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PEP education session attendance & documentation

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PEP education session attendance & documentation

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INC6 first nations people written response

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INC6 first nation people written response

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Welcome to my professional portfolio. My name is Anuja and I will be completing my Bachelor of Nursing degree in June 2023. To be a nurse has been my passion since I was 19 and was determined to achieve it one day. I believe it is never too late when there is strong determination. I have learned skills of working independently as well as working successfully in a group through a multitude of academic exercises. I have successfully engraved skills learned in the Integrated Learning Concepts seminar and workshop into practice through Professional Experience Placement in various clinical settings. Reliability and commitment to the job are my strengths, and I believe these are the foundation for incorporating a person-centred approach to care.

My goal for transition to practice is to improve communication and time management skills, as I believe these two components go hand in hand and are critical for clinical decisions making. As a new graduate transiting from student to working independently will require courage, practice and confidence, and to develop these attributes I will practice giving handovers following ISBAR, whilst receiving patient care I will question if unsure of terminologies, read progress notes from a multidisciplinary team and take note of plans for positive patient outcome. For time management I will stick to the shift planner to guide my task, however, will always prioritise things that are time critical and always come back to check the planner if missed anything.

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Martin's (u3210314) Post: Clinical Policies and their importance in Healthcare

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Martin's (u3210314) Post: Clinical Policies and their importance in Healthcare

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CLINICAL POLICIES AND THEIR IMPORTANCE IN HEALTHCARE

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I would like to discuss the post further by discussing about the effects of patient education on correct inhaler techniques. One of the important parts of asthma management is patient education (Zarmouh, 2019). According to an interventional study by Zarmouh (2019), the impact of the educational activities provided for the patients who were involved in the study was significant. Patients’ knowledge on asthma, usage of inhalers using correct techniques, inhaler treatment adherence, and awareness of the importance of inhalers improved significantly after educational activities. The educational activities provided during this study were inhaler technique training session by nurses, watching the video, reading the leaflet and posters, and encounter with doctors at the clinic (Zarmouh, 2019). Furthermore, patient education is important for patients with chronic obstructive pulmonary disease (COPD) as well. According to a prospective cohort study by Ahn et al. (2020), repeated patient education can improve inhaler adherence, and techniques for patients with chronic obstructive pulmonary disease (COPD). They have also discovered how repeated patient education can improve inhaler satisfaction significantly. Inhaler satisfaction is satisfaction of patients regarding how convenient and ease they find in using their inhaler devices. Satisfaction with inhaler is important as improvement in inhaler satisfaction can lead to fewer COPD exacerbations and better clinical outcomes (Ahn et al., 2020). Patient education on how to use inhaler correctly is important for patients with asthma or COPD or both.

References:

Zarmouh, A. (2019). Does clinic-based education have a sustainable impact on asthma patient awareness?. Libyan Journal of Medicine, 14(1). https://doi.org/10.1080/19932820.2019.1635843

Ahn, J. H., Chung, J. H., Shin, K., Jung, J. H., Jang, J. G., Lee, M. S., & Lee, K. H. (2020). The effects of repeated inhaler device handling education in COPD patients: a prospective cohort study. Scientific Reports (Nature Publisher Group), 10(1). https://doi.org/10.1038/s41598-020-76961-y

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The Subjectiveness of Pain.

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Standard 2: Engages in therapeutic & professional relationships
2.4: Provides support and directs people to resources to optimise health-related decisions.
- involvement of social worker
-involvement of the palliative team
-involvement of dietitian
- in the case of indigenous people: involvement of ALO
-involvement of the pain management team
-involvement of community pharmacy

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Recount: Our regular class for Sam 'a' was canceled and the makeup class was a small group of students. Our unit convenor 'Bec' acted as Sam, and we had to role play, applying a spinal collar and pelvic binder on a trauma Pt. with a suspected spinal injury and abdominal-pelvic bleeding. As a team, we discussed what to apply first and concluded to apply a spinal collar to prevent further damage to the spine.
Reflection: In many videos, I saw the spinal collar and pelvic binder were applied by doing a log roll. However, we used the technique of pushing the collar against the mattress was easiest, similarly applying the pelvic binder was more convenient starting from the knee upward. I found applying the spinal collar without log rolling Pt was the ideal technique..

