Western Nurse Magazine March April 2017 by ANF WESTERN NURSE MAGAZINE

March â&#x20AC;&#x201C; April 2017

incorporating western midwife

LEST WE FORGET

These wreaths pay tribute to 41 brave nurses who gave their lives in service of Australia in WWII. In this our Anzac month we tell their story. PAGE 4 western nurse is the official magazine for ANF members in WA

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Secretary's Report March-April 2017

State Secretary, Mark Olson

on the

cover

FEATURED

4 Brave nurses in World War II 10 ANF election campaign wrap-up 12 WA Nursing and Midwifery Awards

Brave nurses in World War II. Cover shot by Bohdan Warchomij

14 Miriam O'Donoghue 50 years of nursing 25 CPD hours due by May 31

FAVOURITES 8 Internet Watch 18 ANF Out ‘N’ About 20 Across the Nation 26 Around the Globe

30 Research Roundup

ANF election campaign wrap-up

dverse Effects

Disinhibition • Alcohol withdrawal Cellular toxicity • Metabolic disturbance cohol ketoacidosis) • Respiratory failure oor nutritional status • Gastrointestinal eeding • Acute pancreatitis • Alcoholic liver sease (steatohepatitis and cirrhosis) Cancer, including increased risk of opharyngeal, oesophageal, breast, olorectal and liver cancer Heavy drinking (>3 drinks/day) is associated th hypertension, coronary artery disease, nd cardiomyopathy Ventricular arrhythmias Peripheral neuropathy Neurological complications and nystagmus Wernicke’s encephalophay • Korsakoff’s ndrome • Increased risk of infections

HOLIDAY ANF 13 ANF Super Deal Margaret River 32 ANF Super Deal Kalbarri

WIN! CPD hours due by May 31

ological alcohol

verse Outcomes Associated

31 ANF Contact Details

31 Win one of 25 extra-special Star Wars Blu-Ray prizes – Rogue One: A Star Wars Story! We also have up for grabs five beautiful boxed sets containing all seven Harry Potter novels!

CLINICAL UPDATES 6 Botulinum toxin type A (Botox) 16 Alcohol Use Disorders 22 Understanding Electrolytes: Potassium

Alcohol Use Disorders

29 Understanding electrolytes: Phosphorus (Phosphate)

We have a new State Government which means new opportunities for both the WA health system and our members. Our communication with WA Labor shortly before the election was both positive and productive, and following the poll, new Health Minister Roger Cook has already arranged for meetings with the ANF. We hope this approach of dialogue in good faith continues, because progress in the health portfolio in recent years suffered under the bunker mentality of the Barnett Government – where former health minister John Day was so paranoid about meeting the ANF, he refused to do so without a contingent of bureaucrats. This army of health bureaucrats – ever growing under the previous government – significantly contributed to the current mess in public health. They were obstinate in negotiations, and when told by their Government they needed to save cash, they chose to do so in the wrong places. Rather than cut back on highly paid pen pushers, they instead left hospitals lacking supplies and understaffed – pulling old tricks like stashing over-census patients in corridors to be cared for by our members. This understaffing and corridor care brought to a head the need for the ANF to push for legislated nurseto-patient ratios, to replace the current complicated workloads formula based on nursing hours per patient day, which often leaves wards short of nurses. We can argue all we like about whether ratios take into account every variable, but clearly we can agree we need a quick and simple way of ascertaining how many nurses are needed for the number of patients on that shift, in that type of ward, so those patients get proper care. And we need the ratios we decide on protected by a law. As I have already informed you, the good news is the new WA Government has told the ANF it is open to exploring how nurses' workload concerns can be addressed – which is an important step towards achieving legislated ratios. With this goal in mind, Our No More Than Four campaign will continue, building upon the valuable public support and awareness of the need for legislated ratios to protect patient safety. We will let you know on these pages and other mediums what the next steps will be. In the meantime, we will approach the new government as we have approached all others before them, never wavering from our underlying aim to improve the lives of our members and their patients, but also in good faith, and hoping this fresh new cabinet will push through the bureaucracy they have inherited to be able to effect real change, with pragmatic discussion and negotiation as the starting point.

ALCOHOL AND THE GASTROINTESTINAL SYSTEM Alcohol has the potential to cause local damage to the gastrointestinal (GI) tract, including the liver and the pancreas.5,6 See illustration 1 for more details.

REFERENCES 1. Wackernah RC, Minnick MJ, Clapp P. Alcohol use disorder: pathophysiology, effects and pharmacologic options for treatment. Subst Abuse Rehabil. 2014;5:1-12 2. National Health and Medical Research Council. Australian guidelines to reduce health risk from drinking alcohol [Internet]. Canberra: NHMRC; 2009 [cited 2016 Jan]. 179p. Available from: https://www. nhmrc.gov.au/_files_nhmrc/publications/attachments/ds10alcohol.pdf 3. National Institute on Alcohol Abuse and Alcoholism. Alcohol use disorder: A comparison between DSM-IV and DSM-5 [Internet]. Maryland: NIH; 2015 July [cited 2016 Jan]. NIH Publication No. 13-7999. Available from: http://pubs.niaaa.nih.gov/publications/ dsmfactsheet/dsmfact.pdf 4. Gronbaek M. The positive and negative health effects of alcoholand the public health implications. J Intern Med. 2009;265:407-20 5. Patel S, et al. Alcohol and the intestine. Biomolecules. 2015;5:2573-

March–April 2017 western nurse |

Anzac Day has come to commemorate not only the brave soldiers who died at Gallipoli on April 25, 1915, but all Australian service men and women who perished during wars protecting the freedoms we enjoy today. Our special Anzac Day feature pays homage to the 75th anniversary of events that saw 41 army nurses, including five from WA, give their lives during World War II.

Captain Peta Dixon great niece of Minnie Hodgson and Private Amy Harrison.

THE ULTIMATE SACRIFICE February 12, 1942: A cargo ship carrying 250 civilians and the last 65 Australian Army nurses in Singapore sails away from the island – with Japanese forces in the final stages of their invasion during World War II.

Four of the 21 nurses who die at Radji Beach are West Australians – Alma Beard, Peggy Farmaner, Minnie Hodgson and Bessie Wilmott. Among those lost at sea, Louvinia Bates is also from WA.

The nurses find themselves in this precarious situation because rather than evacuating days earlier when it was safer, they decided to stay at their posts, treating casualties in chaotic makeshift conditions, through heavy bombing and fighting.

The only survivor of the beach massacre, Sister Vivian Bullwinkel, only lives because she feigns death after being shot in the left hip. She floats into the island and later spends three and half years in prisoner of war camps. Originally from South Australia, Vivian later, after marriage, becomes a long-time WA resident. She even eventually chairs the Red Cross Ladies' Auxiliary at Hollywood Hospital.

By February 14, 1942, the vessel carrying them, the Vyner Brooke, has been sunk by Japanese bombers, with a heavy loss of life near the Indonesian Island of Bangka. Among the 65 nurses, 12 die at sea, including one of their two beloved matrons, Matron Olive Paschke. Of the 53 nurses who are able to swim or float to shore, 21, including their other matron, Irene Drummond, are killed by Japanese soldiers on February 16 in the waters off Radji Beach, Bangka Island. A further 60 crew members and other civilians are also killed.

Debbie Tatzenko, Kathy Cameron Mark Wilmott, nieces and nephew of Bessie Wilmott, with Anne Leach, 102, Bessie's best friend.

western nurse March–April 2017

Bully, as she was known to friends, later also testifies at a war crimes tribunal. She passes away on July 3, 2000, in Perth, aged 84, after winning various honours, including the Florence Nightingale Medal and the Order of Australia. The other 32 nurses who survive the sinking come ashore elsewhere on Bangka Island, and are captured and confined for the rest of the war in horrendous prisoner of war camps.

Bessie Wilmott who died at Radji Beach.

News article about Vivian Bullwinkel who survived the massacre.

Governor Kerry Sanderson laying a wreath.

A further eight will die of ill treatment, malnutrition or tropical diseases during the next three and a half years in the camps – leaving only 24 of the original 65 nurses who sailed on the Vyner Brooke, to return to Australia after the war ends.

Australian Army Captain Peta Dixon, a nursing officer with 7th Health Company, 13th Combat Service Support Battalion. “I am immensely proud of my Great Aunt Minnie Hodgson and her nursing colleagues, who, though faced with catastrophe and adversity, continued to display the Army values of Courage, Initiative, Respect and Teamwork,” Captain Dixon said on Facebook after the service. “It is these values that guide myself and other serving personnel in their service today, both here and abroad.”

