Collaborative Care with RT

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In clinical, what are you seeing related to sedation vacation and collaboration with Respiratory Therapists? What is ideal? What is standard practice? What medications are you seeing in the clinical setting for sedation? What tools are used to determine the infusion rate?

In clinical the main areas I have witnessed collaboration with Respiratory Therapists (RTs) is my time in NICU, PICU, or when my patient in Med/Surg went into respiratory distress and we had to call rapid response. In the NICU, the RTs play a crucial role monitoring all of the neonates on vents and making changes as needed.

I haven’t witnessed sedation vacations on the floor, but it seems like a good concept to implement. When a patient is on a mechanical ventilator it can be uncomfortable and inadvertently inflict pain on the patient. Sedation is provided to give the individual a more pleasurable experience amongst the necessary equipment to monitor their well-being. The ideal practice is to provide a vacation or weaning from the sedation medications once a shift to assess neurological systems, ability to follow commands, and evaluate the need for remaining on sedation.

In the clinical setting the medications that I have most seen used are fentanyl and lorazepam.

To determine the infusion rate:

drug dose ordered (mcg) x patient’s weight (kg) x 60
drug concentration (mcg/mL)

You also want to know the target goal for sedation, times of sedation vacations, and how often neurological checks are to be performed.

Hogue, M., & Mamula, S. (2013). Sedation vacation: Worth the trip. Nursing 2015 Critical Care, 8(1), 35-37.

Blog #4

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Visibility, representation , and diversity were all key points that were talked about in our readings this week. In the article, “The Poor Will Always Be With Us: Just not on the TV News”, I was not surprised to learn that the media gives little coverage about poverty in America, however, what I found to be very interesting was that coverage on poverty rarely allows for Americans living in poverty to share their opinions. It was even more interesting to learn that concerns for the elderly and veterans living in poverty was seen as more important than any other group living in poverty. This can be understood in both ways. First, the elderly population are more than often portrayed as weak and unable to provide for themselves. Second, the arm forces are a group in our American society that receives not only many resources, but also are seen as national heroes. Thus, these two groups within our society are thought as more “important” and as the “deserving poor”.

Further, reading the article “Let toys be toys: The case for gender-neutral marketing” allowed me to reflect on my own childhood and the choices I made when buying toys with my parents. One of the main points this article states is that  “parents and environment are more likely to influence which toy a child picks up, not gender”, and I completely agree with this statement. Looking back into my childhood, I vividly remember having an endless amount of toys which consisted of Barbie dolls, Barbie dresses, mini-doll houses, etc. Social forces in which a child grows up around shape the way they think and how they perceive the world. Thus in my case, I was taught that girls were supposed to play with dolls and boys were supposed to play with cars. I think it’s a difficult task for parents to not only realize that gender stereotyping is wrong and has a huge impact on how children make sense of the world around them, but also teaching children to be more open-minded. Thus, as the article states “it’s a cycle: Gender stereotypes are fostered in childhood and take shape in adulthood, to be passed on to children.

In the article, “Global Food Disparity: A Photo Diary”, I was shock to see how different each country’s family food choice differs so much from America. This article, brought a different perspective of media in my mind. Though media sometimes portrays ethnic cultures, gender, and race in a rather negative way most of the time, this article help portray the variety of culture we have in this world. Media pieces like this one, helps bring awareness about the obesity problem we have here in America specially with regards to child obesity and gives readers a different perspective.

With all of this being said, I am interested in hearing what are your thoughts with regards to these articles. Were you able to relate your personal experiences to these articles? Did you agree or disagree with what was said? and do you think that certain factors in our society are visible and represented more through media?

Week 7 Check-In

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Hello and happy Friday!  We have a few items to check-in with you about.

