Journal Reading

SUMMARY: With the premise that NSAIDs generally cause GI disturbances or irritations, the study aimed to determine whether or not long term NSAID use affects the effectiveness of Helicobacter pylori eradication in terms of severity of gastric inflammation and H. pylori density in the gastric mucosa. Two control groups, each composed of clients using NSAIDs on a long-term basis and positive for H. pylori, were involved in the study. The first group was continued on eradication, while the other group was on placebo treatment. After some time, biopsy specimens were obtained from the clients. Results of which have shown that severity of gastric inflammation and H. pylori density have significantly decreased. Therefore, the study concluded that concurrent long term NSAID use does not affect the effectiveness of H. pylori eradication. REACTION: NSAIDs are equally known for their therapeutic effects as well as their being gastric irritants; therefore, it is easy to conclude that they may alter any other treatment regimens involving the GI tract. However, in the study conducted, simple logic was defied by evidence, thereby serving as a call that not all associations, no matter how obvious, are factual. A few factors, however, may seem to cause several discrepancies regarding uniformity of subjects. First is the type of NSAID used by the clients on a long-term basis. Second, the dosage of said drug used. Third is the duration of NSAID use (how long is long-term use). And fourth, the underlying condition to which the drug had been indicated for. On the other hand, regarding nursing practice, it was emphasized, though indirectly, that we nurses must still be vigilant with regards to NSAID use. It may be the most widely used over-the-counter drug, but it still has the capacity to afflict harm on our clients; though otherwise proven by the study, such may not be applicable in all other cases. It is therefore our responsibility to educate our client well on the drugs to be taken, for what it is to be taken, how much is to be taken, when it is to be taken, for how long it is to be taken, as well as its adverse effects and drug/food interactions.

SUMMARY: The article opens with the recognition that while catheter insertions answer a problem or two on bladder drainage, it also causes yet another problem--catheter-associated urinary tract infections (CAUTIs). CAUTIs are one of the most common nosocomial infections experienced by clients, eventually leading to prolonged hospital stays. In relation to this, the article highlights an urban hospital’s situation regarding indwelling catheters. Apparently, a significant percentage of such have involved cases wherein the catheter had been in place for more than the recommended length of time or have no standing orders or records whatsoever. With such observation, a nursing student affiliated with the hospital initiated the implementation of a chart flagging mechanism to remind health care providers to assess whether or not the indwelling catheter must be discontinued. The project was first applied on a computer-based system; however, the computer-driven awareness trigger malfunctioned and was not able to fire commands. The project was given a second try, this time through a manual approach wherein physicians and nurses alike write the reminders on the charts themselves. Such approach proved to be much effective as all clients with urinary catheters already have orders, had their urinary catheters removed after 24 hours unless otherwise ordered, and there had been a significant decrease in the incidence of CAUTIs in the institution. REACTION: The urinary catheter is indeed a double-edged sword. But though the benefits outweigh the adverse consequences, we must always be on the look out for ways to prevent such from happening. In this case, an active partnership between two of the usually opposing patient advocates and a simple revisit to the “traditional” ways of charting makes the perfect combination towards the prevention of CAUTIs. And with the project bringing about significant improvements in the well being of clients and on the health care system per se, what better way is left for us than to adopt such program in our very own health care setting. However, an important point of comparison must first be resolved, which is the fact that in the Philippine health care setting, hierarchy is very much magnified. The gap between physicians and nurses is wide enough to make those at the top deaf about what their subordinates think and have to say about such issues although they may be of much worth/substance--- a scenario so much different than in Western countries, wherein most people look at what you have to offer, where your substance equates with one’s worth. On the other hand, regarding nursing practice, though such “chart-a-reminder” mechanism is helpful, we must never forget to perform our responsibilities whenever our clients have urinary catheters. Catheter and perineal care, constant monitoring of client condition, strict observance of aseptic technique, and substantial client education are four of the primary nursing functions that may help prevent CAUTIs.