition. Canberra: DoHA; 2013 [updated 2017 Feb]. Available from: http://www. immunise.health.gov.au/internet/immunise/ publishing.nsf/Content/90ADD02CDCB5D49DC A257D4D0022D886/$File/4-7-Influenza.pdf 3. WHO Collaborating Centre for Reference and Research on Influenza. About Influenza [Internet]. Melbourne: VIDRL; n.d. [cited 2017 Mar]. Available from: http://www. influenzacentre.org/aboutinfluenza. htm#vaccination.

4. Australian Medicines Handbook 2017 (computer program). Adelaide: Australian Medicines Handbook Pty Ltd; 2017 Jan. 5. Therapeutic Goods Administration. Australian Influenza Vaccine Committee (AIVC) [Internet].

Canberra: Commonwealth of Australia; 2016 Oct 25 [cited 2017 Mar 23]. Available from: https://www.tga.gov.au/committee/australianinfluenza-vaccine-committee-aivc

Table 2. 2017 seasonal influenza vaccines available in Australia, by age.1 Age group/Vaccine

FluQuadri Junior (0.25mL)

FluQuadri (0.5mL)

Fluarix Tetra (0.5mL)

6 months – <3 years of age

YES

>3 – 18 years (or equal to)

YES

YES

>18 years (or equal to)

YES

YES

Afluria Quad (0.5mL)

YES

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Julyâ&#x20AC;&#x201C;August 2017 western nurse |

15

update: Cranial nerves

Read this article and complete the online quiz to earn 1 iFolio hour

The cranial nerves are the twelve pairs of nerves which enter and exit the brain. Most are located in the brainstem and extend to various parts of the head, neck, and trunk (see Table 1).1-3 They are part of the peripheral nervous system, responsible for sensory and motor functions, including the sensation of touch, sight, hearing, taste, and smell, movement of the facial muscles, and regulation of the associated glands (see Illustration 1).1-2

THE BRAINSTEM Table 1. Location of the cranial nerves (CN) within the brainstem2

Regions of the brainstem

Location

Cranial nerves

Midbrain

Anterior region, connected to the thalamus and hypothalamus

Nuclei of CN III and IV

Pons

Central region

Nuclei of CN V - VIII

Medulla

Lower region, connected to both the brain and the spinal cord

Nuclei of CN IX-XII

CRANIAL NERVE I: OLFACTORY NERVE The olfactory nerve is responsible for our sense of smell. It travels from the mucous membranes in the nose to the olfactory sulcus on the orbital surface of the frontal lobe.1 It is the only cranial nerve not connected to the thalamus.1 Although it may seem basic, smell is a highly complex aspect of the sensory nervous system, associated with memory, emotions, and nutritional pleasure.1 Assessment of the olfactory nerve is reserved for patients who report a loss of smell, as well as those with traumatic head injuries, altered levels of consciousness, or suspected intracranial lesions.2 Unilateral loss of smell,

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western nurse Julyâ&#x20AC;&#x201C;August 2017

unrelated to any nasal condition, is known as neurogenic anosmia and may be a sign of a facial fracture, frontal lobe lesion, or a tumour in the olfactory bulb or tract.2

CRANIAL NERVE II: OPTIC NERVE The optic nerve is the sensory nerve responsible for vision. It transmits information about colour, brightness, and contrast from the optic disc, through the optic chiasm and into the brain.1 The optic nerve has several destinations within the brain. Visual information is processed by the lateral geniculate nucleus in the thalamus and relayed to other areas, including the visual cortex of the occipital lobe, the suprachiasmatic nucleus of the hypothalamus, the pretectal nuclei, and the superior colliculus.1,3 Assessment of cranial nerve II involves direct inspection of the eye, visual acuity and visual field testing, and examination of the ocular fundus using an opthalmoscope.2 Abnormal findings may indicate a variety of disease processes including congenital blindness, traumatic injury, diabetes, increased intracranial pressure, glaucoma, or a cerebrovascular accident.2

CRANIAL NERVES III, IV AND VI: OCULOMOTOR, TROCHLEAR, AND ABDUCENS NERVE Collectively, these nerves control extraocular muscle movement and the opening of the eyelids.1,2 The oculomotor nerve has mixed sensory and motor functions, including the majority of extra-ocular muscle movement and the constriction of the pupils in response to parasympathetic nervous system stimulation.1,2 The trochlear nerve controls down and inward movement of the eye through innervation of the lateral rectus muscle, while the abducens nerve maintains lateral eye movement through the superior oblique muscles.1,2 Eyelid function is measured through symmetry between the eyes. Drooping of one eyelid may indicate myasthenia gravis, cranial nerve III dysfunction, or sympathetic nerve damage.

Normal pupils are equal, round, and reactive to light. Both eyes should be able to move in all directions. Paralysis suggests damage to one of these three nerves, depending on the affected movement.2

CRANIAL NERVE V: TRIGEMINAL NERVE The trigeminal nerve is the largest cranial nerve. It has both sensory and motor functions, including sensation of the face, scalp, and cornea, regulation of the mucous membranes of the mouth and nose, and control of the muscles of mastication (chewing).1,2 It is comprised of three major divisions. The ophthalmic division is responsible for sensation from the skin and mucosa at or above the eyes, including the cornea and conjunctiva.1 The maxillary division maintains sensation from the the middle region of the face, as well as mucous membranes in the upper palate of the mouth and the nasopharynx. The third division, known as the mandibular division is both sensory and motor. It controls the muscles of mastication and is responsible for general sensation from the skin and mucosa below the mouth.1 Assessment of the trigeminal nerve involves sensory testing of all three facial regions.

