My Self Assessment: My Strengths

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I took the Values in Action Inventory of Strength assessment, which consisted of 120 question survey and at the end  tells you your 24 Character Strengths in order. The first three were Prudence, Hope and Love. I did not know what the word Prudence meant, and since it was my first strength that was listed I saw that it meant that I make very careful decisions/choices because I do not like to regret things later. After reading that, I reflected on my life and it was so true! I hate making decisions, especially ones that can go really really wrong or really good. I would I do agree with my results, no matter what obstacle comes across me I always try to solve it, and if there is no way of solving it then I do not stress about it because that will make me age faster, but also I know that not everything is worth stressing over. Love, I value my relationships with the people who value them just as much as they value the one they have with me. I love people, I consider myself a very people person, and although I know I cannot simply “love” someone as soon as I meet them, that can always change in the long run if our friendship-relationship continued.

Week 4: Delirium in the ICU

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Delirium in the ICU isn’t the name of the next big a horror movie, sadly it is a growing problem in ICUs across the nation. According to the article “A Pilot Study on Delirium in the Intensive Care Unit” published in Dimensions Of Critical Care Nursing, delirium is linked to longer hospital stays and a worse prognosis for patients. According to the article in order for us to stop the rapidly growing problem, we need to have an understanding of the types and causes of delirium. There are 3 different types of delirium, which include: hyperactive, hypoactive, and mixed type (Whitcomb et al., 2013). Hyperactive is most recognizable and is characterized by an agitated patient with a hyperactive motor activity (Whitcomb et al., 2013). Second is the most common type of delirium hypoactive, which is characterized by lethargic stupor and a depressed consciousness, with no signs of agitation (Whitcomb et al., 2013). Third considered the most dangerous type is mixed delirium, which is a mix of hyperactive and hypoactive, so a patient may quickly switch from a lethargic stupor to a frightening state of agitation (Whitcomb et al., 2013). The article also pointed out that the main causes of delirium maybe connected to sleep deprivation and a heavy use of sedatives.

The study focused on a possible correlation between insufficient sleep and the development of delirium. The study also aimed to identify other environmental causes contributing to delirium. This pilot study, studied seven different patients, for seven nights, ages 65 and older, all which were intubated and sedated. The study found that between the hours of 9pm and 6am on average 48% of the patients remained awake, 30% were in a light sleep, only 18.5% were in REM, and 3.4% were in a deep sleep. I found it very interesting that they found that one patient had remained awake for 58-88% during his entire hospital stay. After reviewing the findings of the article I definitely agree that there is a relationship between a lack of REM sleep, sedation, and delirium. I realize that if patients aren’t getting proper rest, they will not be able to heal properly. Sleep deprivation in combination with sedation, and the development of delirium needs to be further investigated in my opinion. It would be interesting to see if with improved quality of sleep if delirium levels would decrease.

 

Reference:

Whitman, J. J., Morgan, M., Irvin, T., Spencer, K., Boynton, L., Turman, S., & Rhodes, C. (2013). A pilot study on delirium in the intensive care unit. Dimensions of Critical Care Nursing, 32(5), 266-270. doi:10.1097/DCC.0b013e3182a077cd

Meal Check Assignment

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Breakfast:

  • 1 Banana (medium sized)

0.4g Fat (0.1g Saturated), 27g Carbs (14g Sugar), 1.3g Protein

  • 1 Cup of Oatmeal

3g Fat (0.5g saturated fat), 0mg cholesterol, 0mg sodium, 27g Carbs, protein 5g

  • 1 cup of 2% low fat milk

4.8g Fat (3.1g saturated), 20mg cholesterol, 100mg sodium, 12.3g Carbs, 8.1g Protein

  • 2 Tbsp of Peanut Butter

16g Fat (3g Saturated), 150mg Sodium, 6g Carbs, 7g Protein

  • 1 Serving of 100% Gold Standard Protein Supplement

1 g Fat, (0.5 saturated fat), 30mg cholesterol, 130mg sodium (5%), 1g sugar, 24g protein

After Gym:

  • 1 Serving of 100% Gold Standard Protein Supplement

1g Fat, (0.5 saturated fat), 30mg cholesterol, 130mg sodium (5%), 1g sugar, 24g protein

