All posts by Shannon B

03Mar/17

Pharmacology Knowledge

This week I decided to interview both my grandparents  to see how strong their medication knowledge is.

One grandma passed with flying colors!  She worked as a nurse for over 50 years.  She knew her scheduled drug names, doses, times, side effects, and critical finding that would need to be reported to the doctor. As an A Fib patient, she is on several different cardiac medications and visits the Coumadin clinic regularly.  She also informed me, “I always call the clinic before I let any other doctor prescribe me anything to make sure it will not throw off my INR.”  I was not surprised that this grandma would be very well informed on her medications.

Grandpa on the other hand, was not quite so good.  He relies heavily on Grandma to assist with his medications.  He is on oral medications for diabetes,  hypertension, and cholesterol and he uses a pain patch for his back.  Although he could name his meds, he was not as strong remembering how much of each one he takes each day.

This activity made me realize how much my grandma’s nursing knowledge can really help them.  Even in their 80’s, my grandma is able to advocate, ask the right questions, and organize medications effectively.  Both carry updated  drug lists in their wallets for emergencies and remain very connected with their physician’s.  I was actually rather impressed by their drug knowledge, but I definitely realize this is not the case for all older adults!

13Feb/17

CPR and MI?

After interviewing a friend about CPR and MI, I realized there are a lot of misconceptions involving a pretty serious topic! Although my friend could identify that CPR involved pounding on somebody’s chest, the actual understanding of what CPR does was not there.  My friend had also never heard the term Myocardial Infarction.  My friend explained that “CPR happens when you have a heart attack.”  Although CPR may be necessary after a bad heart attack, CPR is not only used for heart attacks.  There are many different reasons why a person may go into Cardiopulmonary Arrest, which may include sudden heart failure, cardiomyopathy, respiratory issues, or MI.    My friend only identified chest pain as a symptom of heart attack, so it was important that I educated them that back pain, nausea, vomiting, sweating, SOB, and jaw pain may present.

This interview opened my eyes to the reality that non-medical personnel really do not fully understand how important high quality CPR can be in saving a family member or even a stranger.  Education must be increased to encourage more community members to take CPR classes.  If we fully help them understand what high quality CPR can do physiologically  and encourage FAST action we can see higher survival rates within the community!  

01Feb/17

Cardiac Diet

Many of our patients are forced to eat a “heart healthy,” usually in response to some sort of medical emergency.  Sadly, many people react to a change in health status, rather than taking a preventative approach before confronted with illness.  Most cardiac patients are discharged on low-fat, low sodium diets.  As I thought about this concept, I decided to look at my own diet in hopes of finding preventative foods early in my life.   When I cook at home I feel that I make pretty healthy choices and use a lot of fresh, low-sodium ingredients.  We typically eat leaner proteins, like turkey and chicken, and usually buy the “healthier option.”  I almost never add extra salt to any of my meals, but I know I consume way too much salt when I am in a hurry or dine out.   Prepackaged items are loaded with salt, and unfortunately, sometimes I choose them or the convenience rather than health.  I  also work in a restaurant that is known for salty stuff.  Many of my customers ask, “please don’t put salt on my food” and I always thought this was sort of a weird request.  After hearing it a few times, I decided to really look for the salt in my next meal there.  Too my surprise, I had to agree that the food was INCREDIBLY salty. It was shocking to me because I have always eaten there and never thought much about the obvious saltiness.  I think that our society is almost immune to realizing how salty food is because its almost the norm, or they don’t know that it can still taste good without the salt.

This project made me really put myself in the shoes of a cardiac patient confronted with a new diet.  Healthy food is more expensive, requires more preparation, and involves a degree of nutritional knowledge.  Many of these patients may not have the resources necessary to easily transition to a salt-free, low-fat diet.  Even for myself, who has good resources, it would be difficult to adjust to a completely new diet overnight.  If a patient enjoys dining out frequently, this change might be even more difficult.   I think its important to be understanding and helpful when a patient attempts to switch their lifestyle.  It is so important to consider their resources and abilities when expecting them to switch.  Providing affordable recipes, suggesting better alternatives, and techniques for eating healthier in restaurants  can all be beneficial as they make an effort to support a healthy heart!

27Jan/17

Nursing 220

As we begin this semester, I cannot even believe we are within months of graduating nursing school!   It amazes me to reflect over the past 2.5 years and think about how much each one of us has learned.  This semester I am very excited to get back into the hospital.  I am a little nervous to be taking on the nurses’ patient loads after being out of the setting for over a year.  Although I have some worries, I am confident that I will feel much better after the first week.  I am excited to take care of more critical patients and see everything come together that we have learned during the program.  Last semester I observed one day in the ICU and it was very intimidating.  I hope that after this semester I feel much more competent discussing ICU patients and feel more comfortable with multiple  IV lines, drips, ventilators, and end of life discussions with families.  I am excited and eager to finish our last semester!

