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March 2012, Vol. 23, No. 1
The Publication of the Florida Association of Neonatal Nurse Practitioners
FANNPNEWS
HIGHLIGHTED: HYPOTHYROIDISM IN THE PRETERM INFANT
PLUS: POCKET NOTEBOOK • LEGISLATIVE UPDATE • EDUCATIONAL OFFERINGS • BRING IT ON • LETTER FROM THE PRESIDENT • NEW BRAG BOARD • CONFERENCE UPDATE • KIM NOLAN SPIRIT AWARD RECIPIENT • CALL FOR POSTER AND PODIUM SUBMISSIONS
Letter from the PresidentI hope everyone had a
spectacular Holiday season and memorable celebration ringing in the New Year! Welcome to 2012! Your FANNP Board of Directors, Committees and Conference Planners have already been hard at work creating new and exciting opportunities to maximize your FANNP membership. We are currently updating our website with a “members only” section that will provide many new resources including a Mentorship Program, online voting, and eventually CEU offerings. Also, we are very excited to announce a “Call for Abstracts” for this year’s conference! Please see the details in the conference section of this newsletter. We are actively in the process of increasing your membership benefits and strongly encourage each of you to become involved by participating on committees, creating ideas and implementing ways to improve our organization.
Please SAVE THE DATES for our Annual FANNP Symposium October 16-20, 2012 at the Sheraton Sand Key Resort in Clearwater, FL. Now is time to spread the word to all your NNP colleagues, students and faculty as this year’s conference is going to be fantastic! I am always amazed at how our conference planners continue to “out-do” themselves every year! Registration will begin soon, so please stay tuned and check our website often (WWW.FANNP.ORG). You can also follow us on our FANNP Facebook group page for continual updates.
I am so excited for the things to come over the next several months and really looking forward to seeing everyone in October! Please stay safe, strong and full of spirit… tiny lives depend on us.
Terri Marin, MSN, NNP-BCPresident
Hypothyroidismin the Preterm Infant
Dinorah Rodriguez-Warren, MSN, NNP-BC, RNC
Preterm infants are at an increased risk for neurodevelopmental problems, so it is important for proper identification and treatment of
for normal metabolism and growth, with a strong contribution to brain development. Congenital hypothyroidism is inadequate thyroid hormone production in newborn infants.
PathophysiologyHypothyroidism can be due to thyroid dysgenesis,
dyshormoneogenesis-a serious error in thyroid hormone synthesis or hypopituitarism (Levy, 2000). According to Fisher’s (1999) article, the thyroid’s system development is divided into five phases: embryogenesis, hypothalamic, pituitary thyroid system maturation, thyroid hormone metabolism and effects, and maturation of hypothalamic pituitary system. By the twelfth week of gestation the anatomical structure is complete including the hypothalamus, pituitary and thyroid
releasing hormone content and thyroid stimulating hormone increases progressively from mid gestation
begins to function during second trimester with the volume increasing 8 to 10 folds between 30 to 42 weeks gestation. During this time there is an increase in iodine, thyroglobulin and iodothyronine (T4 and T3) content. It
Hypothyroidism continues on page 3
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2012 FANNP Conference Planning Update
BOARD OF DIRECTORS
Terri Marin, Peachtree City, GAPresident
Leslie Parker, Gainesville, FLPresident Elect
Ruth Bartelson, Winter Park, FLPast President
Kim Irvine, Land O’Lakes, FLSecretary
Sheryl Montrowl, Gainsville, FLTreasurer
NEWSLETTER EDITOR
Tiffany Gwartney
MEMBERS AT LARGE
Ashley Darcy
Jacqui Hoffman
Mary Kraus
Diane McNerney
1-800-74-FANNP • www.FANNP.org P.O. Box 14572, St. Petersburg, FL 33733-4572
THE FLORIDA ASSOCIATION OF NEONATAL NURSE PRACTITIONERS
Hello everyone! I think we have all recovered from the holidays and the Planning Committee has been very busy preparing for the 23rd Neonatal Nurse Practitioner Symposium: Clinical Conference and Review. The committee has proposed many interesting topics and speakers in addition to the tried and true Review Track speakers and content. We are working on an interesting presentation for the Roundtable which will invite discussion along with a panel and up to the minute presentations for the Advanced Track. Oh yes, and don’t forget the fun of renewing old friendships and making new ones and of course relaxing at the beach! Hope to see you all there, and don’t forget to tell your friends!