However, in a situation such as a roadside traumatic injury, unsure whether or not the technique will work.

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Blunt chest trauma

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Patient Safety is the priority, therefore, whilst administering medication nurses must adhere to all the rights, and also be mindful that even low-risk drugs when administered in high doses, consequences can be life-threatening. As in the case of Thomas even though Salbutamol is termed a safe drug, high dosing lead to arrhythmias due to hyperkalemia, which was evident after 12 lead ECG and blood results.

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Progress notes: (23/02/2033 ; 1325) Nursing
Pt was diaphoretic and confused (? new confusion or increased confusion) at the time of handover, Airway was compromised (speaking in a partial sentence, however, nil stridor present), SOB and WOB present; Breathing compromised: RR 28 bpm, O2 sats maintaining 74% in RA. Administered 5L 02 via HM, nil improvement; discussed with the team, suggested HFNP 30/30, O2 sats improving and sitting on 90-91%. O2 sats variance 88-92% signed; continue monitoring and titrate oxygen flow. IVC on L/ Cubfos patent, Pt on ongoing IVAB, Pain managed with PRN oxycodone, requested the resp team to chart oral (liquid) morphine. Pt states feeling better ATOR, however, oral intake has remained low due to exacerbation and difficulty breathing. Encourage food and fluid intake once settle.------------SN (A.Poudel)

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We administered Salbutamol to Thomas as charted by prescriber. we co-related that with Asthma management guidelines and prescription was done as per guidelines. Medication was administered, however, 7 rights were failed to maintain (i.e., documenting administration). When returning back from break, Thomas was administered Salbutamol by another staff member leading to double dosing.
This not only lead negative health consequences but Thomas also lost trust in healthcare system. Further deterioration and complications were evident.

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INC6 Journey & DiscussionModule 3 - Manuel Shinhye Kang Discussion post 1 Alveolar recruitment

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INC6 Journey & DiscussionModule 3 - Manuel Shinhye Kang Discussion post 1 Alveolar recruitment

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One of the topics briefly discussed in class was alveolar recruitment. Alveolar recruitment manoeuvre is used for the opening of the alveoli that are collapsed (Sorbo et al., 2019). The collapse of the alveoli often occurs due to lung inflammation. Alveoli can also collapse when the lungs are compressed by the heart or abdominal organs (Bassi et al., 2019). Opening the collapsed alveoli through recruitment manoeuvre can lead to oxygenation improvement (Sorbo et al., 2019).

Recruitment manoeuvre must be used with caution as it can cause aerated alveoli to over-distend. It can also cause ventilator-induced lung injury (VILI) due to ventilation at high inflation pressures. Lung tissue aeration can be monitored with electrical impedance tomography (EIT). It is a technique that is non-invasive and free of radiation (Xia et al., 2020). Other adverse effects of recruitment manoeuvre are transient oxygen desaturation, arrhythmias, hypotension and barotrauma. If used with caution, patients can benefit from the recruitment manoeuvre (Bassi et al., 2019).

Reference

Bassi, G. L., Comaru, T., Marti, D., Xiol, E. A., Chiurazzi, C., Travierso, C., Carbonara, M., Ranzani, O. T., Amaro, R., Frigola, G., Fuster, C., Saco, M. A., Zanella, A., Rosa, F. D., Rigol, M., Fernandez, L., Luque, N., Ramirez, J., Blasi, F., Suen, J., & Torres, A. (2019). Recruitment manoeuvres dislodge mucus towards the distal airways in an experimental model of severe pneumonia. British Journal of Anaesthesia, 122(2), 269-276. https://doi.org/10.1016/j.bja.2018.07.039

Sorbo, L. D., Tonetti, T., & Ranieri, V. M. (2019). Alveolar recruitment in acute respiratory distress syndrome: Should we open the lung (no matter what) or may accept (part of) the lung closed?. Intensive Care Medicine, 45(10), 1436-1439. https://doi.org/10.1007/s00134-019-05734-7