  1. The grade book is current. The work that was submitted on time for Week 6 (Challenge 3, Component 2 blog post) has been graded. Please check the grade book in CI Learn and read any feedback we may have left for you. Always contact us directly with questions about your scores.
  2. As a reminder, this week you are focusing on Challenge 3-Component 3. This involves searching two social media sites. You are not required to create new accounts, provided you have access to two sites already (Facebook, Twitter, Google+, Instagram, LinkedIn, other?). Full instructions are included in the Weekly Schedule for Week 7. You also have one VoiceThread slide to comment on for the first 9 pages of Chapter 3 in Net Smart.
  3. You will notice that we’ve embedded a Twitter search widget in the left column of our site! All Tweets that include the hashtag #UNIV349DC will appear here. If you have chosen to search Twitter and have an account (or would like to take this opportunity to create one), feel free to share resources and reflections in the form of Tweets — just include our hashtag!
  4. Please click the link below to read more about our guest speakers, Michael Berman and Raechelle Clemmons! Click the “Submit my question” button and complete the form by next Thurs, 10/8. http://tiny.cc/whybesocial

Have a great weekend,
Michelle & Jill

Visibility

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I really enjoyed the articles this week specifically I enjoyed “The Best way to Compliment Little Girls.” I honestly never really thought about how giving someone a compliment can affected them so negatively. I find myself constantly complimenting women on physical aspects of themselves instead of complimenting who they are as a person . For example when the women all got together for lunch and they were complimenting each others hair cuts and hand bags, it just shows how much society tells us that really matters for women are superficial things. Overall I think that this article did a great job in giving alternative ways to pay compliments that make it more about who these girls are as people rather than who they are for their looks.  The following is a quote that really caught my attention from the article “On the other hand, your outfit is fabulous because it reflects your creativity, and your lashes are gorgeous because they are a part of you, and your long legs can take you to the top of a mountain or the front of a stage, if that’s where you want to go. You look great, and you are great. You are beautiful because of who you are, not who you are because you are beautiful.” This made me think of my own mother and how she would have complemented me. My mother was very big on minimizing the importance of looks, so while reading this article I felt like I was reading the words of my mother.

Mechanical Ventilation with Sedation

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A few weeks ago I had a patient in the ICU who had been intubated and placed on a ventilator. This patient had critical aortic stenosis and was placed on a ventilator following an attempted right internal jugular line placement that resulted in a massive right hemothorax. On the day that I was in the ICU the physician and primary RN decided that they would taper the patient down off the Sublimaze (fentanyl) and Versed (midazolam) being used for analgesia and sedation. The team’s ultimate goal was to see if the patient was ready to be extubated. In addition, the patient was placed on CPAP as a trial. In this particular case it was very important that the patient be monitored for any signs of agitation or distress due to the fact that increased stress would activate the sympathetic nervous system and increase the workload on the heart. Due to the severe aortic stenosis and compromised cardiac function, an increase in workload would be poorly tolerated by the patient. By noon the patient started to respond to stimulation. The patient would open his eyes in response to voices and became agitated during suctioning and turning. The increased heart rate that accompanied the agitation required that the Sublimaze and Versed be initiated once again. Ultimately, the respiratory therapist, nurse, and physician agreed that based on the trial CPAP and spontaneous awakening trial, the patient was not ready to be extubated. Ventilation and sedation are often a necessary treatment for a person with severely compromised cardio-pulmonary function. Nonetheless, these treatments have to be used judiciously with constant reappraisal of the situation in order to minimize the potential short- and long-term consequences of ICU-acquired delirium and weakness. During my next ICU clinical I look forward to investigating the procedures and protocols that are instituted in the hospital units.

