Thursday, December 27, 2012
Wednesday, December 19, 2012
12-11-12 at Darton State College
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| "Hello!" |
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| NO...I was NOT intoxicated...it just looked that way! |
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| I've come a long way, baby! |
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| Pinning Ceremony |
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| MaMa, Gail, and Tiana and I |
Monday, December 17, 2012
Y'all saw the "after" picture, this is the "before the punch" picture...(just kidding!)
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| Seriously...notice I didn't change (much)... did I? |
HELLO
Just a VERY quick note to say...HELLO!
It's bedtime, gotta go, just wanted to say hello real quick!
It's bedtime, gotta go, just wanted to say hello real quick!
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| DARTON BRIDGE CLASS 2012 |
Tuesday, December 11, 2012
Monday, December 10, 2012
Tuesday, December 4, 2012
Graduation..it says "Live", but it appears it is a recorded presentation. See dates and times it's available:
I found and copied this from Darton's posting from last year. I changed the dates and times to match this year's -as per my mail notification from the school. I don't know anything about downloading Real Player. When I started to download it, my computer warned me that it may potentially harm my computer, so I haven't downloaded it yet. That warning may be just a generic warning; I don't know. I may ask someone about it. If I learn more, I'll let Y'all know.
Live video and audio stream will be available for the pinnings (Allied Health @
3:00 & Nursing @4:30 pm) and graduation (7:00 pm) ceremonies. They can be
viewed at http://online.darton.edu/graduation. In order to watch, it is necessary
to have Real Player installed on the computer. This can be downloaded for free at
www.real.com. An active Internet connection is also required.
Thursday, December 13 - Wednesday, December 19
Nursing Pinning - 9 AM and 5 PM
Commencement - 10 AM and 6 PM
Monday, November 12, 2012
BELATED HAPPY EIGHTIETH OLDER MAN!
ENJOY!!!
When "only the best is good enough"...HAPPY 80TH DAD!!!
Thursday, November 8, 2012
Tuesday, November 6, 2012
EZRA SKYDIVING OCT. 27, 2012
http://www.youtube.com/watch?v=fhmSoK916N0&feature=fvsr
Wow!
...More balls than I have!!!
Wow!
...More balls than I have!!!
Wednesday, October 24, 2012
DARTON – FALL 2012 10-20-12 PPMH-ED OBSERVATION PAPER
My second
mandated Saturday clinical was another blessing in disguise. Initially I balked
at having to do a clinical on a Saturday, for I only work two days a week, and
they are always Saturday and Sunday. So therefore, I effectively loose a
half-week’s worth of pay every time I pull a Saturday clinical. However, the
primary blessing of these Saturday clinicals was my clinical instructor, Mrs.
Cynthia Chaney. Mrs. Chaney, you truly radiated an inspirational charm that
inspired students towards enjoying their opportunities to learn under your
leadership. I for one feel blessed to have been afforded these two Saturday
clinicals with you, Mrs. Chaney, and I really appreciate every effort and
consideration you contributed towards ensuring that we were each placed into an
area and under the guidance of a nurse that best suited our individual learning
needs.
Now I will focus
on answering the objectives of this assignment. How does the role of the nurse
within the emergency department differ from that of other nurses? Emergency
department nurses are relentlessly challenged with an endless variety of
patients whose needs and conditions are unlimited, and the volume of the influx
of these patients is never predictable. As my primary nurse, Donica, so
eloquently explained, emergency department nurses are expected to be capable of
caring for anything and everything that may walk or be wheeled in at anytime.
Their patients are not confined within any age or specialty categories, and
other than the patients who are brought in by EMS,
have not been pre-sorted or pre-treated by any other medical specialists and
therefore require complete assessments, frequent re-assessments, and a myriad
of treatments. The average number of patients each emergency nurse must care
for far exceeds that of most hospital nurses and each new patient potentially
presents with problems that may be entirely different from those of the
previous patient’s. Emergency nurses are expected to remain current in a
variety of disciplines, and frequently seek to update their knowledge base of
ever-changing treatment modalities and medications as patients are often
presenting with reports of new therapies and varied histories.
Some nurses
may never have to deal with the patient’s family, but the emergency nurse often
does. These family members always broaden the care efforts that the nurse must
extend. Just as the nurse must make a quick assessment of the patient, the
nurse must also incorporate accurate judgments in determining how to
effectively converse with and communicate effectively with the patient’s family
member or visitor. How a nurse responds to the patient’s visitors will often
determine the patient’s response to the medical staff and to their care
efforts, especially when the patient is a pediatric or is mentally impaired. The
emergency nurse’s role should include taking into account the eventual
incorporation of the family into the patient’s care whenever appropriate.
Emergency
nurses are exposed to hazards far beyond those of the average nurse. Emergency
nurses are on the frontline in the war on terrorism and are always at risk of
exposure to infinite threats. As Donica reminded me, emergency nurses assume a
certain element of risk, for they face caring for patients who may have been
exposed to weapons of terrorism, and they quiet likely may unknowingly become
victims themselves. Donica reminded me of the report of the nurses and doctors
who had died as a result of treating the victims of the Tokyo
saran gas attacks. Another sobering reminder of the risks faced by emergency
and flight nurses and flight paramedics was observed outside the trauma
resuscitation rooms. I read the plaque honoring one of each of them, and was
chilled to remember the time that the flight paramedic Michael Elam assisted me
on an emergency ambulance call as a “good Samaritan” volunteering to assist at
a motocross accident in Crawford County, Georgia.