  • 20g of dextrose

20g Carbs (20g sugar)

  • 8 egg whites

0.1g Fat, 55mg Sodium, 0.2g Carbs, 3.6g Protein

  • 1 cup of oatmeal

3g Fat (0.5g saturated fat), 0mg cholesterol, 0mg sodium, 27g Carbs, protein 5g

  • 3 strawberries

3g Carbs (3g sugar)

  • 1 oz of almonds

14g Fat (1g saturated), 0mg cholesterol, 0mg sodium, 6g Carbs (1g sugar), 6g Protein

Snack:

  • 1 Serving of 100% Gold Standard Protein Supplement

1g Fat, (0.5 saturated fat), 30mg cholesterol, 130mg sodium (5%), 1g sugar, 24g protein

  • 1 Apple

0.3g Fat (0.1g saturated), 2mg sodium, 25g Carbs (14.4g sugar), 1g protein

  • 1 oz of almonds

14g Fat (1g saturated), 0mg cholesterol, 0mg sodium, 6g Carbs (1g sugar), 6g Protein

Lunch:

  • 8 oz Chicken Breast

11.12g Fat (3.12 saturated), 120mg cholesterol, 42g Protein

  • 2 cups of rice

3.6g Fat (0.8g Saturated), 20mg of sodium, 90g Carbs, 10g Protein

  • 1 oz almonds

14g Fat (1g saturated), 0mg cholesterol, 0mg sodium, 6g Carbs (1g sugar), 6g Protein

Dinner:

  • 8 oz Chicken Breast

11.12g Fat (3.12 saturated), 120mg cholesterol, 42g Protein

  • 1 cup of Rice

1.8g Fat (0.4 Saturated), 10mg of sodium, 45mg Carbs, 5g Protein

  • 1 Spring roll

Unknown but it contained vegetables and steamed shrimp

Bedtime Snack:

  • 1 Serving of Casein Protein Supplement

1g Fat (0.5 saturated), 30mg cholesterol, 150mg sodium, 24g protein

Overall, I believe I would not have trouble meeting a cardiac diet simply because I can consume meals that are low in sodium, fat, and cholesterol if need be. I am not sure I would be able to comply with a diet if protein was limited! As you can tell by the information above I consume about 200g of protein a day and some diets restrict it to less than 30g/day :(

AND YES I DO EAT A LOT!!!!!!!

ICU Delirium

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The article I read “Incidence, Risk Factors and Consequences of ICU Delirium” stated they found a 30% incidence of delirium as opposed to previous reports of 80%. Excess use of sedatives lengthens time spent on a ventilator and prolongs hospital stays. According to this study patients were evaluated with the 8-item Intensive Care Delirium Screening Checklist (ICDSC) and level of sedation was measured with the Richmond Agitation and Sedation Scale (RASS). According to the article delirium has been term an “organ failure” of the brain resulting from severe systemic disease (Ouimet, et al. 2007). Patients were screened for a plethora of pre-existing diagnoses, and found that as well as those with alcoholism and hypertension had the highest incidence of delirium.  Drug induced comas also has a high incidence of delirium.   All patients in the study were assessed daily and followed until either death or discharge.  I think it is amazing how many patients suffer from ICU delirium.  I have not spent much time in the ICU however when I did my nursing school rotation and the pt was under light sedation and on a ventilator.  I never once see them implement the CAM –ICU Sedation Scale or any other scale nor was the RASS used.  So I see how ICU delirium can go undetected in a patient.  The ICU nurse was doing a lot for the patient so I do not want to come across as she was not doing her job I am just relating my experience.  The first stage is recognizing ICU delirium as an issue before solutions can be implemented. Which hopefully will educate ICU nurses of the incidence in delirium and preventative measures or interventions implemented I think the part I found most interesting was that according to the article hypertension and alcoholism were the leading comorbidities to developing ICU delirium.

 

Reference:

Ouimet, S. , Kavanagh, B. , Gottfried, S. , & Skrobik, Y. (2007). Incidence, risk factors and consequences of icu delirium. Intensive Care Medicine, 33(1), 66-73.