Mary Kraus, MSN, NNP-BCFANNP Conference Planning Chair
FANNP is very fortunate to be associated with and supported by a multitude of talented and professional Practitioners who continually grow and develop themselves. Do YOU have an exciting professional accomplishment you would like to share with us? Beginning with our next newsletter, we would like to publish a section called “The Brag Board” to call attention to achievements
Post Your Achievementon FANNP’s Brag Board
such as acceptance by a professional organization for poster presentations, completing an MSN, DNP or PhD program, passing the NCC exam, acceptance to be published in a professional publication, or even survival of one’s dissertation defense. Please email [email protected] with submissions.
Thank you!
Poster & Podium Presentation Call for Submissions
FANNP is seeking abstracts for posters and podium presentations for the annual FANNP’s National Neonatal Nurse Practitioner Symposium on October 16 – 20, 2012. The planning committee invites submissions by members and non-members and participation is open to health professionals whose specialty has a focus on the Neonatal Population (this includes but is not limited to NNPs, RNs, Clinical Nurse Specialists, & Neonatologists). We invite colleagues to share their expertise in one of the following categories:
n Original Research n Innovations in Practice or Educationn Patient Safetyn Quality Improvement and Benchmarking Initiativesn Case Studies
SUBMISSION DEADLINE:June 1, 2012
NOTIFICATION OF ACCEPTANCE:July 1, 2012
Podium presenters will receive a $75 honorarium.
Please visit www.FANNP.org for full submission guidelines and details.
Student Submissions welcome!
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HYPOTHYROIDISM Continued from page 1
is reserved and increased 3 to 4 fold, in preparation for birth. The thyroid system has a negative feedback system
that begins between 20 to 24 weeks gestation and matures during the third trimester. This system controls the thyroid stimulating hormone secretion. The thyroid function in the very low birth-weight is characterized as an obtunded TSH surge at delivery, low circulating levels of T4 and free T4, low levels of TSH (Fisher, 2007).
In Fisher (2007) the author further explains transient hypothyroxinemia of prematurity (THOP). This event occurs in the very low birth-weight infants and it is associated with low serum and total T4, T3, TBG and TSH and variable levels on free T4 and reverse T3. The impact this may have can include an increase in infections, patent ductus arteriosus, cranial ultrasound changes, hypoxia, and necrotizing enterocolitis (Fisher, 2007). There also are studies that indicate that during THOP, there is an association with neurodevelopmental problems in the preterm infant (Van Wassenaer, Kok, Briet, & Pijning, 1999).
IncidencesThe incidence of congenital hypothyroidism is
approximately 1 per 4000 births in the United States, detected through state newborn screening (Postellon, 2007). Frequency of incidence is typically more females than males by a 2:1 ratio. Congenital hypothyroidism is more common in Caucasians than African Americans by 5:1. It can be 40% higher among Hispanic populations than Caucasians. Native American and Asian populations have the highest incidence (Postellon).
Clinical PresentationClinical signs may be subtle. Infants with hypothyroidism
may exhibit many disparate symptoms. Feeding problems, lethargy, prolonged postnatal jaundice, and constipation are common. Typical characteristics may include enlarged protruding tongue, hoarse cry, protruding abdomen with an umbilical hernia, cold mottled skin, sluggish reflexes, patent posterior fontanelle with widely spread cranial sutures, and delayed skeletal maturation for gestational age.
Diagnostic StudiesIn the United States there has been mandated screening
of newborns for hypothyroidism. Other countries have also established programs for identifying hypothyroidism in
the infant. Most programs utilize a special filter paper spot technique (Fanaroff & Martin, 2002). False positive as well as false negative results are possible with this screening. When presumptive positive screens are reported, appropriate actions from the medical team is required. eMedicine’s web page provided the most recent labs and imaging recommendation and they are as follows:
Lab Studies• Diagnosis of primary hypothyroidism is confirmed by
demonstrating decreased levels of serum thyroid hormone (total or free T4) and elevated levels of TSH.