Abnormal sensation, absent corneal reflexes, or impaired muscular control of the mouth may occur as a result of a cranial nerve lesion, trauma, tumour, increased intracranial pressure, neuralgia, or a motor neuron disorder.2

CRANIAL NERVE VII: FACIAL NERVE The facial nerve controls a variety of sensory and motor functions including facial expression, closing of the eyelids, speech, closing of the mouth, and taste on the anterior two thirds of the tongue. It also regulates saliva and tear production through the parasympathetic nervous system.1 Movement of the face should be smooth and symmetrical. Assessment of the facial nerve involves observation of basic facial expressions including smiling, frowning, eyebrow lifting, puffed cheeks, and exposure of the teeth.

Impaired movement or asymmetry may indicate central or peripheral nervous system disorders, such as a cerebrovascular accident or Bellâ&#x20AC;&#x2122;s palsy.2

CRANIAL NERVE VIII: VESTIBULOCOCHLEAR NERVE The vestibulocochlear nerve is a sensory nerve, responsible for sound reception and balance.1

The Cranial Nerves Filaments of olfactory nerve (I) Olfactory bulb

Olfactory tract

Frontal lobe

Temporal lobe Optic nerve (II) Optic chiasma Optic tract Oculomotor nerve (III)

Infundibulum

Facial nerve (VII)

Trochlear nerve (IV)

Vestibulocochlear nerve (VIII)

Trigeminal nerve (V)

Glossopharyngeal nerve (IX)

Abducens nerve (VI)

Vagus nerve (X)

Cerebellum

Accessory nerve (XI)

Medulla oblongata

Hypoglossal nerve (XII)

It has two divisions: the cochlear nerve and the vestibular nerve. The cochlear nerve transmits sound through a complex pathway that begins in the cochlea of the inner ear and extends to the auditory cortex of the temporal lobe.3 The vestibular nerve transmits signals to neural structures in order to maintain the eye movements and muscles required to keep us upright.3 Hearing acuity is assessed through one’s ability to hear normal and whispered voices, and with the use of a tuning fork.2 Abnormal hearing may occur as a result of inflammation, local occlusions, otosclerosis, drug toxicity, or the presence of a tumour.2

CRANIAL NERVE IX AND X: GLOSSOPHARYNGEAL NERVE AND THE VAGUS NERVE The glossopharyngeal and vagus nerves are both mixed motor and sensory nerves.1,2 The glossopharyngeal nerve is responsible for taste on the posterior third of the tongue, as well as the gag reflex, and movement of the pharynx for phonation and swallowing.2 The vagus nerve also controls movement of the pharynx

and larynx, maintains talking and swallowing, and transmits sensation from the carotid body, carotid sinus, pharynx, and viscera.2 Through the parasympathetic nervous system, these nerves also maintain the parotid gland and carotid reflex, which slows the heart rate and lowers blood pressure in response to pressure and chemical related changes in the body.1,2 Assessment of the glossopharyngeal and vagus nerves is focused on motor function and the presence of a gag reflex as impairments may result in airway compromise. Identification of abnormal signs including poor voice quality, impaired cough or gag reflex, or inadequate swallowing may help prevent life-threatening complications.2

CRANIAL NERVE XI: SPINAL ACCESSORY NERVE The spinal accessory nerve is a motor nerve, which innervates the sternocleidomastoid muscle and the trapezius.1 Strength and symmetry are assessed through the application of resistance. Normal movements are smooth and equal on both sides.2

CRANIAL NERVE XII: HYPOGLOSSAL NERVE The hypoglossal nerve controls motor movement of the tongue. Clinical examination includes inspection, movement of the tongue, and assessment of speech. Abnormal findings, including incomprehensible speech, tongue wasting, tremors, wiggling, or deviations in forward protrusion (away from the midline) may indicate an upper or lower motor neuron lesion.2

REFERENCES 1. Damodaran O, Rizk E, Rodriguez J, Lee G. Cranial nerve assessment: a concise guide to clinical examination. Clin Anat. 2014;27:25-30.

2. Forbes H, Watt E, editors. Jarvis’s physical examination & health assessment. Australian and New Zealand Edition. Chatswood, NSW: Elsevier Australia; 2012. 914p.

3. Rhoades RA, Bell DR, editors. Medical Physiology: Principles for Clinical Medicine. 4th edition.

Baltimore, MD: Lippincott Williams & Wilkins; 2013. 820p.

July–August 2017 western nurse |

17

ANF Out ‘N’ About Our members at both public and private hospitals and other facilities continue to benefit from lunch time visits and other sessions – with snaps this edition capturing members at King Edward Memorial Hospital, Kalamunda Hospital, Princess Margaret Hospital, Rockingham Hospital, and Osborne Park Hospital.

Remember, at the end of the year, we’ll be awarding some terrific prizes to at least one workplace (maybe more if it’s hard to choose!) for great photos – so you’re still in the running. See you at your workplace soon!