Protected: Adherence to VAP Protocol

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Sedation Vacation

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Sedation Vacation

 

Sedation vacation is a term used in the critical care field and refers to patients that are sedated and on a ventilator . The sedative is titrated down in order to perform Neuro checks and assess for the possibility of extubating. The sedation vacation is necessary to reduce ventilator acquired pneumonia, delirium from the sedatives and a shorten ICU stays. This however does not mean that all the patients in the critical care units receive a sedation vacations. The patient has to meet certain criteria. Criteria like being Hemodynamically stable, shows no agitation on current sedative regiment, Fio2 is less than 50% and Peep is less than 10%, the sedation is not used to control status epilepticus or symptoms of alcohol withdrawal. Patient must also not be on a Blakemore tube for the control of bleeding varices. If a patient does not meet these criteria then the patient is not eligible yet for a sedation vacation. But as with all and any medical procedure there is a Policy for that which is basically describing how and when to perform this sedation vacation. The following is a Policy and Procedure form The Jefferson University Hospital

 

 
Index No: I-10
Effective Date:  

NURSING CRITICAL CARE PROCEDURES

Category: General Critical Care
Title: DAILY LIGHTENING OF SEDATION

 

Purpose

Daily lightening of sedation, “Sedation Vacations”, and assessing the patient’s readiness to extubate is an integral part of the Ventilator Bundle and has been correlated with reduction in the rate of ventilator-acquired pneumonia. This procedure is generally initiated after 48 hours of continuous sedation.

Kress et al. demonstrated that daily interruption of continuous sedation decreased the length of time patients spend on the ventilator and in the ICU and diminished the number of diagnostic tests performed to evaluate why a patient was not waking up once sedatives had been discontinued.

This protocol involves daily 50% dose reduction, and furthermore decreasing the sedation of the continuous drug infusion (including opiates) and monitoring the patient until he or she starts to show signs of awakening or agitation. At this time the patient is assessed for readiness to wean. The patient can also be assessed neurologically at this time.

The continuous sedation infusions can be titrated at the discretion of the bedside nurse to achieve a Ramsay sedation score of 2 to 3. In comparison with routine management, the daily cessation of drug infusions significantly reduced time on the ventilator in the ICU and provided a valuable window of opportunity for assessment of the patient’s neurologic function.

 

Steps in Procedure Points to be emphasized
Eligibility for Daily Sedation Vacation evaluated every morning at 7:30 AM on all mechanically ventilated patients receiving IV sedation (Propofol, Benzodiazepines, Narcotics and/or Precedex) after 48 hours of continuous sedation.

 

 

Exceptions to Daily Sedation Vacation include patients who are on paralytics, on medication for chronic pain or on sedation for comfort care.

 

 

Other unit specific exceptions:

  1. MICU – FIO2 > 80, Peep > 15
  2. SICU – open abdominal wounds, in which fascia is not closed, unless ordered by a physician, fresh post-op (10-12 hrs.)
  3. NICU – elevated ICP (ordered as per Physician), on sedation for anti-seizure purposes

 

 Decrease sedation until patient awake and agitated. Assess patient’s readiness to wean. Respiratory therapists are available in the ICU at this time for active weaning.

 

A Spontaneous Breathing Trial (SBT) will be done on patients who meet the criteria. If successful, after 30 minutes patient will be extubated. (Refer to Spontaneous Breathing Trials for details).

 

This process should occur during morning rounds (between 8AM and 11 AM) and patients should be extubated in a timely fashion after passing the SBT.

 

During the Sedation Vacation it is recommended that a neurological exam be completed at this time to assess the patient on continuous sedation for an acute change in mental status or focal neurological deficits.

 

Patients not sedated as deeply will have an increased potential for self extubation. Increased monitoring may be warranted to ensure patient safety.

 

Patients may have an increased potential for pain and anxiety associated with lightening sedation.
   
Procedure for Daily Sedation Vacation:  
Fentanyl

1.       If the patient is not exhibiting significant pain, decrease the Fentanyl drip by 50%.

2.       If after 30 minutes patient is still not overly agitated,delirious, or in significant pain, decrease fentanyl by 50% again.

3.       If patient becomes agitated, delirious, or develops significant pain give a 50 microgram bolus of Fentanyl and restart the drip titrating the rate as necessary to obtain a Ramsay score of 2-3.