Xia, F., Pan, C., Wang, L., Liu, L., Liu, S., Guo, F., Yang, Y., & Huang, Y. (2020). Physiological effects of different recruitment maneuvers in a pig model of ARDS. BMC Anesthesiology, 20(1), 266-266. https://doi.org/10.1186/s12871-020-01164-x

INC6 Journey & Discussion

Module 3 - Manuel

u3232332
4m

Reply to Discussion Post 1 (Alveolar recruitment)-Module 3- Manuel

There is a high risk of atelectasis among people who undergo open-heart surgery, and post-operative pulmonary complications are prevalent after heart surgery, increasing the risk of mortality and morbidity among these populations (Costa Leme et al., 2017).  A randomised clinical trial done between two groups to see the effectiveness of intensive vs moderate alveolar recruitment in preventing postoperative pulmonary complications revealed that intensive alveolar recruitment was beneficial in people post cardiac surgery, these patients had fewer complications and fewer hospital stays (Costa Leme et al., 2017). However, this study was done in a small group, and other factors such as the use of analgesia, oxygen therapy, fluids management and other drugs were not included in the trial (Costa Leme et al., 2017).

Another trial done to investigate the effects of alveolar recruitment in acute respiratory distress syndrome (ARDS) revealed that the recruitment maneuvers using PEEP titration caused harm in the population suffering from pneumonia and the mortality rate was highest (Zampieri et al., 2019).

References

Costa Leme, A., Hajjar, L. A., Volpe, M. S., Fukushima, J. T., De Santis Santiago, R. R., Osawa, E. A., Pinheiro de Almeida, J., Gerent, A. M., Franco, R. A., Zanetti Feltrim, M. I., Nozawa, E., de Moraes Coimbra, V. R., de Moraes Ianotti, R., Hashizume, C. S., Kalil Filho, R., Auler, J. O. C., Jatene, F. B., Gomes Galas, F. R. B., & Amato, M. B. P. (2017). Effect of Intensive vs Moderate Alveolar Recruitment Strategies Added to Lung-Protective Ventilation on Postoperative Pulmonary Complications: A Randomized Clinical Trial. JAMA : the Journal of the American Medical Association, 317(14), 1422–1432. https://doi.org/10.1001/jama.2017.2297

Zampieri, F.G., Costa, E. L., Iwashyna, T. J., Carvalho, C. R. R., Damiani, L. P., Taniguchi, L. U., Amato, M. B. P., & Cavalcanti, A. B. (2019). Heterogeneous effects of alveolar recruitment in acute respiratory distress syndrome: a machine learning reanalysis of the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial. British Journal of Anaesthesia : BJA, 123(1), 88–95. https://doi.org/10.1016/j.bja.2019.02.026

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INC 6 - Semester 1, 2023

Module 3

u3206746
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Discussion Post #1 - Manuel's Pain Medication

During this week’s workshop, the topic that piqued my attention the most was the clinical reasoning behind analgesia medication administration for Manuel. Manuel is an 89 year old male with an extensive history of COPD. My initial choice was per oral Oxycodone 5mg as I thought Paracetamol 1g was insufficient to address his pain. However upon checking with my groupmates, they had advised that Oxycodone would not be well tolerated by Manuel as he is vomiting. We had then decided to administer intramuscular Morphine 10mg as it will also assist him with his breathing.

I was initially conflicted with administering Morphine as I had remembered that one of its adverse effects was respiratory depression. Since Manuel already had COPD, I thought that it would be detrimental to his respiration. However, upon checking the evidence, respiratory depression rarely develops if opioids like morphine are carefully prescribed and monitored (Bryant et al., 2019). Moreover, Manuel does not have liver disease so using opioids at therapeutic doses can indeed help with his pain because renal disease can cause respiratory depression by extending the half-lives of opioids that are excreted in an active form (Bryant et al., 2019).

