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**

Caring for a G-Tube After Discharge

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This website provides a place for patients to go, after being discharged, for information on how to care for their G-tube. There is a brief description of what a G-tube is, how to properly use it, and gives step-by-step instructions on how to do feedings through the G-tube.

http://www.fairview.org/healthlibrary/Article/86493

Brochure: Understanding colon cancer screening

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http://www.asge.org/patients/patients.aspx?id=8074

Protected: GI Disorders Resources

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Patient Education

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Many patients who undergo surgical procedures are unaware of what exactly happens. Many misconceptions can be cleared by going over the procedure with the patient and answering questions they might have. Many hospitals now have educational tools that patients can utilize before the surgery is performed. An informed patient makes recovery easier on the patient and the medical team. Below is a link of what UCLA is doing  to educate their patients before surgery.

 

http://gastro.ucla.edu/body.cfm?id=181

 

 

345G2 2015-10-07 01:49:49

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On the article about the basic facts about children in poverty, it surprised me that there was a difference in the percentage of children in poverty from different age groups. What I did not find surprising was that parents’ nativity contributed to the percentage of children in low-income families.

In the article “Poverty’s Poor Show in the Media,” what struck me the most was the whole idea of how news stations only report on violence and celebrities. “If it bleeds, it leads.” The sad part is that poverty is worse than bleeding. It’s a side that people do not want to see because it is not as easy to fix as a bleeding arm. The other article about the misrepresentation of the poor in media coincides with this one. Even when news stations do report stories about the poor, it is always negative and unrealistic perspectives of them.

As for Sternheimer, I found it interesting that technology is not having such a negative impact on children as we might have thought. I mean I am not saying that watching tv all day long is good for children, but I feel like society might be overreacting to this issue. Let’s face it. We are moving more and more into a world that is completely immersed in technology.