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Fall 2015, Volume 6, Issue 6
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Get the EBSCO Health Nursing Newsletter!
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Recently Updated Topics
Skin Care in the NewbornEarly Mobilization of Patients in the Intensive Care Unit (ICU)Gestational Diabetes Mellitus: DietPostpartum Hemorrhage Cystic Fibrosis: Newborn screening
And much more!
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Nursing Reference Center Peer Review
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Welcome!
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Welcome back to EBSCO Health's free evidence-based nursing newsletter. We will periodically send news on the latest evidence in nursing. Please share this with your colleagues, students, practitioners and others who would benefit from this information.
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Nursing Reference Center Plus in Daily Practice
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Patient Education: Encouraging Adherence to Treatment for Tuberculosis
Ms. W is a 60-year-old patient who was recently diagnosed with tuberculosis. The nurse wants to learn more about encouraging adherence to treatment for tuberculosis in order to facilitate Ms. W's recovery, so she consults Nursing Reference Center Plus, keying in the words "patient education," "tuberculosis" and "treatment." She retrieves the nursing practice and skill "Patient Education: Encouraging Adherence to Treatment for Tuberculosis."
The nurse learns about how to encourage adherence to treatment for tuberculosis, including assessing the patient for readiness to learn, preferred learning style and learning barriers. Based on the information in the nursing practice and skill, the nurse implements the patient teaching plan and evaluates the patient's response to teaching.
Note: The above-referenced nursing practice and skill and accompanying skill competency checklist are freely accessible to all readers of the EBSCO Health Nursing Newsletter.
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Quick Overview
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Caring for Patients with Cannabinoid Hyperemesis Syndrome
Cannabinoid hyperemesis syndrome (CHS) is a disorder that is characterized by cyclic severe nausea and intractable vomiting from chronic, heavy and long-term use of cannabis. Temporary relief of symptoms can be achieved by taking a hot bath or shower, and CHS can lead to habitual and compulsive bathing habits. Persons with CHS require frequent hospitalization for hydration and antiemetics.
Cannabis is often used for the treatment of nausea and cyclic vomiting syndromes (CVS); the exact mechanism of action for its antiemetic effects is not completely understood. It is believed that the anti-nausea effect is related to stimulation of the cannabinoid CB1 receptors in the brain. Delta-9-tetrahydrocannabinol (THC) also acts on CB1 receptors in the gut. The paradoxic link and exact pathogenesis of CHS is not known. Scientists have proposed that a prolonged cannabinoid half-life caused by fat solubility (increasing cannabinoid toxicity), delayed gastric emptying from CB1 receptor stimulation, and thermoregulatory disturbances in the limbic system are possible causes of CHS. The relief of symptoms with hot baths or showers has been proposed to occur as a result of the CB1 receptors near the thermoregulatory center of the hypothalamus-pituitary-adrenal axis, causing chronic CB1 hypothalamic stimulation that is counteracted by hot water.
Diagnosis is difficult because CHS is underrecognized and patients are often hesitant to report a history of cannabis use. Some experts define diagnostic criteria for CHS as weekly cannabis use of less than a year with severe cyclic nausea and vomiting, epigastric or periumbilical abdominal pain, and relief of signs and symptoms with hot showers or baths and with cannabis cessation. Although there are no specific laboratory or other diagnostic studies for the diagnosis of CHS, tests are performed to rule out underlying gastrointestinal disorders and confirm cannabis use.
Treatment of CHS is supportive with I.V. hydration and antiemetics. Some patients do not respond to antiemetics, and only bathing in hot water will relieve nausea and vomiting. Prognosis is excellent if cannabis use is discontinued.
Please log in to your Nursing Reference Center or Nursing Reference Center Plus subscription to read the quick lesson on "Cannabinoid Hyperemesis Syndrome," which includes additional information about assessment and treatment of this condition.
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Evidence-Based Content Update
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Recently, the evidence-based care sheet "Diabetes Mellitus, Type 1, in Adolescents: Psychological Factors" was revised following review under the Systematic Literature Surveillance Program. Among new information of value to nursing practice was a systematic review regarding psychological factors in adolescents with type 1 diabetes mellitus (DM1).
Investigators evaluating depression and adherence to treatment in diabetic children and adolescents concluded that psychological maladjustment in adolescents with DM1 is particularly problematic because it is associated with poor metabolic control and, therefore, diabetes-related complications. Mood disorders, including depression and dysthymia, are the most common psychological diagnoses in adolescents with DM1.
We invite you to log in to Nursing Reference Center or Nursing Reference Center Plus to read updated content as it becomes available.
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