• TBG levels can be measured in infants with suspected TBG deficiency. This condition does not require treatment, but appropriate diagnosis and parental counseling can avoid later confusion and misdiagnosis.
• Routine laboratory testing in patients with TBG deficiency shows a low total T4 level and a TSH level within the reference range. Free T4 and T3 levels are within the reference range.
Imaging Studies• Thyroid scanning (using technetium-99m or iodine-123)
may be useful in defining the cause of hypothyroidism and may aid in genetic counseling. No radionuclide uptake suggests sporadic athyrotic hypothyroidism. Such scans can also demonstrate the presence of an ectopic thyroid, such as a lingual or sublingual gland, which is also sporadic. The presence of a bi-lobed thyroid in the appropriate position would suggest an inborn error of thyroid hormone production.
• Ultrasonography may be a reasonable alternative to scintigraphy but may fail to reveal some ectopic glands.
• A lateral radiograph of the knee may be obtained to look for the distal femoral epiphysis. This ossification center appears at about 36 weeks’ gestation. Its absence in a term or post term infant indicates prenatal effects of hypothyroidism, which is a poor prognostic sign.
Other Tests• Neonatal hypothyroidism screening, using TSH levels,
has proven helpful in countries with mild to no iodine deficiency. It has not been found useful in countries
Hypothyroidism continues on page 4
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HYPOTHYROIDISM Continued from page 3
with moderate-to-severe levels of iodine deficiency disorders (IDD) because resources are insufficient to deal with the problem, and efforts here should be made to supply sufficient iodine to the population as a whole.
The initial state screen for this infant revealed a low T4 and normal TSH. After receiving this information subsequent evaluation needs to include free T4, serum T4, TSH and reverse T3 levels. Endocrinology consultation should also be considered. To determine congenital hypothyroidism, the value of TSH is typically normal; T4 and free T4 are low normal (Fanaroff & Martin, 2002). Infants experiencing respiratory distress often demonstrate euthyroid sick syndrome or non-thyroidal illness, which may affect thyroid function test results but does not produce hypothyroidism. This is typically seen with results of low or normal serum T4, normal free T4, very low total T3, elevated reverse T3 and normal TSH. Shortly after birth hyperactivity of the thyroid function occurs, reaching a peak level at 30 minutes of age (Fanaroff & Martin). This persists during the next 6 to 24 hours after birth. In response to the TSH surge, T4, FT4 and T3 increase dramatically reaching a peak by 48hrs of age, thus causing the neonate to experience a physiologic hyperthyroid state during the first several days of life. Absence of this hyperthyroid state can indicate congenital hypothyroidism. In full term infants the hormone concentration remains elevated for 2 weeks, where as with a preterm infant the levels decline for a week then increase gradually, remaining lower than that of a full term (Fanaroff & Martin).
TreatmentThe drug of choice is Synthyroid. The initial dose
according to Young and Mangum (2007) is 10-14mcg/kg/dose p.o. q24h with adjustment in 12.5 mcg increments. IV dose is 5-8mcg/kg/dose q24h. It is important to monitor T4, T3 and TSH levels after the first 2 weeks. Serum T4 and TSH surveillance will need to be repeated in 2 weeks and every 1 to 2 months, subsequently. It is important to stress to the parents that medication is long-term and must be given consistently. They need to be educated on monitoring for lethargy, poor feeding, constipation, and intermittent cyanosis for these are signs of hypothyroidism. They also need to be alert for hyperactivity, altered sleep pattern, tachycardia, tachypnea, fever, growth, and development; signs
of hyperthyroidism. Prolonged over-treatment can produce premature craniosynostosis and acceleration of bone age.
