Fire ant attacks on residents in health care facilities: a report of two cases.

BACKGROUND: Imported fire ants now infest more than 310 million acres in the United States and Puerto Rico. Colonies have been found in Arizona, California, New Mexico, and Virginia. Available reports suggest that each year, fire ants sting more than 50% of persons in endemic areas, resulting in a variety of medical consequences. OBJECTIVE: To describe fire ant attacks among patients in health care facilities. DESIGN: Case series and literature review. SETTING: Two nursing homes in Mississippi. PATIENTS: Two nursing home residents. MEASUREMENTS: Clinical records to describe clinical sequelae of multiple stings. RESULTS: With the 2 incidents reported here, the total number of reported indoor fire ant attacks on humans since 1989 is 10. Six of the persons attacked, including the 2 nursing home residents described here (who died after the stings), had preexisting neurologic impairment. Eight of the 10 attacks have been reported in the past 4 years. CONCLUSIONS: The presence of fire ants in occupied dwellings indicates the presence of active fire ant colonies in the immediate proximity. Efforts to eradicate these insects should be undertaken immediately, especially if immobile persons are present. These persons should be considered at risk for fire ant attacks as long as the ants are present.

Laparoscopic gastrostomy/jejunostomy.

1. Laparoscopic gastrostomy or jejunostomy provides a safe and effective method for providing nutritional support to patients who are unable to maintain an adequate intake for metabolic requirements. 2. The advantages of the laparoscopic technique include direct intra-abdominal visualization, a shorter anesthesia time, the decreased need for postoperative narcotics, elimination of the need for endoscopy and suturing, and the prevention of complications associated with open abdominal procedures. 3. The perioperative nurse, who is prepared for and knowledgeable about the nursing implications of the laparoscopic approaches to gastrostomy and jejunostomy, will successfully contribute to an optimal patient outcome.

AANA Journal course: update for nurse anesthetists--an overview of electrical safety.

A major part of anesthesia care involves ensuring the safety of the patient. Electrical hazards in the operating room abound. Knowledge of the principles of electricity is an important foundation for promoting a safe and hazard-free environment. This installment of the AANA Journal course deals with issues that have an impact on electrical safety.

The perioperative nurse's role in total knee replacement.

1. Presence of any infection, local or distant, is a contraindication to total knee replacement. 2. Cement may or may not be used in securing the prostheses. 3. Care should be taken in handling implants to avoid scratches, notches, and exposure to lint from towels or drapes.

Perioperative care of the patient undergoing cataract surgery.

1. The perioperative nurse should determine the patient's knowledge base about the cataract procedure, and then relay information about what to expect in the perioperative period, including what is expected of the patient. 2. Postoperative instructions to the patient include wearing the eye shield at all times, no bending or straining, and reporting any drainage from the operative eye, extreme pain, a fall or injury to the eye, or decreased vision in the operative eye. 3. Perioperative nurses caring for ophthalmic surgery patients must be meticulous in instrument care and preparation and in identifying potential problems unique to patients having cataract surgery.

Perioperative care of the craniotomy patient: a review.

1. Knowledge of the patient and the planned positioning allows the perioperative nurse to prepare for the needs of the individual craniotomy patient in surgery. 2. Microsurgical instrumentation often required with a craniotomy requires special handling and care. 3. Methylene blue should never be used in neurosurgical procedures. 4. The sitting position for posterior fossa surgery requires special precautions.

Hemostatic agents. Adjuncts to control bleeding.

1. Allergic reactions can occur with the use of topical hemostatic agents. 2. Some hemostatic agents may be used in combination to provide more effective hemostasis (eg, thrombin and Gelfoam). 3. Documentation should be made of any hemostatic agent left in situ at the time of closure. 4. Use of topical hemostatic agents is generally contraindicated in contaminated wounds.