The
Advocate
Summer, 2011
Volume 22, Issue 1
Central Ohio Chapter
Association of
Rehabilitation Nurses
FROM THE PRESIDENT….
Toni Grice RN CRRN
Greetings,
My name is Toni Grice, and I am your
newly elected COARN president. I am a
CRRN and have worked at The Ohio State
University Medical Center-Dodd Hall since
2004. I did work on the spinal cord injury and
brain injury floor until Feb. 2011, when I
transitioned into case management at Dodd,
working with spinal cord injury and general
rehabilitation patients. I have always wanted
to be a nurse, and now I find so many
opportunities and so many different avenues
that are available. My adventure in nursing
continues.
I am looking forward to serving you
this year and looking forward to some events
that will prove to stretch our minds. COARN
provides educational presentations every other
month. They provide fun, food, and
fellowship and I encourage everyone to come
out and see. I am also looking forward to the
National ARN conference in Las Vegas. I
encourage anyone and everyone if you get a
chance to go, do it. You will learn something
new every day. You will also get to make
lifetime friends.
I thank you for this opportunity to
serve you. Feel free to contact me anytime
with questions, comments, and all
encouragement.
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COARN Upcoming Events
Chapter Meeting
“Save the Date”
Holiday Party at Spaghetti Warehouse
5:30 pm on Dec 13, 2011
COARN Board of Directors
President
Toni Grice RN CRRN
President-Elect
Deb Thomas RN CRRN
Secretary
Carol Beathard BSN RN CRRN
Treasurer
Norma Clanin MS RN CRRN
Directors
Michele Rinkes BSN RN CRRN
Jan Simek RN CRRN
Janice Rook MS RN CRRN
Co-Editors
Maureen Musto MS, RN,ACNS-BC, CRRN
Cindy Gatens MN, RN, CRRN
Submit newsletter articles to Maureen Musto
at maureen.musto@osumc.edu
REMINDERS !
Planning on Taking the Certification Exam ?
Exam Dates: December 1 – 31, 2011
Application Deadline: October 15, 2011
Visit www.rehabnurse.org for details!
Planning to Attend ARN’s National Conference ?
November 2 – 5, 2011 in Las Vegas, NV
Visit website to register online or to print brochure!
http://www.rehabnurse.org/education/2010conference/inde
x.html
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Clinical Situations in a Nutshell
By Norma Clanin, RN, MS, CRRN
James, a 72-year-old man experienced paraplegia after repair of an abdominal aortic
aneurysm. He is now a patient in rehabilitation. Admission evaluations were completed,
and he went for his first session of therapy today. He had lots of questions about what
would be expected of him and was eager to start his rehabilitation.
He returns to the unit, wide-eyed and breathing into a paper bag. The therapist said he
became very anxious when walking in the parallel bars and began hyperventilating.
The physician is paged and oxygen is prescribed. Vital signs: P-86 and weak; R-26; BP138/68. You note his color is pale and his skin feels cool and sweaty as you transfer him
into bed. He said he initially had a few sharp stabs of chest pain. With the head of the bed
elevated, he experiences less dyspnea. He just now coughed up a small amount of blood.
His anxiety now has worsened and he will not let go of your forearm.
An ECG is done. His pulse oximetry is 94%. D-dimer, PT, PTT, platelets, fibrinogen,
cardiac enzymes and blood gases are drawn. An urgent ventilation-perfusion scan is
scheduled. A STAT pulmonary consult is called and the patient is emergently
transported. His wife is called by the physiatrist.
What is possibly happening here?
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PULMONARY EMBOLISM !
Know the latest:
National Guideline Clearinghouse: Guidelines on the Diagnosis and Management of
Acute Pulmonary Embolism
http://www.guideline.gov/content.aspx?id=13410
National Guideline Clearinghouse: Current diagnosis of venous thromboembolism in
primary care: a clinical practice guideline from the American Academy of Family
Physicians and the American College of Physicians
http://www.guideline.gov/content.aspx?id=10580&search=pulmonary+embolism
National Guideline Clearinghouse: Prevention of Thromboembolism in Spinal Cord
Injury. PVA.
http://www.guideline.gov/content.aspx?id=2965&search=nursing+pulmonary+embo
lism
Norma Clanin, MS, RN, CRRN
Anderson, Kim D., Targeting Recovery: Priorities of the Spinal Cord-Injured Population
Journal of Neurotrauma, Vol 21, Num 10, 2004, pp 1371-1383.
This Reeve-Irvine Research Center’s survey results were recently shared through the
Reeve Foundation’s website. A total of 681 responses were completed and returned for
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tabulation and analysis. The purpose was to determine what functions are the most
important to the SCI population, “in regard to enhancing quality of life.” Subjects were
asked to rank seven functions in order of importance to their quality of life.