Maybe this is off-track from the objectives of this assignment, but I felt
compelled to acknowledge his contribution towards assisting me in my care of a 17-year-old
race participant who sustained an angulated thoracic spine, paralysis, and
critical internal injuries. That patient was the same age as my son was at the
time, and Michael’s supreme guidance and assistance during what was one of my
most memorable calls of my 30 years of EMS
experience will forever remain etched in my mind. Even though I did not get to
perform anything exceptional clinically speaking, the opportunity to view that
plaque was an occurrence that equated to applying icing on a cake. Therefore, I
view my emergency department clinical rotation within Phoebe
Putney Memorial Hospital’s
Emergency Department as one of the best clinical learning experiences of my
entire 33-plus years in the medical field.
In regards
to the actual clinical learning opportunities I experienced while in the
PPMH-ED, I have mixed emotions. I was assigned to a very serious and
knowledgeable seasoned nurse who apparently availed herself as much as
possible, but unfortunately seemed to be too busy to allow me many
opportunities for skill practicing. Nevertheless, she (Donica) did go out of
her way to instruct me, and once even researched a textbook on the subject of
disseminated intravascular coagulation (DIC) before furthering her instruction
to provide an in-depth answer to a question I had posed. She also allowed me to administer an
intravenous injection of an anti-emetic, oriented me to areas while instructing
me on equipment used within the emergency department, and explained some of the
processes common to the emergency department. She even complimented my quick
detection of missing items from the set-up arrangement in the trauma
resuscitation rooms. After demonstrating a calm and purposeful approach to
assessing a new arrival, she allowed me to accompany her in transferring and
attending the 8-year-old trauma victim to the CT scan. While attending within
the radiology room, she answered questions yet never seemed disturbed by my
barrage of questions. I accompanied her to the blood bank, and witnessed her
correctly verifying the receiving of two units of fresh-frozen plasma (FFP).
Later, in the ER, I observed as she again verified identity and the correctness
of the FFP with the charge nurse and with the
patient before administering the fluids at a wide-open rate of infusion. I
observed her diligence to following the rules of infusion of blood products,
and was reminded of the importance of staying with the patient during the first
15 minutes of transfusion, of the need to do assessments before, during, and
after the transfusions, and of the never-ending need to provide frequent and
thorough documentation on all of her patients.
Although I
do not feel like I gained much experience in actually performing clinical
procedures, I did stay mostly busy, and was able to observe nurses who were
steadily engaged in nursing activities. In the early after-lunch period, I was re-assigned
and was able to observe another nurse’s interactions with one patient. Although
I have nothing negative to say about that experience or about the nurse I was
temporarily assigned to (Ashley), I did gain a deeper appreciation of the attention
that Donica had committed towards ensuring my clinical experience was instructional.
When the opportunity seemed appropriate, I returned to observe Donica in
action, and was rewarded with more instructional opportunities. If it were
possible and practical, I would enjoy more time in clinical observation of
emergency nurses, and probably would request to attend more such activites on a
volunteer basis.
I have
enjoyed my clinical learning experience, and I would like to take this
opportunity to thank you for this wonderful blessing. I guess I am an
adrenaline junkie, and despite having already spent over 30 years in emergency
medicine, I just cannot seem to get enough of the action. This emergency room
was a busy place, but it certainly was not the most intense emergency
department I have ever worked in, for I was trained at the Air Force’s largest
medical facility, which is one of three trauma center in San
Antonio, Texas. However, I was
impressed with the level of the staff’s expertise, their professionalism and
teamwork, and with the layout and the set-up of the emergency department. I
felt honored to be a part of the team and again, I really appreciate the
opportunity you have provided for me. Most of all, I deeply respect, admire,
and appreciate you for your part in providing educational instruction for the
whole emergency department team and for your efforts to lead, motivate, and
inspire each of us as nursing students of the bridge program. You are an
exceptional leader, I admire your style, and I hope you know you are truly
appreciated by all of the students whom I have heard comments from.
Sincerely,
Eric M. Simpson (“EMS”)
Tuesday, October 9, 2012
Wednesday, October 3, 2012
Role Transition Paper
It was due on September 30th. I turned it in on time, but somehow I forgot to publish it "for your reading pleasure"...or possible displeasure. Anyway, here goes "something". I HAD to turn in something...
