Black Widow Spider Bite: A Case Study

Abstract: This article is a case study of a patient cared for in the hours before her death. After the patient's death, we learned the patient died of a black widow spider bite. This article sheds light on the potential seriousness of this venom and allows for more rapid detection and treatment of those who are unfortunate enough to be bitten. The authors have documented the sequence of events for the patient, outlined the care the patient received, examined the pathophysiology of the body to a spider bite, and then made a passionate appeal for other nurses who work in critical care to do the same with patients in similar situations. Black widow spider bites | Streptococcus pyogenes | venomous bites Keywords: Article: A 56-year-old woman ("Pam") admitted to the medical-surgical intensive care unit (ICU) died within hours of admission despite aggressive treatment. One of the authors, Kristine, discovered after the patient died that she had been bitten by a black widow spider the day before. This article examines the physiological effects of black widow spider bites and the way the patient's treatment might have differed had the team known of the bite. The article examines the progression of the toxic effects of the black widow spider bite, the clinical manifestations to look for, and ways to recognize and treat a patient with a bite. Our aim was to help ICU nurses and physicians recognize these manifestations and institute the treatment needed for a spider bite. We also hope that ICU nurses will remember a patient whose own dramatic story played out for them in much the same way as this one did for the authors and see the importance of looking deeper into a patient's history upon arrival. Other nurses, we hope, will question the mysteriou

Knowing the resident with dementia: Perspectives of caregivers in assisted living facilities

This qualitative study describes the kinds of knowledge used by caregivers when caring for older adults with dementia residing in assisted living facilities. Five focus groups were conducted with a total of 23 caregivers from both small and large facilities. Two categories of knowledge were described: behavior-centered knowledge and person-centered knowledge. Behavior-centered knowledge focuses on strategies needed to manage behaviors, whereas person-centered knowledge focuses on the needs of the person exhibiting the behavior. Recommendations about the role of gerontological nurses and the training of caregivers in assisted living facilities are provided

"Let's get moving: Let's get praising:" Promoting health and hope in an African American church

Stroke and cardiovascular disease are major health problems for African Americans. This article describes challenges, strategies employed, and successes in implementing a combination "faith-based" and "faith- placed" health promotion program called the BLESS Project in a small rural church in North Carolina. The project was implemented by a congregational nurse who teaches nursing at a nearby HBCU and students with a grant from a local agency and partnerships with local health-care agencies. Despite numerous challenges in implementing the project, it was successful in increasing awareness of stroke and heart disease and the need for improving diet and increasing physical activity. Research is needed to test the efficacy of combining faith-based and faith-placed activities in preventing cardiovascular disease in African Americans

A Comfortable Place to Say Goodbye

Bill had suffered severe trauma, the type of injury even a 46-year-old healthy man does not survive. A helicopter transferred Bill to tertiary trauma facility miles from his home. Nurses and physicians worked for hours to stabilize him. Throughout the day, family members arrived, some in tears, some angry, all confused and distraught over Bill's tragic accident. The afternoon of Bill's arrival, the physician had a meeting with the family. The physician was honest, direct, and compassionate with the family. Bill would not likely survive this trauma; however, he discussed the supportive process of comfort care. The family wrestled with their emotions and with the reality of Bill's eminent death for several hours. The family finally agreed to stop the futile treatments and allow Bill to experience a peaceful death. The comfort care protocol for Bill involved continuing mechanical ventilation, continuous intravenous sedation, and pain medications. Family members took turns in their vigil at Bill's bedside, each coping in his/her own way and toward his/her own acceptance of Bill's death, some in tears, some still angry at the unfairness of life. Bill was still alive the next morning, and the nurse from the day before resumed his care. The family's emotional journey culminated that morning with Bill's death, with loved ones surrounding his bedside, holding hands, and singing hymns as Bill's heart rate slowed and eventually stopped. There were tears in everyone's eyes, but there was also relief on their faces. Death had finally come, and Bill had never exhibited any signs of pain or suffering. No death is easy, but we all hope to die peacefully, with our loved ones surrounding us, comforted by each other's presence, and the knowledge that the right decision has been made