The bravery and sacrifice of these nurses has not been forgotten, and the Applecross sub-branch of the Returned & Services League of Australia, holds an annual service commemorating the Vyner Brooke tragedy. This year being the 75th anniversary of the events means the service, which was held on February 12, at Nurse's Memorial, Honour Ave, Point Walter Reserve, Bicton, had special significance. Among about 400 attendees, guests included WA Governor Kerry Sanderson AC, who laid a wreath on behalf of the people of WA in gratitude for the nurses' sacrifice. The Born to Sing Melville choir also performed, including an a cappella version of Largo, one of the songs sung by nurses stuck in Japanese prisoner of war camps. Debbie Tatzenko, Kathy Cameron and Mark Wilmott, who are the nieces and nephew of Bessie Wilmott, were at the service, as was the great niece of Minnie Hodgson –

Anne Leach, 102, best friend of Bessie Wilmott was also there. Anne’s daughter Margaret Burridge said her mum and Bessie met during nurse training at Royal Perth Hospital, and were going to do midwifery together after qualifying, but war broke out. So they enlisted and Anne sailed to the Middle East and Bessie went to Singapore. “She’s never forgotten her,” Margaret told western nurse. Helen Pickering, of the Applecross RSL, said the RSL "strongly believes that all lucky Australians who now live in liberty, would wish to keep alive the memory of the heroic Australian nurses in the armed forces who have served their nation so selflessly, and with such distinction, in the finest tradition of their profession". 

Great niece of Minnie Hodgson – Australian Army Captain Peta Dixon.

Craig Chapman President Applecross RSL at the memorial.

March–April 2017 western nurse |

update: Botulinum toxin type A (Botox) for the treatment of chronic migraines Read this article and complete the online quiz to earn 0.5 iFolio hour

Generic Name: Botulinum toxin type A or OnabotulinumtoxinA

involved in the perception of pain including substance P, calcitonin-gene-related peptide, and glutamate.4

DOSING AND ADMINISTRATION The optimal total dose of botulinum toxin type A for the treatment of chronic migraines is 155195U per cycle.5 100U vials are diluted with 2ml of preservative-free normal saline to create a concentration of 5U/0.1mL.5

Trade Name: Botox Route of administration: Intramuscular injection

OVERVIEW Botulinum toxin type A (Botox) is a purified neurotoxin complex that may be used to treat chronic migraines.1 Multiple clinical trials have demonstrated that Botox is a safe and welltolerated treatment, which may reduce the number of headache days for individuals with chronic migraines.1,2 Since 2014, Botox has been available under the section 100 Botulin Toxin Program of the Australian Benefits Scheme (PBS).3 Subsidised treatment is offered to individuals who meet specific clinical criteria, as outlined below.2

INDICATIONS Botulinum toxin is indicated for adults with chronic migraines who experience an average of 15 or more headache days per month and at least 8 days of migraines over a period of 6 months. Note: Headache days = number of days a headache is present, regardless of duration (hours). In order to be eligible for PBS subsidies, individuals must have demonstrated limited therapeutic benefits from at least three other prophylactic treatments, including propranolol, amitriptyline, or topiramate.2

METHOD OF ACTION Botulinum toxin type A is a neuromuscular blocking agent, which limits communication between the peripheral and central nervous system.1,4 The toxin binds to nerve terminal membranes and is internalised by the presynaptic neuron. Once inside, it destroys target proteins and prevents the release of neurotransmitters.1 The exact mechanism of action for migraine prevention is poorly understood. It is thought that when Botox is injected into the head and neck, it binds to the trigeminal-occipital-cervical complex and prevents the release of neurotransmitters

western nurse Marchâ&#x20AC;&#x201C;April 2017

A standardised protocol has been developed to guide intramuscular injection of the toxin across the head and neck.5 Injection sites include the frontalis, corrugator, procerus, temporalis, occipitalis and trapezius muscles, and the cervical paraspinal muscle group. In total, at least 31 injection sites are used to deliver the optimal dose each cycle (see illustration 1).5 Table 1. Characteristics of Botox treatment for chronic migraines.

Dose

155-195U per cycle

Injection type

Intramuscular

Injection sites

At least 31 sites across the head and neck per cycle

Treatment intervals

12 weeks

Maximum number of cycles

Treatment may be administered every 12 weeks, up to a maximum of 5 times.1,2 Individuals who do not respond initially, may benefit from additional cycles.1 Successful treatment is defined as at least 50% reduction in the number of headache days per month after 2 cycles of treatment.3 Those who experience mild benefits, without meeting the criteria for successful treatment are not eligible for ongoing subsidised treatment under the PBS.3

ADVERSE EFFECTS Botox injections contain albumin, a human blood product. Therefore, there are potential

risks associated with the transmission of a virus or Creutzfeldt-Jakob disease. Other potential complications include pain, bleeding, bruising, tenderness, or inflammation at the injection site, general feelings of being unwell, and mild to severe allergic reactions, ranging from localised irritation to anaphylaxis.6 There is a chance that the effects of botulinum toxin may expand beyond the initial injection site, resulting in generalised weakness, upper eyelid drooping, blurred vision, slurred speech, constipation, aspiration pneumonia, or airway compromise.6 Individuals should perform self-monitoring in the hours to weeks following treatment and access acute healthcare services as required.6

REFERENCES 1. Sun-Edelstein C, Rapoport AM. Update on the pharmacological treatment of chronic migraine. Curr Pain Headache Rep. 2016;20:6. 2. The Pharmaceutical Benefits Scheme. Botulinum Toxin Type A, injection 100 units/vial, Botox [Internet]. Canberra: Commonwealth of Australia; 2013 Jul [cited 2016 Mar]. Available from http:// www.pbs.gov.au/info/industry/listing/elements/ pbac-meetings/psd/2013-07/botulinum 3. The Pharmaceutical Benefits Scheme. Botulinum toxin type a purified neurotoxin complex, lyophilised powder for injection, 100 units, Botox (migraine) [Internet]. Canberra: Commonwealth of Australia; 2012 Jul [cited 2016 Mar]. Available from http://www.pbs.gov.au/info/industry/ listing/elements/pbac-meetings/psd/2012-07/ botulinum-toxin 4. Ashkenazi A, Bulmenfeld A. OnabotulinumtoxinA for the treatment of headache. Headache. 2013 Sep;53(S2):54-61. 5. Blumenfeld A, Silberstein SD, Dodick DW, Aurora SK, Turkel CC, Binder WJ. Method of injection of onabotulinumtoxinA for chronic migraine: a safe, well-tolerated, and effective treatment paradigm based on the PREEMPT clinical program. Headache. 2010 Oct;50(9):1406-18. 6. Allergan Australia. BOTOX Botulinum Toxin Type A-CMI Version 9.0 [Internet]. Gordon, NSW: Allergan Australia Pty Ltd; 2013 [cited 2016 Apr]. 9p. Available from https://www. ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/ pdf?OpenAgent&id=CP-2010-CMI-06645-3

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Marchâ&#x20AC;&#x201C;April 2017 western nurse |

State Election Campaign The achievements of the ANF’s State Election campaign were in no small part due to the efforts of our members and our State Council. This special election wrap-up summarises how far we have come. The ANF’s State Election campaign achieved significant immediate results and has moved WA closer to the long-term goal of legislated nurse-to-patient ratios. Our efforts combined with those of our members and State Council, saw us obtain a written commitment from the new WA Labor Government to remove performance appraisals, which means nurses and midwives will be able to spend more time with patients, rather than wasting valuable hours and public money on useless meetings and paperwork that do nothing for standards or safety. We also now have a pledge in writing from both WA Labor and the local Liberals that penalty rates for nurses, midwives and carers, will remain as they are – addressing an issue which was of huge concern for members.

