As I look back on the last three years, I am astounded at how far we have come. I knew we would become nurses but as I reflect on all of our work and accomplishments it is easy to see we are so much more. What we have learned from the text and skills lab is minuscule in comparison to what we have learned about ourselves, each other, and the populations of people we will be caring for in the hospital. I don’t think many of us were prepared for exactly how exponential our growth would be or how much we would learn from working with patients and families that is so vital to fulfilling the roles of a nurse. We have become nurses, researchers, teachers, and patient advocates. We have grown into health care professionals that are prepared to build the future of nursing and healthcare. I am so incredibly proud of where we have ended up and I look forward to seeing what students continue to do with their nursing careers.
Death is a common occurrence in my family. It seems as though a family member or close family friend dies at least once a year, so the topic of end of life is not new to us. My family members are very vocal about their wishes and speak openly about how the feel about burial options, funerals, and hospitalizations. It seems a bit morbid but when it is so prevalent, these kinds of conversations are common. Our family has never argued or been against making health decisions based on quality of life rather than quantity. I think part of this is because of the faith basis of my family. People are less likely to hold onto one’s physical body when they know the spirit is no longer there. There is also the understanding that when God deems it is time for them to go, it is not our place to make drastic medical decisions to keep them holding on. Yet, this interpretation is not the only one of families of faith. Other families believe so strongly in the power of prayer and miracles that they refuse to let go in hopes of a drastic turn around. My takeaway from this is that you cannot assume a family’s reaction based on their religious beliefs or previous experience with death and dying. Every family dynamic is different and every scenario may be responded to differently.
The culture in America allows for much different practices in caring for the aging population than many other countries. Oftentimes when people are ill, we put them in a nursing home or assisted living, paying strangers thousands of dollars a month to take care of our loved ones. Others pay home health nurses to visit the person in the home; bathing them, giving them medicine, cooking for them. These care tasks are the things our loved ones did for us as children, yet when they are in need of care at an advanced age, it seems to be the norm to have someone else do it for us. In the next 5-10 years, the “baby boomers” are going to be coming into a time where they will likely need advanced care and support. For us to meet the growing needs of this population at the current standard, there will need to be an increase in nursing homes, assisted living, and home health services. However, it is likely those will simply raise their prices in the newly competitive market, making 24/7 care for the elderly a very costly and exclusive. Low income and lower middle class families may have to choose between their job and caring for their loved one due to the lack of services currently for low income families and adult care.
Another major issue we have discussed in class is that of life and death. An aging population means more patients with chronic, life threatening diseases and in turn, ICU patient, ventilator patients, and more talk of extraordinary measures. The time to start advocating for patients and talking to families is now, not once their loved one is dying. To reduce healthcare costs and Medicare spending, it is important for families to understand the concept of life support and the appropriate time to use extraordinary measures so that they can make informed decisions on care in the future. As healthcare professionals, we are responsible for educating patients and families and, in a compassionate way, talk to them about their wishes in tough situations.
Children born with severe Robin Sequence often present with significant anatomical respiratory obstruction. I reviewed a study from 2015 evaluating the outcome of these infants after nasopharyngeal intubation for maintenance of airway patency. 107 infants from the Hospital for Craniofacial Anomalies of Sao Paulo with severe RS treated with NPI were followed for their first year of life. Of 223 infants with RS, 149 had severe respiratory distress and 107 were used for the study. NPI lasted an average 57 days and mean hospital time was 18 days. Due to the diagnosis, all infants faced feeding issues, but 85% were able to be fed orally. Infants following the RS treatment protocol using NPI had shorter hospital stays, improved respiratory and feeding functions, reduced number of surgical procedures, and reduced morbidity and mortality in the first year of life.
You can read the full article at http://dx.doi.org.summit.csuci.edu:2048/10.1155/2015/608905.
The video below is from the Children’s Hospital of Philadelphia for more information on Robin Syndrome.
So I asked my coworkers today what they think a cardiopulmonary arrest meant. Most of them thought it was the same thing as a heart attack. I promptly educated them that a heart attack is when there is decreased or absent blood supply to the heart, which can cause part of the heart muscle to die while a cardiopulmonary arrest is when the heart stops beating all together.
I then asked them if they knew what an “MI” was. Most people gave the “huh” face when i asked this. After i told them MI stood for myocardial infarction some of my coworkers said “oh ya ive heard of that i just didnt recognize the acronym”. However, even though some of my coworkers have heard of a myocardial infarct, most did not know exactly what it is. I then explained a MI or myocardial infarction is a fancy term for heart attack.
My last questions regarding what my coworkers thought happened during CPR was answered the most correctly. Everyone know you did chest compressions and some knew about defibrillation with an AED. I feel like i was able to educate my coworkers on a very relevant subject that they will most likely come across again in their lifetime.