PrognosisOnce treatment is instituted all clinical physical
manifestations of hypothyroidism typically disappear. The prognosis for normal mental and neurological performance is less certain. Fanaroff and Martin (2002) state there have been some reports of low to normal IQ subsequent to severe hypothyroidism at birth. Follow up studies of patients identified by neonatal screening and treated within the first few weeks of life indicated that neurologic function was normal with a few minor exceptions (Fanaroff & Martin, 2002).
Patient EducationIt is important to educate the parents of infants with
this disorder and the problems associated with no treatment or inadequate treatment. Instructions must be given on administering medication appropriately, maintaining follow up appointments with the pediatrician, and attending appropriate developmental evaluation and intervention clinics. Parents can be reassured that with vigilance and treatment the child enjoy optimal growth and development.
ReferencesFanaroff, A., & Martin, R. (2002). Neonatal-perinatal medicine: diseases of the fetus and newborn (7th ed.). Philadelphia: Mosby.
Fisher, D. (1999). Hypothyroxinemia in premature infants: is thyroxine treatment necessary? Thyroid, 9(7), 715-720.
Fisher, D. (2007). Thyroid function and dysfunction in premature infants. Pediatric Endocrinology, 4, 317-328.
Levy, R. (2000). Hypothyroidism in infancy and childhood. Retrieved April 1, 2008, from Thyroid Foundation of Canada Web Site: http://www.thyroid.ca/article/enge11e.html
Postellon, D. (2007, November). Congenital Hypothyroidism. Retrieved April 1, 2001, from WebMD Web Site: http://www.emedicine.com/PED/topic501.htm
Van Wassenaer, A., Kok, J., Briet, J., & Pijning, A. (1999). Thyroid function in very preterm newborn; Possible implications. Seminars in Neonatology, 9, 85-91.
Young, T., & Mangum, B. (2007). NeoFax (20th ed.). Montvale, NJ: Thomson Healthcare.
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2011 Kim Nolan Spirit Award Recipient: Marylee Kraus!
Congratulations to Marylee Kraus, the 2011 Kim Nolan Spirit Award recipient! The Kim Nolan Spirit Award is presented to a FANNP member who exemplifies the “can-do” attitude and commitment to service that Kim possessed.
Mary Kraus has been involved with FANNP for many years and has served as president, past president, president-elect, and board member at large. Currently Mary is the coordinator of the annual FANNP Symposium. Mary works tirelessly to organize the many planning committees in order to put on a quality educational program. Every morning during the conference, Mary is up early to ensure that the day goes smoothly. She consistently welcomes attendees with a smile and engages others while participating in the conference events. You can often see Mary dancing the night away during the annual beach parties.
Mary has worked for the Center for Neonatal Care at Disney Pavilion at Florida Children’s Hospital in Orlando for 16 years. She is a senior member of the NNP group and is a preceptor and role model. Mary is involved in a number of hospital committees and represents the NNP group well. She is also active in her church and is involved in the church’s medical outreach program.
Mary joins a well respected list of colleagues who are past recipients of the award:
2002 Pam Laferriere2003 Madge Buus-Frank2004 Leslie Parker2005 Kim Irvine2006 Karen Theobald2007 Ruth Bartelson2008 Cheryl Robinson2009 Gail Harris
Please join FANNP in congratulating Mary on this prestigious award!
Respectfully Submitted,Paula Timoney, DNP, ARNP, NNP-BC
Calling for Research Proposals... FANNP Grants Available
The FANNP has research grant money available to qualified members! The objective of the grant program is to encourage Neonatal Nurse Practitioners to develop and carry out research projects in the area of neonatal care. These grants will help defray research expenses. Research in the role of the advanced neonatal nurse practitioner is encouraged.
Each year FANNP sets aside funds for the support of research projects. Award amount will vary based on number of applications received each year. Each applicant will be awarded one grant per project, and must be the principal investigator. Novice researchers as well as those with extensive research experience are encouraged to apply. There is no deadline for grant submission; we accept applications year round and you will be notified via mail of reward amount. Grant recipients will be announced at our annual Business Meeting held during our Annual Symposium each year in October.
