Today's abbreviation is leading to an article I hope to post in the next couple of weeks that deals with the ethics of death and dying. Death and dying and the ethics involved have been on my mind lately, and I am working on an interesting piece.
So ahead of that an important abbreviation.
POLST or MOLST
POLST- Physician's Orders for Life Sustaining Treatment
MOLST- Medical Orders for Life Sustaining Treatment
These are not likely to be abbreviations that are common in the medical record, as the use of this form is relatively new. But understanding how they work is important for the medical provider, lawyer, and anyone involved in the client's care.
A living will is a way to speak for yourself if you become incapacitated. It is NOT physician's orders and is designed to guide your family and your physician to your wishes. A POLST or MOLST is a set of physicians orders which dictates exactly what to do in an emergency situation or decline. A fully filled out POLST or MOLST also includes information about tube feeding, long term mechanical ventilation, antibiotics, and other measures that may be desired by the patient. They are discussed in detail with a physician and carry the weight of physician's orders.
Like DNR forms these are bright colored forms that go with clients or patients as they move through the healthcare system and many times photocopies of this form are acceptable. In most of healthcare a photocopied form is not accepted as a physicians order, but DNR forms as well as a few other forms they are accepted.
Although these are less than 10 years old, not only with the increased connections due to digitization of the medical record, and living longer with more complex medical conditions, these will become more common.
You will likely see these abbreviation as follows:
EXAMPLE
Pt. has a POLST and verified with physician.
Discussed MOLST form with patient and family and began completion on this visit.
Monday, February 22, 2016
Monday, February 8, 2016
Post Superbowl Abbreviation
I hope everyone enjoyed the Super Bowl. For me my favorite was all the Super Bowl Babies, and seeing that guy from Carolina flying over both teams for the touchdown, even though Carolina went on to lose.
So because the Super Bowl usually involves snacks I thought we'd do a post Super Bowl food related definition.
CHO - Carbohydrate
Basically a carbohydrate is not a protein, but most people associate carbohydrates with bread products and sweets because they're what our body recognizes first as carbohydrates, in other words the body doesn't have to much to break down carbohydrates into usable sugars.
The most common space to see this abbreviation is in diet orders or discussions about diet. For any number of reasons patients can be on what's called a carbohydrate controlled diet, limiting the amount of carbohydrates that the person eats in an attempt to either control a disease process or for health promotion.
Example
Diet Order: CHO controlled
Pt reports decreased BG levels on CHO controlled diet. (Patient reports decreased blood glucose levels on carbohydrate controlled diet).
So because the Super Bowl usually involves snacks I thought we'd do a post Super Bowl food related definition.
CHO - Carbohydrate
Basically a carbohydrate is not a protein, but most people associate carbohydrates with bread products and sweets because they're what our body recognizes first as carbohydrates, in other words the body doesn't have to much to break down carbohydrates into usable sugars.
The most common space to see this abbreviation is in diet orders or discussions about diet. For any number of reasons patients can be on what's called a carbohydrate controlled diet, limiting the amount of carbohydrates that the person eats in an attempt to either control a disease process or for health promotion.
Example
Diet Order: CHO controlled
Pt reports decreased BG levels on CHO controlled diet. (Patient reports decreased blood glucose levels on carbohydrate controlled diet).
Tuesday, January 26, 2016
Pressure Ulcers
This is where things get tricky. If they weren't tricky before, they get tricky now. Stage 1 and two pressure ulcers are only at the surface of the skin.
Stage III pressure ulcers are the first pressure ulcer that does not involve intact skin that involves more than damage to the skin surface. The difference between a stage III and a stage IV ulcer is the not the size (the total area of the ulcer) but the depth of the ulcer. A stage 3 ulcer involves the fat that lies below the skin, and there is some debate as to whether or not it involves the musculature, but it absolutely does NOT involve bone exposure or that the clinician can feel the bone through the tissue. (sometimes called palpable).
Once you get away from the surface ulcers (stage 1 and stage II) size NO LONGER MATTERS.
Let me repeat that SIZE NO LONGER MATTERS.
I'll say it one more time SIZE NO LONGER MATTERS.
I'm pretty sure I cannot emphasize this point enough, because its hard to wrap your head around. The idea that a stage 3 pressure ulcer that is the size of your entire back is actually not worse than a stage 4 pressure ulcer the size of a pencil that goes all the way to the bone on your leg. This is because the one on across your back looks worse than the one on your leg. In truth the one on the back is NOT worse than the one on the leg.