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western nurse March–April 2017

And the first pivotal steps towards legislated ratios have been clearly taken – with the new Government telling the ANF, also in writing, that it is open to exploring how nurses' workload concerns can be addressed. Public support for, and awareness of, the need for ratios is now also extremely high because of the success of the No More Than Four campaign. ANF State Secretary Mark Olson said this support will be key in helping to persuade the political parties to create the law we need. “Without public pressure, politicians are much less likely to move towards changing the existing system,” Mark said. “But now many West Australians are aware of, and support ratios, and know that having clear rules such as no more than four patients per nurse on a general ward on day shifts, and having more nurses when higher levels of care are needed, will improve patient care. And this public interest will greatly assist us when lobbying parties. “Because we can argue all we like about whether ratios take into account every variable, but clearly we can agree we need a quick and simple way of ascertaining how many nurses are needed for the number of patients on that shift, in that type of ward, so those patients get proper care. “And we know the current complicated workloads formula based on nursing hours per patient day, doesn’t do that. In fact, that formula often leaves wards short of nurses, and also makes it easy for hospital authorities to manipulate figures and hide shortages, leaving our members to cope with the extra work, which negatively impacts patient care.” Mark said also important is that our campaign revealed the candidates and parties who support legislated ratios – “so we know who our friends are on this issue, and we know who remains to be persuaded”. The ANF's final election campaign ad.

Our ANF bees letting the then premier Colin Barnett and his former deputy premier Liza Harvey know that ratios are needed during our campaign

He said in coming months, whether these supporters are now in Parliament, or have lost their bid for seats, the ANF will “remind whomever among them continues in political life of their commitment to ratios”. “(And) we will do whatever we can to leverage that support to achieve safer hospitals in WA,” he said. “Later this year, the next stage of our ratios campaign begins – I will keep you informed about developments as always. And I look forward to working with you all to achieve a law that ensures there are enough nurses on WA hospital wards to safely care for their patients.” 

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March–April 2017 western nurse |

Nursing & Midwifery awards finalists announced Nursing and Midwifery awards 2017 one of the Graduate of the Year Award finalists Marlise Brink.

Thirty three of our State's thousands of dedicated nurses and midwives are finalists in the WA Nursing and Midwifery awards – with the winners announced at the awards gala ball on May 6, 2017.

Finalists in this year’s WA Nursing and Midwifery Excellence Awards are “exemplary” – making a significant difference to their professions, and the health of Western Australians, says Chief Nurse and Midwifery Officer Karen Bradley. “This year’s finalists come from all levels of experience and from a range of work and practice environments,” Ms Bradley said, adding that WA’s 37,500 nurses and midwives are at the “forefront of ensuring compassionate, safe and cost effective care” in our health system. Among the finalists – who are from public, private, education and community workplaces – is one of the contenders for the Graduate of the Year Award, Marlise Brink. Marlise’s nominator said the registered nurse from Joondalup Health Campus is an “extremely hard working, devoted and kind-

12 |

western nurse March–April 2017

hearted person”, who “holds in high regard, quality care for all patients”. Marlise is also described as “very passionate and driven in all that she does to be an excellent RN”. The other two finalists in her category are Georgia Gazzone, from St John of God Murdoch Hospital, and Ashleigh Joy, of Osborne Park Hospital. Winners, including the 2017 WA Nurse or Midwife of the Year and the recipient of the 2017 Lifetime Achievement Honour, will be announced at the awards gala ball/dinner on Saturday, May 6, 2017. The ball starts at 6.30pm and goes till midnight at the Perth Convention and Exhibition Centre. To see the full list of finalists and to buy tickets to the ball visit: www.wanmea.com.au

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Marchâ&#x20AC;&#x201C;April 2017 western nurse |

FIFTY NOT OUT After celebrating five decades of nursing, you’d think Miriam O'Donoghue might be thinking about slowing down a bit – in fact quite the opposite. Though her life has had its tragedies, Miriam hasn’t stopped moving forward.

Miriam did her first triathlon at 60. Miriam with her training group at Salisbury Hospital in Rhodesia, now Zimbabwe at the age 16, fifth from the left at the back.

When asked about where she gets the energy for all of the travel, she said: “I believe passionately in health and fitness, and clean eating. Although I do like dark chocolate. I did my first triathlon at 60 and have progressed to doing Ironman events, and went to the Ironman World Championship in Kona, Hawaii last year, in the 65 to 69 age group. iriam O'Donoghue had just celebrated her 50th year in nursing during a short contract stint at Bundaberg Base Hospital, when western nurse rang her up about doing a story on her milestone.

“I was a bit too slow, so was not permitted to do the run leg. This leaves me unfinished business in Hawaii!” An Ironman triathlon is a tough event comprising a 3.8km swim, 180km bike ride and a marathon run of 42km.

She had arrived back in Perth from Queensland only days before, when we got her on the phone in January. Far from craving a rest, she told us we’d have to “hurry up” if we wanted to get photos – because she was outfitting her car to “drive across the Nullarbor to go nursing at Mt Isa!”

But Miriam’s life hasn’t always been travel and exercise – her previously healthy son Keenan was only 23 when she found him dead in her garden in 2006. Less than a year after her son’s death, her 44-year-old brother Fin also died in a helicopter crash in Africa.

“Nursing is a great way to see different parts of Australia,” the 67-year-old explained about her then impending trip back to Queensland. “Lately I've been doing contract work through an agency, working mainly on Thursday Island and in Bundaberg, where I celebrated my 50th year in nursing.”

After Keenan’s death, she joined a group for grieving parents called The Compassionate Friends, where she found her interest in triathlon – and then first competed in the event aged 60. This was even though she had never been sporty when younger or even ridden a bike in decades. She told western nurse

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western nurse March–April 2017

“I've worked in what was then Rhodesia and is now Zimbabwe, South Africa, England and Scotland, and now Australia, almost continually, apart from short breaks to have my children,” she said. “It's been a long and privileged time for which I'm truly grateful.” Some of the most striking memories from her career include midwifery at Harare Maternity Hospital, where “we averaged 400 births a month!” When working in Scotland in the 1970s at Glasgow Royal Infirmary, she “could not understand the accent, so I worked in theatre where the patients were asleep!” That started her on theatre training. She said she did the “obligatory overland trip from London to Nepal in 1973” and then worked back in what was then Rhodesia on contract in Chiredzi Hospital, “running a front line CASEVAC (Casualty evacuation) unit for three years”.

Miriam celebrated 50 years of nursing in January.

that Keenan’s memory inspired and motivated her when she competed in triathlon. Miriam started her career January 3, 1967, at Salisbury Central Hospital, in what was then Rhodesia, now Zimbabwe. And her job has taken her to a “few” places since, she told us.

Miriam at Fort Victoria Hospital in then Rhodesia, now Zimbabwe, in 1971 at age of 21.

“We had very little equipment, all was reused. We made our own swabs and dressings, and rewashed and sterilised the theatre gloves, swabs etc. ET (Endotracheal) tubes were the non-disposable red rubber variety.” Next she moved to South Africa, and back to the UK, before coming to Australia 11 years ago. Starting in Northam, she then worked in Bunbury and various hospitals in Perth. As for the future: “I intend to continue both my work and Ironman events. I can't imagine not working, I am too young and healthy to stop”. 

EXCITING OPPORTUNITY FOR REGISTERED NURSES

Miriam’s son Keenan O'Donoghue. Below: Helicopter at Chiredzi Hospital in then Rhodesia, now Zimbabwe, 1975/6 Miriam was 25 years of age and running the CASEVAC Unit. A patient had been shot three times in the head but survived.

Hannah’s House in partnership with Nulsen are seeking enthusiastic and passionate Registered/ Enrolled nurses with a minimum of 2 years’ experience, preferably in paediatrics or critical care, to provide in home care to children with complex care needs. This is a casual position involving a flexible roster that includes weekends. We are a new service, and are keen to develop a competent team to move forward.

