This semester learning about critical care has been my favorite semester throughout all of nursing school! It has definitely begun to feel like everything is clicking into place in regards to truly applying all of our knowledge. I have never felt more excited to go into clinical rotations than I have this semester, knowing that I will be learning so much in the short amount of hours available in clinical. My confidence in my clinical skills has skyrocketed, my assessments have improved, and my ability to piece together the whole picture with each patient has exponentially grown. My passion for critical care has shown itself as well, and I know that one day I would love to be able to call myself a critical care nurse. The potential knowledge, wisdom, autonomy, and critical thinking skills gained are incomparable. This rotation has overall strengthened not only my nursing skills but my goals as well. My goal includes becoming a nurse on the intensive care unit, whether that happens as a new graduate or later on in my career. That being said, I honestly cannot believe that three years of nursing school have come and gone. We have all grown so much since we started and will all in turn grow to be amazing nurses when beginning our careers! I cannot wait to see how it all turns out for us, even just a  year or two from now (at the reunion we will be having…right?)

Image: http://i1.wp.com/www.kollytalk.com/wp-content/uploads/2015/04/Nepal-Earthquake.jpg

This past Saturday, April 25th, a 7.8 earthquake struck Nepal that has led to over 4,600 deaths and 9,000 injured people (CNN, 2015). A disaster this large in size with so many people injured requires a significant international response to provide needed supplies and care. Countless buildings and homes have been destroyed, people have have lost their families and are in dire need of food, shelter, and medical care.  The United States Agency for International Development (USAID) has assisted by deploying a search and rescue team to Nepal, along with a Disaster Assistance Response Team (DART) to identify and prioritize needs (The White House, 2015). Humanitarian organizations such as Doctors Without Borders and the Red Cross have also responded to the incident to provide care to those affected by the earthquake and subsequent aftershocks (The White House, 2015).

Recent priorities since the earthquake hit have included search and rescue operations to find survivors and relief efforts (CNN, 2015). Even with the help that has arrived through international aid, however, there have been significant barriers preventing the provision of adequate medical care. Hospitals in Nepal have been overwhelmed and lack needed medical supplies, survivors remain buried in building wreckage, and rural areas are not easily accessed by rescuers (CNN, 2015). One hospital is operating at over 3 times its normal capacity with over 1,000 patients (CNN, 2015). Difficult terrain creates difficulty for surface transport to more rural villages in Nepal, while storm weather conditions preclude access via helicopters (CNN, 2015). However these villages are seeing serious damage. One village in particular saw about 70% of homes destroyed with trapped people inside, especially children and the elderly (CNN, 2015). Another cited barrier has involved the small Kathmandu airport becoming jammed with incoming aid workers, which prevents the ability of all needed aid and supplies to enter the country (CNN, 2015). The supplies highly prioritized currently are food, which approximately 1.4 million people need, and tents to withstand monsoon weather (CNN, 2015).

I believe that there are some aspects of a disaster response such as this that are difficult to control for. Earthquakes are unpredictable and as such are difficult to plan relief for as the size and magnitude cannot be know beforehand. However, in 2009 the Nepal government launched a Nepal Risk Reduction Consortium, which raised awareness of the imminence of a large disaster in addition to retrofitting hospitals to withstand an earthquake (United Nations, 2015). This act has potentially saved many lives in this earthquake as the hospitals are still standing and able to treat patients. The United Nations also plans to assist Nepal in reconstructing the country to be more resilient to disasters (United Nations, 2015). Hopefully other countries will learn from this event to strengthen their own disaster preparation.

References:

Asia News. (2012). For World Bank, Nepal is Asia’s third poorest country. Retrieved from: http://www.asianews.it/news-en/For-World-Bank,-Nepal%27s-is-Asia%27s-third-poorest-country-24668.html.

CNN. (2015). Nepal earthquake: Death toll passes 4,600 as rescuers face challenges. Retrieved from: http://www.cnn.com/2015/04/28/asia/nepal-earthquake/index.html.

The White House. (2015). America’s response to the earthquake in Nepal: What we can do to help. Retrieved from: https://www.whitehouse.gov/blog/2015/04/27/america-s-response-earthquake-nepal-what-we-can-do-help.

