Innovative Patient Education on Gastroenterology

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DrawMD is an app available for an IPad that enables individualized patient education.  Created by two physicians working with the American Society for Gastrointestinal Endoscopy, this application enables visualization of the problem at hand with associated endoscopic diagnostic and treatment procedures. GI conditions include diverticulitis, diverticulosis, strictures, cancer, polyps, ulcerative colitis, and vascular abnormalities.  The procedures included at this time are colonoscopy, polypectomy, hemicolectomy, endoscopic Mucosal Resection, singe and Double Balloon Enterocsopy, abdominoperineal Resection, and hemostasis. This application can greatly increase patient understanding.  These demonstrations can also be printed and emailed allowing for patient review.

Find more information at: http://www.visiblehealth.com/drawmd-gastroenterology-has-arrived/

Sedation Vacations and Spontaneous Breathing Trials

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A “sedation vacation” or “spontaneous awakening trial (SAT)” is a period of sedation cessation during which a patient can be assessed to ensure they are receiving the proper level of sedation. The patient is first screened to ensure they meet the criteria for a SAT. If they meet the criteria for an SAT, sedation will be interrupted and the patient will be evaluated. If the patient tolerates the interruption in sedation, they will then proceed to a spontaneous breathing trial (SBT) safety screen and possibly a SBT.  Upon passing a SBT, extubation may be considered.

According to Balas et. al. (2011), performing SATs and SBTs on a daily basis led to “significant decreases in the duration of mechanical ventilation, shorter ICU stays, … and significantly fewer overall complications (eg, ventilator-associated pneumonia, upper gastrointestinal hemorrhage, bacteremia, barotrauma).” During my clinicals at Cottage Hospital I have only cared for one patient on a ventilator. I did not see a SAT and/or SBT performed on this patient, however looking at this patient retrospectively, I do not think they were hemodynamically stable enough to pass the safety screening. I have yet to have a clinical rotation in the MICU or SICU so I am looking forward to learning more about the hospital’s use of SATs and SBTs during that rotation.

I was able to access and review Cottage Hospital’s policy for their daily awakening trial/weaning protocol. The safety screening parameters and guidelines for SATs and SBTs very closely followed the parameters cited by Balas et. al. (2011) but were slightly more conservative. One thing Balas et. al. (2011) mentioned that I found interesting was “use of the ABCDE bundle should not depend on an individual physician’s order but rather should be structured as a daily part of care with clearly defined safety guidelines (e.g. an “opt-out” rather than “opt-in” approach to care delivery)”. In both the SAT and SBT safety screening policies Balas et. al. (2011) cited, the provider was prompted to include every patient unless they met an “opt out” parameter. Looking at the safety screening protocol for Cottage Hospital, the policy for SATs is written to include all patients unless contraindicated, but the policy for SBTs was written to include only those patients that meet specific parameters. I am curious to know if the language used in the policy affects the amount of patients that are appropriately screened. Using “opt-out” safety parameters may more effectively include patients that are eligible to be screened. It will be interesting to see the culture and practice surrounding SATs and SBTs when on the unit.

 

References:

Balas, M. C., Vasilevskis, E. E., Burke, W. J., Boehm, L., Pun, B. T., Olsen, K. M., … Ely, E. W. (2012). Critical Care Nurses’ Role in Implementing the “ABCDE Bundle” into Practice. Critical Care Nurse, 32(2), 35–48. http://doi.org/10.4037/ccn2012229
Shynk, T. (2010). Daily Awakening trial/Weaning Protocol in Mechanically Ventilated Patients, Cottage Hospital

Social Media

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This week I searched my topic  of the LGBT community on social media. The media I chose was Facebook and Instagram. In both social media sights I typed in LGBT. Simply that, no hashtag no nothing. I was pleasantly surprised to find that on Facebook it took me directly to LGBT News and the next sight was LGBT Nation. Both sights had many articles having to do with the LGBT community. Many of them were about what was happening around the world with regards to the LGBT community. I found that the LGBT Nation page was much more focused on what was happening in US politics. The LGBT News was also about politics but also took into account pop culture, not just political news. It also had as its banner the message “Be Brave” which I felt was heartwarming.