For more information call Susan King on: 0413 372 943

March–April 2017 western nurse |

update: Alcohol Use Disorders and the Physiological Effects of Alcohol Read this article and complete the online quiz to earn 1 iFolio hour

Alcohol is a part of everyday life for many Australians. Unlike many illicit substances, large volumes are required to induce a physiological response.1 An Australian standard drink contains ten grams of alcohol.2 The National Health and Medical Research Council (NHMRC) recommends no more than two standard drinks per day, and no more than four standard drinks on any single occasion, in order to prevent associated health risks.2 Alcohol has positive and negative effects on the body. Benefits may be associated with enjoyment, improved social interaction, and the reduction of some psychiatric symptoms, such as anxiety.1 Low doses of alcohol may also be associated with cardio-protective effects including a decreased risk of cardiovascular disease in specific populations. However, significant long-term complications of alcohol use may outweigh any positive physiological

effects. Alcohol is addictive and known to increase the risk of a wide range of medical conditions, including cirrhosis, gastrointestinal bleeding, neurological dysfunction, and a variety of cancers. The uptake of alcohol, solely for its health benefits, is not recommended.2 Alcohol use disorder is defined as the presence of two or more diagnostic features of alcohol abuse or dependence (see box 1).3 The harmful effects of alcohol are generally most significant for heavy drinkers and those with alcohol use disorder. However, even in generally healthy individuals, higher than recommended doses of alcohol have the potential to cause toxicity to most organs.1

ALCOHOL AND THE PHYSIOLOGY OF THE BRAIN The effect of alcohol on the brain has been well studied. Like other addictive agents, alcohol stimulates the release of dopamine, a neurotransmitter involved in behavioural motivation, pleasure and reward.1,4 Alcohol also interacts with other neurotransmitters including serotonin, glutamate, Gamma-Amino Butyric acid (GABA), and endogenous opioids including endorphins and enkephalins.1 Overall, alcohol has an inhibitory effect on neurons and is a central nervous system

Box 1. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic criteria for alcohol use disorder (AUD)3

Have you had times where you ended up drinking more or for longer than intended? Have you wanted (or tried) to cut down or stop drinking, but couldn’t? Do you spend a lot of time drinking? Or getting over the negative repercussions of drinking? Have you ever wanted to drink so badly you couldn’t think of anything else? Has drinking interfered with your activities of daily living (family, job, school, etc.)?

Mild AUD: 2-3 symptoms

Have you continued to drink even though it caused trouble with friends or family?

Moderate AUD: 4-5 symptoms

Have you reduced other activities in order to drink?

Severe AUD: 6+ symptoms

Have you had multiple situations where you have been at increased risk as a result of drinking? Have you continued to drink despite feeling depressed, anxious or experiencing a worsening health problem? Do you have to drink much more than previously in order to achieve the same effect? Have you found that when the effects of alcohol are wearing off you have symptoms of withdrawal?

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depressant. At low doses it causes relaxation, disinhibition and euphoria; at high doses, sleepiness and confusion; and at excessive doses, death may occur.4 Chronic alcohol use may lead to an increase in the potential excitability of several neurons, which may explain an individual’s response to drinkingrelated stimuli and alcohol related cravings.1 Excessive, long-term use (>10 drinks/day) has the potential to cause neuronal atrophy, neurological dysfunction and dementia.4 See illustration 1.

ALCOHOL AND THE CARDIOVASCULAR SYSTEM The relationship between alcohol and the cardiovascular system is dependent on a variety of factors including the extent of alcohol intake, as well as gender, age, and medical co-morbidities. Light to moderate alcohol intake has been shown to lower the risk of cardiovascular disease and death, as compared to nondrinkers.4 Two large studies performed in the United States suggest that benefits are greatest amongst the elderly.4 Alcohol increases high density lipoprotein (HDL) levels in the blood. Increased HDL levels are associated with the prevention of atherosclerosis and reduced risk of coronary heart disease.4 Alcohol also reduces platelet aggregation, which may decrease the risk of thrombosis in coronary heart disease.4 Further, alcohol has a complicated relationship with other cardiac risk factors including body mass index, diabetes, and physiological stress. It is the second most energy-dense macronutrient consumed (after fat). It has the potential to enhance one’s appetite and stimulate abdominal fat storage.4 For these reasons, alcohol use has been associated with weight gain and obesity. However, there is some research to support that the low, steady consumption of specific types of alcohol (preferably wine) may decrease the risk of obesity and diabetes, and reduce abdominal girth.4 Ultimately, the impact of alcohol on the cardiovascular system is complex and dependent on the individual. While light to moderate intake may be beneficial, heavy consumption is associated with increased rates of hypertension and coronary heart disease.4 One must recognise that any potential cardiovascular benefits are limited by the known risks and addictive properties of alcohol and the realisation that light to moderate intake may be difficult to sustain. See illustration 1.

Illustration 1.

The physiological effects of alcohol

Table 1. Positive Effects and Adverse Outcomes Associated with Alcohol Consumption1,4 Positive Effects

Adverse Effects

• Euphoria • Reduced anxiety • Improved socialisation • Enhanced pleasure • Disinhibition • Increased palatability

• Disinhibition • Alcohol withdrawal • Cellular toxicity • Metabolic disturbance (alcohol ketoacidosis) • Respiratory failure Poor nutritional status • Gastrointestinal bleeding • Acute pancreatitis • Alcoholic liver

of food

• Light to moderate drinking (1 drink/day) may be associated with cardio-protective effects including decreased risk of cardiovascular disease and death

disease (steatohepatitis and cirrhosis) • Cancer, including increased risk of oropharyngeal, oesophageal, breast, colorectal and liver cancer • Heavy drinking (>3 drinks/day) is associated with hypertension, coronary artery disease, and cardiomyopathy • Ventricular arrhythmias • Peripheral neuropathy • Neurological complications and nystagmus • Wernicke’s encephalophay • Korsakoff’s syndrome • Increased risk of infections • Traffic accidents • Violence • Increased overall mortality

March–April 2017 western nurse |

ANF Out ‘N’ About Here’s this edition’s helping of photos of our members, taken while ANF staff are at public and private workplace visits. Don’t forget, terrific prizes are planned for the workplace where we’re able to get the best snaps. So make sure you and your fellow nurses, midwives and carers parade your ANF products when we come by. See you on our visits!

Out ‘N’ About F

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Rockingham General Hospital: A. Kayla Croy, Lucy Reid B. - C. Rockingham group at lunchtime session D. Helen Bayliss, Terrie Stephens, Louise Walker E. Sarah Mitchison, Danica Sarmes F. Rockingham group at lunchtime session G. Alana McColl, David Gray.

St John of God Midland: G

H. Shelle-Ann Elliott, Lucy Brown, Isabel Brawn, Kennedy Ogbonna I. Gail Curtis J. Sinimol Thomas John, Mercy Joseph.

Learn Jamieâ&#x20AC;&#x2122;s tips for cooking from scratch, time saving tricks + cooking on a budget, from $10 per class* Edith Cowan University Joondalup 270 Joondalup Dr, Joondalup WA 6027

For more information and to book: jamiesministryoffood.com.au *$10 per class for a concession card holder, $70 for total 7 week course

Marchâ&#x20AC;&#x201C;April 2017 western nurse |

AcrossTheNation NEWS, VIEWS AND GOSSIP FROM ALL OVER AUSTRALIA

QLD BEATING HUMAN HEART MUSCLE CREATED FROM STEM CELLS Cardiac disease research has been innovated by the creation of functional beating human heart muscle from stem cells.

WA NEW MINISTER SUPPORTS EUTHANASIA Voluntary euthanasia should be legalised in WA to enable terminally ill people to “take control of their lives in their final stages”, according to WA’s new Health Minister Roger Cook. Mr Cook revealed his support to The Sunday Times two weeks after the March 11 State Election, but clarified the new WA Labor Government would not introduce law reform as part of a policy. Instead, the Government supported individual members to table a private member’s Bill, and Labor would allow MPs to “exercise a conscience vote on euthanasia”. “I support voluntary euthanasia and I think we need to legislate to enable people to take control of their lives in their final stages,” he said. “Any debate in parliament on assisted suicide for terminally ill patients would have to be part of a wider community debate.” It was also reported Labor MLC Alannah MacTiernan and Greens MLC Robin Chapple have been working towards introducing a Bill to allow assisted dying. The newspaper said its WA Speaks survey last year of more than 10,000 West Australians indicated nearly 90 per cent supported voluntary euthanasia. 

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University of Queensland scientists and German researchers collaborated to create models of human heart tissue in the laboratory “so they can study cardiac biology and diseases in a dish”. Dr James Hudson from UQ’s School of Biomedical Sciences said: “This (technology) provides scientists with viable, functioning human heart muscle to work on, to model disease, screen new drugs and investigate heart repair.” The UQ Cardiac Regeneration Laboratory researchers also found the immature tissues have the capacity to regenerate following injury. “In the laboratory we used dry ice to kill part of the tissue while leaving the surrounding muscle healthy and viable,” Dr Hudson said. “We found those tissues fully recovered because they were immature and the cells could regenerate – in contrast to what happens normally in the adult heart where you get a ‘dead’ patch. “Our goal is to use this model to potentially find new therapeutic targets to enhance or induce cardiac regeneration in people with heart failure.” The research is published in the journals Circulation and Development. 