Arm and hand function
Upper body/trunk strength and balance
Bladder/bowel function, elimination of dysreflexia
Sexual function
Elimination of chronic pain
Normal sensation
Walking movement
Regaining arm and hand function was most important to quadriplegics. Regaining sexual
function was ranked most important to paraplegics. Improving bowel and bladder
functions was equally important to both groups.
An analysis of responses revealed only slight differences between those injured <3 years
versus those >3 years. The researchers also asked about exercise importance. A majority
of respondents indicated they thought exercise was important to functional recovery, but
more than half did not have access to equipment or a trained therapist to oversee its use.
While this study was conducted to help determine the relevance and direction of future
research emphasis, it has implications for clinical nursing. For example, patient
education principles emphasize addressing the pertinent questions and learning needs of
the individual learner. As rehabilitation nurses, we have identified what the patient
NEEDS to learn, but unless we also address what they WANT to learn, our
conversations, classes and demonstrations may have less impact.
Why You Should Feel the Energy of Possibility Thinking
1. Possibility thinking increases your possibilities.
2. Possibility thinking draws opportunities and people to you.
3. Possibility thinking increases others' possibilities.
4. Possibility thinking allows you to dream big dreams.
5. Possibility thinking makes it possible to rise above average.
6. Possibility thinking gives you energy.
7. Possibility thinking keeps you from giving up
Reference: Maxwell, J. (2003). Thinking for a Change: 11 Ways Highly
Successful People Approach Life and Work, New York: Warner Books, p.
158-162.
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DID YOU KNOW ?
Norma Clanin, MS, RN, CRRN
According to the CARF (Commission on Accreditation of Rehabilitation Facilities)
website:
Their Mission: To promote the quality, value, and optimal outcomes of services through a
consultative accreditation process that centers on enhancing the lives of the persons
served.
There are 1184 accredited providers in Ohio!
There are 39 accredited inpatient rehabilitation programs in hospital settings in Ohio!
To see a list: http://www.carf.org/providerSearch.aspx
(Type “Ohio” in the search box; then filter by “program” and “inpatient
rehabilitation programs-hospital” at left. Click on “filter” box at bottom of column.)
There are 47,000 accredited programs and services on 5 continents!
Paul Nathenson, a well known rehabilitation nurse from Nebraska, is on their Board!
CARF accredits rehabilitation health and human services in these areas:
o Aging Services
o Behavioral Health
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o
o
o
o
o
o
o
Opioid Treatment Programs
Business and Services Management Networks
Child and Youth Services
Employment and Community Services
Vision Rehabilitation
Medical Rehabilitation
DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
Fosfomycin for Urinary Tract Infections
By: Mike Ganio, PharmD
Multidrug-resistant (MDR) bacteria are becoming more and more common. Infections
caused by these bacteria generally require the use of intravenous antibiotics for treatment.
While effective, intravenous antibiotics are generally more costly, inconvenient due to
infusion time, and a risk for infection due to the necessity for an intravenous catheter.
Fortunately, an oral option is available to treat these MDR organisms when they are
causing urinary tract infections. Fosfomycin is an antibiotic with very broad coverage of
resistant bacteria. It can be used to treat VRE and extended-spectrum beta-lactamase and
carbapenemase-producing organisms which typically require expensive or intravenous
medications. However, since fosfomycin does not achieve high concentrations in the
body, it cannot be used for pyelonephritis or systemic infections.
Fosfomycin is only available as an oral sachet (powder packet). Contents of the packet
must be mixed in 90-120 mL of cool water until dissolved. The solution can be
administered via feeding tubes. Most patients
will require one 3 gram packet every other day
for 7-21 days (most typically 3 doses). Doses
must be adjusted for renal function. Most
common side effects include nausea, vomiting
and diarrhea, as well as elevation in liver
transaminases.
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The Nutritional Need for Summer Sun
By: Lauren Vorisek MedDiet IV
 Despite all the negative warnings about excessive sun exposure, the sun can
actually be beneficial for our health with the right amount of rays.
 Our bodies naturally make Vitamin D when exposed to sunshine.
 5-30 minutes of sun exposure between the hours of 10am-3pm at least twice a
week is the recommended time for aiding vitamin D production.
 Vitamin D is important because it works with calcium to promote bone
development (1).
 Current research is studying the possible benefits of Vitamin D related to chronic
diseases such as cardiovascular disease and cancer.
 Research also suggests Vitamin D may help improve immune response and
skeletal health (2).
