For the last two weeks I have been reflecting on my experience, as a third year bachelor’s prepared nursing student. There are many moments within this long awaited journey in which I have seen and felt a drastic growth since my first year. More than ever I feel adequately prepared to enter my professional nursing career and see myself succeeding. My experience at CI in the nursing program has validated my goal to continue to pursue higher education and become a nurse practitioner. This semester really brought everything full circle from my friends, understanding the lecture content, participating in undergraduate research to being able to see myself as a nurse and no longer as a nursing student.

I enjoyed this semester because I felt competent in caring for critically ill patients and their family. The focus of this semester was more about learning to handle various forms of family dynamics while implementing high quality patient care. I have seen how family can have a major impact on a patient’s care and end of life. This experience has opened the door within my own family to talk about situations such as end of life care, which has something that was never been discussed before. It allowed the opportunity for my parents and siblings to become much closer and for that I am very grateful.

In clinical, I was also able to utilize every skill I have learned from my first semester towards now and see the impact it can have on those who I cared for. It almost seems surreal when the patient and the family you are caring for tell you that their hospitalization experience was that much better because of the care they received from you. This confirmed my reasoning for choosing to become a nurse because of the ability to make a positive impact in others. I love being a nurse. I love being able to care for people. It excites me, makes me happy, and fulfills me

I am grateful for all my clinical experiences I have undergone and the support from faculty/hospital staff because it has helped mold me into the nurse I am today. I could have not accomplished so much without their help and guidance. Now time to spread our wings and fly to reach the stars!!!! Congrats everyone…WE MADE IT

I grew up in a very traditional Mexican family having a difficult time acculturating to the American values and lifestyle. In America, it seems almost customary to have a living willor an advanced directive completed before a loved one is at their life’s end, however in Mexico, this is not necessarily the case. The family (i.e. husband, children, etc.) routinely make the difficult decisions about end of life care because death and dying are not normally discussed within families. In Mexico we celebrate el Dia de los Muertos (Day of the Dead), a day that honors the dead with festivities, lively celebrations, food, drinks, and activities that the deceased enjoyed, however this remembrance only focuses on the deceased and does not consider those who are at their life’s end. In our family, we never brought up death and dying. My mother was very adamant against having this conversation even when her parents were very sick.

Because of this resistance, I had never stopped and thought about what I want for my own end of life care until I started nursing school. As I become more knowledgeable about the death and dying process though theory and clinical experience, I know I do not what to be in a situation where machines, tubes, and wires are prolonging my life if the life I would have with these interventions is not worth living (quality of life is poor). In clinical I see this dilemma time and time again where the family is not ready to let their loved one pass. They continue to prolong life when there is no hope or possibility of ever recovering. I feel that this selfishness only adds to the pain/suffering, hospital cost, delays the grieving process making it much harder to let go. I think my younger sister would be the person that would be able to make the hard decisions for me. My family is very supportive but they all would have a hard time letting go.

I sat with my family over the weekend to discuss these issues and they were not very receptive as expected however opened up as I provided them with more knowledge. I think my best approach was to give examples and possible consequences for end of life care. Although my mother thought it was grim even talking about it she expressed that she dis not want to be suffering or have her life prolonged by artificial means if they have a poor quality of life to live. Poor quality of life to her meant she would be in a vegetative state not able to participate in daily activities. My mother agreed that my sisters would have a hard time making life choices and though my youngest sister and I would be able to make them for her. My eldest sister on the other hand was not very receptive. She thought that there was no need to talk about death and dying. I tried the same approach as I did with my mother, but she would not discuss the topic further. I think she needs time to process the information before approaching her. I was glad she listen to me to some extend because I can see that it made her think about it.

This assignment could not have come at a better time because my family gathered for a barbeque over the weekend. At the barbeque, I had the opportunity to ask several family members and friends about their knowledge regarding the medications that have been prescribed to them by a physician. Many were not on a daily drug regimen therefore I asked them to explain the indications and side effects for common over the counter (OTC) drugs such as Tylenol, Aleve and aspirin.

To my surprise, about seventy percent of the people for which I sampled (n=14) were knowledgeable about their personal daily medications. This did not apply to OTC drugs or drugs they were unfamiliar with. They were able to explain what their medication was for, discuss the common side effects they had personally experienced, and also name both the generic and trade name for each. Their extensive knowledge on their medications can be explained in part, because they have been able to successfully manage their chronic diseases for years or because they have work closely in the medical or healthcare field.