A

B

C

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western nurse July–August 2017

D

E1

E3

E2

Out ‘N’ About A. KING EDWARD MEMORIAL

D. OSBORNE PARK HOSPITAL GROUP

HOSPITAL GROUP

E. ROCKINGHAM HOSPITAL

B. KALAMUNDA HOSPITAL Cristina Henriquez, Alecia Kennewell, Semeng Ndhlovu, Elizabeth Morris, Molamma Mathew, Judy Brand and Raji Narayan

C. PRINCESS MARGARET HOSPITAL

E1. Fiona Watson and Liz Robinson E2. Carol Baker and Rhonda Ogle E3. Catherine Maher and Denise Bowman

Cassie Hansen and Gaby Carroll

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July–August 2017 western nurse |

19

AcrossTheNation NEWS, VIEWS AND GOSSIP FROM ALL OVER AUSTRALIA

AUS AUSTRALIAN MENTAL HEALTH PRIZE – NOMINATIONS CLOSE SOON Award-winning Australian soprano Greta Bradman has launched the 2017 Australian Mental Health Prize – with nominations closing August 31.

WA STAB-PROOF VESTS Stab-proof vests could soon be issued to emergency department nurses and other staff in Perth’s most dangerous hospitals.

Health Minister Roger Cook has reiterated in The Sunday Times, Labor’s election promise to give anti-stab vests to hospital security staff, and also revealed he is considering giving the equipment to emergency department medicos.

“If ... we determine a real need for these vests to also be provided to ED staff then we will look at that,” Mr Cook said in an article in July that had WA Health Department figures showing 19,005 code black threat alarms occurred in Perth hospitals last year.

ANF State Secretary Mark Olson told the paper one way to address safety issues in hospital is to have separate areas specifically for violent drug and alcohol affected patients. These "drug tanks" should be staffed by medical personnel, as well as security officers with the powers of transit guards. He said security also needs to be increased generally in hospitals, and having the dedicated regular police patrols in emergency departments promised during the previous government's time, that did not occur, would also assist.

WA Health said increases in code black numbers were caused by changes to the reporting system. 

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western nurse July–August 2017

The prize recognises Australians who have made outstanding contributions to the promotion of mental health, or prevention and treatment of mental illness in areas including advocacy, research or service.

Bradman – who is the granddaughter of cricketer Don Bradman, and a provisional clinical psychologist – who was appointed to the Australian Mental Health Prize Advisory Group, said in late June: “I've experienced first-hand how debilitating mental illness can be. I understand personally and professionally that while it can take time to find a treatment plan to suit an individual, effective treatment is out there”.

The Chair of the Prize Advisory Group – former Australian Women’s Weekly editor Ita Buttrose – said she hopes the prize, decided in November, will help reduce the stigma around mental illness and improve mental health care.

“The number of people with mental illness accessing treatment is half that of people with physical disorders, mainly due to stigma and lack of awareness of treatment options,” Buttrose said. “We urge people to nominate someone making a significant contribution in this field.”

One in three Australians experience a mental health issue during their life, and suicide is the biggest killer of young Australians – above car accidents. Australians are also more likely to die by suicide than skin cancer.

Nomination forms are at: http:// australianmentalhealthprize.org. au/ 

AUS LIFE REALLY PAINFUL FOR AUSSIES Australians have the most bodily pain among nations across four continents, according to a Global Pain Index.

About 96 per cent of Australians suffer bodily pain in their lifetime – ahead of Russia and China respectively – with “nearly seven in ten of us experiencing body pain weekly”, according to the index formulated by pharmaceutical giant GSK. “Of the 32 countries surveyed, Australia had the highest prevalence of weekly body pain (68 per cent vs. 56 per cent globally),” a report of the index’s Australian results said. “Weekly body pain sufferers most commonly experienced pain in their back (38 per cent), lower back (38 per cent), and neck (30 per cent).”

The report added head pain is nearly as prevalent as body pain, with 92 per cent experiencing it in their lifetime, and 27 per cent weekly – just above the global average of 23 per cent, “placing Australia in the top 10 countries suffering from head pain weekly”.

The report also said nearly four in ten Australian workers reported missing work in the past 12 months because of body pain, with about 3.3 sick days off for body pain, compared with 1.4 days for head pain. Absence because of body pain alone cost the Australian economy about $10.6 billion in the last year, the report said. 

WA PERTH SCIENTIST FUNDED FOR MELANOMA VACCINE

VIC REPLACEMENT BODY ORGANS ON THE WAY

A $500,000 fellowship to create a melanoma vaccine has been awarded to Telethon Kids Institute researcher Jason Waithman.

Scientists believe they’ve taken key steps towards producing replacement organs for damaged hearts, kidneys and bowels, using patients’ own stem cells.

The Cancer Council grant will fund work that intends to have a vaccine that can be injected into patients “to activate the body’s good cells and multiply them”, The West Australian has reported. The army of cells then “recognise cancer and eliminate it”.

Dr Waithman said: “The amazing thing about these therapies is they can sort of find the cancer anywhere in the individual’s body, no matter where it’s hiding. They can sort of hunt it down.”

The local researcher wants vaccines personalised to match each person’s own cells, so “the toxicity, the impact on the individual is a lot less”.

His work will move into clinical trials after the four-year research grant ends, if successful.

Australia has one of the world’s highest rates of melanoma skin cancer, with nearly 14,000 cases expected by the end of this year, according to Federal Government estimates. 

NSW YOGA MAYBE NOT AS SAFE AS COMMONLY THOUGHT Yoga can cause musculoskeletal pain “just like any other exercise”, researchers have found – despite it being viewed as a “very safe activity”.

University of Sydney research in the Faculty of Health Sciences found yoga “causes musculoskeletal pain in 10 per cent of people, and exacerbates 21 per cent of existing injuries”.

