Archive for month: October, 2015
Sedation Vacation
I actually have not seen sedation vacation performed in clinicals, but I know Cottage has their own policy and procedure for conducting it. In Cottage, the nurse and Respiratory Therapist collaborate to perform sedation vacation according to the optimal time based on the pt and family’s schedule. In order for the procedure to be performed, the pt must not meet any absolute or relative contraindications. Absolute contraindications includes increased ICP that is exacerbated with awakening or if pt is less than 18 yrs old. Relative contraindications include: PEEP greater than or equal to 10cm H20, PaO2/FiO2 less than or equal to 200, SpO2 less than 90% on FiO2 greater than or equal to 50%. If pt does not meet any contraindications, then all sedation infusions are turned off and pt is assessed according to the Richmond Agitation Sedation Score (RASS). Hospital protocols are then performed according to assessment thereafter.
Standard practice for sedation vacation is the same as Cottage Hospital. Many researchers encourage and promote sedation vacation because of its benefits to the pts (Dunn and Baker, 2011). These include less ICU stays, less chances of developing ICU delirium, and decrease need for ventilator support (Dunn and Baker, 2011). The medications used by Cottage include Lorazepam, Propofol, and Midazolam. If the pt does fail the RASS, then 50% of the previous sedation dose is infused and titrated accordingly. Hospital protocols are followed thereafter.
Reference:
Santa Barbara Cottage Hospital Daily Awakening Trial/Weaning Protocol in Mechanically Ventilated Patients
Dunn, J., Baker, M.W. (2011). Daily Sedation Breaks and Breathing Trials Help Wean Patients from Ventilators Safely: The Authors Give Advice on Developing a Nurse-Implemented Sedation Protocol. American Nurse Today, 6(3). Retrieved from: http://www.medscape.com/viewarticle/741046_6
Reflections on my first semester teaching online
Starting to teach online is a big responsibility, especially when there is not an existing model for your discipline; in my case, foreign languages. For most faculty, changing how we teach can be a very scary experience. This semester, I am teaching my first online class and I have found myself feeling vulnerable and afraid of failure, much like […]
Sedation Vacation
Sedation Vacation Blog
I did not know much about sedation vacation so it was interesting for me to read the blogs of other students. I also found an article that talks about educating the nurses. This article helped me understand this process and the reasons for it to be performed. Sedation vacation is also called daily sedation interruption and can be beneficial for mechanically ventilated patients (Hogue & Mamula, 2013). Critically ill patients often need continuous IV sedation with analgesia since they may experience pain from mechanical ventilation, suctioning, surgical incisions, catheters, etc. Sedation is required to assess patient’s neurologic status and determine the necessity for further sedation. Hogue and Mamula state that evidence based practice recommends interrupting sedation at least daily in mechanically ventilated patients (2013). Some of the benefits include the ability to accurately titrate sedation, which allows to reduce the time on mechanical ventilation, length of ICU stay, lower risk for ventilator associated pneumonia, etc. (Hogue & Mamula, 2013).
The article also suggests a short quiz on testing your knowledge about the Sedation Vacation. They did not provide the answers, but you guys seem to know so much about this intervention that you can probably figure them out!
1.How long should DSI last?
a.10 minutes
b.20 minutes
c.until patient follows commands
d.until patient exhibits agitation
e.c and d
2.Circle all common benefits of daily sedation interruption.
a.decreased length of time of ventilation
b.decreased length of ICU stay
c.increased sedation
d.decreased other complications, such as ventilator-associated pneumonia and central line-associated bloodstream infection.
e.decreased anxiety
3.Which isn’t a potential adverse reaction to DSI?
a.psychedelic dreams
b.self-extubation
c.pain
d.anxiety
e.rebound agitation
4.DSI is better for acute posttraumatic stress disorder.
a.true
b.false
5.Do you think DSI is important for your patients?
a.yes
b.no
References
Hogue, M., & Mamula, S. (2013). Sedation vacation: Worth the trip. Nursing Critical Care, 8(1), 35-37.
week5 posting
hey guys, so I really sat down and started to think after reading Grinberg’s “Let toys be toys,” article, and realized all of the things being taught to different kids each day. It really is true when she states that the way you are told how and which toys you should use (depending on the parent) really does start a way of thinking. I can remeber a bunch of times i heard my male cousins dads basically yell at them for picking up a doll at such a young age and not knowing why it was wrong, but just that it was worng for them to have it in their posession. it was also interesting to read that 78, almost 80% of what people consider to be what makes boys boys and girls girls is in the close to zero range. There really is only a difference in mindset (other than biology) which is seperating boys and girls. Anyways, i sat down and started to ponder all this on a personal level, in temrs of what Grinberg means by letting toys be toys and having children decide which toys or attributes they want to aquire. As much as i told myself no, i too find myself fully sucked into the gender roles of society, and being completely honest (nto trying to stir the pot or anything) but i really don’t know how i would react or feel if I evr had a son who picked up a doll and tried playing with it. I want to say that part of me would let him keep playing with it for a bit before my inner instincts kick in and i try to persuade him to use a more “boy- orientated object” , I dont know, but this article really caught my attention to the gender roles that we associate with, well, everything.