Abstract
While
carefully considering how the role of a registered nurse differs from that of a
paramedic, how I perceive this change in roles, what I have gained in trying to
make this transition, and where I see this transition potentially taking me in
my future career, I realized that I am undergoing a role transformation
tantamount to a partial metamorphosis. I know it is not as if I am undergoing a
molting and shedding my outer coat, but there definitely is an element of
evolution in my professional-development life cycle. Therefore, I suspect that those
who are scrutinizing my actions and behaviors will soon perceive me
differently, and as a result, may become more confident in me. As I transition
into the role of a registered nurse, the shift in paradigm will encompass five
critical areas of changes. The first area of change will involve the
environment and the routines under which I will perform my duties. The second
significant change will be my becoming a collaborative member of a team of
healthcare professionals (Medical-Surgical Nursing, Patient-centered
Collaborative Care, Sixth Edition, p.3). The third change will be an
opportunity to interface with the patient and their family on a basis beyond
the initial entry into the healthcare system. The fourth change will be undertaking
the responsibility to educate the patient and their family about their current
illness or conditions and actions they can take to improve their overall
wellbeing. Finally, as a fifth change, there will be vast choices in terms of
employment options and educational advancement opportunities.
Role
Transition Paradigm Shift
According to the “taketheleap”
website, you should “think of a paradigm shift as a change from one way of
thinking to another” (http://www.taketheleap.com/define.html).
In preparation for the role transition from paramedic to that of a registered
nurse, I am adjusting my way of thinking for this fast approaching paradigm
shift. Aware that many changes in thought processes must occur, I am shifting
my mannerism from that of a paramedic’s to that of a registered nurse’s. While
critical thinking processes will continue to govern my intellect, my actions
now must comply with guidelines of a new scope of practice, and my mind-set
must adhere to a new set of rules, regulations, policies and practices as I
undertake this paradigm shift. The five critical areas of change that I
anticipate assuming in my transition pertain to:
1-
the environment and the routines under which I
will perform my duties
2-
becoming a collaborative member of a team of
healthcare professionals
3-
opportunities to interface with patients and
their families on a prolonged basis
4-
the responsibility to educate patients and their
families about their current illnesses or conditions and actions they can take
to improve their overall wellbeing
5-
vast choices in terms of employment options and
educational advancement opportunities
The first major change I anticipate
in this role transition is environmental and performance related. As a
paramedic responding to emergencies in a variety of environments, on many occasions
conditions were less than favorable, and often they were hostile and dangerous.
My primary focus and responsibility was to utilize my skills, knowledge, protocols,
standing orders, and the limited equipment that I had available to me on the
ambulance to assess and provide emergency interventions in an effort to resuscitate,
ameliorate, or stabilize patients while on-scene and when transporting them to
the hospital. Due to the inherent nature of the risks involved in such a
variety of potentially hazardous environments, it always seemed to be a windfall
if we could do this, arrive alive, and be well upon termination of the call. As
a field paramedic, I sometimes had extra personnel in terms of first-responders/fire-fighters,
occasionally may even have another EMT or
paramedic to assist on-scene or enroute to the facility, and I always worked
with a partner. However, when transporting, my partner was generally driving,
so I usually had only myself to rely upon to perform whatever care measures the
patient needed. Because I desired that patients have the best outcomes
possible, actions usually were initiated on an impromptu basis; having the
luxury of awaiting for orders was not a viable option. Touting over a
quarter-century of experience and a history of sound judgment, supported by
standing orders and personal recognition from doctors who would later sign for
treatment rendered, as a paramedic I usually performed procedures and
administered medications without hesitation or consultation. Nevertheless, those
actions were all undertaken as a paramedic working in the field under standing
orders. Now I recognize the limitations that govern a registered nurse’s scope
of practice, and I realize that while working in a “controlled environment”, I must
abide by a new set of rules and perform in accordance to the role into which I
am transitioning. That means I now must wait for the doctor to do (or order)
what I previously had done (under standing orders) on my own.
The second major change I foresee with
this role transition is my becoming a collaborative member of a team of
healthcare professionals. The role of the registered nurse is multifaceted and
intertwines with numerous health-team members. Guiding the patient and their
family through an illness or injury and ensuring all members of the care team
have correctly assessed and provided appropriate care is tantamount to
providing the patient with the best care possible. Developing a relationship
with the patient and establishing trust so that accurate assessments are
completed is a critical nursing intervention skill needed for a successful
outcome. This trust allows the patient to share private information and to feel
secure that their confidentiality will be maintained. The registered nurse is
the “relationship builder”. In order to match the needs of the patient with the
appropriate services, the registered nurse must build a meaningful relationship
with the entire team of healthcare professionals. Good relationships can
translate into quality care for the patient. Good relationships with the
patient and their family helps them to be more open to the education the nurse
can provide, and to be more compliant with following instructions, thereby
leading to better healthcare outcomes.
Developing a good understanding of all of the resources available in the
work setting is critical to the success of the registered nurse and to the
survival of the patient. Critical thinking includes knowing how to pull all of
the needed resources and interventions together into a plan that will best meet
the needs of the patient, and is a primary role of the nurse. The knowledge I
have gained over the course of the nursing program will provide the foundation
for assessing the needs of the patient, and will guide me in seeking
appropriate interventions through collaboration with other healthcare
professionals.
