Children who are receiving oral analgesia should have pain scores documented at least 4 hourly during waking hours. Assess and document pain on activity such as physiotherapy Pain Assessment Tools Tools used for pain assessment at RCH have been selected on their validity, reliability and usability and are recognized by pain specialists to be clinically effective in assessing acute pain. All share a common numeric and recorded as values and documented on the clinical observation chart as the 5th vital sign. The importance of using the same numeric value is that the number relates to the same pain intensity in each tool.
It is medically necessary that the drug be administered by an implanted infusion pump; and The drug is medically necessary for the treatment of members see medical necessity criteria for various types of infusion pumps below ; and The infusion pump has been approved by the FDA for infusion of the particular drug that is to be administered.
Anti-Spasmodic Drugs Aetna considers an implantable infusion pump medically necessary when used to intrathecally administer anti-spasmodic drugs e.
Pathophysiological Phenomena in Nursing: Human Responses to Illness synthesizes the latest knowledge and understanding about human responses to a range of significant biological processes, symptoms, and clinical manifestations of grupobittia.com: Virginia Carrieri-Kohlman, Ada M. Lindsey, Claudia M. West. Sep 28, · This phenomenon is actually less common than the dawn phenomenon, which is an abnormal early morning increase in the blood glucose level because of natural changes in . Statement Of Phenomenon Of Interest Nursing Essay. Print Reference this. Disclaimer: Statement of phenomenon of interest. the authors have also emphasized the collaboration among the school of nursing and nursing services, increases clinical hours, and prolong post conferences were suggested by the study participants.
Member has failed a six-week trial of non-invasive methods of spasticity control, such as oral anti-spasmodic drugs, either because these methods fail to adequately control the spasticity or produce intolerable side effects; and Member has a favorable response to a trial intrathecal dosage of the anti-spasmodic drug prior to pump implantation.
Intrathecal baclofen Lioresal is considered medically necessary for the treatment of intractable spasticity caused by spinal cord disease, spinal cord injury, or multiple sclerosis and for stiff person syndrome. Baclofen is considered medically necessary for persons who require spasticity to sustain upright posture, balance in locomotion, or increased function.
A trial of oral baclofen is not a required prerequisite to intrathecal baclofen therapy in children ages 12 years old or less due to the increased risk of adverse effects from oral baclofen in this group.
The medical record should document that the member showed a favorable response to the trial dosage of the baclofen before subsequent dosages are considered medically necessary. An implanted pump for continuous fusion is considered not medically necessary for members Clinical nursing phenomenon do not respond to a mcg intrathecal bolus.
Intrathecal baclofen, when combined with other agents clonidine, hydromorphone, morphine, and zinconotideis considered experimental and investigational because the safety and effectiveness of these combinations has not been Clinical nursing phenomenon.
An implantable infusion pump is considered medically necessary when used to administer opioid drugs e. Intrahepatic Chemotherapy Infusion for Liver Metastases from Colorectal Cancer Implantable infusion pumps are considered medically necessary for administration of intrahepatic chemotherapy e.
Aetna considers "one-shot" arterial chemotherapy for persons with liver metastases from colorectal cancer experimental and investigational. Hospital discharge is dependent on resolution of pain, nausea and vomiting which complicate the procedure.
Contraindications to Implantable Infusion Pumps Implantable infusion pumps are considered not medically necessary for persons with the following contraindications to implantable infusion pumps: Members who have an active infection that may increase the risk of the implantable infusion pump; or Members whose body size is insufficient to support the weight and bulk of the device; or Members with known allergy or hypersensitivity to the drug being used e.
Implantable infusion pumps for intrahepatic administration of chemotherapy for indications other than noted above, including treatment of hepatic metastases from cancers other than colorectal cancer; or Implantable pumps for the infusion of heparin for recurrent thromboembolic disease; or Implantable pumps for the infusion of insulin to treat diabetes; or Implantable pumps for the infusion of baclofen for chronic neuropathic pain e.