But in good news, 74 per cent of participants in the study also reported existing pain was improved by yoga, “highlighting the complex relationship between

A team from Monash University has found a protein called Meox1, which is active in stem cells, is “central to directing muscle growth”. musculoskeletal pain and yoga practice”.

The findings – recently published in the Journal of Bodywork and Movement Therapies – resulted from a study of 354 people over a year, which claimed to be the first prospective study to investigate injuries resulting from recreational participation in yoga.

“While yoga can be beneficial for musculoskeletal pain, like any form of exercise, it can also result in musculoskeletal pain,” said lead researcher Associate Professor Evangelos Pappas. "Our study found that the incidence of pain caused by yoga is more than 10 per cent per year, with four per cent losing participation time. This may be comparable to the rates of other sports among the physically active population, and is higher than has previously been reported. However, people consider it to be a very safe activity.

“We also found that yoga can exacerbate existing pain, with 21 per cent of existing injuries made worse by doing yoga, particularly preexisting musculoskeletal pain in the upper limbs.

“More than one-third of cases of pain caused by yoga were serious enough to prevent yoga participation and lasted more than 3 months.”

Their research is focusing on zebrafish, a small, fast-growing tropical Southeast Asian fish, widely used as a model for human biology.

The ground-breaking results were published in the prestigious journal, Cell Stem Cell in July.

The researchers said scientists world-wide have been growing miniature organs in petri dishes.

“But we have known almost nothing about how organs grow in the living animal – the cellular basis of how stem cells make all that tissue,” said Professor Peter Currie, the team leader and Director of Monash’s Australian Regenerative Medicine Institute.

“If we’re ever going to grow complete organs in the laboratory or directly in a patient’s body, we have to know how to grow them properly.

My lab is exploring one of last frontiers of developmental biology – how organ growth is regulated by stem cells.

“Prior to our work in this field, we didn’t even know that these growth-specific stem cells existed or how they were used. Just knowing that they exist leads us to the possibility of orchestrating them, controlling them, or reactivating them to regrow damaged tissue.” 

Most “new” pain was in the upper extremities – shoulder, elbow, wrist, hand – possibly due to downward dog and similar postures putting weight on upper limbs.  July–August 2017 western nurse |

21

update: Interpreting arterial blood gases Read this article and complete the online quiz to earn 1 iFolio hour

Arterial blood gases (ABGs) offer insight into an individual’s acid-base balance. Inexperienced practitioners may struggle to understand the implications of an ABG result. However, with sound knowledge of pH balance, and a systematic approach to analysis, practitioners may hone the skills required for successful interpretation.

PH BALANCE pH is a numeric scale used to determine how acidic or basic an aqueous solution is.1 The normal pH of human blood is 7.35 to 7.45.13 An accumulation of positively charged hydrogen ions [H+] reduces the pH, causing acidosis. Alternatively, a loss of H+ increases the pH, causing alkalosis (see table 1). Acid-base balance is maintained in three ways: buffering, carbon dioxide excretion in the lungs, and regulation of bicarbonate concentrations in the kidneys.1,2 Table 1. Blood pH

Normal pH

7.35 – 7.45

Acidosis

< 7.35 (critical range <7.25)

Alkalosis

> 7.45 (critical range >7.60)

pH Buffering pH buffers act at the cellular level to balance immediate changes in hydrogen ions and maintain a neutral pH.1 The blood’s primary buffering system involves bicarbonate (HCO3-) and carbonic acid (H2CO3) (see chemical reaction 1).1-3 Carbon dioxide (CO2) is an end product of cellular metabolism. It diffuses from the tissues into the bloodstream and reacts with water to form carbonic acid. Carbonic acid rapidly dissociates into hydrogen ions and bicarbonate, which is transported to the lungs in the plasma and red blood cells.

In the pulmonary capillaries, bicarbonate is converted back to carbon dioxide and water through carbonic acid.1-3

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western nurse July–August 2017

CHEMICAL REACTION 1.

HCO3-

Carbonic acid/bicarbonate buffering system.

HCO3- is a measure of the extra-cellular bicarbonate concentration. The normal range is between 22mmol/L - 26mmol/L. Excess bicarbonate reduces the H+ concentration and makes the blood more alkalotic. Inadequate bicarbonate increases the H+ concentration and makes the blood more acidotic.1

CO2 + H2O H2CO3 H+ + HCO3-

Respiratory Response The lungs moderate the release of carbon dioxide through exhalation. In a healthy individual, normal breathing removes CO2 as fast as it is created. Mechanisms such as hyper or hypoventilation and manipulation of tidal volumes are used to alter the release of CO2 in response to changes in pH.1

Renal Response The kidneys are responsible for maintaining the plasma bicarbonate concentration and removing excess hydrogen ions.1 These mechanisms are highly effective at moderating pH, but take up to three to five days, which may be too long for critically ill individuals.3 Steps for ABG Interpretation2-4 Evaluate the pH: Is it normal or abnormal?

Assess the PaCO2 and HCO3-: Is one or more value deranged?

Identify whether an abnormal pH is consistent with respiratory or metabolic changes.

Determine whether no compensation, partial, or full compensation is present.

PaCO2 PaCO2 is the partial pressure of carbon dioxide in the arterial blood. The normal range is between 35 - 45mmHg. An accumulation of CO2 results in an increase in H+ concentration, which makes the blood more acidotic.

