Study: Older patients are at risk for receiving harmful drugs in the ED

Decreased renal and hepatic blood flow. Decreased glomerular filtration rate. Decreased total body water. Increased percentage of body fat.

Here are specific side effects to watch for

"Textbook" side effects will be more pronounced in the older adult, says Joan Somes, PhD, MSN, RN, CEN, FAEN, ED educator at St. Joseph's Hospital in St. Paul, MN. Here, she gives several to watch for:

Watch for this common reaction to niacin

"This is one of my favorite problems to 'diagnose,'" says Joan Somes, PhD, MSN, RN, CEN, FAEN, ED educator at St. Joseph's Hospital in St. Paul, MN.

Clinical Tips: Ask what medications EMS has given in field

"Many times in the pre-hospital arena, we see medications given as if the person were young and with good kidneys and liver," says Joan Somes, PhD, MSN, RN, CEN, FAEN, ED educator at St. Joseph's Hospital in St. Paul, MN. "One of the issues I have dealt with frequently of late, is fentanyl given for pain."

Risk is great if you don't reassess psych patients

(Editor's note: This story is part two of a two-part series on care of psychiatric patients in the ED. This month reports on the best ED nursing practices for reassessment during long waits. Last month, we gave tips for identifying underlying medical conditions.)

Don't leave a psych patient in waiting room

Psychiatric patients can leave your ED without warning or cause harm to themselves or someone else, says Nancy Bennett, RN, MSN, ED educator at The Hospital of Central Connecticut in New Britain.

Clinical Tips: Don't assume patients aren't taking psych meds

If a psychiatric patient came to your ED acting aggressively with pressured speech, you might conclude that the behavior was caused by failure to take antipsychotic medications.

3 things to do immediately if measles is a possibility

When a Swiss tourist came to a Tucson, AZ, ED with pneumonia, none of the ED nurses suspected that measles was the underlying cause. As a result, the patient wasn't isolated, and patients and health care workers in the ED were needlessly exposed.

Signs of DVT can be surprisingly subtle

If a middle-aged woman walked into your ED and told you she felt as if something terrible was going to happen to her, but denied any other symptoms, what would you suspect?

Questions to ask if you suspect DVT

Here are assessment tips to use at triage if you suspect that your patient might have deep venous thrombosis (DVT):

Is your patient hiding something from you?

The middle-aged man on medication for erectile dysfunction who is given beta-blockers for chest pain. The diabetic patient on glucophage who gets a CT scan with contrast.

Could a child in need of help walk out of your ED?

A child who was involuntarily committed managed to walk out of the ED at All Children's Hospital in St. Petersburg, FL, right past a security guard and out the main hospital doors.

ED care of peds psych patients is inconsistent

A child's race and ethnicity is irrelevant when it comes to treatment of pediatric psychiatric patients, correct? Not necessarily, according to a new study, which found that minority children are more likely to receive severe mental health disorder diagnoses in the ED than white children.

December 1, 2008