All posts by Jennifer W

20Apr/17

2007 San Diego Wildfires

During October and November of 2007, a series of wildfires known as Firestorm 2007 spread through San Diego County, causing the largest evacuation in the history of California as 12 fires burned simultaneously in the county. There were over 2,200 medical patients evacuated including patients from 3 hospitals and 12 skilled nursing facilities. Multiple shelters were established and the medical reserve corp responded with 66 healthcare professionals. The Emergency Operations Center, Medical Operations Center, and EMS all responded to the disaster, as well. Barriers to care were related to access to victims and medical supplies. Environment affected this disaster as fires were difficult to contain during this fire season related to the ongoing California drought. Trauma services rendered related to burns and air quality/respiratory symptoms. I would like to think that emergency services are better prepared for the onslaught of fires seen in California because of the success of medical care during this operation, however, the wildfires themselves are still difficult to maintain because of the warm and dry California climate.

https://www.arb.ca.gov/carpa/meetings/summit08/presentations/firestorm07_wwooten.pdf

03Apr/17

Virtual Stroke Rehab

Early intervention with physical therapy has been a mainstay of stroke rehab for many years. Recent research has shown, however, that PT alone might not be enough to help these patients regain their fullest physical potential. A rehabilitation professor at Rutgers University has said that PT alone is boring and exists only at the level of the muscle. Therefore, that have been developing video games that are designed to mimic every day physical activities while at the same time engaging a patient’s cognition in addition to movement, which makes the exercise have more impact and meaningfulness on long term rehab. By increasing motivation, these video game PT sessions last longer, provide more repetition, and lead to more successful rehab sessions.

While similar rehab products were available 20 years ago, they were much too expensive to be practical to home use. Now, the hardware required to utilize this PT modality is approximately $100, substantially increasing affordability of this technology. Imagine how patient compliance would increase in this day and age if we could prescribe an hour of video games for every medical condition?

If you’d like to learn more about the Rutgers University V-Step game, click the link below:

http://www.newsworks.org/index.php/local/the-pulse/92651-fun-side-of-qserious-gamesq-could-aid-in-rehab-

07Mar/17

What’s In YOUR Pill Box?

Today, I called my dad and asked him what medications he’s currently taking. If he knows the names, if he knows what they do. My dad has had hypertension that has been poorly managed for years. He’s the poster child for “I felt better, so I stopped taking them/I forgot to take them/I don’t want to take them/etc.” It’s a repeated topic between us, and the question of what medications he’s on comes up more frequently than I’d like. His regimen has changed a lot over the years, but his description of the medications never changes: Color of pill, whole or half, time of day. I’m left to read labels when I visit most of the time. He doesn’t know the names or what the medications do and his hospital and doctor either don’t explain to him what they do or he’s too embarrassed to tell me he doesn’t remember what they do.

His regimen actually changed quite recently after repeated discussions we’d had about his blood pressure tanking, his heart rate escalating, and his needing to lay down for the effects to go away. I’d been urging him for awhile to call his doctor and at least talk about his medications if he wouldn’t go to the ER. Finally, he started passing out from these “spells,” as he called them. He agreed to call his provider and the provider told him immediately to go to the ER – it’s funny how he listened to the doctor, but not his daughter. But that’s a stubborn dad. Turns out he was having some pretty serious atrial fibrillation to which they made a major attitude adjustment to my dad’s blood pressure regimen.

So, I figured when I called him today, he’d have a pretty good idea of his new medication regimen since the whole ordeal had been pretty scary for both of us. I asked the question and waited for his response. What was my dad’s reply? What color, whole or half, and time of day. It seems as though with knowledge of medications, especially in older populations, old habits die hard, and he still only knows of his medication regimen by the same information he knew about them before his health scare. So I will continue to educate my dad on his medications every time I see him, I’ll continue to look at the bottles and the doses and his blood pressure numbers (when he monitors them consistently), and I will continue to urge him to call his pharmacist when it seems like the regimen is having adverse effects on his health – hopefully next time he’ll listen to me and not wait to call his PCP. He’s lucky he didn’t have a stroke. Considering the medication education the VA Hospital provides, I am left to wonder if they educated him on his increased stroke risk both related to his hypertension AND his possibility of developing atrial fibrillation again.