External Infusion Pumps Aetna considers external infusion pumps medically necessary DME for administration of any of the following medications: Certain parenteral anticancer chemotherapy drugs e. Aetna considers external infusion pumps experimental and investigational for all other indications.
Members must meet all of the following criteria: The member has been on a program of multiple daily injections of insulin i.
Aetna considers external infusion pumps for diabetes experimental and investigational where the above-listed criteria are not met. It may be considered medically necessary for poorly controlled women with diabetes to sometimes get started on the pump pre-pregnancy or in the first trimester.
Notes on External Insulin Infusion Pumps: Aetna considers a programmable disposable external insulin infusion pump e. Documentation of continued medical necessity of the external insulin infusion pump requires that the member be seen and evaluated by the treating physician at least once every 6 months.
External subcutaneous insulin infusion pumps are only considered medically necessary for persons who have demonstrated ability and commitment to comply with a regimen of pump care, frequent self-monitoring of blood glucose, and careful attention to diet and exercise.
Some external insulin infusion pumps e. These insulin pump features, when present, are considered integral to the external insulin infusion pump and blood glucose monitor.
The pump must be ordered by and follow-up care of the member must be managed by a physician with experience managing persons with insulin infusion pumps and who works closely with a team including nurses, diabetic educators, and dieticians who are knowledgeable in the use of insulin infusion pumps.
Such supplies include those drugs and biologicals that must be put directly into the equipment in order to achieve the therapeutic benefit of the DME or to assure the proper functioning of the equipment.
Replacement Pumps Replacement of a functioning insulin pump with an insulin pump with wireless communication to a glucose monitor is considered not medically necessary as such wireless communication has not been shown to improve clinical outcomes Replacement of an external insulin pump is considered medically necessary for children who require a larger insulin reservoir.
The replacement of infusion pumps that are out of warranty, are malfunctioning, and cannot be refurbished is considered medically necessary. Baclofen Lioresal is a derivative of gamma aminobutyric acid GABA that acts specifically at the spinal end of the upper motor neurons to cause muscle relaxation.
Intrathecal baclofen may be indicated for patients with severe chronic spasticity of spinal cord origin. An implantable infusion pump is required for the administration of intrathecal baclofen. Intrathecal baclofen therapy is indicated for persons with severe chronic spasticity of spinal cord origin including multiple sclerosis that is refractory to oral baclofen or where there are unacceptable side effects from oral baclofen at the effective dose.
The patient should be shown to respond to a single intrathecal bolus dose of up to mcgs of baclofen. A positive response is defined as an average two-point drop on an objective muscle tone or spasm screening system e. According to available guidelines, intrathecal baclofen therapy is not considered appropriate if the patient has a history of hypersensitivity to Lioresal, is pregnant or has inadequate birth control, has severely impaired renal function, has severe hepatic or gastrointestinal disease, or has cerebral lesions as the source of spasticity.
The result is facilitation of daily caring, and symptomatic relief from painful spasm. With increasing experience of ITB use, novel applications and indications are emerging.Jan 21, · Nursing researchers have come up with an answer for health care systems and professionals struggling with how to most effectively adopt evidence-based practice in their clinical .
Perfectionism, the impostor phenomenon and psychological adjustment in medical, dental, nursing and pharmacy students. Workplace incivility (WI) continues to hamper professional nursing practice, patient care, and the health of nurses who encounter this phenomenon in their workplace.
The treatment of this phenomenon usually involves lowering insulin dosage prior to sleep. Another disorder similar to the Somogyi Effect is known as the Dawn Phenomenon.
Although most diabetics are affected by this disorder, it seems to occur more often in pubescent adolescents. A Review of Leadership in Nursing related to Clinical Nursing Practice Abstract: Leadership in Nursing has become a major issue in health care settings and in management.
Leadership in nursing is a wide in nursing field which includes different aspects. Research, evidence-based practice (EBP), and quality improvement support the three main goals of the Magnet Recognition Program ® and the Magnet Model component of new knowledge, innovation, and improvements.
The three main goals of the Magnet Recognition Program are to: 1) Promote quality in a setting that supports professional practice 2) Identify excellence in the delivery of nursing.