Medication education

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Medication Education

This is something that happened to me recently. My friend has IBS and told me she had to go for a cortisone injection and was going to the Doctor’s office to get the injection. I noticed my friend has ben exhibiting the signs and symptoms f a cold over the last couple of says. My first question was. Has anybody educated you on cortisone? Has anybody told you about the side effects and when not to take it?. At this point my friend said what most people say. No, my Doctor told me to take it so I will take it. At this point I brought Skyscape up on my phone and showed her. Cortisone suppress the immune system and care should be taken when exhibiting sign and symptoms of colds and flu. So when she read it she called her Doctor and told him what was happening and he noted that the injection could wait a couple of days until she felt better.

My wife’s grandfather had a stroke and was put on a medication regiment of 16 medications. As a result he ended up in assisted living. When he came to visit my wife’s mother she was responsible for giving him all this medication. I asked if anybody trained her on how to give all this medication and she said. I just read the labels and give it when it is due. This was shocking to me. We trust healthcare providers and just follow the instructions. But I feel we must be educated on how to take medications correctly. Especially when it comes to a multi-medication regiment. When I looked at the medication it was overwhelming. The only thing that was listed was when to take, how to take it, and whether or not to take with food. For the side-effects and interactions I had to go online to find the information. I used pocket pharmacist an Application on my phone to check the medications and was surprised that some of the medications did have interaction warnings. Granted your Doctor has training and education in this regard but we should not just blindly follow instructions and take medications. We should always be part of the conversation and ask question, we should do research and ask more questions. I know a little knowledge can be a dangerous thing but if your healthcare provider practices Holistic medicine they would be happy to have you ask questions

Patient education about nutritional needs post Billroth 2

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This article talks about the post operative diet that needs to be followed by all people who have undergone a billroth 2 procedure, which is done to treat severe PUD.

http://www.livestrong.com/article/545768-billroth-ii-post-procedure-diet/

operation_Billroth

http://img.tfd.com/dorland/operation_Billroth.jpg

Patient Education

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Patient education is a HUGE role for a nurse and is also, in my opinion, one of the most important roles. With the right patient education you as a nurse are giving the patient knowledge to care for themselves and to get better. Without the knowledge and resources to manage a chronic illness or care for a new life style (such as a new colostomy bag or new medication that needs to be taken a certain way everyday like insulin) the patient is not going to be able to be successful with their treatment. The patient is the primary care for themselves once they go home, most likely, so it is so important to educate them correctly. The best methods to educate your patient I believe is to talk to them about it, give them pamphlets, demonstrate, and then have the patient explain what you just taught and demonstrate as well.

Sedation Vacation

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Sedation vacation

I haven’t seen this yet in the hospital but I read the Cottage Hospital Policy on Sunday. Here are some points that I found to be significant and important.

At Cottage Daily Awakening trial (DAT) is performed once daily between 0500-1200.

The goal is for the patient to breath spontaneously once all the sedatives are interrupted. If the patient has met all initial screen criteria RN and RT will assess patient for 2 minutes. Sit up at least 45 degrees, Suction airway, CPAP 5 with 100% tube compression, DO NOT change FiO2. The Nurse is to document sedation level (RASS-Richmond Agitation Sedation Score) and pain score every 30 minutes. Continue for 90 minutes.

Termination Criteria-

  • Apnea for 60 seconds in first 2 mins
  • Use of accessory muscles, nasal flaring, paradoxical movement of abdomen and ribs
  • SpO2<90%
  • Severe anxiety, agitation, diaphoresis or decreased LOC
  • RR > 28bpm or <6bpm
  • SBP >40mmHg over baseline or SBP less than 90mmHg
  • HR>25bpm over or under baseline
  • New or worsening cardiac arrhythmia.

Evidence based practice states that Daily Sedation Vacation evaluates the need to IV sedation and allows the titration of sedation to reduce the need to mechanically ventilate. This also reduces the time in ICU, ventilator pneumonia and PTSD.

The benefits of Sedation Vacation seem very important for a patient but I’m wondering how often it is truly done and what are the limitations. According to Hogue and Mamula in Nursing Critical Care 2015 nurses understand the importance to evaluate neurological function but agree that documentation of DSV are cumbersome. That’s where education comes in to teach the importance of DSV and what evidence base practice demonstrates. Through education I believe nurses can feel empowered to make a difference and get their ventilator patients put of the ICU and onto recovery.

 

Hogue, M., & Mamula, S. (2013). Sedation Vacation. Nursing Critical Care, 8, 35-37.

Cottage Hospital Weaning program protocol

 

Ostomy Care

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In an article featured on Americannursetoday.com talks about patient education regarding ostomy care. Some of the topics covered include types of ostomies and stomas, finding the right ostomy pouch system, complications, nutritional considerations, and drug therapy.

The types of ostomies mentioned are the colostomy, ileostomy, and urostomy, and what is included is which organ will be affected, the location of the surgical opening, the consistency of the stool for each ostomy, and whether it is permanent or not. Regarding stomas, the type of stoma is picked based on the disease process, how much of the intestine is functioning, and the patient’s condition. The type of stomas that may be used are a double-barrel stoma, end stoma, or loop stoma.