26Feb/17

m-CCRP

While researching articles and news stories related to advances respiratory care, I ran across an interesting article about what’s called an m-CCRP. The acronym m-CCRP stands for mobile Critical Care Recovery Program. This is a program recently developed by the Indiana University Center for Aging Research utilizing a $3.2 million grant from the National Heart, Lung, and Blood Institute. The focus of the 5 year study is post-ICU care brought directly to patients that have gone home after admissions for acute respiratory failure.

The focus of these units is to decrease the incidences of post-intensive care syndrome, improve quality of life and brain health, and reduce the incidences of rehospitalization. It aims to make meaningful recoveries more attainable through bypassing the fragmented post-ICU resources available to discharged patients and their families; instead, m-CRP patients and their families will be followed closely by a mobile care coordinator whom can be reached by patients and families on an as needed basis. For 12 months, the mobile care coordinator will visit ICU survivors biweekly and be supported by a multi-disciplinary team consisting of an ICU physician, a geriatrician, a neuropsychologist, and an ICU symptom management nurse.Additionally, this team will meet on a weekly basis to develop and continually revise a personalized recovery plan incorporating the goals of both patient and caregiver.

Learning what we’ve learned about the fragmented post-discharge care and resources for patients and the lack of continuity of care, a service such as the m-CCRP could be monumental in decreasing both hopitalizations and the length of time needed to return to optimum health.

The article can be found here:

http://www.news-medical.net/news/20170209/New-2432-million-NIH-grant-funds-development-of-mobile-Critical-Care-Recovery-Program.aspx

14Feb/17

Public Perception of Cardiac Emergencies

This week, I asked two good friends three very important questions with regard to cardiac emergencies. I asked them what the phrase “cardiopulmonary resuscitation” meant to them, what they thought “MI” meant, and what they thought took place during CPR.  The first friend I asked is a direct assistant to CEOs at hospitals and the other is a lead mechanic at a high end automotive dealership. When I heard the answers of my friends, I was surprised at who of the two knew the most about all three questions.

As stated in the previous paragraph, the first friend I asked works as the direct assistant to a hospital CEO that presides over several large hospitals in the area that she lives in. She said that cardiopulmonary arrest is “like a heart attack. The heart arrests (and) you cannot breathe.” She didn’t know what “MI” meant, but guessed that is was “muscular something.” Lastly, what she though took place during CPR was “manual pumping of the heart.” So it’s fairly apparent that, despite working in hospitals, she only has a vague and generalized idea of these cardiac emergencies.

The second friend I had spoken to, the general mechanic (who has worked as a mechanic for approximately 30 years), seemed to have a better idea of what goes on during these cardiac emergencies. He said that during cardiopulmonary arrest, “for some reason or another, the heart muscles do not continue their regular operation. I think the cause is flexible. Lack of blood supply, lack of nerve input, whatever.” While he didn’t know what the acronym “MI” stood for, he had a very good idea of what it represented: “Does it mean actual heart muscle damage from lack of blood supply?” His idea of what occurs during CPR is that it is “an effort by another person to rhythmically contract the chest, which should use the heart valves to continue to restore blood flow to vital organs until the heart receives enough blood to hopefully resume function.” Not totally correct, but his mind was in the right place.

After seeing these two vastly different responses to these three questions, it made me realize how great the knowledge deficit is with regard to cardiac emergencies. Additionally, it showed me that you can’t assume that someone will know more about cardiac emergencies just because they work in a hospital. I fully expected my friend that worked for the hospital CEO to know infinitely more about MI and CPR than my mechanic friend, but I was proved wrong quite quickly. It just goes to show that, despite the best efforts of public health and the American Heart Association to educate the general population about cardiac emergencies, there is still a lot of education to be distributed to raise awareness and hopefully save more lives in the future.

04Feb/17

The Watchman

Patients with atrial fibrillation are at an increased risk of stroke. This risk is present because when the atrium of the heart are in a state of fibrillation, the pumping capacity of the heart is decreased and blood is allowed to pool in the atrium. Blood that does not circulate is at increased risk of clotting, increasing the risk of stroke for patients with atrial fibrillation.

The Watchman is an implant that was developed for patients that have non-valvular atrial fibrillation. Known as a left atrial appendage closure device, implantation of this device can remove the need for life long use of blood thinners such as Warfarin. The website  advertises that it is just as effective as Warfarin in risk of stroke and puts an end to the life long testing and food restrictions that are associated with the drug. According to the website, 9 patients out of 10 can discontinue their Warfarin therapy as soon as 45 days after the procedure.

