It is officially one more week until out pinning ceremony. It all seems quite surreal. However, looking back at this course and all we have learned this semester in addition to all of our previous semesters, I feel that I am ready. This course has helped me to bring everything together. In patho we learned patho. In pharm  we learned medications. However, in critical care I feel that I learned how all of these previous courses work as one to help us become competent nurses. Through this course I learned how to look at everything on a whole (labs, ABGs, test results, assessments) to see how it makes these patients with their specific diagnoses. I am excited to put the knowledge I have learned in this course and all of our others to work in the filed of nursing.

A 7.8 earthquake recently devastated the country of Nepal. On Saturday, April 25th, a 7.8 earthquake struck 48 miles northwest of the capital of Katmandu. Numerous aftershocks rocked the country with the highest aftershock registering a 6.8. the earthquake was also felt in India and Tibet.Over 1800 people are known to be dead, with just under 5,000 injured and the figures are expected to rise dramatically as search efforts continue.  This earthquake triggered an avalanche on Mt Everest killing at least 17 people there and many others are thought to be stranded. The capital was one of the worst hit areas as many of the building were built with unreinforced brick or crushed stone and many people were hit with flying debris. Many of the country’s medical facilities were rendered inoperable by the large earthquake. Additionally, the capital’s water system is thought to be contaminated. These are two major barriers to providing health care to the survivors. Additionally, due to the large death toll the number of healthcare workers can be assumed to be substantially decreased. The U.S. embassy has already given 1 million dollars to aid in disaster relief along with sending a response team. Australia and the Asian Investment Bank has also given millions in aid. The government of Nepal is asking for medical supplies as well as aid workers to help in the after math. The economy of this country is very much dependent upon tourism. This can be expected to have a large negative impact on their economy. Imagining being a healthcare provider during a natural disaster such as this is hard to imagine but should be a reality for all of us that live here in California. Overcoming obstacles such as lack of supplies, clean water, electricity, and mass injuries and fatalities are common problems after earthquakes. While California has endeavored to become prepared for earthquakes there are still many areas that are unprepared. Additionally, I believe there is only so much preparation a country can do while mother nature can wreak havoc no matter those preparations.

Williams, C. J., Makinen, J. & Rai, B. (2015, April, 25). Nepal quake kills over 1,800. Los Angeles Times pp. A1 & A6.

Having discussions about end of life and the type of care that we want is extremely important. When I was in 8^th grade my grandma suddenly suffered a brain aneurysm. She survived her trip to the hospital but was intubated and on mechanical breathing with a poor prognosis. It was her wishes if it looked like she would to not remain like this if there was only minimal or no chances of her ever getting off life assisting devices. All of my family was there when stopped everything and she passed. While still devastated, at this age I could understand that this was what my grandma had wanted.

At the same time my mother talked to my sister and me and said she wanted the same thing. My mom said she never wanted to be hooked up to machines, to stay that way and never get off. And she has been open about her wishes ever since this time. She has since made me her medical power of attorney. I think this has helped me to be open about my desires as well. I have shared these desires, which are the same as my mom’s and my grandma’s, with my fiancée. And I had to ask him if he could pull the plug. He certainly did not like the topic and did not want to talk about it at first. However, I told him you never know what’s going to happen in life and it is best to always be prepared then to make someone suffer something they do not want. I told him what happened to my grandma and how she was the epitome of health, always busy always running around. And then so suddenly on life support. He finally said that he would pull the plugs if he had to. When prompted for his wishes in the same situation, he wanted the same as me. I think it is very important to discuss and be open with your family and loved ones about the end of life.

This week I talked to my mom and my fiance, Eddie,  about their medications.

Eddie takes levothyroxine regularly. He knows it is also called synthroid.  He knows this drug is for his thyroid and he is supposed to take it every morning, 1 hour before he eats. He does not know any side effects per say, but knows if he does not take it, he feels tired. OTC he takes Advil. He only knows this name and does not know the generic. When asked how often he can take it he responded, “however often the bottle says.”

My mom takes an inhaler for her asthma regularly. She could not remember the name as she has recently started taking it. She does not know any side effects.  She knows she is to use as needed for her symptoms. When asked how she uses the inhalers she stated she puts her mouth on and inhales as she depresses. OTC she takes multivitamins and calcium supplements. She takes Advil for pain as needed. She knows it is also called ibuprofen. Also did not know frequency she could take but knows to read the bottle.

This week I read an interesting article discussing the utilization of nutritional screening tools for cardiac patients. As we know, diet can play a major role in the development and progression of all types of heart disease and assessing patient’s diet is becoming extremely common and important. This interesting article examined whether a simple five question screening tool could be as effective as the proven diet assessments done by dieticians that are in depth and often take 30 minutes. The quick screening tool asked questions regarding the intake of monounsaturated fats (such as canola oil, olive oil, avocados), whether the client eats seven fruits and vegetables daily, do they eat fish twice weekly, do they have two portions of soluble fiber weekly, and do they drink two or less alcoholic drinks per day. As a side note this research was done in Australia. In Australia only 5.5% eat the recommended daily fruits and vegetables and 20% consume more than the recommended portion of alcohol. I thought these were pretty scary stats.

The study encompassed 34 participants that did both the screening tool by a nurse and the diet assessment by a dietician. What the study found was that the quick screening tool was accurate in determining the amounts of fruits, the amount of alcohol, and amount of fish consumed. However, items such as monounsaturated fats and soluble fiber were not as accurate. This lack of accuracy may be that they are not simple items but need more explanation or thought about these items in their diet. Also the screening tool was not accurate for vegetables. When fruit and vegetables were put together in the question people would meet this goal but when asked separately and in detail by a dietician they found they were eating more fruits than vegetables, giving that question a false positive for vegetables in the screening tool. I think that these types of screening tools may be useful in the hospital setting as they would be quick to administer and may give and overall sense of a patient’s diet. However, I feel that most cardiac patients would benefit with the consultation of a dietician as eating in today’s world and reading food labels can be very difficult.

References

Neubeck, L., Lowres, N., Jackson, A., Freedman, B., Briffa, T., Bauman, A., & Julie, R. (2014). A simple screening tool for assessment of nutritional status in cardiac patients. British Journal Of Cardiac Nursing, 9(10), 508-512.