Having opportunities to interface
with patients and their families on a prolonged basis is the third major change
I predict upon transitioning to the nursing role. As a paramedic responding to
emergency calls, there was minimal initial contact with the family, and often that
contact ended once a report was given and the patient had been handed over to
the care of emergency room personnel. It was not always that simplistic though,
for many calls did involve non-emergency transports, hospital-to-hospital
transfers, and hospital discharges to residential locations, so family contact
sometimes was sometimes markedly increased. However, I believe while
functioning in the role of the registered nurse, there will be far more opportunities
afforded to interface with both the patient and their caregivers than what was
available to me as a paramedic, and that these contacts will benefit the
outcome of the patient in a variety of ways. For example, for hospitalized
patients, the registered nurse may function as the bridge between the family
and the doctor after the family was not available when the doctor-patient
contacts occurred.
The fourth major change I look
forward to is the responsibility to educate patients and their families about
their current illnesses or conditions, and actions they can take to improve
their overall wellbeing (Fundamentals of Nursing, 7th Edition, p.10).
As I transition into being a nurse, my responsibilities will encompass teaching
the patient and their family. As a paramedic, I voluntarily advanced my
knowledge level, became an instructor in several disciplines, and taught for
several years. However, I mostly only taught allied health professionals basic
and advanced life support classes and all of the teaching was optional; never
was any of it expected as a job responsibility. I enjoy teaching and sharing
knowledge with others. Therefore, I look forward to helping patients develop a
better understanding of their illnesses, injuries, or conditions, and I yearn
to teach them how they can improve their overall wellbeing. Not only are
educated patients more receptive to their care, but family members who were
instructed by a nurse also have a better understanding of the patient’s needs and
are more apt to assist the patient in being compliant with their care
(Maternal-Child Nursing, Third Edition, p.799). Teaching the patient and their
family is one of the main job responsibilities of a nurse, and I anticipate
giving my best efforts in that regard.
The fifth and final main change I
recognize in the transition from the paramedic role to a registered nurse role
is the vast choices in terms of employment options and educational advancement
opportunities. Because I knew the pay and the hours were better, there always
were many more job offerings, the working conditions were less hazardous, and
the physical requirements were less strenuous, for several years I have advised disgruntled or frustrated
paramedics who were either burnt-out (or otherwise unhappy with their current
employment) to consider nursing as an optional opportunity of advancement. According
to information published by the U.S. Bureau of Labor Statistics, “Employment of
registered nurses is expected to grow 26 percent from 2010 to 2020, faster than
the average for all occupations” (Occupational Outlook Handbook, 2012). Now
knowing a lot more about nursing than I did when I began this bridge program, I
am still convinced of each of those benefits to transitioning from a paramedic
to a registered nurse. I also now realize there are numerous areas of expertise
within the nursing field to specialize in, and several avenues to continually
advance within each of those fields.
In conclusion, the final shift that I need to
address is where do I go next? The possibilities are vast. The United States
Bureau of Labor Statistics, Occupational Outlook Handbook, predicts a twenty
six percent-growth rate in the need for registered nurses over the course of
the next ten years. Nursing is predicted
to be one of the biggest growth markets in our country. I am still undecided
regarding my exact next steps. My entire focus has been on getting to the end
of this long and challenging journey. I have learned through some preliminary
exploration that some doors are closing in the hospital arena for nurses who
hold an associate’s degree. Many hospitals have set deadlines for nurses to
obtain bachelor degrees. I have worked to not be discouraged by this, but
rather to see it as another step in my journey. The future holds the promise of
being able to touch the lives of patients and have an impact on their health
and wellbeing. I long for this challenge. My transitioning from performing
according to the roles of a paramedic into the realm of responsibilities expected
of a registered nurse reminds me of the renowned words of Neil Armstrong, “That’s
one small step for man, one giant leap for mankind” (http://www.space.com/17307-neil-armstrong-one-small-step-quote.html). However, I do not feel as
if my transition is equivalent in importance to his accomplishment, for in my
opinion, my transition ranks more along the humble lines of, “That’s one giant
leap for (this) man, one small step for mankind”.
References
Ignatavicius, D.D., & Workman, M.N. (2010). Medical-Surgical Nursing, Patient-Centered
Collaborative Care, Sixth Edition. St.
Louis, MO. Saunders
McKinney,
E.S., James, S.R., Murray, S.S.,
& Ashwill, J.W. (2009). Maternal-Child
Nursing,
Third Edition. St.Louis, MO.
Saunders
Potter,
P.A., & Perry, A.G. (2009). Fundamentals
of Nursing, 7th Edition. St.
Louis, MO. Mosby
Unknown, A. (23 Sept 2012). Occupational Outlook Handbook. U.S.
Bureau of Labor
Unknown, A.,
(23 Sept 2012). Paradigm
Shift, Moving From One Thought System to Another. http://www.taketheleap.com/define.html
Wolchover, Natalie (23 Sept 2012).‘One Small Step for Man’: Was Neil Armstrong
Misquoted?. SPACE.com, http://www.space.com/17307-neil-armstrong-one-small-step- quote.html
Tuesday, September 25, 2012
BELATED HAPPY ANNIVERSARY
BELATED HAPPY ANNIVERSARY
DAD AND MOM!
Sorry I missed calling Y'all yesterday; I had meant to. I hope Y'all had a great one and that Y'all have many, many more!!!
Tuesday, September 18, 2012
Hello Tiana!
