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Excited to work collaboratively with this group through our INC6 modules

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Beths' Case

54 year old female

12 hr. history of intense abdominal pain 7/10

What questions would I ask Beth?

1. Has she been able to keep fluids down?

2. Nauseous/Vomiting? Frequency?

3. Does the pain radiate, sharp, dull or increase in intensity on movement?

4. Bowel movements - are they soft? Constipated? Loose?

5. What medication has Beth taken to help alleviate the pain?

6. When/What did she last eat?

Identified possible diagnoses.

1. Pancreatitis

2. Hernia/Ulcer

3. Diabetes

4. Bowel obstruction

Beth starts vomiting and I notice a fruity smell

* Fruity smelling breath is an indication of Diabetic Ketoacidosis (DKA) which is common in Type 1. Diabetics, less so in Type 2

Identified Priorities.

1. Dehydration IV fluid therapy - replace electrolytes.

2. Antiemetic - reduce nausea.

3. Analgesia - manage pain.

(I was reminded that it is important to consider an antiemetic before pain relief so that the analgesia stays in the body, despite my first reaction/priority in reducing pain levels for Beth)

Follow up with documentation of progress notes, fluid balance chart, MMSE to monitor confusion, a possible side effect of DKA.

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An excellent and relatable breakdown on the pathophysiology of DKA
I enjoyed the simplicity of the video as the host made it easy for beginners to understand the concept of DKA

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Potassium
3.6 - 5.2 mmol/L
Helps to regulate fluid and mineral balance in the cells and maintains normal blood pressure by limiting the effect of Sodium. Any level less than 2.5 mmol/L requires urgent attention and can be life threatening.

Sodium
135-145 mEg/L
Dissolved in the blood and plays a vital role in maintaining blood pressure, nerve function and muscle contractions.
Hyponatremia occurs when the sodium in your blood falls below 135mEg/L

Phosphate
Adult = 2.8 - 4.5mg/dL
Child = 4.0 - 7.0mg/dL * Higher as children's bones are still growing *
Works with calcium to build strong bones and teeth, absorbed through the intestines and filtered through the kidneys. High levels of phosphate promote vascular calcification which leads to elevated cardiovascular risk.

Magnesium
0.8 - 1.10 mmol/L
Aids in the production of energy and protein and helps adjust blood glucose levels by regulating insulin levels. Diabetes frequently associated with Mg deficit.

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Team exercise completed on the 09/02/2023 during seminar

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An evidence-based approach that draws on our prior knowledge, helps pose questions while developing an understanding through engagement and exploration.

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Respiratory Assessment

Inspection
A visual examination where I need to view the patients breathing rate, pattern and level of effort, skin colour, level of consciousness and symmetry of chest expansion. More assessments include are they diaphoretic?, is there tracheal tugging or nostril flaring ( a great indication of respiratory distress in infants..

Auscultation
Patient breathes slowly and deeply through the mouth and starting at lung apices we work our way down comparing both sides of the chest. Each placement should last for one full breath cycle.
Adventitious sounds include wheeze, crackles and stridor.

Fun Fact on how Auscultation came about:

"I recalled a well known acoustic phenomenon: if you place your ear against one end of a wood beam the scratch of a pin at the other end is distinctly audible. It occurred to me that this physical property might serve a useful purpose in the case I was dealing with. I then tightly rolled a sheet of paper, one end of which I placed over the precordium (chest) and my ear to the other. I was surprised and elated to be able to hear the beating of her heart with far greater clearness than I ever had with direct application of my ear. I immediately saw that this might become an indispensable method for studying, not only the beating of the heart, but all movements able of producing sound in the chest cavity". (Dr Rene Theopile Hyacinthe Laennec, 1816)

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I had a basic knowledge of DKA coming into this seminar but enjoyed delving further into the specifics. Reading up on how electrolytes are maintained and the clinical considerations if levels drop low or high and how this affects the overall body was fascinating. Working out the clinical priorities, I needed guidance on where to begin, as my first instinct was to reduce pain. Even though Beth presented with 7/10 pain, my first priority needed to be an anti-emetic, so that she can keep the analgesia dispensed down. Slowing down my thinking and looking at all clinical indicators will be something I need to work on throughout this INC 6 unit. Working together with my group, finding a mentor on placement and hands on experience will assist me in honing these skills.