Alternatively, the loss of CO2 results in a decrease in H+ concentration, which makes the blood more alkalotic.1 Changes in pH that are primarily caused by PaCO2 are known as respiratory acid-base imbalances. Respiratory acidosis is caused by increased carbon dioxide as a result of conditions that prevent effective ventilation, such as pulmonary oedema, asthma and central nervous system depression. Respiratory alkalosis is caused by carbon dioxide losses with excess exhalation, as in hyperventilation, pulmonary embolus and sepsis.3

Changes in pH that are primarily caused by HCO3- are known as metabolic changes.

Metabolic acidosis occurs with inadequate bicarbonate, from conditions such as shock, renal failure, diabetic ketoacidosis or excessive physical exercise. Metabolic alkalosis is caused by excessive bicarbonate, which may arise after an increase in base or a loss of acid, as occurs with significant gastrointestinal losses, such as excessive vomiting.3

BASE EXCESS/BASE DEFICIT Base excess or deficit values give insight into the bicarbonate that is available in an individual’s system.3 The normal range is between -2mmol/L and +2mmol/L. In patients with high bicarbonate concentrations, base excess highlights the amount of H+ that would be required to return the pH of blood back to normal, if the PaCO2 were adjusted to normal.5 Base deficit, suggests a depletion of bicarbonate and may be used as an indicator for mean arterial pressure (MAP) and blood volume depletion.3 For example, a base deficit of between -2mmol/L and -5mmol/L correlates with a MAP of approximately 92mmHg, while a base deficit of less than -15mmol/L correlates with a MAP of approximately 68mmHg.

COMPENSATION Respiratory and metabolic systems may also adapt to an altered pH through compensation.

Compensation occurs when one system changes in order to minimise the pH disturbances caused by an underlying disorder in the other system.1-3 Full compensation occurs when a normal pH is maintained.

Partial compensation describes conditions where both the respiratory and metabolic systems are deranged, but the pH remains abnormal. For example, if a patient has primary respiratory acidosis with a pH below 7.35 and a bicarbonate level above 26 mmol/L, then partial compensation has occurred.

Unfortunately, compensation cannot correct an underlying disorder and rarely reverses imbalances for prolonged periods of time.1

Table 3. Summary of acid-base disorders.2

Disorder

pH

Primary Change

Compensation

Respiratory acidosis

< 7.35

Increased PaCO2

Increased HCO3-

Respiratory alkalosis

> 7.45

Decreased PaCO2

Decreased HCO3-

Metabolic acidosis

< 7.35

Decreased HCO3-

Decreased PaCO2

Metabolic alkalosis

> 7.45

Increased HCO3-

Increased PaCO2

PUTTING IT ALL TOGETHER A patient comes in to the emergency department complaining of abdominal pain, vomiting, and diarrhoea. Their ABG results are outlined in table 4.

Table 4. ABG results

Blood Gas Measure

Value

Reference Ranges1

pH

7.48

7.35 – 7.45

pCO2

48mmHg

35 – 45mmHg

HCO3-

32mmol/L

22 – 26mmol/L

Base excess

1mmol/L

-2 – +2mmol/L

1. Evaluate the pH. 7.48 is an abnormally high pH. Therefore, the patient is alkalotic.

2. Assess the PaCO2 and HCO3-. The PaCO2 is high. The HCO3- is also high.

3. Identify if an abnormal pH is consistent with respiratory or metabolic changes. A high PaCO2 causes primary respiratory acidosis, while a high HCO3- causes primary metabolic alkalosis.

Therefore, because the patient is alkalotic, they must have metabolic alkalosis.

4. Determine whether compensation is present. Despite the patient having a metabolic condition, their PaCO2 is abnormally high.

Therefore, compensation must be present.

However, the pH is deranged, which indicates that the patient has partially compensated metabolic alkalosis.

REFERENCES 1. Larkin BG, Zimmanck RJ. Interpreting arterial blood gases successfully. 2015 Oct; 102(4):344-54.

2. Brantley SL, Langdon JR. The ABCs of ABGs. Support Line. 2011 Jun;33(3):13-18.

3. Rhoades RA, Bell DR, editors. Medical Physiology: Principles for Clinical Medicine. 4th edition. Baltimore, MD: Lippincott Williams & Wilkins; 2013. 820p.

4. Romanski SO. Interpreting ABGs in four easy steps. Nursing. 1986;16(9);58-64.

July–August 2017 western nurse |

23

WINNERS – READY FOR THIS COMING SUMMER

ANF BBQ winner Carolyn Stone (middle) with her ED pals, Dr Adam Coulson, and Karen Wilding.

We know it’s tough getting through winter so we thought we’d remind you there is a summer at the end of all this!

Bunbury Regional Hospital’s Carolyn Stone, said all the staff in the ED now expected her to hold a sausage sizzle!

We thought you’d get a kick out of seeing your fellow members with the warm weather special ANF prizes they won earlier in the year – Ziegler & Brown portable barbecue twin grills.

And Shane Lynch, of Royal Perth Hospital, wrote the ANF a lovely thank you note, saying: “An absolutely fantastic prize for belonging to the ANF, and clicking the competition tab in the iFolio pages – a little side track that paid off whilst I was doing some of the online tutorials. I would highly recommend all the ANF members give it a go”.

And we’ll have plenty of other terrific summer prizes coming into the Christmas holiday period, along with loads of terrific books and films that we’ll give away for you to enjoy in the meantime.

We were thrilled to hear from Anita Herbert, of St John of God Hospital Midland, who’d “never won anything before” that her barbecue prize was “a lovely surprise”.

Anita Herbert and her ANF BBQ prize.

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western nurse July–August 2017

We certainly hope you do give our competitions a go, especially if you haven’t won anything before.