AUS WORKING MORE THAN 39 HOUR WEEK A HEALTH HAZARD If you work more than 39 hours a week you’re risking your health, new Australian research indicates.

"Long work hours erode a person's mental and physical health, because it leaves less time to eat well and look after themselves properly," said lead researcher Dr Huong Dinh, from Australian National University’s Research School of Population Health. The research, which relied on data from about 8,000 Australian adults from the Household, Income and Labour Dynamics in Australia Survey, found the work limit for a healthy life should be 39 hours a week, “instead of the 48-hourweek limit set internationally about 80 years ago”. In February, Dr Dinh said about two in three Australians in full-time jobs, work 40 hours-plus a week, but long hours are a bigger problem for women who also do more unpaid work at home. For women the “healthy work limit was 34 hours per week” once their other care and domestic work commitments were considered. But he said the healthy limit for men was up to 47 hours a week “generally because they “spend much less time on care or domestic work than women”. 

“About half of all cases of measles that occur in Australia are in those aged 19 years or over. “In addition to poor adult vaccination rates contributing to the high cost of managing preventable infections, adults are often the starting point for epidemics because they have the highest rate of infections and so transmit infection more.”

NSW HUMAN TRIAL OF NEW ALZHEIMER’S DRUG A potential Alzheimer’s disease treatment seen by some as the “world’s next blockbuster drug” will be tested in clinical trials on humans. The Xanamem 12-week trial will recruit about 174 mild dementia sufferers from Australia, the United Kingdom, and the USA in coming months, with results expected in 2018. Xanamem, which blocks the stress hormone cortisol to improve mental function, “is being billed as the world’s next blockbuster drug after it improved the mental function of mice”, the Herald Sun reported in March.

NSW DISEASE RISK FROM MILLIONS OF UNVACCINATED ADULTS While Australians furiously debate the merits of vaccinating children, the biggest unvaccinated group is adults. Of 4.1 million unvaccinated Australians 3.8 million are grownups, reported The Conversation website in March, in a post authored by three University of New South Wales infectious disease specialists. “Adults contribute substantially to ongoing epidemics of vaccinepreventable diseases,” the experts said. “Most cases of whooping cough, for example, occur in adults.

The experts described health workers as a potential “vector for infection” who can “trigger outbreaks among vulnerable patients”. They added: “The highest risk institutions are hospitals, childcare centres and aged care facilities”. The Australian Government provides free adult vaccines for influenza, pneumococcal pneumonia and shingles for people older than 65 years, and some for those with underlying medical conditions, Indigenous people older than 15 years and pregnant women. But only 51 per cent of older adults receive all government-funded vaccinations yearly, compared to 93 per cent of children, and 73 per cent of adolescents, “yet public health efforts focus on coercive measures and financial penalties to improve immunisation rates in infants”. 

Australian company Actinogen Medical’s trials of its Alzheimer’s drug will be held on the Central Coast of NSW, Sydney and Melbourne. University of Newcastle’s Jonathan Sturm, whose patients are to take part in the trial, said the new pill was promising, but “it’s still an early stage study”. He said new treatments were needed because current ones “boost neurotransmitters, so they treat the symptoms”, but “don’t treat the underlying disease”. The Herald also reported a CSIRO study of 1000 elderly Australians beginning in 2006 found a link between elevated cortisol in the blood, and the subsequent development of Alzheimer’s.  March–April 2017 western nurse |

update: Understanding Electrolytes: Potassium Table 1. Distribution of potassium throughout the body1

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

Potassium (K+) is an essential intra-cellular electrolyte, which contributes to a variety of cellular functions and helps to maintain homeostasis. Inside the cell, potassium plays an important role in regulating cell volumes. It is an osmotically active solute; where it goes, water follows. As the intra-cellular concentration of K+ decreases, the cell loses water and shrinks. The alternative is also true. As the intra-cellular K+ concentration rises, the cell expands.1 The balance between intra- and extracellular potassium is also important for maintaining the cell’s resting membrane potential and moderating nerve and muscle excitability.1 Increased extracellular (plasma or serum) potassium may stimulate excessive membrane depolarisation and enhanced cellular excitability. In the myocardium, this has the potential to cause cardiac arrhythmias including lethal rhythms, such as ventricular fibrillation. Low plasma K+ levels also have an impact on muscle and nerve cells, resulting in muscle weakness.1 As a positively charged ion, potassium contributes to the acid-base balance within the body. Altered potassium concentrations are related to irregular pH levels. Excess K+ has the potential to cause metabolic acidosis and primary disturbances in acid-base balance may impair K+ levels.1 Along with all of its other functions, potassium also has primary physiological responsibilities. It is used in carbohydrate metabolism, electron transport, tissue growth and repair.1 In the event of tissue breakdown or protein catabolism, potassium is released from the cells, resulting in an increased amount of extracellular potassium available for healing.1

POTASSIUM DISTRIBUTION Potassium is a predominantly intracellular ion (see table 1). Movement of K+ into and out of the cells is controlled by complex physiological processes including Na+/ K+-ATPase, which

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LOCATION

APPROXIMATE DISTRIBUTION OF K+ (PERCENTAGE)

Trans-cellular fluid

Extra-cellular fluid including blood plasma, interstitial fluid, and lymph

Bone, dense connective tissue and cartilage

Intra-cellular fluid

90%

pumps K+ into the cells, acid-base balance and osmolality, stressful conditions such as exercise, trauma, infection, ischaemia, and haemolysis, and the influence of circulating molecules including insulin and catecholamines (including adrenaline).1,2

Urine potassium may help identify the cause of unexplained hypokalaemia. A high urine potassium level suggests excessive renal losses, while a low result indicates an alternative cause. Although difficult to collect, a 24-hour urine measurement is generally more accurate.3

The balance of potassium is maintained through gastrointestinal absorption in the small intestine and excretion by the kidneys.1 Most foods contain potassium. Gastrointestinal losses tend to be low, unless complicated by adverse conditions, such as vomiting and diarrhoea.1 The extent of potassium excretion is dependent on intake. Potassium is filtered by the glomerulus and may be re-absorbed in the collecting duct, as required. All excess K+ is excreted in the urine.1

HYPOKALAEMIA

INVESTIGATIONS Abnormal potassium levels may be investigated with serum or urine potassium concentrations (or both). Investigation of acid-base balance may also be helpful for diagnosing unexplained hypokalaemia or hyperkalaemia.3 Serum potassium concentrations measure the concentration of potassium in the plasma. Normal plasma potassium ranges from 3.5-5.0mmol/L.1 Potassium levels are commonly requested in conjunction with other basic blood tests including other electrolytes, full blood count, bicarbonate, urea and creatinine, and glucose levels.2 Investigations may be performed with a venous or arterial blood sample, as in a normal venous blood test or arterial blood gas.2 Inaccurate results may occur. For example, pseudohyperkalaemia (falsely elevated serum potassium levels) may occur following exposure to ethylenediamine tetra-acetic acid (EDTA), used in some collection tubes, as well as with difficult venepuncture, prolonged tourniquet use, long transit times, and haemolysis.2 Abnormal levels, low or high, require careful investigation and treatment as they have the potential to cause significant clinical complications including life threatening cardiac arrhythmias.

