To honor Malignant Hyperthermia Awareness Month, there is no better time to review what malignant hyperthermia (MH) is and how to prepare for a crisis. Although this is primarily common in the perioperative setting, a malignant hyperthermic crisis episode can occur up to 24 hours after the administration of a triggering agent (Duchene, 2024). This is a rare, hereditary, but life-threatening condition that causes a reaction due to accelerated metabolism and uncontrolled release of calcium in the skeletal muscle caused by anesthetic gases, those typically ending in -fluane, and succinylcholine, resulting in sustained muscle contraction, increased carbon dioxide and heat production, and cell content leakage, such as potassium, CK, and myoglobin (Watt & McAllister, 2023). Therefore, all nurses must understand what causes MH, the signs and symptoms of an MH crisis, and how to successfully treat a reaction. With more surgical patients going home the same day as their procedure, this could be a reality for anyone caring for those patients.

Risk Factors for Developing MH and Triggering Agents

MH is a genetic disorder, so there will be other people in the patient’s family who have had a reaction. There are regions in the United States where there are higher incidence areas, with Wisconsin being one of them. The gold standard for diagnosing an MH allergy is through a muscle biopsy, so it is important to gather a clear family history before any surgical procedure. Triggering agents include halothane, isoflurane, sevoflurane, desflurane, enflurane, and succinylcholine (Rosenberg et al., 2007).

Signs and Symptoms of MH

Early identification of MH is vital to successful symptom management and the prevention of complications. Early signs and symptoms include unexplained tachycardia, tachypnea, muscle rigidity, masseter muscle rigidity, a sudden increase in end-tidal carbon dioxide, and metabolic acidosis. Later signs and symptoms are fever, rhabdomyolysis, mottled skin, and myoglobinuria (Duchene, 2024).

Treatment Plan for MH

As a rule of thumb, you must abide by your facility’s policies and procedures for MH. However, here are some guidelines recommended by the American Association of Critical Care Nurses that generally encompass most MH crisis plans.

1. Call an MH code, rapid response, or the method used by your facility to get extra help, especially if the MH cart is not in your department.
2. Stop the triggering agents if surgery is still underway.
3. Hyperventilate the patient with a bag-valve-mask to lower the end-tidal CO2.
4. Prepare dantrolene as ordered and per your facility guidelines and immediately administer it to the patient. This typically reverses the signs of MH and is crucial in this situation.
5. Cool the patient with ice packs, lavages, and IV fluids as needed until their body temperature reaches less than 38C or 100.5F.
6. Insert extra lines: large bore IVs, urinary catheter, nasogastric or orogastric tube, and an arterial line as necessary.
7. Transfer the patient to the ICU as soon as possible.

To reiterate, make sure to review your facility’s policies and procedures on MH management and emergency treatment, especially if you work in a non-critical care area. Familiarize yourself with your facility’s protocol for dosing dantrolene as this is the life-saving agent in this case. If your facility does not address your department in its MH policy, please reach out to your leadership to get clarification on what to do if a patient shows signs of symptoms of MH in your department. Also, be an advocate for yourself and others and partake in MH drills or ask that an MH be conducted in your department. As nurses, we should be prepared to care for any patient that comes our way. Although cases are rare and chances may be low, it is essential to prepare ourselves for MH and how to best save our patients as quickly as possible.

References

Duchene, A. (2024, May). “It’s getting hot in here”: A discussion on malignant hyperthermia. AACN. https://www.aacn.org/blog/its-getting-hot-in-here-a-discussion-on-malignant-hyperthermia

Rosenberg, H., Davis, M., James, D., Pollock, N., & Stowell, K. (2007). Malignant hyperthermia. Orphanet Journal of Rare Diseases, 2, 21. https://doi.org/10.1186/1750-1172-2-21

Watt, S. & McAllister, R. (2023, August). Malignant hyperthermia. In StatPearls. StatPearls Publishing. Retrieved March 2, 2025, from https://www.ncbi.nlm.nih.gov/books/NBK430828/#:~:text=The%20earliest%20signs%20of%20malignant,few%20of%20the%20usual%20signs.