Recommended Daily Allowances for Vitamin D
600 IU
(15 mcg)
600 IU
19–50 years
(15 mcg)
600 IU
51–70 years
(15 mcg)
800 IU
>70 years
(20 mcg)
14–18 years
8
600 IU
(15 mcg)
600 IU
(15 mcg)
600 IU
(15 mcg)
800 IU
(20 mcg)
Sources of Vitamin D
 Sometimes, people may not get all the Vitamin D they need through the sun.
 It may be difficult to get sun during certain seasons (such as winter). It may also be
difficult for people who spend most time indoors, or who were told by their doctor
to avoid sun exposure.
 Other factors such as cloud cover, amount of skin exposed, and sunscreen may
effect Vitamin D production.
 Luckily, we can also get Vitamin D through foods we eat.
 Eating a balanced diet and a variety of foods will help you reach your Vitamin D
needs.
 When reading a food label, look for the %DV (daily value) of Vitamin D.
 When shopping, look for foods that advertise “Vitamin D fortified.” This means
vitamin D has been added to the food. You can often find Vitamin D fortified
Orange Juice, Yogurt, and breakfast cereal.
 Foods that are a good source of Vitamin D include:
IUs per
Percent
Foods
serving Daily Value
Salmon (sockeye), cooked, 3 ounces
447
112
Mackerel, cooked, 3 ounces
388
97
Tuna fish, canned in water, drained, 3 ounces
154
39
Orange juice fortified with vitamin D, 1 cup (check product
137
34
labels, as amount of added vitamin D varies)
Milk, nonfat, reduced fat, and whole, vitamin D-fortified, 1
115–124
29–31
cup
Yogurt, fortified with 20% of the DV for vitamin D, 6 ounces
88
22
(more heavily fortified yogurts provide more of the DV)
Margarine, fortified, 1 tablespoon
60
15
Liver, beef, cooked, 3.5 ounces
49
12
Sardines, canned in oil, drained, 2 sardines
46
12
Egg, 1 large (vitamin D is found in yolk)
41
10
Ready-to-eat cereal, fortified with 10% of the DV for vitamin
D, 0.75–1 cup (more heavily fortified cereals might provide
40
10
more of the DV)
Cheese, Swiss, 1 ounce
6
2
9
Vitamin D supplements
 People exposed to very little sunshine and who do not eat many Vitamin D
foods in their diet may choose to consider a supplement.
 People who are vegans, ovo-vegetarians, or who do not drink milk are at risk
for not getting enough in their diet.
 Supplements are readily available on the market and should be taken as directed
to avoid getting too much.
 Oftentimes, Vitamin D is present in Calcium supplements, since these two
nutrients work together to build strong bones.
 If you have questions about if a supplement is right for you, it is always best to
ask your doctor.
Vitamin D deficiency
 In adults, Vitamin D deficiency is called osteomalacia, which leads to weak
bones and other complications such as fractures.
 Low vitamin D levels can also lead to osteoporosis, because without vitamin D,
calcium cannot make strong bones.
 To reduce your risk of osteomalacia and osteoporosis, eat a healthful diet that is
rich in calcium and Vitamin D and enjoy some time in the sunshine.
Summary
 Spending some time in the sunshine helps our bodies make Vitamin D, an
important nutrient for bone health.
 We can also get Vitamin D through a balanced diet and eating fortified foods.
 If you do not think you are getting enough Vitamin D, talk with a Doctor or
Dietitian about a supplement.
1. http://ods.od.nih.gov/factsheets/vitamind/
2. http://www.uptodate.com/contents/patient-information-vitamin-d-deficiency
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Nurses at the Statehouse
Deb Thomas, CRRN
I wanted to take a few minutes and let you know about my visit at the statehouse in
June. It was a great experience. I had not been familiar with the legislative aspect of
nursing. So I went into the day with an open mind. The day started out with a guest
speaker. Her name was Anne Gonzales and she is a representative of the House. She was
responsible for penning some very important health care bills during her term. She
seemed to be very knowledgeable of our nursing issues. She said she often consults
nurses for their input when developing an issue into a bill.
Next came the panel presentations. There were a lot of different nursing groups
represented. Surgical nurses, psych nurses, ED nurses, occupational nurses, deans of
nursing schools, med surg nurses as well as rehab nurses were all part of the group.
They spoke on various topics from nursing safety at work, to staffing ratios, to issues
with school nursing and workplace violence. It was very interesting to see the problems
that are faced by our fellow nurses in the state of Ohio. Some of them are universal but
some are very specialty specific.
When I presented the rehab issues, I wanted to make sure the legislators had a good
idea about what we are facing and also how we as a rehab group can be very cost
effective for the health care budget. I likened an inpatient stay to that of a child going
away to college. There is a bigger investment up front for the training, but when the
schooling (therapy) is finished, you hope there will be an independent person at the end.