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| Remember when...? |
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| Well, yeah, the caption on the picture does kinda remind us of the actual date... HEY Y'ALL... WATCH THIS.....(THESE!) |
Hello again! Just wondering if you were still checking this out occasionally... I hope all is well with everyone out there. I wish we could go floating!!!
Thursday, September 13, 2012
mod2 Discussion question 2.1
As stated on page 692 in the “Iggy” textbook, “The nurse
plays a pivotal role in the coordination of care and the prevention of
problems”. In a planned event, the nurse is responsible for ensuring all
parties are present prior to the occurrence. This of course includes ensuring
that the physician, anesthesiologist, nurse anesthetist, pulmonologist,
paramedic, respiratory therapist - or WHOMEVER is going to do the intubating -
is present. Even if the respiratory therapist does not perform the intubation,
they are requested because they most likely will be responsible for making the
connections to and adjusting the ventilator as well as performing an ABG
afterwards. Radiology has a role as well, for after the patient is “tubed”, a
portable x-ray film is needed for tertiary confirmation after primary and
secondary actions are undertaken. If the worst-case scenario develops as an
outcome of the intubation, a code team may have be paged or summoned by the
nurse.
Long before
the actual intubation phase, nurses are usually the ones responsible for
ensuring that the equipment is available, up to date, and functional. Documentation
of daily inspections help to ensure this. Also prior to a planned event, nurses
witness and sign consent forms and are responsible for alleviating some of the
patient’s anxieties by further informing patients and answering some of their
questions. Sometimes this “ounce of prevention” prevents problems from
occurring. Simply forewarning patients about what changes they may expect after
intubation may ward off complications arising from an inability to communicate
or having to explain why the patient has a sore throat and is hoarse after
extubation. The nurse should have already reviewed the patient’s medical record
in an effort to become familiar with the patient’s allergies, medications, and
any special anatomical considerations that may apply to the individual patient.
In regards
to the actual procedure itself, the role of the nurse will vary based
according to assignments and expectations of each individual
facility and its protocols. In general, the nurse may expect to be responsible
for “everything”. Duties MAY include, but
are not limited to ensuring the patient has a functional IV and:
- Gathering
and checking the necessary equipment and supplies (may be done simply by
getting the crash cart) and beginning to set-up and prepare the equipment.
- Laryngoscope
handle, blades (and spare bulbs if not fiberoptic)
- Stylet
(and lubricant to ease its removal)
- Stethoscope
- Syringe
- Suction
device (on high setting initially, but decreased to ~120 mm/hg for use
with a catheter) and set-up with tubing, yankeur and catheters
- Defibrillator/monitor
with electrodes, defibrillation pads, razor and cables
- ETCO2
monitor and connectors for ET tube and for oral/nasal monitoring
- Pulse
oximeter (if not part of cardiac monitor)
- Tracheal
tubes, size expected and one larger and one smaller
- BVM
with appropriate size mask
- Securing
device for tube or tape
- Tincture
of Benzoin and/or possibly a hydrocolloid dressing for the face
- Soft
restraints
- Sedation
and/or paralytics (and antidotes/reversals for each)
- Backboard
in the event the patient arrests
- Positioning
the patient for the procedure may include raising the bed to a comfortable
height (I’m tall), placing the patient supine with a slightly extended
neck (or neutral/sniffing position for a child or infant and placing a
roll under the shoulders), and may include moving the patient towards the
head of the bed after lowering the head of the bed and removing the
headboard.
- If
respiratory therapy is not attending to these duties, pre-oxygenating
and/or hyperventilating also may within the duties of a diligent nurse.
- As the
procedure begins to unfold, the nurse is responsible for monitoring and
ensuring several things:
- The
nurse may be ordered to administer sedation and/or paralytics upon the
initiation of the procedure, but be sure you do not administer paralytics
unless authorized by you facility’s policy and your state’s nursing scope
of practice.
- Initially,
note the time; the amount of time expended attempting the procedure
should be limited to 30 seconds MAXIMUM (ideally less than 15-20 seconds).
- Monitor
the oxygenation status as noted through observation of SpO2 readings.
- Monitor
the patient’s heart rate and rhythm. Intubation may cause a vagal effect.
Stop the procedure if bradycardia or hypotension develops and
pre-oxygenate with BVM ventilation until the rate returns to baseline
prior to further attempts.
- ETCO2
status can be monitored through the use of nasal/oral cannula prior to
intubation, and through a tracheal tube adaptor after intubation. After
intubation, simply noting there is a waveform or a numerical reading is
insufficient as a means of confirming correct tube placement. A right
mainstem bronchial intubation could give THOSE results. ETCO2 is a
primary form of correct tube placement, but IT ALONE IS INSUFFICIENT! Someone,
likely the nurse, who is the catch-all blame for everything, must listen
for bilateral breath sounds. Ideally, we like to think we are listening
for “equal bilateral breath sounds”, but in some instances, this is not
possible. Remember, if the patient has a pneumothorax, a pleural
effusion, or anything else that impedes breath sounds on either side,
equal breath sounds may be impossible to hear! Nevertheless, we are
hoping to hear bilateral ventilatory sounds but we must remember what our
pre-intubation exam revealed in regards to the symmetry of chest sounds
and chest excursion (movement). The levels of the ETCO2 readings are
beyond the intent of this discussion, but you do need to learn what
numbers and trends to expect when the patient is SUCCESSFULLY intubated.