This device looks like a jelly fish and works by blocking the left atrial appendage, which is where 90% of blood clots form in patients with atrial fibrillation that isn’t caused by heart valve problems. If clots do form, they are trapped in the Watchmen, thereby preventing them from traveling to the brain and causing a stroke.

If you’re interested in learning more about The Watchman, please visit the following URLs:

The Watchman for Consumers

http://www.watchman.com/home.html

The Watchman for Providers

http://www.watchman.com/hcp/home.html

27Jan/17

The Final Semester

It’s hard to believe that the school journey is almost over. Seven years ago, I began my journey to my BSN. I was working full time for the Navy active duty and attending night classes 2 to 3 nights a week to accomplish general education and pre-requisite requirements for this degree. Seven years, three different colleges, one associates degree, countless late nights, many times crying over exam grades and from being overwhelmed, and a running tally of 150 units has brought me to today, and in just a few short months, my over seven years Bachelor’s degree journey will be over. Sure, I could have done it faster or more efficiently, but I wouldn’t change anything about the path I took to get where I am today. I’m excited to walk across that stage in May and am excited for the challenge that this semester will bring.

28Oct/15

Disconnecting

bansky cell phone love

This is literally what I see everywhere I go. Mothers crossing the streets holding their child’s hand in one hand and glaring at the glowing screen in the other. Couples on dates so disinterested in one another that all they do is stare in to their phone screens. It’s a sad state of affairs. I’m not immune; I’ve caught myself wasting so much time on my dumb phone sometimes that I literally do turn it off. It’s kind of disgusting the time spent on phones. There are some people that are better than others, but many are absolutely tethered to the device. I’d be concerned with how some people would function without them. Mind you, they’re not terrible. They’re very helpful for looking up medications, etc in the hospital or directions for travel. But they become a problem when we’d rather use them then interact with other people. Personally, I’m the type of person that tries to do interactions in person or at the very least via phone call. Important things I try not to handle via text or email. And I try to NEVER bring my phone out EVER in a patient’s room. That interaction is solely person to person with no phone involved. Only once has my phone come out and that was to confirm a parameter for a medication for the instructor. How about everyone else? How do you prefer to conduct important business?

(The painting is by a street artist named Banksy.)

04Oct/15

Patient Teaching Modalities

The patient teaching method I found that stood out as most unique to me does not pertain to GI modalities alone, but all aspects of patient care.

www.getwellnetwork.com

This program was developed by a former cancer patient who wanted to make improvements in the overall patient care process. It involves the use of mobile devices, TVs and PCs to deliver many aspects of patient care to all age groups and demographics. It has programs tailored pediatrics, adults, senior adults and even veterans to cater to each demographic’s specific needs. It engages patients and allows them to become more directly involved in their care in all settings (inpatient, ambulatory, etc) through an education library containing thousands of award-winning videos and content on specific health conditions, medications, tests and procedures. Patients are also prompted to relevant education and care tasks to help enhance their care. The program also enables communication with the primary care provider.

I am in no way endorsing this program having not seen it in the hospitals yet, but I think it could be a valuable asset to both patient healing and nursing care and would like to see it first hand in a hospital to see how effective it is. I also like how it was developed by a former patient, who through their own experience has a unique perspective on what might be lacking or need enhancement with regard to patient teaching and discharge planning modalities.

I just thought it sounded pretty interesting. If anyone else would like to check it out, I posted the link to the overall page above and I will post the link to the adult program, since it is relevant to our current course content. Enjoy!

http://www.getwellnetwork.com/solutions/patient-experience/adult

27Aug/15

Testing, testing…

The older I get, the more behind the times it seems I get with internet related applications. Thankfully, Jaime donated some precious class time to help us figure out this new tool to enhance our education and keep us up to date with various tools we can use to enhance and facilitate our learning. In addition to new learning applications, I’m excited (and perhaps a little intimidated) for the material to come in our course NRS 222. Despite the slight intimidation, I know that if we all put in both 100% to ourselves and 100% to helping each other, we will all both benefit from the course and move on to the next semester together! I am excited to start learning with everyone again!