Hypokalaemia is defined as a serum potassium below 3.5mmol/L.4 Even small losses of extracellular potassium have the potential to cause significant nerve and muscle impairment.2 Severe hypokalaemia, less than 2.5mmol/L, is associated with an increased risk of life threatening arrhythmias and sudden cardiac death.2 Other symptoms may include muscle weakness, syncope, palpitations, and electrocardiography (ECG) changes, such as small T waves, ST depression, prominent U waves, and a prolonged QT interval. Treatment for hypokalaemia includes oral or intravenous potassium replacement. Oral potassium may be given as a controlled release or effervescent tablet.5 Intravenous replacement is reserved for individuals with severe acute losses and must be given slowly in order to prevent cardiac arrhythmias.5 Table Table2.2.Common Commoncauses causesof of 1,4 hypokalaemia hypokalaemia1,4 Gastrointestinal Gastrointestinallosses lossese.g. e.g.vomiting vomiting and anddiarrhoea diarrhoea Renal Renallosses losses Drug-induced Drug-inducedhypokalaemia hypokalaemiae.g. e.g.from from diuretic diureticagents, agents,intravenous intravenousinsulin, insulin, salbutamol, salbutamol,ororverapamil verapamiloverdose overdose Reduced Reducedoral oralintake intake(in (inconjunction conjunctionwith with other othercauses) causes) Hypokalaemic Hypokalaemicperiodic periodicparalysis paralysis Thyrotoxic Thyrotoxicperiodic periodicparalysis paralysis Cushing’s Cushing’ssyndrome syndrome Diabetic Diabeticketoacidosis ketoacidosis Renal Renaldiseases diseasesincluding includingrenal renaltubular tubular acidosis acidosisororhereditary hereditaryrenal renaltubular tubular disorders disorders

HYPERKALAEMIA Hyperkalaemia is defined as a serum potassium concentration of greater than 5.3mmol/L.2 It may range from mild and asymptomatic to severe and life threatening.2 Clinical symptoms include muscle weakness, paraesthesia, ECG changes including bradycardia, tall and narrow T waves, a prolonged PR interval, loss of P waves, and broadened QRS complexes, and potentially fatal arrhythmias.2 Treatment for hyperkalaemia includes reversing the underlying cause, enhancing renal potassium

excretion, and promoting the cellular uptake of potassium with pharmacological agents.5 Calcium gluconate may reduce the cardiac effects of hyperkalaemia, while diuretics enhance potassium excretion.5 For rapid relief (within 20 minutes), intravenous insulin and glucose may be used to promote the shift of potassium from the extra-cellular to the intra-cellular fluid. Nebulised beta-adrenergic agonists, such as salbutamol, may also be used to promote potassium shifting in the shortterm. Rarely, intravenous sodium bicarbonate

may be indicated to reduce the potassium concentration in individuals with severe acidosis.5

CONCLUSION Potassium is a vital electrolyte for normal physiological functioning. Abnormal intraand extra-cellular concentrations have the potential to cause severe and life-threatening complications. Cases of both hypokalaemia and hyperkalaemia require careful investigation and treatment to prevent adverse outcomes.

Table 3. Common causes of hyperkalaemia2 Acute or chronic renal failure

REFERENCES

Drug-induced hyperkalaemia, as a result of:

1. Rhoades RA, Bell DR. Medical physiology: Principles for clinical medicine. 4th ed. Baltimore: Lippincott Williams & Wilkins; 2013. 839p

• Decreased renal potassium excretion e.g. angiotensin converting enzyme inhibitors (ACEI), angiotensin II receptor blockers, and spironolactone • Nephrotoxic drugs e.g. non-steroidal anti-inflammatory drugs • Trans-cellular shift e.g. glucose infusions or digoxin poisoning • Drugs containing potassium e.g. supplements, laxatives, and penicillin Excessive dietary intake Tumour lysis syndrome Recent crush injury, excessive physical exercise, or hypothermia Massive blood transfusion Addison’s disease Hyperkalaemic periodic paralysis Diabetic ketoacidosis

2. McDonald TJ, Oram RA. hyperkalaemia in adults. Oct;351:h4762

Investigating BMJ. 2015

3. Mount DB. Evaluation of the adult patient with hypokalaemia [Internet]. Wolters Kluwer; 2015 Sep 9 [cited 2016 Apr]. Available from: http:// www.uptodate.com/contents/evaluation-ofthe-adult-patient-with-hypokalemia 4. Oram RA, McDonald TJ, Vaidya B. Investigating hypokalaemia. BMH. 2013;347:f5137 Medicines Handbook 2015 5. Australian (computer program). Adelaide: Australian Medicines Handbook Pty Ltd; 2015 July.

March–April 2017 western nurse |

AUDIT. Your CPD is due by MAY 31

Don't risk your registration by failing a CPD audit! Of course, if you’re using your iFolio to knock off your required Continuing Professional Development (CPD) hours, the thought of an AHPRA audit is no issue. But to make life even easier, we have a feature on iFolio that allows you to create a complete CPD audit log. Your iFolio is easy and it's free. Use it to meet your CPD requirements!

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DON’T RISK YOUR CAREER AHPRA requires your CPD hours are done by May 31. So don’t endanger your registration, let iFolio help you – there’s still time.

The Australian Health Practitioner Regulation Agency randomly audits nurses and midwives to ensure you’ve fulfilled your Continuing Professional Development requirements. CPD hours have to be completed by May 31 each year, and if you are audited and your CPD is not up to scratch, you can lose your registration – and that means no work. So if you haven’t done all your hours yet, it’s time to get moving! Extra CPD hours can be tallied up by doing the free CPD modules on your iFolio. And your iFolio has another great feature to help – you can download an evidence record that lists everything AHPRA asks for on CPD, including your identified learning need, activity undertaken and reflection on the activity. Remember, nurses and midwives are required to do at least 20 hours CPD, and those who are both nurses and midwives have to do 40 hours CPD. Nurse and midwife practitioners, and those who hold scheduled medicines endorsements have to complete an additional 10 hours, on top of the CPD hours they need for their normal nursing registration. The best way to complete your CPD is on the ANF iFolio, where there are hundreds of Clinical Updates across a range of topics. iFolio also records all the CPD activities you have completed. ANF State Secretary Mark Olson, who created the ANF iFolio, said: “When you’re working shifts and often looking after a family as well, or just dealing with a busy life, it can be difficult to find time for your CPD hours. So I created a system that would make it easy to get

your hours done properly,” he said. “iFolio is easy to navigate, and also records other relevant CPD activities on it, not just your iFolio modules. Nurses and midwives attend ANF seminars, education sessions or legal talks, and these activities are automatically updated on your ANF iFolio, so you receive CPD credit. And now you also have an evidence record that should make even AHPRA happy.” Mark said tertiary courses and other accredited study, conferences, short courses and workshops, as long as they were recognised to relate to your work, can all count towards CPD and be recorded on your iFolio. It’s important to note that even when you are on maternity leave, long service leave or other leave such as leave without pay, you still need to fulfil your CPD obligation if you want to retain your registration. In April and May the ANF will begin touring Perth suburbs to provide free 30 minute Audit Without Tears talks. Go on iFolio now to book your place, so you can find out all about how to prepare for an audit. We also want to ensure our members know they don't have to pay for CPD from the ANF federal office, because you get all those services for free on your ANF WA iFolio as part of your local membership – so don’t waste your cash! We often raise this matter, because Mark continues to get calls and emails from local members asking why they are being charged for CPD – it's because they are signing up to the wrong CPD provider.

"You can download an evidence record that lists everything AHPRA asks for on CPD, including your identified learning need, activity undertaken and reflection on the activity"

The Nursing and Midwifery Board recommends you keep CPD records for a minimum of three years. But don’t worry, if you use your ANF WA iFolio, we retain your records indefinitely.  March–April 2017 western nurse |

AroundtheGlobe WORLD NEWS

SUPERSTAR CLOONEY BRINGS FLOWERS TO FAN IN AGED CARE HOME Heartthrob George Clooney has given an 87-year-old aged care home resident an extra special birthday treat. The 55-year-old philanthropic screen star surprised fan Pat Adams with flowers and a birthday card at her home at the Sunrise of Sonning Retirement and Assisted Living Facility in Reading on March 19 – and stayed for a chat and a picture.

“The lady in the picture, loves George Clooney and mentions everyday how she would love to meet him, especially as he lives so near to where I work.

Linda Jones, a worker there, who is pictured with the pair on Facebook, had written to the actor about his fan – and he showed up.

“So letter have been sent asking would it be possible for her dream to come true. And what was extra special it was her Birthday in the week. He bought a card and a lovely bunch of flowers. X.”

Jones posted on Facebook: "A dream came true for one of our residents today! – at Sunrise Sonning.

Clooney owns a home near the facility in Berkshire, according to The Associated Press, which reported on the visit. 

CARB-GORGING INDIGENOUS AMAZONIANS HAVE HEALTHIER HEARTS THAN ANYONE ELSE Meet the Tsimane: the forager-horticulturalist indigenous people of the Bolivian Amazon – who also happen to have the “lowest reported levels of coronary artery disease of any population recorded to date”.

researchers, who were from the USA, Egypt, Germany, France, Bolivia, and Peru, added: “The relative contributions of each are still to be determined”.

That’s according to prestigious medical journal, The Lancet, which in March published findings from an assessment of the difference between the Tsimane and 6814 participants from the Multi-Ethnic Study of Atherosclerosis.