February is Heart Health Awareness Month

Heart disease is very common. According to the CDC, heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the United States. In 2022, 1 in every 5 deaths in the United States was caused by heart disease.

How can nurses make a difference

Nurses can promote lifestyle changes, provide heart disease screening, remind patients to be aware of their family history, educate patients on how to manage their medications, and encourage action.

• Lifestyle changes: Nurses can advise patients on how to reduce their risk of heart disease through lifestyle changes, such as eating a healthy diet, exercising, and managing stress. 
• Screenings: Nurses can encourage patients to get screened for blood pressure, cholesterol, blood sugar, and body mass index (BMI). 
• Family history: Nurses can remind patients to be aware of their family history. 
• Medications: Nurses can help patients understand how to manage their medications. 

Encourage action

• National Wear Red Day: Nurses can encourage patients to wear red on National Wear Red Day, which is the first Friday in February. 
• Spread the word: Nurses can encourage patients to spread the word about the importance of physical activity and heart health. 
• Learn CPR: Nurses can encourage patients to learn CPR. 

To see more ideas on how to make an impact, check out the National Heart, Lung, and Blood Institutes flier on 25 Ways to Take Part in Heart Month.

Traumatic Brain Injury (TBI) is caused by a sudden and rapid head acceleration or deceleration, blow to the head or skull penetration. TBI can damage neural fibers causing intracranial hematoma, increased intracranial pressure and midline shift (Alouani & Elfouly, 2022). Based on clinical presentation can be characterized as Mild, moderate, and severe. Mild TBI, also called concussion, is the most common type of TBI in the US accounting for 70-90 percent of all TBI cases. Sports injuries and falls are the main causes of mild TBI. It is manifested as a brief loss of consciousness or mild change in mental status. Patients may show signs days or weeks after injury (Institute of Medicine [IOM] 2009; Kundu & Singh, 2023).

Moderate and severe TBI are characterized by an extended period of unconsciousness or amnesia. Common causes are a blow to the head or penetrating injury. Moderate and severe TBI can lead to death or long term disabilities. According to Centers for Disease Control and prevention, falls, firearm-related suicide, motor vehicle crashes and assaults account for the majority of moderate and severe TBIs (https://www.cdc.gov/traumatic-brain-injury/about/moderate-severe-tbi.html).

Who is at risk for TBI?

TBI can affect anyone, but higher cases have been reported among children 0-4 years of age, adolescent and young adults ages 15-24, those >65 years of age and among military combats. 7000 Americans are admitted to military and Veteran hospitals each year for TBI (IOM, 2009).

In Wisconsin, there were 1500 deaths involving TBI in 2020, 9800 emergency room visits and 4200 hospitalizations during the same time. Adolescents ages 15-19 had the highest rate of emergency room visits while patients aged 85 and over had the highest hospitalizations (https://www.dhs.wisconsin.gov/injury-prevention/traumatic-brain-injury.htm)

How is TBI diagnosed?

• Neurological assessment such as Glasgow Coma Scale (GCS)-Used for early detection. The score ranges from 3 (comatose/unresponsive) to 15 (no deficits).
• Neuroimages such as computed tomography (CT), magnetic resonance imaging (MRI), magnetic resonance angiography (MRA) and electroencephalogram (EEG)

Prevention and early detection are most effective ways to tackle TBI. Nurses should:

• Educate patients on the signs and symptoms of TBI such as headaches, nausea or vomiting, dizziness, vision issues, foggy or groggy memory, and interrupted sleep. For more resources, visit: https://www.cdc.gov/traumatic-brain-injury/signs-symptoms/index.html
• Encourage children, caregivers, and parents to always wear a seat belt when riding in a motor vehicle (even short distances).
• Continue fall prevention.
• Advocate for safe living and playing spaces for children.
• Educate/Encourage wearing a helmet and other appropriate head gear when:
• riding a bike, scooter, hoverboard, unicycle, horse
• Playing contact sport
• Skating, skateboarding, or snowboarding.