- As
already mentioned, at some point in time, checking for symmetrical chest
excursions and bilateral breath sounds is usually the responsibility of
the nurse assuming care for a patient.
- The
nurse should note air emerging from, and condensation in, the tracheal
tube.
- The nurse should observe (and record)
the centimeter mark upon the level of the upper incisor teeth, and confirm
that the tube is secured away from the corner of the patient’s mouth in
an effort to avoid creating pressure sores. Also ensure the securing
device is patent, but not so tight as to create a pressure sore.
- Assuming
a cuffed tracheal tube was inserted, the pilot balloon should be palpated
to confirm inflation, the pressure within it may have to be measured, and
assurance of minimal to no air leak around it must also be ensured.
- The
correct ventilatory rate must be initiated immediately after the patient
is intubated and confirmation of placement by visual, tactile, auditory
and ETCO2 measures are undertaken.
- The
nurse may be ordered to administer certain medications such as (NAVEL)
narcan, atropine, valium epinephrine or lidocaine endotracheally.
- Verification
of placement by radiography must be undertaken soon after primary and
secondary means are confirmed.
- Upon
the completion of the intubation, confirmation, and securing the tube, instilling
medications, and assuring an appropriate ventilatory rate, it is almost
time to consider the 6th right – right documentation. Document
everything, because “if it wasn’t documented, it wasn’t done”!
- And as
someone mentioned, let’s not forget to ensure that we attend to the
patient’s nutritional and mouth care needs…to reevaluate “everything”
about our patient frequently…to ensure that the ventilator is set
according to orders…to assess for patient’s compliance with therapy…to
suction ONLY as necessary…to communicate with and assess for our patient’s
other needs…and to document, document, document!
- Laryngoscope handle, blades (and spare bulbs if not fiberoptic)
- Stylet (and lubricant to ease its removal)
- Stethoscope
- Syringe
- Suction device (on high setting initially, but decreased to ~120 mm/hg for use with a catheter) and set-up with tubing, yankeur and catheters
- Defibrillator/monitor with electrodes, defibrillation pads, razor and cables
- ETCO2 monitor and connectors for ET tube and for oral/nasal monitoring
- Pulse oximeter (if not part of cardiac monitor)
- Tracheal tubes, size expected and one larger and one smaller
- BVM with appropriate size mask
- Securing device for tube or tape
- Tincture of Benzoin and/or possibly a hydrocolloid dressing for the face
- Soft restraints
- Sedation and/or paralytics (and antidotes/reversals for each)
- Backboard in the event the patient arrests
- The nurse may be ordered to administer sedation and/or paralytics upon the initiation of the procedure, but be sure you do not administer paralytics unless authorized by you facility’s policy and your state’s nursing scope of practice.
- Initially, note the time; the amount of time expended attempting the procedure should be limited to 30 seconds MAXIMUM (ideally less than 15-20 seconds).
- Monitor the oxygenation status as noted through observation of SpO2 readings.
- Monitor the patient’s heart rate and rhythm. Intubation may cause a vagal effect. Stop the procedure if bradycardia or hypotension develops and pre-oxygenate with BVM ventilation until the rate returns to baseline prior to further attempts.
- ETCO2 status can be monitored through the use of nasal/oral cannula prior to intubation, and through a tracheal tube adaptor after intubation. After intubation, simply noting there is a waveform or a numerical reading is insufficient as a means of confirming correct tube placement. A right mainstem bronchial intubation could give THOSE results. ETCO2 is a primary form of correct tube placement, but IT ALONE IS INSUFFICIENT! Someone, likely the nurse, who is the catch-all blame for everything, must listen for bilateral breath sounds. Ideally, we like to think we are listening for “equal bilateral breath sounds”, but in some instances, this is not possible. Remember, if the patient has a pneumothorax, a pleural effusion, or anything else that impedes breath sounds on either side, equal breath sounds may be impossible to hear! Nevertheless, we are hoping to hear bilateral ventilatory sounds but we must remember what our pre-intubation exam revealed in regards to the symmetry of chest sounds and chest excursion (movement). The levels of the ETCO2 readings are beyond the intent of this discussion, but you do need to learn what numbers and trends to expect when the patient is SUCCESSFULLY intubated.
- As already mentioned, at some point in time, checking for symmetrical chest excursions and bilateral breath sounds is usually the responsibility of the nurse assuming care for a patient.
- The nurse should note air emerging from, and condensation in, the tracheal tube.
- The nurse should observe (and record) the centimeter mark upon the level of the upper incisor teeth, and confirm that the tube is secured away from the corner of the patient’s mouth in an effort to avoid creating pressure sores. Also ensure the securing device is patent, but not so tight as to create a pressure sore.
- Assuming a cuffed tracheal tube was inserted, the pilot balloon should be palpated to confirm inflation, the pressure within it may have to be measured, and assurance of minimal to no air leak around it must also be ensured.
- The correct ventilatory rate must be initiated immediately after the patient is intubated and confirmation of placement by visual, tactile, auditory and ETCO2 measures are undertaken.