BBC News reported that 17 per cent of the Tsimane diet is game such as wild pig, tapir, and capybara – the world's largest rodent. A further 7 per cent is freshwater fish including piranha and catfish. Family farms grow most of the rest of their diet of rice, maize, the sweet potato-like manioc root, and plantains. Foraged fruit and nuts top up their diet.

The Tsimane live a subsistence lifestyle of hunting, gathering, fishing, and farming, with few cardiovascular risk factors, but high infectious inflammatory burden, said the study. "These findings suggest that coronary atherosclerosis can be avoided in most people by achieving a lifetime with very low LDL (low-density lipoprotein), low blood pressure, low glucose, normal body-mass index, no smoking, and plenty of physical activity,” the study said. But the

RETIRED NURSE GIVES $656,000 TO NURSING STUDENTS A high achieving former nurse and nurse instructor has donated $500,000 U.S. ($656,300 AUD) to help nursing students afford to study. Helen Faye Newman’s gift will be used to offer four nursing students a $5000 scholarship each year at the University of Findlay’s newly established nursing department, in Ohio.

The BBC concluded that 72 per cent of the indigenous people’s calories come from carbohydrates, compared with 52 per cent in the US. Only 14 per cent of their calories come from fat, compared with 34 per cent in the US. And they eat way less saturated fat than in the US. Both Americans and the Tsimane derive 14 per cent of their calories from protein, but the Tsimane eat more lean meat. 

She was a registered nurse for 50 years, and retired aged 70. During her career, she was also an instructor at the Toledo Hospital School of Nursing, a supervisor at Mercy Hospital, Toledo, and head nurse at Riverside Hospital, Toledo, besides working at several hospitals and practices in Greenville, South Carolina. She was on the University of Findlay committee that established the new nursing program, which opened three years ago.

The scholarships will be named after the 84-year-old Findlay resident, and will start this autumn, reported U.S. news site The Courier in March.

“If nurses aren’t trained and educated properly, the patient may not recover as well,” Newman said. “Nurses are there for the patients, to reinforce what the doctor told them and the things they can do to help themselves get well. Nursing is one of the most important professions that a woman or a man can do, because they’re helping people all the time.”

Newman received a nursing arts degree from the then-Findlay College in 1970, after completing registered nurse training in the Toledo Hospital School of Nursing in 1954.

Newman’s past donations to the nursing program have bought equipment, including a defibrillator, a crash cart, and an electrocardiogram machine. 

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OREO THE CAT HAS BIG JOB CARING FOR RESIDENTS AND WORKERS AT NURSING HOME

When you walk into St. Augustine Health Ministries nursing home in Cleveland, you may be greeted by a black and white cat who seems to own the place. That would be Oreo – previously a stray, who after gradually winning the hearts of staff, eventually moved inside a few years ago. This feline now has become famous for bringing joy to both residents and workers, reported the cleveland.com news website in March. Dana Carns, director of advancement for St. Augustine, said many of the residents owned pets before coming to the facility which they couldn't bring with them, and Oreo “makes it like home”. “I think (Oreo) just brings a lot of laughter, a lot of smiles and a lot of just normalcy, a lot of those feelings of home for people who are working here, or the residents that live here,” she said on the cleveland.com youtube site. She said she is always getting pictures that staff are taking: “Oh look, Oreo’s at the reception desk answering the phones because it’s after hours, she’s sitting on a bench with a resident who’s waiting for a ride”. Tim Fredmonsky, a security guard who works at the facility’s north entrance said: “She's such a character. The residents see her and pet her all the time. Even the visitors get a big kick out of her. She's a good cat”.  Watch Oreo on https://www.youtube.com/ watch?v=RpHaZzckR8M

AGENCY NURSES GET $2500 FOR A SHIFT Scottish hospitals have forked out thousands of dollars to agency nurses for just a single shift. National Health Service Lanarkshire said the highest amount it paid for a shift in 2015/16 was £1565 ($2560 AUD), according to The Herald of Scotland news site earlier this year. This was followed by NHS Lothian, which paid £1528 ($2500) for an agency nurse the previous year. In NHS Ayrshire and Arran, the highest single payment for a shift, which is defined as more than eight hours, but less than 14, was between £1300 ($2127 AUD) and £1600 ($2617 AUD).

TRAIN HARD – GET YOUNG AGAIN Exercise not only helps you look better – it can even turn back the clock deep inside you, according to a new U.S. study. Researchers from the Mayo Clinic said high-intensity aerobic exercise “can reverse some cellular aspects of aging”, such as improving “age-related decline in muscle mitochondria”. The researchers compared high-intensity interval training, resistance training and combined training in a group of young and older adults over 12 weeks – tracking metabolic and molecular changes.

Another agency was paid £1251 ($2047 AUD) for a single shift last year in NHS Tayside. The Herald said most health boards refused to release such data, which had been requested through freedom of information by the Scottish Conservatives. Also according to The Herald, the Scottish Government has been repeatedly criticised for increasing use of bank and agency nurses, and high levels of vacancies, “with hundreds of roles lying empty for months at a time”. But Health Secretary Shona Robison said the total bill for agency nurses and midwives was more than 11 per cent lower than10 years ago. And she said a “record number of people now work within the NHS in Scotland, with 99.6 per cent of all care delivered by NHS staff". 

“All training types improved lean body mass and insulin sensitivity, but only high-intensity and combined training improved aerobic capacity and mitochondrial function for skeletal muscle,” the researchers said. “Decline in mitochondrial content and function are common in older adults. “High-intensity intervals also improved muscle protein content that not only enhanced energetic functions, but also caused muscle enlargement, especially in older adults”. The researchers said an important finding is: “Exercise training significantly enhanced the cellular machinery responsible for making new proteins. That contributes to protein synthesis, thus reversing a major adverse effect of aging. However, adding resistance training is important to achieve significant muscle strength”.  March–April 2017 western nurse |

AUDIT WITHOUT Book on TEARS iFolio Why?

• The registration year is almost over (ends 31 May) • Nurses & midwives are now randomly audited throughout the year • Know your responsibilities under National Registration • ANF iFolio – a big help with your annual CPD requirements • Don't risk your registration with AHPRA!

Where?

How?

Joondalup, Rockingham, Gosnells, Melville, Midland. There’s also an online Video Tutorial in case you can’t get to a session! Log on to iFolio and click 'Courses' to see locations and times that suit you. Choose a venue, make a booking! Heaps of venues makes it easy for everyone to come along and learn ( and earn some CPD time).

ANF LEGAL TALKS 30 minute legal talk

Legal talks are free, informative and you'll earn CPD time too.

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western nurse March–April 2017

Questions? email: legaltalks@anfiuwp.org.au phone: 6218 9444

update: Understanding electrolytes: Phosphorus (Phosphate)

Read this article and complete the online quiz to earn 0.5 iFolio hour

Box 1. Phosphorus, phosphorous and phosphate

The distinction between these three can be very confusing for practitioners. Phosphorus is an element (atomic number 15), while phosphate is a salt that contains phosphorus. Phosphorous is the adjective of phosphorus. It refers to something that relates to or contains phosphorus.1

PHYSIOLOGICAL IMPORTANCE OF PHOSPHATE Phosphate is used in the formation of phosphorylated compounds.2 Approximately 85% of phosphate in the body is found in the bones; most of the rest makes up intracellular organic compounds found in the tissues including phospholipids, nucleic acids, Nicotinamide adenine dinucleotide phosphate, abbreviated NADP+ or, in older notation, TPN (triphosphopyridine nucleotide), and Adenosine 5’-triphosphate (ATP).2 Only about 0.1-0.3% of the body’s phosphate is found in its inorganic form in the extracellular fluid.2,3 In the blood it may be free, bound to protein, or in a complex with calcium, magnesium or sodium.1 Phosphate has many critical physiological functions including maintaining cell metabolism, structure and function, and regulating pH.3 Serum phosphate levels are maintained through gastrointestinal absorption and renal excretion. In the kidneys, phosphate is filtered by the glomeruli and then reabsorbed in the proximal tubules.3 The process of excretion and reabsorption helps to remove excess phosphate, maintain serum phosphate levels and respond to changes in the acid-base balance of the body.3

In order to optimise accuracy, specimens are collected in the morning from patients who have been fasting.2 In some cases, urine phosphorus levels may also be indicated. In these circumstances, a 24-hour urine sample is indicated to overcome variations in phosphate levels throughout the day.4 Table One. References ranges for serum phosphorus (phosphate) levels, as determined by age 2, 4 AGE Newborns Infants (10 days-2 years) Children (<12 years) Adults (<60 years) Older adults (>60 years) Males Females