Finally, pain management for Manuel must be closely monitored during his entire stay in the hospital as a study of COPD patients with a median age of 72 years old found that low doses of extended-release morphine at 8 mg/d and 16 mg/d did not significantly reduce the intensity of the patient’s worst breathlessness after 1 week of treatment (Ekstroem et al., 2022).

References:

Bryant, B., Knights, K., Darroch, S., & Rowland, A. (2019). Pharmacology for Health Professionals (5th ed). Elsevier.

Ekström, M., Ferreira, D., Chang, S., Louw, S., Johnson, M., Eckert, D., Fazekas, B., Clark, K., Agar, M., & Currow, D. (2022). Effect of Regular, Low-Dose, Extended-release Morphine on Chronic Breathlessness in Chronic Obstructive Pulmonary Disease: The BEAMS Randomized Clinical Trial. JAMA: Journal of the American Medical Association, 328(20): 2022-2032. DOI: 10.1001/jama.2022.20206

INC 6 - Semester 1, 2023

Module 3

u3232332
4m

Response to Discussion Post #1 of u3206746 (Manuel's Pain)

There is obstruction of normal airflow in COPD due to dysfunction in the alveoli, this not only leads to impaired oxygenation but also causes air hunger and increased work of breathing (Anzueto & Miravitles, 2017). Breathlessness is one of the major issues in advanced chronic obstructive pulmonary disease (COPD), especially among palliatives; breathlessness not only affects the physical ability to attend activities of daily living but is also distressful for other people to visualise (Verberkt et al., 2020). During an exacerbation or simple activity of daily living the chemoreceptors are stretched leading sensation of chest tightness, as well as shortness of breath can be a trigger to cause pain, especially chest pain and bronchospasm (Anzueto & Miravitles, 2017). Therefore, management of symptoms and/or prevention is better than cure. The use of low-dose Morphine regularly for 4 weeks has shown to be effective in advanced COPD and has improved quality of life and is cost-effective for individuals and the healthcare system (Verberkt et al., 2021).

Morphine is also used for the management of moderate-severe pain. Therefore, administering morphine in low doses can not only help in the management of breathlessness and improve quality of life but also help manage pain symptoms.

References

Anzueto, A., & Miravitlles, M. (2017). Pathophysiology of dyspnea in COPD. Postgraduate Medicine, 129(3), 366–374. https://doi.org/10.1080/00325481.2017.1301190

Verberkt, C.A., van den Beuken-van Everdingen, M. H. J., Dirksen, C. D., Schols, J. M. G. A., Wouters, E. F. M., & Janssen, D. J. A. (2021). Cost-effectiveness of sustained-release morphine for refractory breathlessness in COPD: A randomized clinical trial. Respiratory Medicine, 179, 106330–106330. https://doi.org/10.1016/j.rmed.2021.106330

Verberkt, C. A., van den Beuken-van, M. H., Schols, J. M., Hameleers, N., Wouters, E. F., & Janssen, D. J. (2020). Effect of sustained-release morphine for refractory breathlessness in chronic obstructive pulmonary disease on health status: a randomized clinical trial. JAMA Internal Medicine, 180(10), 1306-1314. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2769373

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Identification of first nation people. In INC5 PEP my CLN asked if I looked after any first nation people, I was unsure because I did not know how to identify anyone as first nation person. In the INC6 seminar of Week 4 when doing task related to bias and judgement, we were shown different images and were asked to portray our viewpoint. Looking at one particular image of an elder first nation person, we explained the person being happy, nice moustache, etc., but none of us identified the individual as aboriginal. I personally felt difficult to ask someone whether or not they were first nation people from their external look, I felt that might remind them of past trauma, or may give a sense that I will discriminate them for being what they are. However, after attending mandatory ACT health e-learning “Working with Aboriginal and Torres Strait Islander Patients and Families” now I feel confident to ask question if people identify themselves as Aboriginal and Torres Strait Islander, and the most efficient way to do it is just by asking everyone/or every patient the same question “Do you identify yourself as an Aboriginal and/ or Torres Strait Islander”.