References/Resources

Alouani, A. T., & Elfouly, T. (2022). Traumatic brain injury (TBI) detection: past, present, and future. Biomedicines, 10(10), 2472. https://doi.org/10.3390/biomedicines10102472

Institute of Medicine (IOM). 2009. Gulf War and Health, Volume 7: Long-term Consequences of Traumatic Brain Injury. Washington, DC: The National Academies Press.

Kundu, S., & Singh, S. (2023). What happens in TBI? A wide talk on animal models and future perspective. Current neuropharmacology, 21(5), 1139–1164. https://doi.org/10.2174/1570159X20666220706094248

Wisconsin Department of Health Services. https://www.dhs.wisconsin.gov/injury-prevention/traumatic-brain-injury.htm

Centers for Disease Prevention. Preventing TBI | Traumatic Brain Injury & Concussion | CDC

Cervical cancer is one of the lesser-discussed female cancers that is one of the most easily preventable. In 2024, it was estimated that 13,820 new cases of invasive cervical cancer were to be diagnosed, and approximately 4,360 women would succumb to the disease (ACS, 2024). Cervical cancer is unique in that it is primarily caused by a persistent viral infection by the human papillomavirus (HPV). Although this is a large and common family of viruses, a persistent infection with a high-risk strain of HPV can significantly increase a woman’s chance of developing cervical cancer (IARC, 2025). As nurses, we must discuss the importance of cervical cancer prevention with all our patients who are assigned female at birth, regardless of their sexual orientation or gender identity. The two most effective ways to prevent cervical cancer are to vaccinate early and screen regularly.

Prevention through vaccination

The Centers for Disease Control and Prevention (CDC) recommends that all boys and girls get the HPV vaccine at age 11 or 12 due to the more vigorous immune response produced by the vaccine during the preteen years (CDC, 2021). If the vaccine series is started before the patient’s 15^th birthday, they will only be required to receive two doses. Patients ages 15 through 26 receiving the vaccine must complete a three-dose vaccine series.

The HPV vaccine can be given to patients up to age 45 if they were not adequately vaccinated when they were younger. Discussing vaccine administration over the CDC recommended age of 26 with a healthcare provider is best to determine the best course of action.

Prevention through screening

The traditional screening exam for cervical cancer is the Pap test. Current screen guidelines suggest women should begin receiving Pap tests at age 21 (NCCC, n.d.). This test looks for any abnormal cells on the cervix. More frequent OBGYN monitoring or further testing will occur if abnormalities or dysplasia are noted. This is to prevent the progression of further cervical changes and early detection of neoplasms.

At age 30, there are three available screening options: a Pap test every three years, a Pap and HPV test every five years, or an HPV test alone every five years (NCCC, n.d.). This screening schedule heavily depends on past medical history, previous Pap results, and  new Pap findings. After 65, women are no longer required to receive screening Pap tests if their medical history allows (NCCC, n.d.). Any patient who has had a hysterectomy with complete cervix removal does not need to be screened at any age unless they have a history of high-grade precancerous lesions or a change in sexual partners and wish to have a vaginal swab completed.

References

American Cancer Society. (2024, June). Cervical cancer statistics: Key facts about cervical cancer. Cervical Cancer Statistics | Key Facts About Cervical Cancer | American Cancer Society. https://www.cancer.org/cancer/types/cervical-cancer/about/key statistics.html

Centers for Disease Control and Prevention. (2021, November 16). HPV vaccination recommendations. Centers for Disease Control and Prevention.

https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.html International

Agency for Research on Cancer. (2025, January 3). IARC marks Cervical Cancer Awareness Month 2025. Featured News. https://www.iarc.who.int/featured news/iarc-marks-cervical-cancer-awareness-month-2025/

National Cervical Cancer Coalition. (n.d.). Cervical cancer screening: Pap and HPV tests.  NCCC. https://www.nccc-online.org/cervical-cancer-screening/

Why is this event important?