I'll get into the multitude of problems that a stage IV pressure ulcer can cause next week, because that's not our focus, our focus is the stage III ulcer.
Stage III ulcers like stage I ulcers tend not to last terribly long if they're not caught and treated almost immediately. Its not long before a stage III ulcer without treatment develops into a stage 4 ulcer.
Depending on the depth, treatment usually involves keeping the wound bed moist and clean to promote healthy tissue generation, and the surrounding tissues dry to prevent additional breakdown, and regular turning and repositioning of the client. If the client's nutritional status has not been previously evaluated, it is CRITICAL to get their nutritional status evaluated and start nutritional support if it's needed. This is because the body puts it's energy into healing these wounds, and it has been my finding, as it has been many others, that patients without adequate nutritional support not only take longer to heal but also are at significantly increased risks for developing additional pressure ulcers and infections.
Pressure ulcers are a slippery slope and once started down them if a stop is not put in place immediately it can lead to death.
For all pressure ulcer cases it is important to have at least one nurse evaluate the case, because the first line of prevention is the nurse providing day to day care. A wound nurse is ONLY called in once a wound has formed.
Stage III pressure ulcers are the first pressure ulcer that does not involve intact skin that involves more than damage to the skin surface. The difference between a stage III and a stage IV ulcer is the not the size (the total area of the ulcer) but the depth of the ulcer. A stage 3 ulcer involves the fat that lies below the skin, and there is some debate as to whether or not it involves the musculature, but it absolutely does NOT involve bone exposure or that the clinician can feel the bone through the tissue. (sometimes called palpable).
Once you get away from the surface ulcers (stage 1 and stage II) size NO LONGER MATTERS.
Let me repeat that SIZE NO LONGER MATTERS.
I'll say it one more time SIZE NO LONGER MATTERS.
I'm pretty sure I cannot emphasize this point enough, because its hard to wrap your head around. The idea that a stage 3 pressure ulcer that is the size of your entire back is actually not worse than a stage 4 pressure ulcer the size of a pencil that goes all the way to the bone on your leg. This is because the one on across your back looks worse than the one on your leg. In truth the one on the back is NOT worse than the one on the leg.
I'll get into the multitude of problems that a stage IV pressure ulcer can cause next week, because that's not our focus, our focus is the stage III ulcer.
Stage III ulcers like stage I ulcers tend not to last terribly long if they're not caught and treated almost immediately. Its not long before a stage III ulcer without treatment develops into a stage 4 ulcer.
Depending on the depth, treatment usually involves keeping the wound bed moist and clean to promote healthy tissue generation, and the surrounding tissues dry to prevent additional breakdown, and regular turning and repositioning of the client. If the client's nutritional status has not been previously evaluated, it is CRITICAL to get their nutritional status evaluated and start nutritional support if it's needed. This is because the body puts it's energy into healing these wounds, and it has been my finding, as it has been many others, that patients without adequate nutritional support not only take longer to heal but also are at significantly increased risks for developing additional pressure ulcers and infections.
Pressure ulcers are a slippery slope and once started down them if a stop is not put in place immediately it can lead to death.
For all pressure ulcer cases it is important to have at least one nurse evaluate the case, because the first line of prevention is the nurse providing day to day care. A wound nurse is ONLY called in once a wound has formed.
Monday, January 25, 2016
Abbreviations
So we've touched briefly on the abbreviations surrounding today's abbreviation, but I thought we'd focus on the abbreviation for the disease process itself.
SCI- Spinal Cord Injury
This is a general very broad abbreviation that includes everyone from those paralyzed from the upper neck down, to those whom outwardly appear to have no spinal cord damage. It literally means what it says, that someone suffered damage to their spinal cord.
The causes of spinal cord injury can be as simple as a bad fall, or as complex as spina bifida or tumor formation. Usually after an injury there is a huge learning curve for a patient who has suffered a spinal cord injury, in terms of damage done to the spine, and what the prognosis is, but those who can figure out how to live with their injury usually have some of the most positive attitudes that I have seen, and as a nurse I find them a joy to work with.
Examples
Pt suffered a C5-6 SCI.
(It is common to see the level of injury (e.g. C5-6) mentioned with the injury as it can have critical impact on the type of care the patient is likely to need. We will explore this more as part of our disease process exploration.)
Dx: Incomplete SCI. Pt. is expected to make a full recovery with few deficits.
(Again- we'll explore exactly what this means at a later date.)
SCI- Spinal Cord Injury
This is a general very broad abbreviation that includes everyone from those paralyzed from the upper neck down, to those whom outwardly appear to have no spinal cord damage. It literally means what it says, that someone suffered damage to their spinal cord.