Blog 4 how to compliment girls
I am going to be an aunt for the first time, so this article stuck out to me. I realized that i will always compliment my friends on clothes and accessories. I do this mainly because i have a slight obsession with clothes. I realize that its very surfaced, and even though i have good intentions I want to try and compliment my friends on deeper traits. Also, when it comes to children i will compliment their sparkly shoes, or princess dress because i feel like its an easy way to connect with little kids. However now i see that by focusing on appearance as a way to connect can create a larger issue. When my sister has her baby I will now think about what i say to my future niece or nephew. I want to compliment their kindness, intelligence, and other traits that mean so much more than physical appearance. Although i will want them to feel beautiful, i think kids need to understand that the important beauty truly comes within.
Sedation Vacay
I had never encountered the term sedation vacation before my time in the SICU last week. My nurse did bring up the term in educating me and said that it is used on critical patients such as the patient with a TBI I had on Thursday who was on long-term heavy sedation with Versed, Fentanyl, and Propofol, while intubated in the ICU to give her various body systems a break from the physiological effects of the sedatives. It also allows the nurse to perform a neurovascular check, as well as reducing the risk of ventilator acquired pneumonia and ICU delirium as well as assessing the patient’s readiness to extubate, which is the ultimate goal. I asked my nurse if, when they were given the sedation vacation, they were disturbed by the ventilator.
I imagined that if I were awakened suddenly out of a foggy sedation and found myself on a ventilator, I would be very disturbed. The nurse assured me that the patients were not fully awakened and so that was not a problem.
My nurse explained that ideally the sedation vacation is performed by a multidisciplinary team consisting usually of the nursing, respiratory, pharmacy, and the primary intensive care unit team. It is ideally done daily or once a shift. It can only be performed on patients who are hemodynamically stable enough to tolerate the vacation. These patients must also not show agitation, be properly oxygenated, not have very much secretions, and normal respirations under 38 per minute (ICU Sedation Guidelines of Care).
Patients are assessed for spontaneous breathing The Ramsey Scale which identifies six levels of sedation from severe agitation to deep coma is used. The Richmond Agitation and Sedation Scale is also used. It measures from light sedation to unarousable (ICU Sedation Guidelines of Care).
Sedation vacations, or daily sedation cessation trials have been found to reduce overall time on the ventilator, needed fewer diagnostic tests to examine neurologic function, had a better psychological adjustment and fewer instances of PTSD six months after their ICU stay (Dunn & Baker, 2011).
Dunn, J. & Baker, M.W. (2011). Daily Sedation Breaks and Breathing Trials Help
Wean Patients from Ventilators Safely. American Nurse Today 6(3). Retrieved from http://www.medscape.com/viewarticle/741046
ICU Sedation Guidelines of Care. (2009). Retrieved from
http://www.carefusion.com/pdf/The_Center/2009-ICU-sedation-toolkit-disclaimer-updated-may-30-2014.pdf
10/5/2015
Little girls
Wow! was how the articles left me complimenting little I believe on things like the newest clothes and shoes is absurd to me 10 years ago because I didn’t grow up with those things and my sisters did. I always have been on the late train with the newest things and have always complimented my sisters on their clothes although I never thought of how much it would be of such importance in todays youth. A smile is way more deserving than a compliment over nice Jordans. However I was more moved by the target story.
Target is amazing for breaking the stereotypes on what toys boys and girls shpuld play with. I remember growing up my brother would be called a sissy if he played with my dolls and that’s because Ken Barbie was a boy. I know that earlier generations were highly affected with this issue and at some pint to the extreme where they even questioned their sexuality and all because of a doll, stroller and toys that were gender labeled for little girls. I allow my nephew to play with dolls and strollers because hes only 2 and he should be able to play baby one day little biys will be dads and will be carrying around one I think this topic leads into many and am excited to hear the whole classes input on both I really enjoyed the article and sent it to my sister so she can read it too.
SandCrabs and Micro Plastics/Fibers
As of Friday I was able to get 31 sand crabs dissected and 20 of them had ambient fibers in their stomach content or surrounding tissues. That is approximately 64% of the sandcrabs so far have ambient fibers. Since the data from the summer research institute shows that a high percentage of the beaches sampled also had fibers and micro plastics, I hypothesize I will continue to find microfibers in the sand crabs.
Over the weekend I was able to travel north to San Louis Obispo county and collect 35 more crabs from 3 different sites as well as sand samples to process. Hopefully my contacts in Orange county, Santa Cruz and San Francisco will come thru with more sand crabs and sand samples as well. I am hoping to get a wide geographic range in sampling to see what I find.
Once the collected crabs are dissected I plan to test a hypothesis that the sand crabs will ingest micro plastics by sequestering them into small jars with sea water and exposing them to plastic microbeads I have filtered out of a face soap product that will be on the “to be banned” list if legislation is passed.
