Author: C. Aseysalinas

The very beginning of nursing school was very up and down. I got an email that I was accepted! Then I got an email that the previous message was a mistake. Then later surprise! I’m back in! Even at orientation I wasn’t 100% sure that I was officially allowed to be here.

Year one was a whirlwind. Year two was a marathon. And now this last year is playing out like the Wizard of Oz, where I’m Dorothy and the Good Witch is reminding me that I had the power all along.

I am so ready to graduate. My year one goal is to get a job in Med Surge, then in 5 years use my experience to go into public health.

Last clinical, I needed a drug from the Pyxis but it wasn’t there. The pharmacy said that there wasn’t any in the hospital so we had to wait for a shipment later in the afternoon. My nurse explained that there are more shortages now than there used to be because of the Hurricane in Puerto Rico. A lot of our medical supplies are made there, and the island is still having problems.

Interested, I read about the disaster in Puerto Rico on Wikipedia. First, Hurricane Irma hit September 4th, 2017 and left 80,000 people without power. A state of emergency was declared in PR at that time, and FEMA started setting up teams on the island on September 6th. Two weeks later Hurricane Maria hit the island, causing 64 deaths and leaving all 3.4 million people without electricity. These two hurricanes completely destroyed PR’s electrical grid, cell towers, phone and internet cables. Hospitals were damaged and operating on backup generators.

According to a December article in the New York Times, the federal response included setting up field hospitals and medical shelters that treated 30,000 people, a federal prescription reimbursement program, and the aid of the US Navy hospital ship Comfort, aboard which 191 surgeries were performed. The ship was in PR from October 3rd to November 15th. The Trump administration was heavily criticized for not doing enough.

Barriers included bad weather, rough terrain, destroyed roads, no electrical power, unusable communications, and unclear organization. 7 months later many people are still without power. It will take billions of dollars that Puerto Rico doesn’t have to repair the damaged infrastructure. In my opinion, the US response was very poor, and it does not look like it will be getting better as our politicians are more hostile and adversarial than ever.

References

 

I did a lit search for trends in elder care and came across an interesting article about meeting the needs of older people who are trans-gendered. My previous perception of gender issues was that it was a movement spearheaded by young people but of course people have had their own gender identities forever, it is just now talked about more.

This Australian article discusses negative experiences that patients have from interactions from staff in nursing homes such as pathologizing, misgendering, marginalizing, and coercive queering, collectively known as cisgenderism.

As a nurse I will take the article’s suggestions to heart, and focus on providing privacy, researching ‘scripts’ that are respectful regarding personal care, using the preferred pronouns for the patient, supporting gender expression and appearance, and advocating for my patients to get the prosthesis or hormones that they express a need for.

Ansara, Y. G. (2015). Challenging cisgenderism in the ageing and aged care sector: Meeting the needs of older people of trans and/or non-binary experience. Australasian Journal On Ageing, 3414-18. doi:10.1111/ajag.12278

My favorite patient was especially troublesome. He was someone that marched to the beat of his own drum and was not at all inclined to follow other people’s rules.

He had been homeless for the last 12 years, drank alcohol everyday, and was intoxicated when he was struck by a vehicle and broke 4 bones. He was in a lot of pain, but that didn’t stop him from trying to roll a cigarette in bed. After I swept the tobacco off the floor, I explained that he couldn’t smoke in the building but was able to at least get him a nicotine patch. His CIWA score wasn’t high enough to warrant an ativan, although I think that could have helped him.

He was my introduction to a radically different type of patient who lived outside of societal norms, and for that reason he will always stick out in my mind.

The ways that I engage in self-care in the clinical setting are to pack myself healthy food like fruit and yogurt, wear compression socks (I’m prone to foot pain), and bring water with me so that I do not get dehydrated. My water bottle actually has marks on the side so that I can measure how many ounces I drink in a day. Unfortunately its usually about 8 oz but I’m working on beating my current high score!

I asked a friend in the program and she mentioned that recovery is important to her – she goes to a massage school in TO for inexpensive massages on a regular basis. I think I’ll try that too, as controlling stress is another one of my goals. i think that managing stress and anxiety will be a big factor in my success in the clinical setting going forward.

Reason #1 that self care is important for professional development: we can be a good example to patients by taking our own health seriously (Mills, 2015).

Reason #2 that self care is important for professional development: there is a link between compassion towards oneself and compassion towards others (Mills, 2015)

My plan to refresh over spring break is to get back into music. My hand has finally recovered pretty well after my car accident over the summer and I’m ready to start playing my viola again.

References

Mills, J., Wand, T., & Fraser, J. (2015). On self-compassion and self-care in nursing: Selfish or essential for compassionate care? International Journal of Nursing Studies, 52(4), 791-793.

Imagine spending a week in bed. You eat there, go to the bathroom there, and entertain visitors there. Now imagine that due to illness and heavy medications, you are disoriented and scratch, pick, and pull on wounds, dressings, IV lines, and urinary catheters. You can’t get up to go to the shower or the sink. Good thing your hygiene needs are being taken care of by the healthcare team, right?

Not so fast. A 2015 study by Fox, et. al., stated that “researchers reported that patients unable to wash their hands had their hands washed by nurses only 14% of the time.”