 

Morphine

1.       If the patient is not exhibiting significant pain, decrease the Morphine drip by 50%.

2.       If after 30 minutes patient is still not overly agitated, delirious, or in significant pain, decrease Morphine by 50% again.

3.       If patient becomes agitated, delirious, or develops significant pain give a 4 mg bolus of Morphine and restart the drip titrating the rate as necessary to obtain a Ramsay score of 2-3.

 

Hydromorphone

1.       If the patient is not exhibiting significant pain, decrease the Hydromorphone drip by 50%.

2.       If after 30 minutes patient is still not overly agitated, delirious, or in significant pain, decrease Hydromorphone by 50% again.

3.        If patient becomes agitated, delirious, or develops significant pain give a 0.5 mg bolus of Hydromorphone and restart the drip titrating the rate as necessary to obtain a Ramsay score of 2-3.

 

  
Propofol

1.       If patient has significant pain make sure patient has a form of medication ordered for routine pain relief.

2.       Reduce Propofol rate by 50%.

3.       If after 30 minutes patient is still not overly agitated or delirious decrease the rate again by 50%.

4.       If patient becomes agitated or delirious after reducing the drip resume infusion of Propofol and titrate to a level that results in a

 

  
Lorazepam or Midazolam

1.       If patient has significant pain make sure patient has a form of medication ordered for routine pain relief.

2.       Decrease the Lorazepam (Ativan®) or Midazolam (Versed®) drip by 50%.

  1. If after 30 minutes patient is still not overly agitated or delirious decrease the rate again by 50%.
  2. If patient becomes agitated or delirious and needs to return to IV drip, administer 2 mg bolus of Lorazepam or Midazolam and restart the drip. Titrate the rate up or down as necessary to obtain a Ramsay score of 2-3

Dexmedetomidin

1.       If the patient is not exhibiting significant pain, decrease the dexmedetomidine drip by 50%.

2.       If after 30 minutes patient is still not overly agitated, delirious, or in significant pain, decrease dexmedetomidine by 50% again.

3.        If patient becomes agitated, delirious or develops significant pain, load with 1 mcg/kg dexmedetomidine and restart the drip titrating the rate as necessary to obtain a Ramsay score of 2-3.

 

  
Repeat Sedation Vacation at least Daily  
   

Documentation

Nursing:

1.        Critical Care Flowsheet/JeffChart – document wean attempt, ventilator settings, and success or failure of procedure. Document patient’s response to SBT.

2.        ABG results

3.        Document neurological assessment and response to decreased sedation.

 

Respiratory:

1.        Respiratory Flowsheet – document wean ventilator settings and response to attempt to wean.

2.        Document assessment findings and patient response that indicated success or failure of wean.

 

References

 

Kress JP, Pohlman AS, O’Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. New England Journal of Medicine. May 18 2000;342(20):1471-1477.

 

Original Issue Date: 8/8/2007
Revision Date(s): 1/25/08
Review Date(s):  

 

Responsibility for maintenance of policy: Content Expert, Amy Callahan, RN, CRNP, ANCC
  (Signature on File)

 

(Signature on File)

Approved by: Sharon Millinghausen, RN MSN Vice President

 

 

 

 

 

References

Jefferson University Hospital Sedation Vacation protocal retrieved from

http://hospitals.jefferson.edu/

Strategies for Sedation Vacation in the MICU retrieved from

http://www.aacn.org/wd/ntispeakermats/PosterPresentations/00042670/00042670.swf

Reagan Library Reflection

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As both a museum and a memorial of sorts, to both Reagan and his time in office, the Reagan Library is filled to the brim with historical information, testimonies, and artifacts. In a place that has such an extensive wealth of history and provides so many opportunities to expand one’s knowledge, it was difficult to choose just a few points of focus.