FANNP research grant applications can be obtained by contacting the FANNP through the website at [email protected]
Ashley Darcy, PhD, RN, NNP-BCFANNP Research Chair
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FANNP Scholarship Funds Available!FANNP was founded to support the educational advancement of
Neonatal Nurse Practitioners and remains committed to promoting education for NNPs.
Each year on December 31st, at least 10% of the available monies in the FANNP general operating budget are put in a scholarship fund.
FANNP is proud to be able to award scholarships to nurses and NNPs continuing their educational pursuits in the field of neonatal health care.
Three scholarships were awarded in 2011 to Scarlette DeLeon, from Miami, Florida, Leigh Ann Cates from Sugar Land, Texas and Melanie Ellis from Brandon, Mississippi.
FANNP would like to be able to award more scholarships in 2012, but we can only award scholarships if we receive applications.
Are You, or is Someone You Know, Eligible for a 2012 FANNP Scholarship?
FANNP members who attend an educational program leading to a degree related to the health care field between September 15, 2011 and September 15, 2012 are eligible for a 2012 scholarship.
FANNP Scholarship Eligibility Criteria:
1. Scholarship applicants must be FANNP members.
• All members, student members and associate members are eligible.
• Priority for scholarship award will be given to members, followed by student members and then associate members.
• Priority for scholarship award will be based on length of membership and service to FANNP.
2. Scholarship applicants must be a licensed RN, ARNP, NNP or equivalent.
• Preference will be given to currently licensed certificate NNPs working towards a NNP degree.
3. Scholarship applicants must attend an educational program leading to a degree related to the health care field
during the application period.
• Preference will be given to those working towards a degree in neonatal health care.
• The application period for the 2012 scholarship is September 15, 2011 to September 15, 2012. (i.e. To be eligible for a 2012 scholarship you must have attended classes sometime between September 15, 2011 and September 15, 2012.)
• An applicant may receive a maximum of two scholarship awards for each degree sought.
Applicants are asked to include a 3-5 page submission for publication in the FANNP newsletter as part of the application process. The submission can be an original article, a paper you submitted for coursework, a case study, best practice clinical update or a literature review.
The completed scholarship application packet must be postmarked by September 15, 2012.
For questions, more information or to obtain an application please contact FANNP via email at: [email protected].
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POCKET NOTEBOOK#Diane McNerney DNP, MS, NNP-BCBasics of ECMO
Part 2 of a 4 Part Series
1. Definition — Extracorporeal Membrane Oxygenation (ECMO) is a therapy for hypoxic respiratory failure due to reversible pulmonary disease in neonates. It allows time for intrinsic recovery of the lungs and heart.
2. Pulmonary System ManagementECMO is used temporarily while awaiting pulmonary recovery
3. Cardiovascular System Management• Systemic perfusion and intravascular volume should be maintained. • Volume status can be assessed clinically by urine output, physical signs of perfusion and by measuring the central venous pressure and the mean arterial blood pressure.
• Cardiac output can be enhanced with inotropic agents. Echocardiography should be performed to exclude any major congenital heart anomaly that may require
• Immediate intervention other than ECMO. Central Nervous System management- 4. Central Nervous System (CNS)
• Head ultrasonography should be performed before beginning ECMO in a neonate.• CNS complications are the most serious and are primarily related to the degree of hypoxia and
acidosis.• Serial head ultrasonography may be needed on a daily basis, especially after any major event.• Aggressive treatment is recommended in neonates with seizures.
5. Renal System Management• ECMO triggers an acute inflammatory-like reaction. • Oliguria and acute tubular necrosis associated with capillary leakage and intravascular volume
depletion are commonly seen in the first 24-248 hrs. • Diuresis, which usually begins within 48 hours, is frequently one of the earliest signs of recovery. • Diuretics are often required to reduce edema, if oliguria persists for 48-72 hours, • If renal failure persists, hemofiltration or hemodialysis filters may be added to the circuit.