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Abdominal-pelvic cavity lies inferior to the diaphragm; the abdominal cavity contains the liver, stomach, intestines, etc., and the pelvic cavity contains reproductive organs, urinary bladder and rectum. For the purpose of assessment, the abdominal-pelvic cavity is divided into 4 quadrants and nine regions.
4-quadrants are:
Right upper Quadrant (RUQ): mainly contains liver, gallbladder, part of ascending and transverse colon, head of the pancreas, duodenum, and part of the ileum.
Left upper quadrant (LUQ): mainly contains the stomach, body of the pancreas, part of the transverse colon, descending colon, ileum, and spleen.
Right lower quadrant (RLQ): mainly contains appendix, cecum, part of ascending colon, ileum, and urinary bladder.
Left lower Quadrant (LLQ): mainly contains descending colon, sigmoid colon, part of the ileum, urinary bladder, rectum and anal cavity.
9-Regions are:
Umbilical: deep, centremost, surrounding navel
Epigastric: superior to the umbilical region
Hypogastric: inferior to the umbilical region
Right & Left hypochondriac region
Right & Left lumbar region
Right & Left iliac (inguinal) region

Maireb, N.E., Keller, M. S., (2018). Essential of Human Anatomy and Physiology. (12e). Pearson Education Limited.

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Ventilation is the process of inhalation and exhalation of air from the environment or atmosphere and out of carbon dioxide from the lungs (Lakna, 2019). During this process, the air taken in from the environment has more oxygen and less carbon dioxide, hence it facilitates passive diffusion in the alveoli where Oxygenation takes place (Lakna, 2019). When oxygenation occurs the partial pressure of oxygen in RBC becomes higher and is transported to the body (Lakna, 2019).

Chronic Obstructive Pulmonary Disease (COPD) is a group of lungs diseases that includes emphysema, chronic bronchitis and chronic asthma (irreversible). Pathophysiology: presence of both component pulmonary (lungs) and systemic; hyperplasia of goblet cells enhances secretion of mucous, which accumulates in airways limiting the airflow. The cholinergic tone of smooth muscle and reduced elasticity due to existing lung conditions further reduces lungs ability to function. In all these conditions either the airway or the alveoli are compromised, leading to difficulty in gas exchange.

The role of Nurses is to monitor patient vital observation, form a clinical judgement, prioritise care needs and take necessary steps based on clinical judgement, administer prescribed medication and supplemental oxygenation, perform non-invasive tests such as spirometry before and after medication administration, breathing exercise recommended by physiotherapists, physical exercise as tolerated, provide education and advocacy where needed.
NPS Medicinewise. (2022). The most common medicines used for COPD help to relieve symptoms such as coughing, wheezing and shortness of breath, making it easier for you to breathe. https://www.nps.org.au/consumers/medicines-for-copd#%C2%A0what-medicines-will-i-need?

Lakhna. (2019). What is the difference between Oxygenation and Ventilation. PEDIAA.  https://pediaa.com/what-is-the-difference-between-oxygenation-and-ventilation/#:~:text=The%20main%20difference%20between%20oxygenation%20and%20ventilation%20is,ventilation%20reduces%20the%20partial%20pressure%20of%20carbon%20dioxide.

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Stridor: Continuous, high-pitched, monophonic sound caused by obstruction to the upper airway. louder in the neck, originating in the larynx or trachea. obstruction can be a foreign body, swelling, lump, etc.
Wheeze (high-pitched: sibilant): high pitch, polyphonic, squeaking sounds, predominant in expiration; occurs in diffused airway obstruction.
Wheeze (low pitched: sonorous Ronchi): low-pitched monophonic sounds heard during expiration.
Crackles (fine): Heard during late inspiration, high-pitched crackling or popping sound. Deflated alveoli pop open due to sudden gas pressure. Usually heard in the base of the lungs. Occurs in pneumonia, heart failure, and emphysema.
Crackles (Coarse): Heard during early inspiration as well as expiration, high-pitched gurgling sound.

Source: Jarvis, C., Watt, E., & Forbes, H. (2015). Jarvis’s physical examination & health assessment (Watt & H. Forbes, Eds.; Second edition, Australian and New Zealand edition.). Elsevier Australia.