The first part of the museum that really grabbed my attention was the exhibit featuring Nancy Reagan and her support and love for her husband. She seems to have been an extremely notable first lady, particularly in how she took her role in stride. In this exhibit, one of her quotes was displayed which stated “I threw myself into these various first lady roles- spokeswoman, hostess, manager, and friend…above everything else, the first lady is the president’s wife.” Though the last part of the quote seems simplistic, I believe that it truly encompasses what it means to be an admirable first lady. Being the president’s wife does not just mean that you are committed to your love and your marriage, but it means that you are also committed to your country and to assisting your partner in his work. Nancy Reagan went far beyond that, instigating her own improvements throughout the country such as her “Just Say No” campaign, which sought to keep school kids from turning to drugs and alcohol. She traveled across the country, made television appearances, and visited rehab centers all as a part of this campaign.

Other particularly gripping aspects of the museum include the auditory stimuli given. One in particular the old-fashioned phone on which you could ‘dial in’ to one of Reagan’s speeches. Listening to his famous “Tear Down This Wall” speech through the speakers and hearing his way of describing communism as this huge evil entity was interesting. He even refers to the Berlin wall as a “scar” which every person in Berlin is forced to look upon.

While we were visiting the replicated Oval Office, there was a group of young school-children in the room with us who pointed out that there were jelly beans on the table. At first I had thought nothing of it, but the museum workers pointed out that Reagan had loved jelly beans. This became more apparent throughout the rest of the museum, including an entire portrait of Reagan himself consisting entirely of Jelly Belly jelly beans.

A more emotionally driven aspect of the museum which attracted my attention was the video of the attempted assassination. Since I wasn’t exactly the greatest history student in high school, I hadn’t even known prior to going to the museum that there had been an attempted assassination on Reagan. Seeing the video and hearing the reactions of both the people then as well as the people now who were in the room watching with me was an incredibly interesting experience. Even today, people still feel the fear and the ache of watching a president nearly die before their eyes.

Though my next piece from the museum may be seemingly unremarkable, I found that the section on music and art from the time period was enjoyable and emotionally driven. As somebody who is very in touch with music, it was almost a personal experience to be taken back in time to what they listened to and were entertained by at that point in time, some familiar and some not. Reagan himself said “where there’s liberty, art succeeds.” I understood this as meaning that, since America is a great country, it has incredible things to offer in terms of the arts and in terms of music- aspects of culture which transcend age and time.

I believe that the curator chose to include not only the “Tear Down This Wall” speech, but other huge signs and images against communism in order to portray communism as an incredible evil that the “hero” Reagan sought to defeat. Nowhere in particular can I recall there being any actual description of Communism. In fact, even in the open film-sequence, it was only referred to as an evil that was threatening to take over the world. In all honesty, though I know communism in practice has had major and tragic downfalls, the actual ideology of it isn’t necessarily bad. Rather than choosing to educate on communism though, the museum only seeks to portray it as the evil that those at the time believed it to be.

It was the same exact fear that was meant to be felt as part of the museum that lead to unfair persecution against those who were believed to be Soviets and Communists during the Red Scare. The room surrounding communism was dimly lit with lights which would change unexpectedly, in order to replicate a feeling of a lurking evil and uneasiness. I personally believe that perpetuating stereotypes without providing any concrete pro/con information gives less potency to the library and museum as a whole. In spite of this, though, the overall museum experience was quite enjoyable and I will hopefully be visiting again sometime in the future.

The Reagan Library Significance

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Reagan Library Discussion

Last week I went to the Reagan Library to visit the time of Ronald Reagan’s presidency. It was a really amazing place to see with all sorts of cool exhibits and showcase rooms to see as well. It was an incredible experience to see sow many exhibits showing what he did during his administration. Today I plan on talking about some of the exhibits there and what there significance was to me. There were so many that choosing which ones I’d be discussing was really quite troublesome but totally worth it. I’ll also give my own personal opinions on the subject. This was one of the greatest presidencies of all time for me and hopefully it will be for you as well.