According to the American Cancer Society, cigarette smoking remains the most preventable cause of serious illness and death.

• Smoking and exposure to secondhand smoke cause more than 480,000 deaths in the US every year.
• Smoking cigarettes increases the risk of at least 12 different cancers.
• In the US, cigarette smoking causes about 3 of every 10 cancer deaths. This number is higher in parts of the South and Appalachia.
• Some groups of people smoke more heavily or at higher rates. These populations tend to be those who face barriers to care and inequities in multiple areas of their lives, including:
  • People at lower socioeconomic levels
  • Those without college degrees
  • American Indians/Alaska natives
  • African American/Black communities
  • LGBTQ+ communities
  • People serving in the military
  • People with mental health conditions

It’s never too late to quit using tobacco.

No matter your age or how long you've been smoking, quitting can improve your health—both immediately and over the long term.

While giving up smoking is challenging, having a solid plan and support system can greatly increase your chances of success. In fact, seeking help through counseling and medications can double or even triple your likelihood of quitting for good.

Take the first step today—your health and well-being are worth

How to Quit

Below are some guides to assist in the process of quitting smoking provided by the American Cancer Society.

• Making a Plan to Quit and Preparing for Your Quit Day
• Quitting Smoking or Smokeless Tobacco
• Quitting E-cigarettes (Vapes, Vape Pens)
• Dealing with the Mental Part of Tobacco Addiction
• Nicotine Replacement Therapy to Help You Quit Tobacco
• Prescription Medicines to Help You Quit Tobacco
• Are There Other Ways to Quit Tobacco?
• Staying Tobacco-free After You Quit
• Help for Cravings and Tough Situations While You're Quitting Tobacco
• Talking With Your Cancer Care Team About Tobacco Use

Additional resources and information on quitting tobacco use.

• Reasons to Quit Smoking
• Health Benefits of Quitting Smoking Over Time
• Empowered to Quit (Tobacco Cessation Program)
• The Great American Smokeout
• 1-800-QUIT-NOW [CDC]
• Learn About the Quit2Heal Study to Help People With Cancer Quit Smoking

This information and more can be found on the American Cancer Society website.

November is Diabetes Awareness Month

The Wisconsin Nurses Association held the Annual WNA Diabetes Care and Education Conference September 28-27, 2024 at the Kalahari Resort & Convention Center.

The purpose of the conference was to provide the most recent evidence-based practices on diabetes care and management for healthcare professionals. The activities included 15 educational topics, three product theaters, 28 exhibitors, eight poster displays with three live presentations, and the opportunity to apply and wear a glucose monitoring sensor.

Background

WNA was an active partner in a CDC, Wisconsin DHS Bureau of Public Health chronic disease and prevent grant from 2018 – 2021.  One of the areas of focus was increasing nurse awareness of the latest clinical information on diabetes, promoting diabetes self-management education programs in primary care and community projects.  WNA’s first diabetes conference was supported by the CDC/DHS/DPH grant funds. WNA remains committed to working with diabetes-related organizations and experts in providing an annual diabetes conference for all health care providers. 