The causes of spinal cord injury can be as simple as a bad fall, or as complex as spina bifida or tumor formation. Usually after an injury there is a huge learning curve for a patient who has suffered a spinal cord injury, in terms of damage done to the spine, and what the prognosis is, but those who can figure out how to live with their injury usually have some of the most positive attitudes that I have seen, and as a nurse I find them a joy to work with.
Examples
Pt suffered a C5-6 SCI.
(It is common to see the level of injury (e.g. C5-6) mentioned with the injury as it can have critical impact on the type of care the patient is likely to need. We will explore this more as part of our disease process exploration.)
Dx: Incomplete SCI. Pt. is expected to make a full recovery with few deficits.
(Again- we'll explore exactly what this means at a later date.)
Monday, January 18, 2016
Abbreviations
This week, we're going to focus on another abbreviation that most people are familiar with because I hear it regularly discussed when people have children, especially small babies.
The abbreviation is
BM-- bowel movement
Nurses are always concerned about whether or not our patients have had one because it is a signal of good health. A blocked bowel can cause problems, as can too loose flowing a bowel. Good nursing practice is to know if your patient has had a bowel movement on your shift, or if they have had one on the previous shift.
Although it is normal to go one or two days without a bowel movement it is not common to go longer without one, so this particular item gets its own spot in the output area of a patient's record. Loose bowel movements can lead to problems including, but not limited, infection in patients that have pressure ulcers in their sacral area, and even their hips.
Example
Pt. had BM, soft formed this shift.
Pt. failed to have a BM this shift, abdomen remains soft and non-distended, bowel sounds present.
The abbreviation is
BM-- bowel movement
Nurses are always concerned about whether or not our patients have had one because it is a signal of good health. A blocked bowel can cause problems, as can too loose flowing a bowel. Good nursing practice is to know if your patient has had a bowel movement on your shift, or if they have had one on the previous shift.
Although it is normal to go one or two days without a bowel movement it is not common to go longer without one, so this particular item gets its own spot in the output area of a patient's record. Loose bowel movements can lead to problems including, but not limited, infection in patients that have pressure ulcers in their sacral area, and even their hips.
Example
Pt. had BM, soft formed this shift.
Pt. failed to have a BM this shift, abdomen remains soft and non-distended, bowel sounds present.
Tuesday, January 12, 2016
Stage II Pressure Ulcers
Stage II pressure ulcers are the most common pressure ulcers that we experience. Everyone at some point in their life has had an injury similar to a stage II pressure ulcer although we may not have called it that.
Stage II pressure ulcers can be blisters. The same blisters that we have on our heels or toes when our shoes rub, or we get on our hands after doing unusual yard work without wearing appropriate protection. Stage II ulcers are defined as damage to the outermost layer of the skin. They sometimes appear as open areas that do not involve the deeper layers of skin, muscle, or bone, and other times as the above described blisters.
That's how stage II pressure ulcers form more often than not, from a combination of moisture and rubbing. A patient left in a wet bed a little too long might form a stage II pressure ulcer.
The best part about a stage II ulcer, is like stage I ulcers they require very little treatment to cure them. The stage II pressure ulcer requires a dry surface and some sort of a protective covering to keep excess moisture out. Many times, ensuring the bed and the area around the wound remains clean and free of excess moisture, either from a dry dressing or a barrier product of some sort, is enough to heal the wound.
This wound is easy to spot on all skin types because unlike the stage I and DTI the skin is clearly broken and no longer intact. In fact because of the lack of intact skin for the first time we have an ulcer that can usually be seen more clearly on a patient with non Caucasian skin tones than those with Caucasian skin tones.
The fact that stage II pressure ulcers are easy to heal makes them difficult from a litigation standpoint. Many times the wounds heal and don't get any worse without any assistance and the same level of care as prior to the wound, or with the simple expedient of more frequent diaper or bed changes, or ensuring the skin is drier than it was previously. If a stage II ulcer is left untreated though, or if the patient is continually left in a damp situation stage II pressure ulcers can quickly decline into stage III or stage IV ulcer. Each ulcer requires a more complex treatment plan, and even more therapy and costs everyone more. Many times facilities get into trouble because they fail to reassess their patient's needs at the stage II level.