On the other hand, the remaining twenty percent (n=6) had a difficult time explaining medication indications, side effects or the contraindication for some of the more common OTC drugs. Reoccurring key themes included 1) following physician orders without question, 2) inability to recall the information or 3) simply never bothered to look them up. The identification of side effects did not pose too much of a problem because lets face it seems that every medication can cause stomach pain, nausea, vomiting and diarrhea. Measuring the proper dosing was a bigger problem than I thought. A couple of people mentioned eyeballing what they assumed to be a teaspoon verse a tablespoon for liquid medications. Others even admitted to taking more than what the label clearly stated. My grandmother referred me to my father who helps her manage her medications. Unfortunately these examples are not uncommon, especially for individuals whom English is not the primary language or are no longer unable to manage their health conditions due to their age as in the case of my grandmother. Fortunately, this assignment opened the discussion about medication safety and proper drug management in my family.

Homeopathic and herbal medications are very common in Mexican heritage and culture. Many of these remedies have been passed down from generations to generation and are built upon hope and faith. I can remember my grandfather going to the back yard to cut aloe vera leafs to treat minor cuts instead of going to the store to by Neosporin. My grandmother is known for grinding several herbs together to make remedy teas for our ailing sore throats. Unfortunately many of these alternative treatment measures have not proven to work or provide better results. Some herbal medicines can in fact be toxic and result in detrimental effects including death. Nonetheless, these traditions have been strongly ingrained and will continue to be performed for years to come.

Graft Preservation with heparinized blood/saline solution induces server graft dysfunction

As we have learned in class, coronary artery bypass grafting (CABG) is the most common surgical procedure performed on the heart and the patient’s prognosis largely depends on the long-term patency of the bypass grafts. In practice, grafts are stored at temperatures between 4 C and room temperature in various preservation solutions including saline, heparinized blood, or Custodial solution (Veres et al., 2014). According to Veres et al. (2014), heparinized autologous blood solutions is considered the most suitable solution for storing human arterial and venous grafts and samples, however there have been conflicting results on the effect of this solution on endothelial cells. This article looked at the early and mid-term effect of ischemia/reperfusion injury on endothelial cells of implanted grafts using a rat model of aortic transplantation. They examined the both the functional and molecular aspects of endothelial dysfunction induced.

A major finding of this study was that application of the daily used physiological saline or heparinized blood to preserve the arterial graft was incapable of reducing the endothelial damage after cold storage and warm reperfusion (Veres et al, 2014). They also concluded that both had similar weak preservation effect on the endothelial cells, however blood preservation solutions had a negative impact on these cells as compared to normal saline solution.

The peak of endothelial damage in both heparinized and saline groups occurred after twenty-four hours of reperfusion. This is said to correlate with the early complications in bypass grafts that lead to transient ST segment elevations occurring in the first 12-24 hours after CABG (Veres et al., 2014). Additionally this study found that endothelial integrity was damaged however it took the cells sample about one week of reperfusion to recover supporting previous findings of the ability of endothelial cells to regain functional integrity.

This study is important because the goal and current protocol for graft recovery is to minimize mechanical damaged during harvesting and this study demonstrates that both saline and heparinized blood solutions are incapable of this function as previously believed.

Veres, G., Hegedus, P., Barnucz, E., Zoller, R., Klien, S., Radovits, T., Korkmax, S., Karck, M. & Szabo, G. (2014). Graft Preservation with heparinized blood/saline solution induces server graft dysfunction. Interactive CardioVasular and Thorasic Surgery. 1-7. doi:10.1093/icvts/ivv010.

Nursing 420: Care of a Complex Patient

Nursing 420: Care of a Complex Patient or better known to the senior nursing students as the final stop to our three year roller-coaster ride called NURSING SCHOOL. This semester our Professor Dr. Jaime Hannans has surpassed all expectations for what I thought my last semester will be like in a positive and innovative manner. I am very excited to take part in bringing technology and everything it offers us into our curriculum and our classroom. With technology constantly evolving around us and improving accessibility on a global scale, its presence in our nursing program has been long overdue. I am excited to see the end products that will be created by using a platform like CI Keys for my fellow nursing students and myself. So far things look promising. I am grateful Dr. Hannans and Dr. Hoffman share the vision of promoting excellence through the use of various innovative channels such as CI Keys. I can not wait to get started! Buckle your seatbelts!

MiggyVee