Anita, Carolyn and Shane, have fun with your prizes!

Shane Lynch with his ANF BBQ prize.

The 2018 ANF Diary is yours for FREE with your ANF membership in WA Keep track of all your important appointments and events!

Just login to your iFolio to order a copy.

We'll post you one with the September-October

ifolio.anfiuwp.org.au

Julyâ&#x20AC;&#x201C;August 2017 western nurse |

25

AroundtheGlobe WORLD NEWS

NIGHT SHIFTS CONNECTED WITH CANCER? Night work is being associated with reduced repair of DNA, which might increase cancer risks.

US researchers have linked night work with reduced repair of 8-hydroxydeoxyguanosine (8-OHdG) lesions in DNA – material that indicates cellular oxidative stress and is theorised to be a risk factor for cancer.

They believe this reduced repair effect is likely caused by melatonin suppression occurring during night work, because people miss out on night sleep. Melatonin is a hormone produced by the brain’s pineal gland. Bright light reduces its production.

The Fred Hutchinson Cancer Research Center researchers used urine specimens collected from 50 night workers, then compared night work to night sleep DNA damage levels.

Their findings – published in the journal Occupational and Environmental Medicine in June – were that circulating melatonin levels during night work were much lower than during night sleep.

Also, average urinary 8-OH-dG levels during night work periods were only 20 per cent of those during night sleep periods – with less excretion of the harmful material indicating decreased repair, according to the researchers.

Lead researcher, epidemiologist Dr. Parveen Bhatti, wants to conduct a new study examining melatonin supplementation in night workers. But he warned people should not start consuming melatonin, because it is unproven for now. 

NURSING DEGREE APPLICATIONS DROP IN UK

The bursaries are due to be replaced with student loans. The data released in July by the Universities and Colleges Admissions Service reveals applications dropped by 23 per cent in England, 10 per cent in Wales, 2 per cent in Scotland and 6 per cent in Northern Ireland.

University nursing degree applications have plummeted by 19 per cent in the UK in the past year – while the National Health Service faces staffing shortages.

European Union applications also dropped by 400 or 24 per cent.

The only increase was among applicants from outside the EU, which increased from 480 to 670, or nearly 40 per cent.

Applications reduced in number from 65,620 in June 2016 to 53,010 in June 2017 – ahead of the abolition of bursaries for nursing and allied health professional students in England in August, the UK’s Nursing Standard website reported.

IMMUNE CELLS MAY HOLD KEY TO BALDNESS CURE A type of immune cell associated with controlling inflammation has been found to directly trigger stem cells in the skin to promote healthy hair growth.

Giving new hope to sufferers of hair loss – University of California​San Francisco researchers discovered these regulatory T cells (Tregs) have this effect in mice.

The stem cells cannot regenerate hair follicles “without these immune cells as partners” – leading to baldness, the researchers found.

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Katerina Kolyva, executive director of the Council of Deans of Health, which represents students in the nursing, midwifery and allied health fields said: “… a campaign to promote healthcare professions as rewarding careers with high employability and value to the public is now vital”. 

“Our hair follicles are constantly recycling: when a hair falls out, a portion of the hair follicle has to grow back,” said Michael Rosenblum, UCSF assistant professor of dermatology, who was senior author on the paper of the study, published recently in the journal Cell.

“This has been thought to be an entirely stem cell-dependent process, but it turns out Tregs are essential. If you knock out this one immune cell type, hair just doesn’t grow.”

He said the findings suggest defects in Tregs could be responsible for alopecia areata, an autoimmune disorder causing hair loss, and “could potentially play a role in other forms of baldness, including male pattern baldness”.

The same stem cells help heal skin after injury, so Tregs may also play a role in wound repair. 

NO BOOZE CONSUMPTION IS SAFE Drinking alcohol even at moderate levels leads to “adverse brain outcomes”, UK researchers have found.

Effects include hippocampal atrophy and there is “no protective effect of light drinking over abstinence”, said the researchers from the University of Oxford and University College London, in a report in the British Medical Journal.

Men and women in the UK are recommended to drink no more than 14 units per week – which equals five 175ml glasses of 14 per cent wine or four pints (568ml) of 5.2 per cent beer or cider.

The researchers said those consuming more than 30 units a week were at highest risk compared with abstainers, but even those drinking moderately – 14-21 units per week – “had three times the odds of right sided hippocampal atrophy”, compared with non-drinkers.

“We have found a previously uncharacterised dose dependent association between alcohol consumption over 30 years of follow-up and hippocampal atrophy, as well as impaired white matter microstructure,” the researchers said. “Additionally, higher alcohol consumption predicted greater decline in lexical fluency.”

The study examined 550 men and women, with an average age of 43, from 1985-2015, none of whom were alcohol dependent. 

LIFE-SAVING BANANAS Thousands of children will likely be saved from death or blindness by the development of vitaminrich golden fleshed bananas.

The new type of Ugandan banana that is rich in pro-vitamin A, is the result of a world-first project led by Queensland University of Technology Distinguished Professor James Dale, and backed with nearly $10 million from the Bill & Melinda Gates Foundation and the UK Government’s Department for International Development.

It is hoped Ugandan farmers will be growing pro-vitamin A-rich bananas in 2021.

“The East African Highland cooking banana is an excellent source of starch. It is harvested green then chopped and steamed,” Professor Dale said. “But it has low levels of micronutrients particularly pro-vitamin A and iron. The consequences of vitamin A deficiency are severe.”