- The nurse may be ordered to administer certain medications such as (NAVEL) narcan, atropine, valium epinephrine or lidocaine endotracheally.
- Verification of placement by radiography must be undertaken soon after primary and secondary means are confirmed.
Tuesday, September 11, 2012
Hello...
Monday, September 3, 2012
Tuesday, August 28, 2012
Saturday, August 25, 2012
Emergency Department clinical experience 8-23-12
In
comparison to processes within some areas of the hospital, the nursing process
within the Emergency Department (ED) is dramatically different and dynamic. It
is ever-changing, and lends itself to needing constant attention and
reevaluating as the flux of patients and orders are relentless and seemingly
never-ending. Our exposure to this process began quiet interestingly while
observing the nurses as they began their shift “huddling” in the break room preparing
for their onslaught against the challenges of the day ahead. As we began our
clinical rotation in the area of the hospital that holds one of the most
compelling and attractive nursing roles, we were privy to the final moments of
this huddle. We listened as team members expressed their concerns and expectations
concerning an item that holds the potential to dramatically improve the
efficiency of their operations and keep them closely connected and accessible.
They were concluding their pre-shift report huddle by discussing their new
individually assigned radios, and some were expressing excitement at the
possibility of “bedazzling” and personalizing their newest “weapons against
ignorance”. With these radios, they apparently anticipated improving their
abilities to stay abreast of events as they unfolded, and of each other’s
whereabouts.
Seriously, my clinical experience within the
ED was almost everything I had hoped it would be. It was not a day of unusual
and extremely interesting case presentations and endless episodes of
once-in-a-lifetime chances; however, it was a grand opportunity to “do anything
they’ll let you do”. My day began in the
best way it could, by being assigned to the ED. In the ED, I was assigned to
shadow Leah, a relatively “new” nurse; a very effective and polite nurse who maintained
a great attitude, demonstrated excellent care for her patients, and presented
herself quite professionally at all times. She managed to offer frequent
instruction and directions without being overbearing or insensitive while
simultaneously attending to her responsibilities and making me feel appreciated
and respected. Leah was one of many
wonderful ED staff members who made us feel welcomed and appreciated.
I began the shift observing the layout of the
unit, and noted some distinct similarities with the ED where I work part-time.
I shared my limited knowledge and instructed my fellow clinical student in the
utilization of the status boards, and how the “tracker” monitors are used to
alert staff in regards to outstanding orders, procedures, and other information
pertinent to the patients.
Throughout
this day, I was awarded numerous opportunities to assist in direct patient care
activities. I provided multiple blood-draws and made one IV attempt (which
incidentally was successful on a “very difficult stick”). I assisted with and observed
repeated external jugular cannulations made by the emergency room physician. I regulated
and monitored intravenous fluid administration, provided a few intramuscular
and Z-track injections, performed some physical assessments of initial and repeat
vital signs, attended one patient transfer to the radiology department for a CT
scan and one to the CCU for admission, and assisted with receptions and movements of
EMS patients.
During
the little downtime there was, I was allowed to interact independently with
patients, and occasionally provided much-appreciated efforts directed towards
positioning, cleansing, comforting, consoling, humoring, and even educating
patients and family members. At times, I reported the patient’s or their
family’s needs or desires as requested, and subsequently followed-up to
determine if their requests had been met. In many of these “nursing process” instances,
I acted as a nurse would, for I was assessing, intervening, and evaluating for the
effectiveness of our treatments and efforts. I even made repeated efforts to
help in the restocking of linen when the need presented itself, and frequently
provided efforts to clean and prepare the rooms and stretchers for awaiting or
upcoming patients.
I
saw and learned a lot during my short clinical exposure in the ED. I observed and
appreciated the effectiveness of three team leaders who each were partially
responsible for a very successful day. Our clinical team leader, Cliff, availed
himself to us often, and provided much welcomed, appreciated, and respected
assistance to us many times during our day. It is no wonder he is a supervisor
at his job, for he seems to possess a natural ability to provide comfort and
strong leadership. The ED’s team leader, or charge nurse, Carolyn, was another
person who inspired me during this clinical. She also seems to have the unique and
rare quality of a leader who is there for all the right reasons. Moreover, of course, I must recognize our
clinical instructor, Ms. Brown-Lucas; without her, our day would have been
incomplete, and would have lacked the icing on the cake. Ms. Brown-Lucas has
complimented our cadre of instructors, and brings a much-welcomed style of
leadership that is truly respected and very much appreciated. I really
appreciate Mrs. Miller’s including her in our team of clinical instructors, and
by all reports, I am not the only one.
Friday, August 24, 2012
15 Years...and one day!
Yesterday I celebrated making the final payment and "owning" a little piece of "heaven on earth". The river-land is paid-off!!! I stopped enroute back from Albany and camped out and visited with Mark. Well, time to try to make up for lost time, for I haven't studied since the day before yesterday. Gotta hit the books...Love Y'all!