6. Hematologic Considerations• The neonate’s hemoglobin should be maintained at 12-15 g/dL using packed red blood cells (PRBC),
to optimize oxygen delivery, • As a result of platelet consumption during ECMO, platelet transfusions are required to maintain platelet
counts above 100,000/mcL.• To avoid bleeding complications activated clotting time (ACT) should be maintained at 180-240
seconds 7. Infection Control
• Strict aseptic precautions are required. • The circuit at least once a week, to monitor for infection. • Other appropriate cultures (eg, fungal and viral) should be obtained as needed.
8. Fluids, Electrolytes, and Nutrition• Patients on ECMO require close monitoring of fluids and electrolytes.• The high-energy requirements should be met using transparenteral nutrition techniques.• The patient’s weight increases in the first 1-3 days on ECMO because of fluid retention.
References:
Bulas D, Glass P. (2006). Neonatal ECMO: Neuroimaging and neurodevelopmental outcome. Seminars in Perinatology; 29(1):58-65.
Vidmar, I., Primozic, J., Kalan, G., and Grosek, S. (2008). Extracorporeal membranous oxygenation (ECMO) in neonates and children experiences of a multidisciplinary paediatric intensive care unit. Retrieved on 11/5/2011 www.signavitae.com
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Nominate someone you know today!Kim Nolan Spirit AwardCharacteristics: Can-do attitude; Service to family, work, & community
Purpose:• To honor the contribution that Kim Nolan, founding
member, made to FANNP and her community.• To recognize an NNP who exemplifies the characteristics
of Kim.
Eligibility Requirements:• A nominee must be a member of FANNP.• A nominee may be a practicing NNP, a retired NNP, or a
NNP student.
Selection Criteria:• A nominee should demonstrate service to his/her
community or professional organization.• A nominee should possess excellent communication skills.• A nominee should demonstrate positive “can-do” behavior
in daily activities.
Nominee Characteristics:• Enthusiastic;• Family oriented;• Role model/mentor;• Caring, nonjudgmental, respectful.
Selection Process:• Nominations will be accepted from any FANNP member.• Blinded applications will be reviewed by the Spirit Award
Committee members.• Once selected, the award recipient will receive written
notification of selection.
Award Recognition:The recipient will receive the following:• Complimentary conference registration and
accommodations for this or next year’s NNP Symposium in October;
• One year waiver of FANNP dues;• Recognition in the newsletter and on the Website;• A certificate suitable for framing;• A Lladro statue
Get Kim Nolan Spirit Award nomination forms on the web at FANNP.org
Florida Nurses Association Raises Funds for Political Action
In a letter to Florida Nurses Association members, Bonnie Sklaren, Chair of the Political Action Committee writes:
This is going to be a busy year politically for all of us. First, we have a legislative session starting two months earlier than usual. Once session is over in March, serious campaigning will begin. EVERY seat in the House and the Senate will open for election.
Once session is over and candidates have filed for election, it is going to be VERY important to have each of you contact the candidates, discuss our legislative agenda with them, and provide feedback to the PAC. This will be of utmost help in determining who we endorse. For a copy of FNA’s 2011-2012 Legislative Platform, please visit the FNA website at www.floridanurse.org and click on Legislative Activities then double click on the U.S. Capitol Icon and you will enter Capitol Wiz.
To that end, it takes money to support our efforts. We have a fundraising campaign, “$20 FOR 2012.”If each of you could donate $20.00 for the effort, that would give us a great head start, but of course, any amount (more or less) would be greatly appreciated and put to good use.
Thank you all for all you have done and will do. Please keep us updated on your activities and let us know what we can do to help you help us.