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Inspect: Inspecting with eyes what we see, how the person is looking (tired/active), completing a full sentence or using words; skin colour peripheral, lips and central; inspecting the shape of the chest wall, neck muscles, the position taken whilst breathing, both anterior and posterior chest skin colour (no cyanosis/ pallor). Inspecting equal rise and fall of the chest, work of breathing, shortness of breath, depth of breath, use of accessory muscles, and pattern of breathing (normal, tachypnoea, bradypnoea, hyperventilation, hypoventilation, cheyne-stokes etc.

Auscultate: Listening to breath sounds and differentiating normal and abnormal sounds. Listening to the bilateral chest with a stethoscope following a sequence, either from left to right or right to left. Note any abnormal sounds stridor, rhonchi, wheeze, crackles, or pleural friction rub.

Palpate: placing hands on the posterior chest T9 or T10 to feel the symmetry of the chest. Note chest expansion whilst taking a deep breath; feel the temperature of skin and lump or masses, Note any pain exhibited whilst breathing. Asymmetrical chest expansion can be due to several respiratory conditions such as atelectasis, pneumonia, trauma such as rib fracture, pneumothorax, or haemothorax.

Percussion: Healthy lungs have low-pitched, clear, hollow sounds. abnormal findings are dull note (thud sound) and hyperresonance (lower-pitched sound).

Source: Jarvis, C., Watt, E., & Forbes, H. (2015). Jarvis’s physical examination & health assessment (Watt & H. Forbes, Eds.; Second edition, Australian and New Zealand edition.). Elsevier Australia.

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Box comparison: Standard Glucose Prescription

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09/02/2023 group of 5 students, we discussed Beth case. On the basis of clinical judgement we prioritised care needs for Beth. we also checked medications charted and discussed what medications to administer on the basis of the clinical judgement. It was learning for all of the students to check current policy as in policy of CHS  reviewed in 2017 recommended commencement of NaCl for rehydration before commencing Glucose, however, the revised policy in 2021 did not state rehydration prior to commencing glucose 5% when BGL is less than 15 mmol/L. The take-home learning was to always check updated policy prior to commencing any medical intervention.

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Discussion Post Reply #1 (Reply by u3206746)

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Discussion Post Reply #1 (Reply by u3206746)

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During the workshop I found that I myself did not know the correct technique in using a metered dose inhaler (MDI) for patients who suffer from asthma. After further reading, I found that by using an MDI with a spacer, this method can deposit up to 80% more medication in the lungs instead of in the oropharynx (Crisp et al., 2021). This discussion by u3232332 interested me as I wanted to build on the importance of why the correct technique is needed when using MDI’s and how as future registered nurses (RN), we can educate patients and their families on the correct use of MDI’s to achieve the best therapeutic effect.

Looking through the lens of a paediatric patient suffering from asthma, it not only affects them by missing out on school attendance, but it also places them at risk of lower academic achievement, risk of disability and emotional problems (Cicutto et al., as cited in Isik et al., 2019). From the parents’ perspective, they miss out on work as they must stay at home and look after their children (Engelke at al., as cited in Isik et al., 2019).

As future RN’s who may potentially work as a school nurse, a study has found that school-based asthma instructive interventions with topics such as “practical trainings on metered dose inhaler performances” are effective in promoting and maintaining health for school-age children who suffer from asthma (Suwannakeeree at al., as cited in Isik et al., 2019). This highlights the importance of patient education and is a practical and achievable project that we can undertake as RN’s in our future nursing practice.

References:

Crisp, J., Douglas, C., Rebeiro, G., & Waters, D. (2021). Potter & Perry’s Fundamentals of Nursing Australia and New Zealand 6 th edition. Elsevier.

Isik, E., Fredland, N., & Freysteinson, W. (2019). School and Community-based Nurse-led Asthma Interventions for School-aged Children and Their Parents: A Systematic Literature Review. Journal of Pediatric Nursing, 44, 107-114. https://doi.org/10.1016/j.pedn.2018.11.007