He said an estimated 650,000 to 700,000 children die from pro-vitamin A deficiency each year worldwide, with several hundred thousand others going blind.

“What we’ve done is take a gene from a banana that originated in Papua New Guinea and is naturally very high in pro-vitamin A, but has small bunches, and inserted it into a Cavendish banana,” he said of the research, which was detailed in the Plant Biotechnology Journal in July.

“Over the years, we’ve been able to develop a banana that has achieved excellent provitamin A levels, hence the golden-orange rather than cream-coloured flesh.

“Achieving these scientific results … is a major milestone in our quest to deliver a more nutritional diet to some of the poorest subsistence communities in Africa.” 

SUNSCREEN LAWS Laws permitting students to use sunscreen in school and at afterschool activities without a doctor’s note have recently been enacted in several US States – with several others set to follow.

Though such moves sound unusual to Australians, they had to occur in order to protect children, because sunscreen is grouped with overthe-counter drugs by the U.S. Food and Drug Administration, and therefore by nearly all schools, USA Today’s website reported in July.

This means children cannot bring it to school without a doctor’s note, and even then have to consult the school nurse to be allowed to use it.

Alabama, Arizona, Florida, Louisiana, Utah and Washington passed such laws for school and afterschool activities this year. California, New York, Oregon and Texas, have previously removed sunscreen

Credit: Patria Jannides

restrictions in school, while Arizona, New York and Washington also allow children to bring to and use sunscreen at, summer camps.

USA Today said: “The legislation is designed to allow school districts to implement ‘sun safety’ policies that encourage kids to use sunscreen and wear hats and long sleeves in the sun – though in a nod to school dress codes, the legislation allows schools to ban clothes and hats deemed inappropriate”.

Massachusetts, Pennsylvania and Rhode Island are working on sunscreen legislation, but “a sunscreen bill that cleared the Senate in Mississippi, died in a House committee, and a bill introduced in Georgia has stalled”.

Republican State Senator Terry Burton, who co-sponsored the Mississippi bill said: “Parents, I think, are the best decision-makers on their children’s sunscreen use. The school should not interfere with that decision that a parent makes to protect their child.”  July–August 2017 western nurse |

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Are you an ANF member who does humanitarian volunteer work?

VOLUNTEER FUNDING

ANFIUWP Humanitarian Aid Volunteers Fund provides financial help to ANF members who are undertaking humanitarian volunteer work in Australia or overseas. The closing date for applications is the 15th December 2017.

The fund may be used for planned or completed volunteer work.

For more information about the fund or to get a copy of the application form and selection guidelines, call the ANF office on 6218 9444, email anf@anfiuwp.org.au or log on to iFolio.

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update: Doppler ultrasound for deep vein thrombosis Read this article and complete the online quiz to earn 0.5 iFolio hour

Doppler ultrasound is a diagnostic imaging technique that has been used since 1954.1 It is a non-invasive, reliable tool for investigating pathologies in the venous system.2 It is indicated for the diagnosis, or exclusion of deep vein thrombosis (DVT) in symptomatic patients. However, it is less reliable for patients who are asymptomatic.2 Therefore, venous ultrasound should be reserved for patients with clinical symptoms of DVT and/or a positive serum D-dimer test result (see Box 1).2 Box 1. D-dimer3

D-dimer is a degradation product of crosslinked fibrin. Serum levels are elevated in patients with clotting conditions such as venous thromboembolism, pulmonary embolism, arterial thrombosis and disseminated intravascular coagulation, as well as in a variety of other conditions including liver disease, inflammation, malignancy and pregnancy.

With respect to DVT, D-dimer is used as a tool for exclusion.2,3 It should only be done in cases where DVT is a potential diagnosis based on clinical presentation. Otherwise, clinicians may be distracted by a broad positive result.

If patients have a negative serum D-dimer test, they are unlikely to have a DVT. In contrast, a positive serum D-dimer test could indicate a number of conditions, including DVT, and requires further investigation with ultrasound.

Clinical symptoms of DVT include unilateral calf or thigh pain, leg swelling, and redness.4 Urgent venous ultrasound may be required for symptomatic patients at risk of proximal thrombosis, such as those with pain or poor perfusion following the use of a central venous catheter.2

DOPPLER FINDINGS TO INDICATE DVT Venous ultrasound is used to assess the compressibility and appearance of veins, and limitations in blood flow.2 Signs of DVT include: • • • • • •

Absent or reduced compressibility Thrombus in the vein Static valve leaflets Absent flow Impaired or absent augmentation of flow Loss of spontaneous flow and respiratory variation • Increased flow in collateral channels

COMPRESSIBILITY Lack of compressibility is the primary diagnostic criterion for individuals with their first episode of DVT.4 Normal veins are easily flattened with mild to moderate manual pressure. The presence of a thrombus limits vein compressibility.2,4 The extent of restricted motion will depend on the duration of the thrombus; new clots are like jelly, while chronic clots are hardened and firm.2 In order to measure compressibility, technicians apply pressure to the vein with the ultrasound transducer. If there is no change in calibre on compression, a thrombus may be present.2

APPEARANCE The entire lumen of a healthy vein can be seen on colour Doppler. A thrombus alters its appearance in several ways. Veins generally distend around a clot. They may appear fuller and rounder than normal. There may also be limited filling above the clot due to obstruction. New clots have a thin tail that extend into the lumen of the vein, and may allow blood to pass around them as they adhere to the vein wall.2 As they become more established, they gain fibrotic tissue and occlude blood flow completely. At this point, echogenicity (the ability to transmit ultrasound waves) also changes. Flowing blood is generally not echogenic (anechoic), and appears black on the screen. As a clot forms, the vein becomes more echogenic (hyperechoic), which appears white on the screen and may be difficult to differentiate from other tissues.2

SPONTANEOUS FLOW AND RESPIRATORY VARIATION Healthy veins have spontaneous blood flow, which changes slightly in response to

intra-abdominal pressure changes during respiration.2 On inspiration, pressure is high and there is less venous return. Conversely, on expiration, pressure is low and venous return is greater.2 The presence of a thrombus limits flow through the vein. Blood flow may still occur in areas below the clot, however respiratory variation will not be present.2

AUGMENTATION Normally, manual compression results in an increased blood flow rate through the veins.