What the data shows about diabetes:

• 4 million Americans—or about 11.6% of the U.S. population—have diabetes.[1]
• 7 million Americans are unaware that they have diabetes.
• Approximately 97.6 million people ages 18 or older have prediabetes, a condition in which blood glucose levels are higher than normal but not high enough to be diagnosed as diabetes.
• More than 8 in 10 adults living with prediabetes don’t know they have it.[2]
• About half of women with gestational diabetes go on to develop type 2 diabetes. Gestational diabetes is a type of diabetes that women develop when they are pregnant.[3]
• For Wisconsin 1 in 11 people in Wisconsin have diabetes, further breakdown on this data shows:
  • 1 in 10 Native American people have diabetes
  • 1 in 7 African American people have diabetes
  • 1 in 5 Hispanic American people have diabetes

The risk for developing pre-diabetes includes the following conditions

Nurses Role in Diabetes Care and Education

WNA Resources

WNA recorded four sessions from the 2024 Conference that offers continuing education credit.

COMING SOON!

The self-study offerings are:

Beyond Type 1 and Type 2: Genetic causes of diabetes and new categories of classification.

Kidneys and Kale: Preventative kidney care associated with diabetes-related implications.

Treating Obesity vs Treating Type 2 Diabetes: are they one in the same?

Pediatric Type 2 Diabetes - Not Your Grandma's Diabetes

[1] National Diabetes Statistics Report. Centers for Disease Control and Prevention website. Updated November 29, 2023. Accessed January 22, 2024. www.cdc.gov/diabetes/data/statistics-report/index.htm

[2]  Centers for Disease Control and Prevention. The surprising truth about prediabetes. Updated July 7, 2022. Accessed January, 22 2024. www.cdc.gov/diabetes/library/features/truth-about-prediabetes.html External link

[3] Centers for Disease Control and Prevention. Gestational diabetes. Updated December 30, 2022. Accessed January 22, 2024. www.cdc.gov/diabetes/basics/gestational.html

[4] Diabetes. State of Wisconsin Department of Health Services. Accessed November 10, 2024.

https://www.dhs.wisconsin.gov/diabetes/index.htm

[5]Dickinson JK, Guzman SJ, Maryniuk MD, O'Brian CA, Kadohiro JK, Jackson RA, D'Hondt N, Montgomery B, Close KL, Funnell MM. The Use of Language in Diabetes Care and Education. Diabetes Care. 2017 Dec;40(12):1790-1799. doi: 10.2337/dci17-0041. Epub 2017 Oct 17. PMID: 29042412.

Definition

Breast cancer is the most common cancer diagnosed among women in the United States. It is the 2nd leading cause of death from cancer among women. Only lung cancer kills more women each year.

Five Important Statistics:

1. Breast cancer rates are increasing (but deaths from breast cancer have been decreasing). 

2. White women are slightly more likely to be diagnosed with breast cancer than women of other races or ethnicities, but Non-Hispanic Black women are significantly more likely to die from breast cancer than women of other races or ethnicities.

3. Breast cancer is most often diagnosed in women in their 60s.
4. Breast cancer survival rates have improved in recent years.

5. The number of breast cancer survivors in the United States is more than 4 million.

2024 Screening Recommendations for Breast Cancer from the U.S. Preventative Task Force

What’s New in Breast Cancer Research? https://www.cancer.org/cancer/types/breast-cancer/about/whats-new-in-breast-cancer-research.html

• Research studies
• Breast cancer causes
• Breast cancer prevention
• New tests to personalize treatment
• New imaging tests
• Breast cancer treatment
• Supportive care

References

https://www.cancer.org/cancer/types/breast-cancer/about/how-common-is-breast-cancer.html

https://www.cancertherapyadvisor.com/features/breast-cancer-statistics/

Ways for nurses to improve their practice during Minority Mental Health Awareness Month• Educate patients

Talk with patients about mental health regarding how it can impact physical health and normalize discussing emotions.

 Provide resources

Have visible signage about mental health in appointment rooms, in waiting rooms, and online.

Screen Patients

Screen patients for depression using PHQ-9 form, screen for anxiety using GAD-7 form, and refer patients to accessible mental health services.

Communicate effectively 

Use non-stigmatizing language when referring to or speaking with patients. Review Preferred Terms forSelect Population Groups & Communities from the CDC for more information.