Beyond the Bridge

Left ventricular assist devices (LVADs) implanted for patients as destination therapy have been shown to improve quality of life and survival, improve functional status, and prolong survival in patients with end-stage heart failure.[1,2] The indications for LVADs include bridge to recovery for patients who need short-term support, bridge to transplant for patients awaiting a heart transplant, and destination therapy for patients ineligible for cardiac transplantation. Originally developed as a bridge to heart transplant, permanent LVAD implantation as destination therapy is the fastest growing indication for device implantation, particularly as the population ages and more patients are diagnosed with end-stage heart failure (see What's an LVAD? and When an LVAD is needed).[1]]]> 2013 English http://libres.uncg.edu/ir/uncg/f/D_Kautz_Beyond_2013.pdf oai:libres.uncg.edu/17154 2014-11-03T10:19:17Z UNCG Creative Ways to Teach Arterial Blood Gas Interpretation Kautz, Donald D. NC DOCKS at The University of North Carolina at Greensboro <![CDATA[There are many creative ways to teach arterial blood gas interpretation. This article illustrates the use of the stepwise approach, tables, figures, case studies, illustrations, computer-based learning modules, and the tic-tac-toe approach. The authors recommend making several approaches available so students and new critical care nurses can choose the ones that work best for them

Beyond “Baby Blues”: Recognizing Postpartum Psychosis

After childbirth, some women experience postpartum depression, and in most instances it subsides without treatment. In rare cases, however, women experience the sudden onset of psychotic symptoms following childbirth, a dangerous medical condition known as postpartum psychosis (PP). This article explores how to identify patients at risk for PP, what signs and symptoms to assess for, and how to support them and their families during treatment

A Puddle of Happiness

Many critical care nurses travel overseas on American medical missions. On a trip to rural Africa, my daughter Lilly, then 16, accompanied me. Much of our time was spent in a van as our group (which included a physician and several other nurses) was driven to schools, clinics, and homes to provide care to those in need. Every day, people from remote villages would walk to see us for treatment of infections and other illnesses. One day, we visited a local AIDS organization and the homes of several people with HIV, ate a traditional African meal prepared by an HIV-positive support group, and visited a school they'd founded

Overcoming Low Health Literacy

Low health literacy is so widespread among patients in outpatient settings, some authors have called it a silent epidemic.[1] Research continues to show that many patients don't understand the recommendations given to them by their healthcare providers.[2,3] Because of this lack of understanding, these patients can't follow directions to adopt healthful lifestyle behaviors, make wise healthcare decisions, actively participate in their plan of care, manage medication regimens, and follow their healthcare providers' treatment advice

Endnotes: Laughing with Cathy

My father Harry died recently at age 89. When he filled out the hospice forms and answered the question “How do you want to be remembered?” he wrote, “That I was a Christian and had a good sense of humor.” When I was growing up in the 1960s and 1970s, my family was very active in our local church near Denver, Colorado. My father was a constant volunteer—except on the stewardship committee. That was not because he didn’t believe in giving—he always tithed. The problem was that he made it clear he expected everyone to tithe, and so he made other people uncomfortable when he approached them about their yearly pledge. Dad felt the same way about premarital sex. He didn’t have sex until he married my mother when he was 38, and he expected everyone else to do the same. So I was shocked when Mom and Dad invited Cathy and her family to come stay at our cabin in the Colorado mountains. Cathy was one of the popular girls at school—and a cheerleader. That’s why I didn’t know her very well; I was never in the popular crowd. But at age 17, Cathy was pregnant ... and unmarried. My parents must have figured Cathy and her family needed to get away

Nurturing Nursing Students During Intensive Care Unit Clinical Practicum

Approximately one-third of new graduates will quit their jobs in the first year. When nurses leave, vacant positions result in increased overtime for the remaining staff, which eventually results in burnout. Burnout leads to even more turnover. This article describes how the staff transformed a neurosurgical intensive care unit and nurture students through the application of Jean Watson's 10 Caritas processes. When nursing students complete their clinical practicum in the unit, learning is enhanced, the students seek to continue to work in the intensive care unit, recruitment and retention are encouraged, and burnout may be prevented