This is measured with a gentle manual squeeze of the calf muscle to visualise for a rapid rise and fall in the velocity of blood as it passes the transducer.2 In individuals with a DVT, a blood clot is already occluding flow, so external compression will either have no effect or may result in further flow restrictions.2

FLOW IN COLLATERAL CHANNELS The last sign that may indicate a DVT is increased blood flow in the collateral veins.2 Increased velocity and flow may be noted in other major veins, while blood in the intramuscular channels builds up over time and is often a late sign of a clot.2

DIAGNOSING DVT IN PATIENTS WITH A PRIOR DVT Many of the ultrasound changes noted above will persist regardless of anticoagulation treatment for a DVT.4 Therefore, it is important to recognise the difference between acute and chronic changes. Acute DVTs are usually completely occlusive and not echogenic, while chronic DVTs are non-occlusive and echogenic.2,4

REFERENCES 1. Adam A, Dixon AK, Gillard JH, Schaefer-Prokop CM. Grainger & Allison’s Diagnostic Radiology.

6th edition. China: Elsevier Limited; 2015.

2. Pozniak MA, Allan PL. Clinical Doppler Ultrasound. 3rd Edition. China: Elsevier Limited; 2014. Chapter 5, The peripheral veins; p94-121.

3. Zucker M. D-dimer for the exclusion of venous thromboembolism. Labmedicine. 2011 Aug;42(8):503-4.

4. Wells P, Anderson D. The diagnosis and treatment of venous thromboembolism.

Hematology. 2013:1;457-63.

July–August 2017 western nurse |

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ResearchRoundup LATEST AND GREATEST FROM SCIENCE researchers monitored the effect on blood pressure during IHG, and after eight weeks of training.

“The participants sat in a chair and squeezed a hand dynamometer for two minutes and then would rest for three minutes, then squeeze again, until they had completed four isometric handgrip repetitions,” Carlson said.

COFFEE HELPS YOU LIVE LONGER Your daily coffee fix could be extending your life, according to two huge international studies.

“Coffee drinking was associated with reduced risk for death from various causes (and this) did not vary by country,” according to a study of 521,330 people from 10 European nations, published in the Annals of Internal Medicine in July.

A second study, in the same journal at the same time, detailed how among “185 855 African Americans, Native Hawaiians, Japanese Americans, Latinos, and whites” in Hawaii and Los Angeles, “coffee consumption was associated with lower total mortality”.

The University of Southern California, which led the second study, said lower mortality occurred regardless of regular or decaffeinated coffee, and people who consumed a cup daily were “12 percent less likely to die” than non-coffee drinkers. For those drinking two to three cups daily, there was an “18 percent reduced chance of death”.

University of Cambridge Professor Sir David Spiegelhalter told The Telegraph in the UK that based on the findings, a cup of coffee daily could extend a man’s life by three months and that of a woman by a month. 

HANDGRIP EXERCISE REDUCES BLOOD PRESSURE People who find aerobic exercise risky such as heart patients may now have a safe alternative to manage high blood pressure – handgrip exercises.

Researchers at the University of New England in NSW found that “simple exercise with isometric handgrip (IHG) dynamometers was enough to lower blood pressure”.

They said systolic blood pressure reductions after eight weeks compared to those in aerobic exercise studies.

Debra Carlson from the School of Science and Technology said during the research, which was part of her PhD, her team conducted a randomised trial with 40 participants training at two different intensities of IHG exercise.

Sessions were held three times a week for eight weeks, and the

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“The study demonstrated that eight weeks of IHG exercise lowers blood pressure, with minimal effect on Rate Pressure Product in pre-mild hypertensive participants during the handgrip exercise,” the university said of the work that was published in the Journal of Hypertension and Cardiology. 

SNIFFER DOGS HUNT CANCER Sniffer dogs may hold the key to saving lives in a small town with some of Japan’s highest rates of stomach cancer.

Kaneyama, in the nation’s northeast, has launched a dog research program to “improve the accuracy and effectiveness of health checkups”, The Japan Times has reported.

To help his residents, Mayor Hiroshi Suzuki called on Masao Miyashita, a medical school professor who visited the town last year, and received a proposal for research where dogs would sniff out cancer from test samples.

Frozen urine samples are sent to Miyashita at the Nippon Medical School Chiba Hokusoh Hospital, east of Tokyo, and are tested at a facility in the Chiba prefecture, which is where the dogs are trained.

It is not known what the cancer cells release that the dogs can sense, but the news so far is good. “In our research so far, cancer detection dogs have been able to find (signs of) cancer with an accuracy of nearly 100 percent," Miyashita said.

Japan only has five such dogs trained for this work, and it costs about 5 million yen ($57,500 AUD) to train each dog. Labrador retrievers are used. 

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