Attend further training

Consider attending cultural sensitivity training to better serve minority populations. Review CulturalCompetence In Health And Human Services from the CDC for more information.

Advocate for policy change

Write to your local representatives to advocate for improving mental health policies and funding for minority communities. Review “The US Playbook to Address Social Determinants of Health” to review current approaches from the government.

Citations

CDC. (2024). Support for public health workers and health professionals. Retrieved from:https://www.cdc.gov/mentalhealth/public-health-workers/index.html

El Centro de Corazon. (2018). July is mental health minority month. Retrieved from:

https://www.elcentrodecorazon.org/july-is-minority-mental-health-awareness-month/

Nursing Considerations: How to Positively Impact Your Nursing Care for the LGBTQ+ Community.

Author: Faleasha Gallagher, MPH, RN, PCCN, TNCC

WNA Tri-council member

• Educate yourself:Learn about LGBTQ+ history, culture, and current issues.
  • Learn how pride month came to be: The History of Pride: How Activists Fought to Create LGBTQ+ Pride
  • Learn where same-sex marriage is legal: Same-Sex Marriage Around the World
  • Learn about LGBTQ+ experiences: CAP Survey Data on LGBTQI+ Experiences

Use the correct terminology: When caring for patients, use the correct LGBTQ+ terminology.

***A patient’s sexual orientation does not inherently define their gender or gender expression or that of the patient’s partner(s).

(NurseJournal Staff, 2024)

 (LGBTQIA Resource Center, 2024)

• Ask questions:Ask questions that focus on behaviors that impact health instead of sexual orientation.
  • Review language to talk about sexual history: Taking A Sexual History
  • Use resources to enhance your knowledge on the LGBTQ+ community.
    • CDC Healthcare Provider Training
    • LGBTQ Equity Learning Modules
  • Promote a welcoming environment: Help promote a welcoming environment for LGBTQ+ patients by wearing pride swag.
  • Support policies:Support and promote policies and practices that reduce harm and improve affirmative care.
    • Policies and bans for LQBTQ+ community in WI ACLU LGBTQIA Rights
  • Attend events:Participate in local Pride events, such as parades, marches, or festivals.
    • June 6-8^th, 2024 Milwaukee's Pride Fest

Resources:

LGBTQIA Resource Center, (April, 2024). Pronouns & inclusive language. Retrieved from: https://lgbtqia.ucdavis.edu/educated/pronouns-inclusive-language

NurseJournal Staff, (April, 2024). Nurse Journal. Nursing care for LGBTQ+ patients: Tips and resources. Retrieved from: https://nursejournal.org/articles/nursing-care-lgbtq-patients/

April:  Autism Spectrum Disorder

Every month, organizations spotlight health conditions to increase awareness. As noted in allnurses.com, April is the month to spotlight Autism. Here’s a bit of information nurses should know about Autism.

Accelerating Science to Improve Early Autism Screening

Today, thanks to research focused on embedding routine screening in well-baby checkups, the early signs of autism can be identified in children as young as 12–14 months. These efforts, many supported by the National Institute of Mental Health (NIMH), show that making early autism screening part of routine health care can have a significant impact on children and families, helping connect them to support and services as early as possible.

• Autism is a neurodevelopmental disorder that affects how people interact, communicate, and learn.
• Making early autism screening part of routine health care helps connect families to support and services as early as possible.
• Despite American Academy of Pediatrics guidelines, only a small fraction of pediatricians reported screening for autism at well-child visits.
• NIMH-supported efforts to close the gap between science and practice have yielded key insights into effective strategies for expanding early autism screening.
• Researchers are identifying new tools for detection, new models for delivering services, and new strategies for embedding early autism screening and rapid referral into routine health care.

Every month, different organizations spotlight different health conditions to increase awareness. According to the Centers for Disease Control and Prevention, March is a month to spotlight colorectal cancer and endometriosis. What should nurses know about these two health conditions?