Clinical Pearls, April 2008

On Target for Urine Samples
Next time you have a (male) pediatric patient who refuses to provide a urine specimen, draw a target on the outside bottom of the plastic cup with a marker. Then tell the child to "go hit the target when you pee."
Charlene M. Morris, MPAS, PA-C, Stonewall, NC

Detecting Cogwheel Rigidity
One of the classic signs of Parkinson's disease is cogwheel rigidity, but this can be difficult to detect. The wrist is the best joint to check for this. Have patients completely relax the right wrist while they are opening and closing the left hand. As they are doing this, passively flex and extend the right wrist; if it catches or ratchets as you are manipulating it, that is cogwheel rigidity. Repeat the test, reversing wrist and hand--many patients with Parkinson's will have worse rigidity on one side than the other.
Karen Graham, MPAS, PA-C, Toledo, OH

Impress With This Compress
When instructing patients to use a moist, warm compress for abscess care, advise them to wet a washcloth with hot tap water and put it in a sealable plastic bag. Then apply this compress to the wound. It will stay hot longer than a warm washcloth alone, and if there is any drainage, they can throw out the baggie to reduce contamination of the surroundings with the exudates. The same washcloth can be reused in a new baggie later, which also reduces laundering.
Laurel Ballentine, FNP, Shamong, NJ

Pop-ular for Immunizations
To reduce the chances of having an adolescent faint following immunizations (particularly for human papillomavirus), give the patient an ice pop to eat immediately after administering the injection. The patient will have something other than the shot to focus on, the cold and sugar will give her a boost, and by the time she is finished, it will be time for her to leave.
Mary Brett, CRNP, Curwensville, PA

Scratch Stopper
For patients who are covered in chiggers and for whom there are no contraindications, have them apply lindane lotion to bites only using a cotton swab. The chiggers will die, and patients won't scratch themselves "to death."
Kristi Allen, APN, Lepanto, AR