United Nations. (2015). UN allocated $15 million in emergency funds for Nepal earthquake response. Retrieved from: http://www.un.org/apps/news/story.asp?NewsID=50708#.VUAfI5Ozl2A.

My first true encounter with end of life was when my granddad passed away last February. In the last few months of his life he was experiencing progressive cognitive decline with dementia, multiple TIAs/strokes, physical decline such as being unable to care for himself, and frequent  ER visits and hospitalizations. Eventually he could no longer be cared for in his home, so he moved into a board & care, and eventually he experienced another stroke and developed pneumonia. He had been in the hospital for a couple days for this admission and we knew it would not be long. On the morning he passed I was woken up by my mother stating that the nurse at the hospital had called saying his breathing had changed and that we should go over. I was unsure of whether or not I would be able to witness his passing but I went to the hospital with my parents, grandmother, and aunt regardless because I knew I would regret not going. And I was very glad that I went; although it was difficult being there in his passing helped to bring a sense of closure and we were able to be there together saying goodbye.

Luckily before this had happened my mother had initiated a discussion with my grandparents regarding their wishes regarding end of life. With the information out in the open we did not have to worry about making the difficult choices when my granddad became ill and were able to focus more on the time left together. This event also prompted my mom to open the discussion regarding her end of life wishes and to create an advanced directive. She has shared her wishes with me and she has made me her secondary healthcare proxy after my dad due to my healthcare knowledge. My dad has not outright talked about this end of life wishes with me, but through talking with my mom she has shared that his views are similar. Neither of them want to prolong their life to the point living chronically with a breathing tube, feeding tube, etc. I feel the same way, and I suspect that the majority of us would agree after our experiences. I would 100% trust my parents, especially my mom due to her nursing experience, to make the right decisions for me if it were to come to it. However I have not had this discussion yet with my sisters, which would be a good idea to have next time we are all together.

Image: http://static.guim.co.uk/sys-images/Society/Pix/pictures/2010/12/30/1293727279713/Only-4-of-people-have-a-w-007.jpg

I interviewed my sister, my mom, and my dad asking them about the medications they usually take. I was surprised both at what they knew versus what they needed more teaching on.

(They look so colorful! Who knew there was so much to know about them?)

My sister: My sister takes vitamins and birth control pills. When asked if she knew how they work to prevent pregnancy she was unsure, stating she “had been told 3 times and still not quite sure.” So she learned how they work by preventing ovulation and changing the uterine lining. She named some side effects, such as weight changes, mood swings, and potential skin changes. I gave her more information on additional side effects, especially pointing out the risk for blood clots, which she was not aware of either. She did know about potential interactions of birth control and other items, such as grapefruit, but I let her know also about medications such as certain antibiotics that would require the use of additional birth control methods.

My mom and dad: My mom is a nurse, so I expected that she would know about medications she takes. She only uses albuterol and corticosteroid inhalers when needed for asthma. She was able to state the correct steps in using them, such as coordinating the MDI with inhalation, holding your breath for 10 seconds, and rinsing your mouth after the corticosteroid. I was surprised when asking my dad about the medications he takes, which includes OTC Tums, Tylenol when needed, and Prilosec. He explained how Tums work to neutralize the hydrochloric acid in the stomach, how Tylenol can cause liver damage, especially with alcohol. He answered almost every question I had correctly. I did remind him though to check other medication labels for acetaminophen to make sure he didn’t combine multiple drugs with Tylenol.

It can be easy to forget in the healthcare profession how other people do not get the same education regarding medications that we do. Things that seem so common sense to us now are not that way to others. I think it emphasizes the importance to educate our patients on the medications they are taking as we are giving them. It is something that has been engrained in us now since pharmacology, however it never hurts to survey people every now and then to see how much they really know.

We have all learned about stem cell therapy in the context of procedures such as bone marrow transplantation for cancer patients. Recently, there has also been significant research regarding testing the use of stem cells in the treatment of heart disease and the improvement of complications from acute myocardial infarction (AMI), heart failure, and cardiomyopathies. With AMI, percutaneous coronary intervention (PCI) has become standard treatment, and it is successful in reducing mortality (Puliafico, Penn, & Silver, 2013). This reduction in mortality however is associated with people living with the long-term complications of AMI, such as heart failure, in which half will die within five years of diagnosis (Puliafico, Penn, & Silver, 2013).