First, I want to discuss about the vehicles that Reagan used during his time to get from place to place. The model car used during his administration was a 1972 Lincoln Continental that was reinforced with bullet proof glass on all the windows. Some areas of the car were bulletproof as well in order to secure the president’s safety at all times. It was considered one of the most fashionable models at the time and usually well guarded as well. A surprising fact about this particular model was that it wasn’t used by just Reagan in that the model had been continually used since Lyndon B. Johnson’s as a sort of tradition. Though it did end with Reagan’s presidency it was also involved with both his and Ford’s assassination attempts which would seem to suggest why they discontinued that tradition. To this day it still sits proudly in the museum’s exhibit next to Air Force One.

Secondly, is the most famously known object that everyone knows about the president of the United States… Air Force One. It’s the most common thing about presidents since planes were first invented. Air Force One is a private jet or plane exclusively for the president to anywhere in the country. Whether it’s to reach important meetings like the State of the Union Address to Congress or simply taking it for a much needed vacation when they have the time. Reagan’s plane is a lot smaller compared to the ones flown today like Barack Obama’s with much more confined space. A fun about this plane is that Ronald loved eating chocolate cake and would always want to eat it but his wife wouldn’t let him. So he came up with a plan to always have a chocolate cake onboard in case it was someone’s birthday. That way he could eat the cake and his wife didn’t realize that fact. Air Force One has always been a symbol for the President and will do so for years to come, you can see it for yourself at the library in the wing made especially to house it along with a few other pieces.

Third, is the suit that Ronald Reagan was shot in on his assassination attempt decades ago. The attempt happened on March 30, 1981 while leaving the Washington Hilton Hotel in D.C. He was shot twice one in the chest and the other in the arm and besides him three other people were injured in the shooting. The perpetrator, John Hinckley Jr. was found not guilty by reason of insanity. One interesting fact about this incident was him motive for doing this and according to him he tried to gain favor Jodie Foster, an actress/producer during this time was still fairly young. Reagan’s suit is currently on display at the library also with the live footage from news crews as the shooting took place.

Another important exhibit is the replica of the Oval Office during Reagan’s presidency. The room is exactly alike in both height and length making it the closest replica of the oval office ever made to scale before. It included many other things such as a mid century tower clock and his official desk is set there. One rarely gets to see the oval office from photos or videos but this is a one of a kind exhibit to feature the entire Oval Office of a given President. One fact about this is the desk which every president calls the Resolute desk is that it was sent by Queen Victoria to President Hayes as a gift and was fashioned by remains of the British Artic Exploration ship Resolute. The Oval Office is a symbol of the President’s power and will be for many years to come from those who came before them.

The last of them is also related to Air Force One in a way but just a bit different and that is Marine One. Marine One is a helicopter that is used to transport the President of the United States the same way Air Force One does only over a much shorter distance. It usually landed in the White House South Lawn since ample room was available and is the only authorized aircraft to fly in a no-fly zone. An interesting fact about Marine One is that it isn’t only a helicopter but a call sign as well for the Marine Corps. Sometimes the Army took turns escorting the President and when they did they called it Army One. The helicopter that flew Reagan sits proudly next Air Force One in the same exhibit to show off it’s time during the Reagan Administration.

The one to me that was the most fascinating is definitely the suit during his assassination attempt because it evokes feelings of realization. Before this I always thought the President of the United States couldn’t be killed but this proved me wrong because it has happened before and may happen again when we least expect it. This is a testament o that truth and helped me understand that not everything is at we seems with the people near the President. This represents one of the well presented facts of Reagan’s legacy because it shows that everything is possible when it seems implausible. This a truly accurate representation in Reagan’s history though not the best one in most people’s eyes and that most wish that this never happened.