That is a harsh fact, but one that lines up with what I have seen in the clinical setting. Foaming in-and-out has pretty good adherence by nurses but patient hygiene is more crisis-oriented and revolves around immediate needs, usually related to managing bowel movements.

When I am doing my assessment in the morning and I check cap refill, I usually notice the state of my patients’ hands. Unfortunately they are usually pretty crusty, and I’ll use wet wipes to clean them up.  The Fox, et. al. study used a TID 2% chlorhexidine patient-handwashing intervention to see if it would reduce hospital-acquired infections (HAIs).

The results of that study were no statistically significant reductions in HAIs. There are also some drawbacks to using CHG, such as skin redness, irritation, and allergy potential. That said, I still want to implement a patient hand-washing regimen into my practice because hand hygiene is still the best way to prevent infection, as well as being important for patient dignity.

References

Fox, C., Wavra, T., Drake, D. A., Mulligan, D., Jones, L., Bennett, Y. P., & … Bader, M. K. (2015). USE OF A PATIENT HAND HYGIENE PROTOCOL TO REDUCE HOSPITAL-ACQUIRED INFECTIONS AND IMPROVE NURSES’ HAND WASHING. American Journal Of Critical Care, 24(3), 216-224. doi:10.4037/ajcc2015898

So I asked my two early thirties friends if they take any medications, prescribed or over the counter. They both said no. “Unless Advil counts? Like, for headaches?” It does actually!

I was even able to get the generic name out of them, but they were not aware of the side effects or safe doses. “I just take two.”

So here are the Ibuprofen (Advil) facts:

Usual adult analgesic dose: 200-400 mg 3 to 4 times a day

Adult max dose: Do not exceed 3200 mg/day

Usual child analgesic dose: 4-10 mg/kg every 6-8 hours

Child (6 months-12 year) max dose: Do not exceed 2400 mg/day

Most common side effects: headache, constipation, nausea, vomiting

Life threatening side effects: heart failure, stroke, myocardial infarction, GI bleeding, stevens-johnson syndrome, allergic anaphylaxis

References

Davis’s Drug Guide. Nursing Central. Accessed Feb 28, 2018

 

 

Funnily enough, a portion of my leadership project was concerning difficult airway situations!

I learned that a nurse can do the following to assist with intubation:

• Position the patient to elevate the head and align the ear with the sternal notch to improve respiratory mechanics
• use wedges, towels, or reverse trendelenberg

• Pre-oxygenating the patient before the intubation attempt and between attempts

• Be familiar with and prepare appropriate equipment
• (ETT and bougie pictured)

 

• Apply cricoid pressure if asked by the respiratory or anesthesia specialist
• This can help with visualization of the trachea

References

http://www.narcomed.com.au/g0.htm (picture)

Lutes, M., and Slawter, A. (2007) Focus on: Emergency management in the pregnant patient. American College of Emergency Physicians

Matshe, J. (2014) The Difficult Airway Management in Adult Critical Care. http://slideplayer.com/slide/4244922/ (picture)

Perioperative Care of Bariatric Patients. (2017) AORN Study Guide PDF

Seifert, P. & Wadlund, D. (2015). Crisis Management of Failed Airway in the OR. AORN Journal. https://doi.org/10.1016/j.aorn.2015.07.002

 

So I asked an actor friend of mine several questions about heart issues. Here were his responses:

• A cardiopulmonary arrest is stopping of lungs and heart.
• MI stands for Michigan.
• CPR is lifting the chin, blowing air into the mouth, 15 chest compressions and 2 breaths to force air into the lungs and blood through the heart.

I was pretty impressed with his answers to be honest, because his college career was focused mostly on languages and history, not biology. I recommended that if he ever needed to do CPR, that he do 30 compressions but maybe not do mouth-to-mouth because of the risk of inflating the stomach and potential for vomiting.

I think he was teasing me when he said MI stands for Michigan, but I let him know that it stood for myocardial infarction. Then he told me to stop being a know-it-all and reminded me that he was doing me a favor by helping me with my blog. I am choosing to believe that deep down, he was really appreciative of the information.

I’m trying to watch what I eat, so I use the My-Fitness-Pal app to log my meals. I normally track calories, but for fun I looked at my fat and sodium numbers.

• AHA Ideal Sodium Intake: 1500 mg (I ate 2581 mg)
• AHA Saturated Fat Intake: 5% of total calories (I could not find that information on the app but I’m certain that I went over)

Breakfast: 16 g fat, 760 mg sodium

• Jimmy Dean Delight Turkey Sausage Breakfast Sandwich
• Half and half in my coffee

Lunch: 22 g fat, 305 mg sodium

• Smoothie with Spinach, raspberries, strawberries, protein powder, olive oil
• Ruffles plain potato chips

Dinner: 35 g fat, 1517 g sodium

• 2 Slices of Pepperoni Pizza
• Glass of milk

If I were a patient with a cardiac issue, I would have to cut the pizza and milk from my diet because those are the largest sources of saturated fat. I would also have to cut the microwave breakfast sandwich and chips because they are so high in sodium.

It can be difficult to cut sodium and fat, especially if you don’t have time to cook all of your meals from scratch. If I were going to give myself advice on what to eat instead, I would probably opt for a quick packet of oatmeal for breakfast instead of the Jimmy Dean Sandwich. And maybe a use the crock pot to make a convenient pot roast dinner instead of ordering pizza.