In terms of pouch systems, there is a variety of options available nowadays. They may range from being one-piece systems or two-piece systems which consist of a barrier that may be precut or cut-to-fit and a pouch that is opaque or transparent.

Complications that should be reported involve fever, increased pain, dehydration, diarrhea, and infection of the surgical site. Also, the patient should note whether if there is no discharge coming from the stoma within 24 hours.

Nutritional considerations the patient should abide to are to start with clear liquids and to slowly introduce new foods to figure how well it may be tolerated. Also, the patient should make sure to stay hydration in order to prevent dehydration. The recommended fluid intake is 64 ounces per day for ileostomy patients.

Certain drugs should not be taken such as laxatives by ileostomy patients as dehydration may occur. It is important to contact your physician before taking any new drugs.

Through teaching patients about ostomy care and equipment, patients will hopefully be able to find the confidence and skill to gain independence and a better quality of life.

You can read the full article here.

References:

Bak, G. P. (2008). Teaching ostomy patients to regain their independence. American Nurse Today, 3(3). Retrieved from http://www.americannursetoday.com/teaching-ostomy-patients-to-regain-their-independence/

 

Sedation Vacation

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The two sedatives I have seen used in clinical are propofol and versed. The two times I saw propofol used were for short-term procedures (an ankle reduction and a pediatric liver biopsy). These were not sustained sedations that required sedation vacation. The one patient I worked with that did require sedation vacation was a young woman who was the pedestrian in a pedestrian vs car accident. She had greatly increased ICP and a poor glascow coma scale on arrival. When I worked with her she had been in the PICU for 1 week and was still intubated and being sedated with versed. Sedation was important for her because of her ICP, but they had started weaning protocol and sedation vacation a couple days previous to my shift. Each morning they would reduce the versed drip and turn off the ventilator to assess the patients breathing efforts and neuro function. According to Skyscape, versed used for sedation of intubated and mechanically ventilated patients is dosed 0.02-0.1 mg/kg/hr IV. I didn’t get to witness a sedation vacation, but from talking with the nurse about it a few thoughts come to mind:

The nurse will need to keep the half life of the drug in mind when they begin to titrate            down as some drugs need to be reduced sooner than others (ie versed vs propofol). The nurse should be prepared to titrate throughout the sedation vacation if needed according to response, agitation, etc. Nurse and RT must collaboratively assess respiratory function; RT should measure ABGs. Comfort and ease of breathing should be supported with positioning and medications if possible, such as bronchodilators and/or pain medication.

Care for a patient with Cholecystectomy

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Today I was fortunate to care for a patient who was post op laparoscopic cholecystectomy. Patient presented to the ED with sharp pains, ultrasound and ct presented gallstones, murphys sign present. Patient decided to go home and take pain meds to let it pass but pain became excruciating to point of limited function. Patient then had urgent surgery in which laparoscopic cholecystectomy was performed. One of the gallstones was the size of a golfball! Priority of care was pain management. Patient was tolerating clear liquids.

This website contains further information on the surgical procedure

http://www.surgery.usc.edu/divisions/tumor/pancreasdiseases/web%20pages/BILIARY%20SYSTEM/laparoscopic%20chole.html

Protected: Sedation Vacations

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Week 6: Sedation

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While in the MICU this week, I did not have an intubated patient. However, I asked my nurse about the sedation vacation policy at Cottage. A sedation vacation is a period when critical patients who are intubated are given a break from the heavy sedative drugs (such as Versed, Fentanyl, Lorazepam) so the team can assess if the ventilator can be discontinued (the ultimate goal). She explained that the policy was recently changed to take the patients off sedation early in the morning, so that by the time the doctors are making their rounds the patients are waking up. This was a simple change in policy, yet the result was more patients were extubated sooner and had shorter ICU stays simply because the physician was present during the sedation vacation. My nurse also explained that you can expect all the patients on the unit who are intubated to have sedation vacations.Therefore you can anticipate it, and it will only not be performed if there is a doctors order that the patient is too critical and does meet criteria.

Patient Education on GERD

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Gastroesophageal Reflux Disease (GERD) is the backwards flow of acid from the stomach into the esophagus. This happens because the valve this prevents the acid from flowing up into the esophagus does not close properly.

Some common symptoms that may be experienced include indigestion, regurgitation, pain on swallowing, and excess production of saliva

Before taking medication, less invasive measures should be initiated to help with the s/s. Nutrition plays an important role. There are certain foods that may make the symptoms worse. Foods to avoid include chocolate, caffeinated beverages, spicy foods, mints, and acidic foods like tomatoes, lime etc. Eating smaller meals throughout the day instead on three large meals is best. Try to avoid eating or drinking 2 hours before bedtime/lie down. Elevating the head of the bed on 6-8 inch blocks may help if the symptoms occur at night. Avoid tight fitting clothes and if weight needs to be lost, 5-10 lbs may help. Smoking can make GERD worse, so cessation is important.

GERD can be treated at home by buying OTC meds. For indigestion, antacids like Tums can help. Meds that reduce acid, such as Pepcid are also helpful **before buying, consult doctor to make sure they are not contraindicated with other meds that are being taken**