You may mail contributions to: Florida Nurses Political Action Committee, Post Office Box 536985, Orlando, Florida 32753
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8th Annual Highlights Newborn Intensive Care ConferenceJanuary 19-20, 2012Norris Conference Center – City CenterHouston, Texaswww.norriscenters.com/houstoncitycenter
NEO – The Conference for NeonatologyFebruary 22, 2012 Continuous Quality Improvement Pre-ConferenceFebruary 23- 27, 2012 Walt Disney World Dolphin Orlando, Floridawww.neoconference.com
Texas Association of Neonatal Nurse Practitioners 8th Annual ConferenceMarch 29-31, 2012Sheraton GunterSan Antonio, Texaswww.txannp.org/2012
9th National Advanced Practice Neonatal Nursing Conference“Buiding the Evidence – Supporting the Practice”April 19-21, 2012Hyatt Regency HotelNew Orleans, Louisianawww.academyonline
First Coast Neonatal SymposiumApril 24-27, 2012World Gulf Village Renissance ResortSt. Augustine, Floridawww.neonatalsymposium.com
15th Annual Advanced Practice Nursing ForumShow Me the Evidence: Celebrating 15 Years of Excellence in Neonatal Advanced Practice NursingMay 30-June 2, 2012Omni Shoreham HotelWashington, D.C.www.CHADKIDS.ORG/APNFORUM
Save
the
date
!
23rd Annual Neonatal Nurse Practitioner Symposium: Clinical Update and Review
FANNP’S 23rd Annual Neonatal Nurse Practitioner Symposium: Clinical Update and ReviewOctober 16-20, 2012Sheraton Sand Key ResortClearwater Beach, Floridawww.fannp.org
Hot Topics in NeonatologyDecember 3-4, 2012Omni Shoreham Hotel, Washington, DCwww.hottopics.org
2012 Annual Vermont Oxford Meeting & 13th Quality ConferenceOmni Shoreham Hotel, December , 2012Washington, DCwww.vtoxford.org
EDUCATIONAL OFFERINGS
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LegislativeUpdate
Diana Morgan-Fuchs, ARNP, NNP-BCS
Currently, there are many legislative topics involving Nursing. These topics extend from the International platform to the State level. They encompass topics that have direct impacts on nursing including the educational aspect with regard to DNP programs, and funding for hospitals at the State level.
On February 7, 2012, the CDC published a statement regarding their recommendations for the Influenza Antiviral Medications. The CDC reviewed randomized clinical trials, which raised questions regarding the value of antiviral medications for the prevention and treatment of influenza. The CDC remains committed to its previous recommendations. To review the details of the investigation, go to http://www.cdc.gov/media/haveyouheard/stories/Influenza_antiviral.html
The CDC’s recent statement on the Influenza antiviral medication raises new issues concerning nurses and nursing care. The National Vaccine Advisory Committee and the American Nurses Association (ANA) are combining efforts to provide a framework to achieve a 90% influenza vaccination rate of healthcare personnel. The framework includes an education program, providing free vaccines to personnel, and encouraging facilities to have a comprehensive infection programs. The ANA framework is not currently available however; one
can remain informed via visiting the ANA and/or State Nursing Organization websites such as the Florida Nurses Association (FNA) for future statements. If approved, all healthcare personnel would be federally mandated to receive vaccination. In the meantime, some facilities are implementing strict guidelines regarding vaccinating healthcare personnel. The basic principle is that healthcare personnel are offered vaccination free of charge. If healthcare personnel choose not to receive the vaccine, a mask must be worn during all direct patient care. An additional resource regarding this topic is George Washington University who released a model of a state law mandating vaccination of healthcare personnel.
The American Nurses Association (ANA) has been actively following the case of Amanda Trujillo, MSN and the Arizona Board of Nursing. The Case of Amanda Trujillo is about patient advocacy. Mrs. Trujillo supported her patient’s right to seek additional information from hospice care prior to transplant surgery. Consequently, the patient refused transplantation and Amanda Trujillo was terminated for her actions. She is currently undergoing investigation by the Arizona Board of Nursing to evaluate whether she practiced outside the scope of her profession. The ANA continues to strongly support nurses as well as their rights and responsibility to engage in patient education and advocacy.
The ANA is hopeful that the Arizona Board of Nursing will make a non-biased judgment, however it cautions nurses to know their State Nursing Practices. The ANA is a great resource for documents regarding nursing issues such as the Code of Ethics for Nurses and Nursing: Scope and Standards of Practice. To review this document or the many resources available on the ANA’s website, visit www.nursingworld.org.