My dad and I were talking about some of my experiences working on a Med Surg Unit as a student nurse and he began asking me questions about CPR and what happens to the body during a code. I thought this would be a good opportunity to ask him what he thinks a cardiopulmonary arrest in, his idea of an “MI”, and what he thinks occurs during CPR. He was mostly concerned about what happens to the body during CPR and what he should do if he needs to provide CPR. He recently renewed his CPR card and was asking me about giving rescue breaths. We talked about the idea behind rescue breathing and what the purpose is. I explained how oxygen stays in the bloodstream for some time even though a person may not be breathing and how high quality compressions are more important to maintain circulation and percussion to vital organs. He knew what an MI was and we talked about the importance of going to the ER if you feel like you have a crushing pain in your chest, have difficulty breathing, feel light headed or dizzy, or have lower back pain and numbness down your arm. I commend him for getting his CPR certification as a lay person and told him how important it is so give quality CPR and know the actions to initiate the emergency response system. Having people in our community who know CPR can greatly impact people and we can strive to save as many lives as possible!
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!
Heart failure is a significant adverse outcome of an MI. Other than a heart transplant, not many treatments have been identified as significant methods of improving outcomes. One new treatment on the horizon is cardiac cell regeneration, also known as “cellular cardiomyoplasty.” Testing has not yet reached human subjects but has proven to be promising in animal studies. Some potential uses include acute and chronic ischemic myocardial damage, cardiomyopathy, and as pacemakers. Stem cells that have been identified as most effective for the treatment include embryonic stem cells, umbilical cord stem cells, amniotic stem cells, and cardiac stem cells. Clinical trials continue to work towards a common standard of practice for this treatment, so I am looking forward to how the research may be utilized in cardiac care in the upcoming years.
Check out the photo below with information about stem cell sources and read the article to learn more at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2779354/.
Camilles chicken California wrap (half)
Total fat: 13g
Sat fat: 4g
Sodium: 790 mg
Total carb: 21g
Calypso kiwi lemonade- 300 calories, 4.5mg Na, 0g fat
Homemade lasagna (ground beef, cheese, noodles, basil pasta sauce):
Total carbs 24g
Total sodium: 1165mg
Total fat: 32g
Total calories: 1,096
Overall, I believe that it would not be too difficult for me to adjust to a “heart healthy” diet if I had cardiac disease. The recommended sodium intake per day, according to a 2,000 calorie diet,in order to lower ones blood pressure, is 2,400 mg, as recommended by the American Heart Association (The American Heart Association’s Diet and Lifestyle Recommendations, n.d). Additionally, they state that if possible reducing the daily intake of sodium to 1,500mg is even more desirable (The American Heart Association’s Diet and Lifestyle Recommendations, n.d.). After comparing these goals to my daily intake of sodium, I have come to realize that my intake is rather low. Also, I exercised this day and therefore am working to maintain a healthy weight, another recommendation stated by the American Heart Association if one has heart disease or hypertension. Although my log from this day reflected a lower sodium intake, I often consume soda. This is an area where I would struggle to follow the guidelines for a “heart healthy” diet. Although I try to not drink more than one soda a day, a coca cola contains 45mg of sodium. In the end, I believe that, because I do not consume large amounts of food per day, I am able to keep my intake of sodium and fat within the recommended levels. However, I much watch the consumption of soft drinks and candies and maintain a moderate degree of physical activity to balance everything out. Lastly, although my diet reflects a “heart healthy” diet, I know that I have other days when my consumption does not follow these guidelines. Either way, it would be extremely difficult to abide by these guidelines constantly!
The American Heart Association’s Diet and Lifestyle Recommendations. (n.d.). Retrieved February 07, 2017, from http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/The-American-Heart-Associations-Diet-and-Lifestyle-Recommendations_UCM_305855_Article.jsp#.WJqipvkrK00
Today i evaluated what i ate…. and it was not very healthy. I started the day off by eating some dry cinnamon life cereal. For lunch i had a banana, carrots, bell peppers, and a burrito. For dinner i had an apple and some frozen yogurt. My diet is not very compatible with a “heart healthy diet”, which is low in sodium and fats. The carrots, banana, bell peppers, and apple were in alignment with a heart healthy diet. However, the cinnamon life cereal, burrito, and frozen yogurt are not. The burrito has 510mg of sodium on its own with 7g of fat. The cinnamon life cereal has 1.3g of fat and 153mg of sodium per serving. I probably had about 4 servings of the cereal. Lastly, the frozen yogurt has no fat but 17 g of sugar per serving and 75mg of sodium. I probably had about 5 servings. Overall i had approximately 1500mg of sodium and 12.2 grams of fat.
According to the AHA, you should have no more than 2400mg of sodium and the fat should exceed no more than 5-6% of the total calories of your diet. I was able to keep my sodium levels within range, however i need to cut down my sugar and fat intake.