I went into the costs of having someone released to home as opposed to being discharges
to an ECF or SNF. I also encouraged all disciplines that were represented at the meeting
to consider inpatient rehab as a bridge to home to help cut costs. I received many
supportive comments and discussions about how important rehab can be.
After the panel presentation, we had the opportunity to network with fellow nurses in
our district as well as the House and Senate representatives affiliated with the district. It
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was an informal discussion over lunch, but the legislators were very interested in our
issues. They also opened their doors for any of us who may have concerns and issues that
we would like to discuss with them at any time. So, if you have anything you would like
to talk about or make sure they know about, feel free to look them up and give them a
call. They truly are just one of us!!
The day ended with many opportunities to sit in on sessions and tour the Statehouse.
Interestingly enough, I was able to talk with the representative from the Democratic
Nursing Caucus.
In conclusion, I want to tell everyone how great an experience it was to be a part of
the Nurses Day at the Statehouse. I never thought I would be interested in the political
process in regards to nursing, but I am thinking about applying for the Nurses Internship
in Washington that is offered yearly from ARN. Who knows, maybe you’ll see me on the
Senate floor one day……...
What is the TBI Network?
Submitted by Maureen Musto RN CRRN ACNS-BC
Exerts taken from www.tbinetwork.org
The TBI Network is a substance abuse treatment program for individuals who have
sustained a traumatic brain injury (TBI). The program is ODADAS and CARF certified
and is a contract agency with the Franklin County ADAMH Board. Persons with TBI
who abuse substances have special needs for recovery services. Frequently their
substance problem interferes with their ability to find and keep a job. Traditional
treatment modalities are often ineffective, leaving both client and counselor frustrated.
The TBI Network attempts to bridge this gap and make services more beneficial for
clients.
The TBI Network consists of an interdisciplinary staff with expertise in TBI, substance
treatment, and vocational rehabilitation. Services provided are designed to support and
enhance existing services in the community. The primary method of intervention is
resource and service coordination.
The TBI Network provides drug and alcohol treatment services only for persons who
have experienced a traumatic brain injury and who are abusing substances or are at a high
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risk for substance abuse. In addition to having sustained a TBI, individuals accepted for
service must meet eligibility criteria. There are five eligibility requirements for persons
applying for outpatient substance abuse treatment services through the TBI Network.
These are:





The individual is 18 years of age or older.
The individual lives in Franklin County.
The individual is living in the community or is working toward that goal.
The individual is currently abusing alcohol and other drugs or is at considerable
risk of abuse.
The individual has a history of sustaining a brain injury or injuries with consequent
cognitive disability
The TBI Network provides case management services to persons who have sustained a
brain injury and have issues, or are at risk for problems, with substance use or abuse.
Services provided are designed to meet the client where they are with an attitude of
“whatever it takes” to get needs met.
Services provided include: Assessment, Crisis Intervention, Case Management,
Individual Counseling and Group Counseling.
Referrals for services can be made by the person seeking treatment, a family member, or
a community service provider.
Contact information:
The Traumatic Brain Injury Network
106 McCampbell Hall
1581 Dodd Drive
Columbus, Ohio 43210-1290
Phone: 614-292-4559
FAX: 614-688-3737
E-mail: tbinetwork@osu.edu
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Submitted Deb Thomas RN CRRN
Chart Blooper.....
*Check orthostasis while on the floor
* Nurse to Doctor: "I just want to let you know that this lady has had decreased urinary intake"
* Order: "Incentive spirometry Q 1 hour until awake"
* Pleasant man lying comfortably in bed. Appears somewhat uncomfortable
* Her stomach showed 3+ edema up to the knees
* 2-4 packs of whiskey QD
* Pt is on clonidine, not
* Pt was given banana bath
* Order: "Please feed patient only when awake"
* She is to wear STD stockings
* non-audible wheezing noted
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* The pelvic exam will be done later on the floor
* Skin: somewhat pale but present
* Large brown stool ambulating in the hall.
* Patient has two teenage children, but no other abnormalities
* Since she can't get pregnant with her husband, I thought you might like to work her up.
* Patient has left white blood cells at another hospital
* The patient refused autopsy
* Discharge Status: Alive but without my permission
* On the second day, the knee was better, and on the third day, it disappeared.
* The patient has no previous history of suicides.
* Rectal examination revealed a normal sized thyroid.
* While in the ER, she was examined, X-rated, and sent home.
* She stated that she had been constipated for most of her life, until she got a divorce.
* Examination of genitalia reveals that he is circus sized.
* Both breasts are equal and reactive to light and accommodation.
* I saw your patient today, who is still under our car for physical therapy.
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