As previously mentioned I visited Instagram as well. I did not search through hashtag at first but simply put the acronym LGBT and was featured the account of LGBT text. It was hilarious in a meaningful kind of way. I also looked up the hashtag but only found vague pictures. I did however look up Ellen Page’s Instagram because I saw her on the LGBT News timeline. She had a speech for the Human Rights Campaign Dinner. Anyway, I discovered that she is in a movie called Free Held, which is about two women who are in love with each other in which one of the women contracts cancer and attempts to have her pension benefits be passed on to her partner. I feel this movie will have historical significance because I cannot recall a movie about a gay/lesbian couple as the main characters and at least one of the main actors be lesbian in real life. I am ecstatic about the information I found on Ellen Page’s account.

I, for one, am going to watch and support this movie.

PT Education With GI

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The only patient teaching I have seen in regards to GI is about ambulation increasing bowel activity and the importance of adhering to the laxative (Golytely) regimen in regards to colonoscopy’s.There is a lot more patient teaching in regards to GI in the endoscopy rotation I had been to for my out rotation last semester.

October 12

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“It distracts us from knowing too much about the way American society is structured, being too aware of social problems that might seem boring in the face of so much other interesting stuff out there to pay attention” (73). Yes, we society is engulfed in materialistic possessions and media. For starters, the UGG fascination. We were all so wrapped up in the fad and cute they were and cozy they felt. Everyone was wearing them and they just looked like a great fashion staple. Once you open your eyes to what goes on behind the scenes at this factory, you will throw up (if you are a decent human being). This goes for so many things on the media, we are blind to the reality. How many citizens actually know about the refuge crisis right now? The internet has definitely increased knowledge for the public. Television does dumb down the public only in the case that it doesn’t promote cognitive thinking so your brain starts to “fall asleep”.

 

Honestly, for kids to be affected so highly by television for it to be a problem they have to be watching large amounts of television; It is kind of ridiculous.

This chapter basically says that adults are more likely to abuse television than children, way to set an example.

Honestly I feel like my brain is working harder when I am multi-tasking. It takes more work for you to say write this blog and listen to a song. It takes more energy to write and essay and watch a show than to just watch the essay. I feel like my brain works more when I multi-task.

Santa Clara Recon

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“It wouldn’t be called research if we knew what we were doing.” -EinsteinIMG_7240Big thanks to Dr. O’Hirok and Patrick Costa for coming out to help pick spots along the beach that would give the most exciting results for profiling. Learning how to use the GPS was also helpful given the sand is forever moving.

About

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Casey Lysdale is the Environmental Coordinator of the California State University Channel Islands Chapter of the Surfrider Foundation. The Surfrider Foundation is an international environmental organization dedicated to the protection and enhancement of the world’s waves and beaches through conservation, activism, research, and education (CARE). Casey has been working to restore the coast and watershed in Ventura, California.

Hello world!

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Welcome to WordPress. This is your first post. Edit or delete it, then start blogging!

Hello world!

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Welcome to WordPress. This is your first post. Edit or delete it, then start blogging!

Pharmacological Education at Home

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Hi this is Breehan! person_with_pill_bottleBecause my mom just had a knee replacement, I talked to her about her different medications. She is on Percocet and Tramadol. I was surprised that her doctor did not educate her about not mixing the Percocet and Tramadol too closely together until she actually asked him after I told her that she should not take the maximum amount of each medication all at once, especially because she enjoys a glass of wine in the evening when she tends to take her pain medications to help her sleep. I warned her not to mix the wine and medications and explained why it was a bad idea.

 

Once my mom was educated about that, she was then confused about whether she could mix Ibuprofen with the opiates and I had to educate her that Ibuprofen and Percocet or Tramadol are ok together but to make sure not to take too much Acetaminophen along with the Percocet if she takes the maximum amount every 4-6 hours as is recommended on the bottle. Once again, I was so dismayed and surprised that my mom’s surgeon did not take the time to give her this important pharmacological education.

 

The surgeon did succeed at least in telling my mom about the side effects of being on strong opiate pain medication post-op. He encouraged her to take stool softeners for the constipation and not to drive while under the influence of the medications.

 

I was glad I was present to assist my mom in educating her about her medications and rather appalled that she had not been told what I considered very basic information about them in the post-op period.