22Oct/15

Unplug activity

This morning I am reflecting on my past 24 hours of “unplugging” from my phone and social media accounts.  Although school work still required some use of my electronic devices, my use for the day was decreased significantly.

My first “unplugging” moment was when I went on my run.  I decided to leave my phone at home and run without music.  I was surprised to see so many other people out exercising at the same time. As I ran past each person, I waited to see if they were going to say hi.  Most of them did not, until I initiated the exchange.  I normally say “hello” to people on my runs, but this time I tried to be even more friendly.  I asked a few people, “Hi, how’s your day going?”  I noticed that just a few more words out of my mouth created a much more connected feel in the few seconds I was running past them.  Two people even offered me a “good job” or “keep it up” as I ran past.  Stepping away from my music made me notice more people out and about and I think it enhanced the short, few second exchanges I had with my neighbors.

I also noticed that I was finished with my homework by about 6:00 yesterday.  Without the distraction of my phone or computer (for social reasons), I was able to be a lot more productive.  Being done earlier allowed me to sit down in the backyard with my parents and hear all about their days.  We are usually pretty good about visiting without distractions, but being finished with my homework allowed me to give them 100% of attention without feeling the need to run off to something else.

Lastly, I left my phone in the car when I went to take my Pilates class last night. Usually I mess around on my phone as I sit waiting for class to start, just to have something to do.  Last night I sat there just observing things around me.  I was surprised to see an older gentleman come up and sit right next to me.  He began to ask if I had taken this class before and told me it was his very first time taking it.  He asked me all about it and even admitted he was a little nervous.  It was nice to spend those few minutes visiting with a person, rather than checking my Facebook or catching up on junk emails.  After class I checked in with him to see if he liked it and he said he hopes to be back next week! I think that “unplugging” from my devices made me appear more approachable to that gentleman.  If I was on my phone, I probably would have missed the opportunity to make a new friend.

As a waitress, I see people plugged into their phones way too much.  Often when I approach my tables with, “good evening, how are you tonight?”  I am rudely interrupted with “I’ll take a water.”  It is as if they didn’t even hear me trying to start a friendly exchange because they are too involved with their phones.  Its incredibly disrespectful and immediately makes me want to just walk away from them.   Unfortunately, because I still want my job, I am left in an awkward place and cannot even say anything to them.  It also drives me crazy when parents bring their kids iPads, mini TVs, or cell phones to act as babysitters during dinner.  What happened to kids being entertained through the conversations, the coloring sheets provided by the restaurants, and a few small toys they were allowed to bring when we were kids?  Sadly, this kind of behavior within restaurant settings is only going to lead to children becoming “plugged in” adults in the future.  Its a terrible cycle!!!

This exercise was a really good reminder of how reliant we are on our devices and how it can negatively impact the relationships around us. Putting it down once in a while is a great way to observe what’s taking place around us.   Although I am writing this response now, I am going to continue to stay disconnected throughout the weekend and see what other social exchanges I can have with those people around me.

14Oct/15

Osteomyelitis

  1. Infection of bone that results in inflammation, necrosis, and formation of new bone
  2. Can be Hematogenous (blood borne infection), Contiguous focus (Contamination from bone surgery, open fracture, or trauma) or Osteomyelitis with vascular insufficiency (Patients with diabetes or vascular disease, most common in feet)
  3. High Risk: Elderly, poorly nourished or obese, immunocompromised w/ chronic illness, those receiving long term corticosteroid therapy, IV drug users
  4. Clinical Manifestations: Area becomes tender, swollen, warm, painful.  May describe constant, pulsating pain.
  5. PREVENTION IS THE GOAL. Treatment is often difficult because drug penetration of the infection is difficult due to low vascularization of the bone. Infection often  requires long-term antibiotics (3-6 weeks).

With love,
Shannon and Darcy 🙂

09Sep/15

Hydrochlorothiazide (Darcy and Shannon)

Hydrochlorothiazide

WHO: Hypertensive patient, Heart Failure patient, Renal Failure patient, Liver cirrhosis patient, someone taking glucocorticoids, or someone on estrogen therapy.

WHAT: Thiazide Diuretic, Anti-hypertensive

It works by increasing the excretion of sodium and water by stopping sodium reabsorption in the distal tubule of the nephron. It also encourages the excretion of chloride, potassium, hydrogen, magnesium, phosphate, calcium, and bicarbonate. May also cause arterioles to dilate.

HOW:  Adult dose: 12.5-100mg/day, given over 1-2 doses. Can be given up to 200mg/day.  Given by mouth.

Safety: Watch for electrolyte imbalances. Monitor BP, I&O, assess edema, watch for skin rash and Stevens-Johnson syndrome.  Allergy Warning: Assess for allergy to sulfonamides.

WHEN: It is generally given daily, but may be given every other day. Give when blood pressure is too high or there is edema present. Also, give in the morning to prevent disrupting sleep cycle.

WHERE: Can be used in the acute care setting or at home.

WHY: Treatment for edema and hypertension.