Archive for date: January 29th, 2015

To have a digital identity is to have an online presence through social media.

I found it rather high that 8% of companies had fired an employee over abusing social media. I find this odd because I find it hard to believe that many people were in a position to abuse their power through means of social media

Because I am seeking a leadership role on campus and potentially in the political realm I need to hold myself to a higher standard and be very selective when it comes to the content I allow to become public.

I plan to create a positive online identity by being careful and vigilant of what I post and what I allow others to post that may affect me.

CI Computer Girls were invited to volunteer in The Great Race of Agoura Hills, which in its 30th edition, is one of the largest running events in our area with the goal of raising money for elementary schools. If you would like to participate as a runner here is the registration information: http://greatraceofagoura.com/register/ – the registration closes on February 6th.

CI Computer Girls will have a table at the water station on Mile 8 (intersection of Paramount Ranch and Cornell) from 6:45 to 10:30 am.

Discussion #4

Pain management in sedated and mechanically ventilated patients is always something that has interested me. Though we have scales and modalities through which we assess and manage pain in patients that aren’t coherent, it seems impossible that they are all completely foolproof in terms of accuracy and effectiveness.

Additionally, according to a 2013 article, these treatments may also have a negative effect on patient outcomes. I read an article titled Pharmacological Management of Sedation and Delirium in Mechanically Ventilated ICU Patients: Remaining Evidence Gaps and Controversies. This article explored the treatment of pain, anxiety, and delirium (PAD) in ICU patients. The authors assert that, drugs once thought to have a been effective in reducing PAD have been shown to have either little benefit, the potential for significant risk associated with any benefit, or in some cases, the potential to worsen patient outcome (Devlin et al., 2013).

The article provides health care practitioners with background on the most important areas of delirium pharmacotherapy in the ICU,  information on the recent evidence based practice surrounding the treatment of PAD, and discusses areas in relation to this topic that require further investigation or study. The recommendations are all based on the Critical Care Medicine (ACCM) Pain, Agitation, and Delirium Clinical Practice Guidelines.

The guidelines include recommendations such as giving patients daily sedation interruptions while in the ICU; titrating medications to induce a light sleep as opposed to deep sedition, in addition from drug specific recommendations to guide health care practitioners.

The article stresses the importance of closing the gap between evidence-based recommendations and current PAD management practices. In order to achieve these guidelines as well as the many others suggested, the authors suggest a multi-faceted, interdisciplinary approach. They stress the importance of facility specific protocols for PAD management in addition to standardized order sets. The article concludes by saying that in order for the ACCM guidelines to be achieved and patient outcomes to be improved, comprehensive staff accountability and consistent patient education is vital.

 

Devlin, J. W., Fraser, G. L., Ely, E. W., Kress, J. P., Skrobik, Y., & Dasta, J. F. (2013). Pharmacological management of sedation and delirium in mechanically ventilated ICU patients: remaining evidence gaps and controversies. Semin Respir Crit Care Med, 34(2), 201–215.

 

To me, it is very scary to take care of a patient on a ventilator. To think that a machine is making the patient breath and keeping them alive is quite intimidating. I am sure it is a scary sight to witness a delirious patient while in an intense environment. Having to monitor critical patients when sedation vacation is happening could be very frightful especially when they start trying to pull out tubes, IVs, and foleys. I am absolutely for the mnemonic THINK solution. Where the components within the pneumonic is looked at when a patient is delirious. Toxic, Hypoxia, Immobility, Non-pharmacological interventions (clustering care, having hearing aids and glasses available) and the Potassium level are the most important factors that could tell you why a patient is delirious. Making sure these factors are not causing the patients delirium is very important. The video of the gentleman who was in the hospital for 22 days was very eye-opening. He stated he can remember these vivid nightmares like it actually happened. He remembers the 15 IVs in the constant worrying that he continues to go with on the daily basis. To be on paralytic and sedatives for so long can cause cognitive impairment. This gentleman is living with post-traumatic stress disorder (PTSD) due to the flashbacks he experiences of the nightmares he endured during his time in the ICU. He also stated that his family wanted to be involved more than they were. This is a scary situation and I am surprised that family members would want to be more involved but I can understand because it could be a scary being in an environment and seeing their loved ones in a situation like this. Study show that early ambulation in the first three days decreases delirium. So the study shows this I think it needs to be done. Evidence-based practice is done because of the best patient outcomes. One hospital decreased the amount of sedatives and paralytics and noticed that 15% of their patients were less likely to die and their length of stay was shortened by four days. Combining the decrease in the amount of drugs given an early ambulation can decrease delirium in the ICU patient. I also agree that follow-up care at home should be done because there’s no way of knowing if the patient had an out of body experience or the constant state of worry and fear while they were under the strides. Being able to identify the psychological stresses and intervene can help them get back to life they were living before the incident.

As I was reading through all of your first week posts and your initial thoughts about blogging, I have to say I have an overwhelming sense of pride. So let me explain …

I equally love and hate technology.

Technology is challenging, whether it is just getting logged in and started on what you want to achieve, or change a font or background, or figure out how does it seem ‘so easy’ to others, it is still frustrating beyond belief. I get it. I am amazed at your willingness to jump in and stand up to the challenge. I pretty much am anticipating many of you may surpass my skills and be teaching me. We are learning together. Small steps. There is no ‘perfect’ page.

Honesty is not given freely.

You have all been willing to honestly evaluate your thoughts and feelings. Reflect upon your learning. Evaluate yourself in both strengths and weaknesses. You say what you like and don’t like. However, you are willing to still try new things. Honesty and flexibility are wonderful skills for nurses, so this again makes me proud of you all. I know I am pushing you and stretching your limits in some areas (mostly technology!). I have the intent to try to further develop your learning beyond what you thought you could do. Recording is difficult. Blogging can be long and frustrating. I greatly appreciate your openness to try and sharing your thoughts. The end goal: learning.

 There is never enough time

This is my life-long complaint. There is never enough time to lead/guide you to all the information out there. There is never enough time to try out themes, or edit and modify pages or posts. There is never enough time for patient education, collaborative care planning, and hand-holding. There hasn’t been enough time to individually help you through CI Keys, but CI Keys is new this year. Hopefully you are finding the videos helpful and don’t forget to share tips with each other! I am proud and excited that you are some of the first few hundred students signed up! Many times, if you just show up and do the best you can, you will make a difference. Your ‘best’ is significant. Be in the present moment and enjoy every moment you can.