I am going to spend a few lines here discussing nomenclature. Nomenclature (how you express yourself in writing) for pressure ulcers consists of two different choices. The common/preferred choice for pressure ulcers is to write their stages as Roman Numerals, however I have seen the ulcers, particularly stage 1 and stage 3 expressed as arabic numerals. There isn't anything wrong with this and its not uncommon, nor is a deviation for the standard of care, and in writing it can be easier to see stage 3 ulcers specifically when written in arabic numerals. I see them interchangeably used all the time and for the purposes of this blog I will attempt to stick with the roman numerals for expression.
Stage II pressure ulcers can be blisters. The same blisters that we have on our heels or toes when our shoes rub, or we get on our hands after doing unusual yard work without wearing appropriate protection. Stage II ulcers are defined as damage to the outermost layer of the skin. They sometimes appear as open areas that do not involve the deeper layers of skin, muscle, or bone, and other times as the above described blisters.
That's how stage II pressure ulcers form more often than not, from a combination of moisture and rubbing. A patient left in a wet bed a little too long might form a stage II pressure ulcer.
The best part about a stage II ulcer, is like stage I ulcers they require very little treatment to cure them. The stage II pressure ulcer requires a dry surface and some sort of a protective covering to keep excess moisture out. Many times, ensuring the bed and the area around the wound remains clean and free of excess moisture, either from a dry dressing or a barrier product of some sort, is enough to heal the wound.
This wound is easy to spot on all skin types because unlike the stage I and DTI the skin is clearly broken and no longer intact. In fact because of the lack of intact skin for the first time we have an ulcer that can usually be seen more clearly on a patient with non Caucasian skin tones than those with Caucasian skin tones.
The fact that stage II pressure ulcers are easy to heal makes them difficult from a litigation standpoint. Many times the wounds heal and don't get any worse without any assistance and the same level of care as prior to the wound, or with the simple expedient of more frequent diaper or bed changes, or ensuring the skin is drier than it was previously. If a stage II ulcer is left untreated though, or if the patient is continually left in a damp situation stage II pressure ulcers can quickly decline into stage III or stage IV ulcer. Each ulcer requires a more complex treatment plan, and even more therapy and costs everyone more. Many times facilities get into trouble because they fail to reassess their patient's needs at the stage II level.
I am going to spend a few lines here discussing nomenclature. Nomenclature (how you express yourself in writing) for pressure ulcers consists of two different choices. The common/preferred choice for pressure ulcers is to write their stages as Roman Numerals, however I have seen the ulcers, particularly stage 1 and stage 3 expressed as arabic numerals. There isn't anything wrong with this and its not uncommon, nor is a deviation for the standard of care, and in writing it can be easier to see stage 3 ulcers specifically when written in arabic numerals. I see them interchangeably used all the time and for the purposes of this blog I will attempt to stick with the roman numerals for expression.
Monday, January 11, 2016
Abbreviations
This week we're going to focus on an abbreviation that comes up frequently in a specific population. This particular abbreviation can be triggered by a pressure ulcer.
Eventually I'd like to come back and focus more on this abbreviation as part of our disease process exploration because it is a potentially deadly abbreviation.
This week's abbreviation is
AD - Autonomic Dysreflexia
AD or Autonomic Dysreflexia is a condition that occurs only in patients with spinal cord injuries, when their autonomic nervous system responds to a stimulus inappropriately. It represents a medical emergency.
The reason I decided to pick this particular abbreviation this week, is the impetus for a stage II pressure ulcer, the focus of our Tuesday post, can cause an AD episode in spinal cord injury patients. Because of the decreased ability to shift their own position, and the deceased ability to feel the need to move, spinal cord injury patients are at higher risk for pressure ulcers.
Examples
Pt is at increased risk for AD due to difficulty of catheter insertion.
Pt.'s AD episode was triggered by wrinkled linen under him. Stimulus removed and AD episode resolved.
Eventually I'd like to come back and focus more on this abbreviation as part of our disease process exploration because it is a potentially deadly abbreviation.
This week's abbreviation is
AD - Autonomic Dysreflexia
AD or Autonomic Dysreflexia is a condition that occurs only in patients with spinal cord injuries, when their autonomic nervous system responds to a stimulus inappropriately. It represents a medical emergency.
The reason I decided to pick this particular abbreviation this week, is the impetus for a stage II pressure ulcer, the focus of our Tuesday post, can cause an AD episode in spinal cord injury patients. Because of the decreased ability to shift their own position, and the deceased ability to feel the need to move, spinal cord injury patients are at higher risk for pressure ulcers.
Examples
Pt is at increased risk for AD due to difficulty of catheter insertion.
Pt.'s AD episode was triggered by wrinkled linen under him. Stimulus removed and AD episode resolved.
Subscribe to:
Posts (Atom)