NORMAL RANGES (mmol/L) 1.45 - 2.91 1.45 – 2.16 1.45 – 1.78 0.87 – 1.45 0.74 – 1.20 0.90 – 1.30

HYPOPHOSPHATEMIA Phosphorus level less than 0.81mmol/L Hypophosphatemia is relatively uncommon in the general population. However, high rates may occur in at risk groups including hospitalised patients, as well as those with alcoholism, sepsis, or critical illness.5 Low serum phosphate levels may be acute, as in cases of intracellular shifting to replace losses, or chronic, as a result of complete phosphate depletion.5 Hypophosphatemia occurs as a result of decreased phosphate intake, excessive loss and/or intracellular shifting. Some underlying conditions, such as diabetes, alcoholism, starvation, and malabsorption, effect serum phosphate levels through multiple pathways.5 Symptoms of hypophosphatemia include respiratory muscle dysfunction, poor perfusion, decrease cardiac contractility, arrhythmias, haemolysis, blood cell dysfunction, insulin resistance, myopathy, rhabdomyolysis, seizures, and altered levels of consciousness.5 Severe hypophosphatemia is associated with increased morbidity and mortality and must be urgently treated through the administration of intravenous (or oral) phosphate replacement.

INVESTIGATIONS

HYPERPHOSPHATEMIA

A serum phosphorus (phosphate) level is used to measure the level of inorganic phosphate in the blood. Diurnal variations of serum phosphate levels occur as a result of circadian rhythms, dietary intake, meals, and exercise.

Phosphorus level greater than 1.45mmol/L The primary cause of hyperphosphatemia is chronic renal disease. Patients with an impaired glomerular filtration rate are unable

to filter the blood effectively, but maintain the ability to reabsorb phosphate. As serum phosphate levels rise, phosphate binds to calcium and precipitates in the soft tissues.3 This leads to a build up of calcium phosphate in dangerous areas, including blood vessels and pulmonary tissues, which may result in life threatening complications including heart failure or pulmonary insufficiency.3 Serum phosphate levels are inversely related to serum calcium levels. Through complex physiological sequences, hyperphosphatemia may also lead to hypocalcaemia and elevated parathyroid hormone levels, causing increased bone resorption and a risk of fractures.3 Box 2. Foods and medications high in phosphorus4 Foods high in phosphorus include: - Beans - Chicken - Eggs - Fish - Milk and dairy products

Medications that may influence phosphate levels include: - Antacids - Laxatives - Corticosteroids - ACE inhibitors - Anticonvulsants

In order to manage hyperphosphatemia, patients with end stage renal failure are advised to limit their dietary phosphate intake and add supplements, which help to prevent the uptake of phosphate in gastrointestinal tract. Synthetic vitamin D3 may also help to manage hypocalcaemia, prevent excess parathyroid hormone production, and reduce the occurrence of fractures in patients at risk.3

REFERENCES 1. Iheagwara OS, Ing TS, Kjellstrand CM, Lew SQ. Phosphorus, phosphorous, and phosphate. Hemodialysis International. 2013 Oct;17(4):479-482. 2. Williamson MA, Snyder LM. Wallach’s Interpretation of Diagnostic Tests. 10th ed. Philadelphia: Wolters Kluwer Health; 2014. 1288p. 3. Rhoades RA, Bell DR. Medical physiology: Principles for clinical medicine. 4th ed. Baltimore: Lippincott Williams & Wilkins; 2013. 839p. 4. Chernecky CC, Berger BJ. Laboratory tests and diagnostic procedures. 6th ed. Missouri: Saunders; 2013. 5. Felsenfeld AJ, Levine BS. Approach to treatment of hypophosphatemia. AJKD. 2012 Oct;60(4):655-61.

March–April 2017 western nurse |

ResearchRoundup LATEST AND GREATEST FROM SCIENCE

SPIDER VENOM FOR STROKE VICTIMS A protein in venom produced by Australia's Darling Downs funnelweb spider is showing promise as a stroke treatment. Australian researchers said Hi1a – a “disulfide-rich spider venom peptide” – blocks “acid-sensing ion channels in the brain, which are key drivers of brain damage after stroke”. “We believe that we have, for the first time, found a way to minimise the effects of brain damage after a stroke,” said the University of Queensland’s Professor Glenn King who led the research, working with Monash University. “During preclinical studies (with rats), we found that a single dose of Hi1a administered up to eight hours after stroke, protected brain tissue and drastically improved neurological performance. “Hi1a even provides some protection to the core brain region most affected by oxygen deprivation, which is generally considered unrecoverable due to the rapid cell death caused by stroke. “This world-first discovery will help us provide better outcomes for stroke survivors by limiting the brain damage and disability caused by this devastating injury.” The study was published last month in Proceedings of the National Academy of Sciences of the United States of America. 

DISCOVERY ABOUT PROTEIN SHAPE IS KEY TO SUPER BUG BATTLE The fight against super bugs has been boosted by new knowledge about the shape and structure of a protein responsible for multidrug resistance in many bacteria. An international collaboration led by scientists from the University of Western Australia uncovered the three-dimensional molecular structure of the protein called EptA. This protein “causes multi-drug resistance by masking bacteria against both the human immune system and important classes of antibiotics”, said UWA’s website. A variant of EptA called MCR-1, discovered in 2015, causes resistance to colistin, “a last resort antibiotic for bacteria untreatable by other means”. “This new knowledge of the shape and unique structure of EptA (and MCR-1) will help scientists develop an effective treatment to prevent antibiotic resistance of these super bugs, a huge step forward for global health,” said the study’s lead scientist, UWA Professor of Structural Biology, Alice Vrielink. She said the function of this protein molecule “is directly related to its three-dimensional shape”. Multi-drug resistant bacteria cause about 700,000 deaths yearly. 

BEING LONGWINDED MIGHT BE AN EARLY SIGN OF ALZHEIMER'S Friends who take too long telling an anecdote might not just be longwinded – they may be exhibiting early signs of Alzheimer’s disease. “Subtle changes in speech style occur years before the more serious mental decline takes hold”, according to findings discussed

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in February at the American Association for the Advancement of Science in Boston, and reported by The Guardian. But worsening “mental imprecision” was the key, rather than just being verbose. The scientists compared language abilities of 22 healthy young people, 24 healthy older ones and 22 with mild cognitive impairment (MCI), a precursor to dementia. An exercise involving use of three words, such as pen, ink and paper, saw healthy volunteers usually join the three in a simple sentence, but the “MCI group gave circuitous accounts of going to the shop and buying a pen”. “They were much less concise in conveying information, the sentences they produced were much longer, they had a hard time staying on point,” said Janet Cohen Sherman, clinical director of the Psychology Assessment Center at Massachusetts General Hospital. She said a big challenge is detecting changes early “when they are still very subtle and to distinguish them from changes we know occur with normal ageing” 

NEXT STEP FOR FIGHTING HEART ATTACKS – GROWING CARDIAC MUSCLE ON SPINACH LEAVES Cardiac muscle grown on spinach leaves may in future replace dead heart tissue resulting from myocardial infarction. Startling new U.S. research sees scientists using the leaves’ vascular system to provide human cells grown on them with nutrients and oxygen through a blood source. “Patients who’ve had heart attacks or myocardial infarctions, part of the heart no longer contracts,” said Worcester Polytechnic Institute Biomedical Engineering Professor Glenn R. Gaudette on a WPI video. “What we’re trying to do, is grow cardiac muscle on these leaves which can then be perfused with a blood source by the veins that are inside the leaf “We can, in theory, sow those veins into the native arteries in the heart, and therefore produce a contractile muscle that can replace the infarcted or the dead tissue.” Joshua Gershlak, a graduate student also at WPI in Massachusetts – and another co-author of the study, which is in May’s issue of Biomaterials – said the major limiting factor for tissue engineering “is the lack of a vascular network”. “(With) a bigger and bigger graft for say, like a heart attack on a human, you’re going to need something fairly large. Without that vascular network, you get a lot of tissue death.” He said cardiac cells attached, and continued to contract on spinach leaves “for a long period of time”. He added “they look and act like normal cardiac cells when they’re on there”, which “seems to be very promising”. 

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March–April 2017 western nurse |

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