My trip to the Reagan Library

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Knowing about presidents was something I did because I had to for all of my history classes. It wasn’t until Friday that I actually had an interest for learning about someone else besides myself and my friends. I went with an open mind ready to learn and that’s exactly what I did. I learned so much not only about Reagan but about history as well. I got an inside to how times were back then. It is so different to read about it in a book than actually see objects that take you back in time. It’s like everything became so real when I read the side comments next to an object or saw pictures. What caught my attention the most was the president then and the first lady’s love stories and the wedding memory section they had. I was surprised that they would let such intimate object be seen by everyone but I’m happy they did because I enjoyed it and it made me feel a connection with the museum. With that said I will be going to more and I’m very happy I was able to go to the Reagan library because it opened a whole new door full of curiosity to something I had never been interested before. After going I called my dad and I couldn’t stop telling how amazed by some things I had seen. I’m planning on taking my siblings for them to experience what I experienced and become more interested in history.

1

The picture above was one of the ones that impressed me as soon as I walked in because as a president I would have never thought that he was an actor. I had always known that acting was not a career but more like a hobby. It was interesting that Reagan committed to it from High school to College. Those stages of my life have been the ones I have taken more serious than any other stage in life only because those are the ones I feel are shaping my life. If I would have been acting I know for sure my parents wouldn’t have been happy. My parents would have just seen it as me throwing my life away and that’s one of the things I was most excited to tell my dad. I told him the president of the United States of America at one point was an actor and not at a young age. I thought he was going to laugh and be surprised but like always the smartness of my dad surprised me and instead he said yes because that you are meant to be you will be either sooner or later and Reagan was a really smart man. I thought to myself that is really true. ” What you are meant to be in life you will be either sooner or later”

2 Athletes usually practice to be famous one day for the sport they practice not to be the president, that’s exactly what I thought to myself when I read this. Also the fact that he was not planning to become president but an actor. I usually think people who become very important are those who keep their noses in books all throughout High School. Although by the looks of it Reagan proved me wrong. It seemed like he was the jock everyone liked and knew or so that’s how I picture it in my head. The most important thing I took out of this was the fact that he was so involved in many things and was still able to have the grades to become president. I admire that because as a student when I was in High school I thought six classes was to much to handle especially with cheer. I could only imagine the amount of stress he had with being president of the drama club as well as being involved in yearbook. My props to you Reagan!

3 I thought it was so fascinating to see the yearbooks Reagan designed. I have yearbooks and I knew the people who designed them and I would never think they would become president one day. Not only was it nice to see the yearbooks a president had designed but it was also interesting to compare them to the ones I have of my senior year. They are nothing alike. The ones in the picture seem more serious to me although they are still nice. My yearbooks look like a children’s book compared to these. I would have liked to have seen them from inside to see him maybe acting or simply be a normal teenager like me now. Not only would I be interested in seeing Reagan but maybe his friends and how girls my age dressed like back then. Just by looking at the cover of the yearbook I had so many questions what if I looked in it and looked through every page. I probably would not be able to stop thinking of questions to ask. It would be one of those things that would take me back in time just by looking at pictures. I could not help it to think the black and white picture on tip did not look like him. That’s when he was a teenager in High school. Maybe looking through the yearbook would have helped me see more of how he was as a teenager which is something I would have been interested in finding out. I already knew by him previously being an actor that he was outgoing and loved being on stage but what else was he into? anything I’m into now maybe?

4 From what I know the world in Hollywood is really aggressive and competitive. Yet Ronald Reagan in his first 18 months had 13 films already that’s very impressive to me. I would have thought as being as smart as he is that it would not be hard to get what he wanted but like it says in the comment ” He lobbied hard for the part of…….”. It is also pretty admiring that he was noble enough to buy his parents a ranch and house. People who get to become something re usually those who I believe become less humble but from what I see Reagan was humble and it shows a lot of his personality.

Overall like I said before I enjoyed myself at the Reagan library it was definitely a new experience that I enjoyed. I would go back and walk through it again just to learn more about the small details.