According to the February update on the APRN Consensus Model, DNP graduates may now sit for an accredited certification examination. The American Board of Comprehensive Care (ABCC) located at the Columbia University School of Nursing has been awarded accreditation of the certification examination by the National Commission for Certifying Agencies (NCAA). The ABCC developed the certification examination in collaboration with the test service of the National Board of Medical Examiners (NBME) for graduates of DNP programs. The link to the press release is available at http://www.newswise.com/articles/cuson-led-american-board-of-comprehensive-care-receives-national-accreditation.
On the Florida State level of legislation, there is a plea to contact your local legislator regarding the current proposal by the Governor to cut $2.1 billion in health care dollars, which would directly impact the Medicaid program and indirectly effect hospitals. The FNA and the Florida Hospital Association are combining efforts to lobby against the proposal. The details of the Florida legislation sessions can be viewed in a video medium by simply going to www.Floridanurse.org or http://www.associationstudios.com/Publisher/Preview_Video.aspx?VideoId=3166 to watch a video from Alisa Snow, FNA chief lobbyist.
Bring It OnAnswers(Questions on page 12)
1. Answer is A;
35% of birth asphyxiated infants.
50% of infants of insulin depen-dent diabetic mothers (IDDM)
30% of preterm infants (<37 weeks gestation)
90% of VLBW infants (<1500 grams)Several factors appear to be involved in the development of hypocalcemia in the first few days of life: abrupt termination of maternal calcium supply, tempo-rary functional hypoparathyroid-ism (IDM), increased calcitonin concentrations (asphyxia, preterm infants), and 1,25-dihydroxyvita-min D resistance (VLBW infants).
2. Answer is C; Although gastro-esophageal reflux is common and gastric capacity is small, the main limiting factor in enteral feeds for premature infants is gastrointesti-nal motility.
3. Answer is B; Plasma glucose of the fetus in normal pregnancy will be approximately 70-80% that of the mother. Glucose is trans-ferred along a downward concen-tration that is not saturated even at high maternal levels. Thus, fetal glucose levels can become excessive to requirements of energy production and lead to abnormal deposition of glycogen and triglyceride levels.
11
Linkous & Associates, LLC800.738.NNPs (6677)
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Neonatal Nurse Practitioner Tallahassee Memorial HealthCare
This newly created position is seeking a self-starter to work directly with RegisteredNurses, Neonatal Nurse Practitioners, Neonatologists, and Respiratory Therapists to provide safe, quality care. The 32-bed NICU is part of the Florida Neurological Network led by Shands Hospital in Gainesville. For additional information on this opportunity, please contact George Bruno at 850-431-5134 or [email protected]
Advertising in FANNP Newsletters
Acceptance of Advertising
• Classified ads only• Link on website for direct submission• All advertisements are subject to
review and approval by the Editor
Ad Options
May run ad in one newsletter or all year – 4 total newsletters, March, June, September and December.
Cost
• $50.00/ad each newsletter or $150.00 for all 4 newsletters. No cash discounts.
• Payment must be received in full prior to the scheduled close date for the quarterly issue.
• Payments can be made though paypal on the FANNP website
Format
• The classified ad section of the newsletter will be limited to 1 page only with approximately 30 ads per page
• Ads will be processed on a first come first serve basis
Closing Dates for Space and Advertising Materials
• June, 2012 – ads must be received by May 11, 2012, and paid in full
• September, 2012 – ads must be received by August 17, 2012, and paid in full
FANNPP.O. Box 14572St. Petersburg, FL 33733-4572
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Bring it On… Practice Questions to Prepare for the NNP Certification Exam
Answers on page 11
1. Which of the following infants would be most likely to develop hypocalcemia:
A. Preterm 1000-gram infant.
B. Infant of a diabetic mother (IDM).
C. Birth-asphyxiated term infant.
2. Which of the following is the most limiting factor related to enteral feeds for premature infants?
A. Gastric capacity.
B. Gastroesophageal reflux.
C. Gastrointestinal motility.
3. If maternal glucose doubles from 120mg% to 240mg% the fetal glucose anticipated would be approximately:
A. 120mg%.
B. 180mg%.
C. 240mg%.