Wednesday, August 22, 2012
Tuesday, July 24, 2012
We're Jammin
Hello. My name is Eric Simpson, and I look forward to sharing with you
today my first canning experience as I prepare pepper jam. Pepper jam can be
used in everything from dips to meat. My arm had to be twisted a little the
first time I ever tried pepper jam, but once I tried it, I was hooked. Not only
is this my first canning experience, it is also one of my first cooking
experiences beyond heating something up in the microwave. My goal today is to
share with you the steps to making and preserving pepper jam using fruits grown
in my garden. As I knew nothing about canning or making jam, I went to the Ball
Canning website to research the canning process because they are one of the
oldest and most well-known canning resources. Many of the steps that I will
demonstrate in the canning process could be applied to the preserving of any
fruit or vegetable.
The basic process for making jam is fairly simple. I began my research
for this assignment by looking for the perfect recipe. My first goal was to
locate a recipe that utilized the peppers I had growing in my garden, and was
also easy enough for me to learn how to prepare pepper jam. After researching
several sites, I located the recipe I wanted to use and a list of supplies I
would use at Cooks.com, and I chose the process I would follow from the
directions found on the Ball Canning website. During my research, I was a
little surprised to learn that peppers are a fruit and not a vegetable as I had
thought. In researching the types of peppers that I had growing, I also learned
from The Nibble – Great Food Finds that the heat, or the pungency level, is
produced by the capsaicin found in peppers. A website called Miss Vickie’s
Pressure Cooker Recipes outlined the Scoville Scale. It is the scale by which
the heat or intensity of peppers is rated. The greater the number of Scoville
Heat Units, the hotter the pepper. In my garden I had four varieties of peppers;
bells, bananas, jalapenos, and cayennes. On the Scoville Heat Units Scale, the
bell pepper ranks a very low of zero heat units, the jalapeno scores 5,000 to
8,000 Scoville Heat Units, The bananas is scored at 5-10,000 Scoville Heat
Units, and the hottest of my four peppers is the cayenne, which is typically
rated from 30,00 to 50,000 Scoville Heat Units. I gathered fresh, vine-ripened
fruit from the garden, and then washed them in preparation for making my jam. Along
with pictures of the peppers that I used, here are some pictures of my garden
that I took prior to making the pepper jam.
Once
I had gathered my fruit, I began the process of washing and preparing the
peppers. First, I had to dice and prepare the fruit. Removing the seeds and
ribs of the peppers is required before placing the peppers into the food
processor. The recipe from Cooks.com instructs that peppers are to be processed
until they are “finely diced”. The Nibble – Great Food Finds site cautioned
that handling hot peppers is best done with gloves on so the capsaicin contained
in the ribs and seeds of the pepper is not absorbed by the skin and cause pain.
Here is a picture I took of my peppers once they had been diced in the food
processor and mixed with the ingredients.
Now that the fruit has been prepared, the glass jars sterilized, and the
supplies gathered, it was time to begin the cooking process. Using my recipe from Cooks.com, I cooked all
of my ingredients until they reach a “bull boil”, which is a hard rolling boil
that can not be stirred down. The Ball
Canning website explained the critical importance of adding pectin so that your
jam will “set”. When shopping for this assignment, I found both a powdered and
liquid variety of pectin. I selected liquid over powdered pectin based on the
recommendation of the recipe from Cooks.com. The pectin is added at the point
that the bull boil is reached. I was unable to take pictures of my jam as it
reached its boiling stage because I was preparing to add my pectin. My
Cooks.com recipe advised to continue the boil for a full 60 seconds after the
last package of pectin was added. I
never imagined that one of the side benefits to this assignment would be clear
sinuses! The smell of all of those
peppers and apple cider vinegar sure cleansed my nasal passages and filled the
whole house with the unmistakable aroma of freshly cooked peppers.
Now that I have followed the recipe, it is time to ladle the jam into
the sterile, previously prepared canning jars. Preparation of the canning jars
was completed based on the directions found at the Ball Canning website. Per the Ball Canning website, in order for
the rubber gasket to make a complete seal around the perimeter of the jar, it
is critically important to ensure that the rims of the jars are free of jam and
are clean. I used a canning funnel to
reduce any spills while ladling my jam into the jars, and then placed the lids
and bands on the canning jars. I photographed the ladling of the jam and the
jars with the lids and bands.
Now that the jam is in the jars, it is time to clean up and prepare the
jars for the water bath which will ensure they are sealed. According the Ball
Canning website, placing your jars in a water bath is the final step to
ensuring a complete seal which will preserve your jam and ensure the safety of
your consumers. Bacteria, including Botulism, can form in your jam if your jars
are not properly sealed. Step by step instructions on this process can be found
on the Ball Canning website. Pictures of
my dirty dishes ready for clean-up, along with pictures of my finished pepper
jam both in canning jars and served on cream cheese were taken to share the
finished product with the audience.
I would like to conclude my demonstration today by sharing that I have
learned a great deal about peppers and the process of making jam through my
research for this presentation. My goal today was to share with you the steps
to making and preserving pepper jam using fruit grown in my garden. I hope this
presentation has been interesting enough for you to try pepper jam, or at least
to try making a jam out of your favorite fruit.
I hope that you have enjoyed “Jammin” with me, and that you feel your “hot pepper” juices flowing. Thank
you! I appreciate your time, and hope I have raised your interest in “Jammin”.
Thursday, July 12, 2012
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