Then came the discovery of cardiac stem cells (Puliafico, Penn, & Silver, 2013). These stem cells are activated in the event of an AMI to attempt to repair damaged myocardium. It was then found that non-cardiac stem cells, such as those from bone marrow or adipose, can transdifferentiate into cardiomyocytes to help repair damaged heart tissue. There have been a multitude of different types of stem cells tested, along with different routes of infusing or injecting them into heart or vessel tissue. Research has shown that the introduction of stem cells after an AMI can improve ventricular ejection fraction (EF), volumes, wall motion, and infarct size. In heart failure patients, stem cells have also improved ventricular function through EF, improved functional class, reduced infarct size, decreased mortality, and acceptable safety outcomes (Puliafico, Penn, & Silver, 2013).

I think that this topic is fascinating because it has so much potential to save lives and improve outcomes for those with heart disease. Heart disease is the number one leading cause of death in the United States, and that will most likely not be changing anytime soon (Puliafico, Penn, & Silver, 2013). The research that is done now regarding stem cells can not only lead to improved outcomes for heart disease patients, but it can lead to future research for so many other conditions. While results presented in the article showed that improved outcomes were not consistent across a number of studies, it could be due to the multitude of different stem cells and administration methods possible. More research will be needed because cardiovascular stem cell therapy is still in its infancy. It is exciting to see where this research could potentially lead to though.

Reference:

Puliafico, S.B., Penn, M.S., & Silver, K.H. (2013). Stem cell therapy for heart disease. Journal of General Internal Medicine, 28(10), 1353-1363.

Image: http://www3.imperial.ac.uk/newseventsimages?p_image_type=mainnews2012&p_image_id=23503

Group #7
• Group Name: Fluid Resuscitators
• Group Members: Maria Magaña, Robert (Bobby) Martinez, Emily Sentianin

• Why group name was chosen: We chose to study sepsis for our group project and fluid resuscitation is a very important concept in sepsis management.

• Meeting times and locations for duration of semester: Meeting times 1100 on Wednesdays in the Student Union as needed.

• Role of each group member: Bobby-Researcher, Emily-Editor, Maria- Making presentations, everyone: Voice Thread Contributors. The duties will be shared but the ultimate responsibility will be the assigned person for each task.

• Who will lead each meeting? We will rotate leaders each week so that everyone has a chance to run a meeting.

• Who will take minutes and record action items? Maria

• What will the process be for dealing with group members who miss meetings or who are late? How will you address first time offense and repeat offenses? Will the discussion happen one on one or as a group? If the reason for missing meetings or tardiness is valid, then it will be excused. First time offense, if reasonable, will be given a warning. If repeat offenses occur and assigned workload is not completed, then this will be reflected in the final project grade. The discussion will happen as a group because it affects the entire group.

• What will your process be for dealing with distractions during your meeting? How will you address first time offense and repeat offenses? Will the discussion happen one on one or as a group? Meeting times need to be productive so will be no cell phone use rule during meetings unless expecting an important call/message. First time offense will be and repeat offenses will result in dismissal from the meeting. The discussion will happen as a group.

• What will your process be for decision making? If you decide on a consensus vote, what will be your process for making a decision if consensus cannot be reached? The decision making will consist of discussing options and ideas from all members and coming to a consensus. If consensus cannot be reached, further options will be explored and final decisions will be decided by a 2/3 majority vote.

• What will your process be for dealing with a team member who does not fulfill team assigments? How will you address first time offense and repeat offenses? Will the discussion happen one on one or as a group? Perform a verbal root cause analysis of failure to complete duties to ensure that assignment was fully understood. If deadlines are not met then, the first time offense will have an extension of 1 day, additional failures to meet deadlines will be reflected in the final grade. This discussion will happen as a group.

• What will your process be for resolving conflict within the group? Will the discussion happen one on one or as a group? The conflict will attempt to be resolved within the group by a roundtable discussion of issues; if the issue cannot be resolved then it will be taken up with the course instructor. This discussion will occur one on one if only involving two people but will occur as a group if the conflict is amongst the entire group.

• List any other applicable group norms:
o If you can’t make it to a meeting, let the group members know in advance as soon as possible, preferably the day before.
o Respect other group members.
o Collaboration and teamwork will be utilized.
o Do not be afraid to verbalize disagreement.