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Abdominal organs and their function - Drawn by student u3207688

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As the weeks progress, I'm starting to feel like everything I have worked and sacrificed for is slowly starting to pay off. Admittedly there have been a few hurdles that needed to be overcome in the last two weeks and after almost three years of study, I finally asked for help. This is something I should have done earlier, and is something that I will remember to do in future practice as it provided a positive outcome. A definite learning moment!. My goals for the remainder of the semester are to stay up to date with module content and not allow negativity to derail me.
I'm excited to be attending Gunghalin Mental Health Unit for placement. Although I too suffer from poor mental health, my knowledge is limited so its going to be beneficial to learn more about it, the types, triggers and coping mechanisms.
My strengths on placement have always been a lack of fear in asking questions, practising clinical skills till I feel proficient and being proactive throughout the shift. Areas for improvement include staying out of my own head and not letting anxiety win, IVAB administration and understanding that I'm not in the way. I'm sure I have many more areas to improve, but these goals are of the utmost importance to me during this upcoming placement.
I understand that mental health includes emotional, psychological and social well-being. Through research I have discovered that 2 in 5 Australians aged 16-85, have experienced a mental disorder in their lifetime with statistics showing adult females are slightly more affected than males. In children, males were more prevalent to this condition than females at 16% to 12%. I look forward to expanding my knowledge on placement.

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At completion of prep materials.
Reviewing the respiratory assessment and familiarising myself with breath sounds aided me in being able to recognise the different diseases that they may link to. I found the you tube links to be educational and insightful.

Completion of Workshop.
Thomas had a MEWS score of 9 which meant that a MET was called. It was my role during class to handover to the team about Thomas' condition and care thus far. I spoke loud and clear which is vital with so many staff needing the information at this time. With the assistance of a team member, we wrote the information in the exact order I would be speaking it and feel that should I ever be put in this position again, I will have a better understanding of what needs to be said. The only vital piece of information that I did not state was Thomas' past history, something that the MET team should know as it may be vital to helping him recover.

Completion of Seminar
I enjoyed working collaboratively within our group discussing how to engage in therapeutic and professional relationships and how to evaluate outcomes to inform nursing practice. We reflected on these standards and came up with quite a few as pictured below.

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Working collaboratively with our team on standards 2 and 7, and unit outline 2 and 6

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Chronic obstructive pulmonary disease (COPD)

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Chronic obstructive pulmonary disease (COPD)

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According to the World Health organisation, Chronic obstructive pulmonary disease (COPD) is a common lung disease causing restricted air flow and breathing problems due to inflammation in the airway, lung tissue and pulmonary vasculatore. There are three main diseases under the umbrella of COPD which are chronic bronchitis, emphysema and asthma.
Emphysema causes breathlessness and is caused by cigarette smoking. A healthy lung has elastic properties and once subjected to irritants continuously, the elastic stretches becoming thicker and swollen. Complications include pneumonia, pneumathorax and heart problems due to lower oxygen levels in the blood.
Chronic bronchitis is a long term inflammation of the bronchi. It is classified as having a productive cough for more that 3 months over a span of 2 years. There is no cure for Chronic bronchitis however it can be managed by bronchodilators, oxygen therapy, steroids to help open airways, oral tablets to reduce mucus build up and quit smoking.
Asthma is the narrowing of air passages due to inflammation and the tightening of muscles around the small airway. Treatment involves avoiding triggers if known, long acting bronchodilators, anti-cholergenics and anti inflammatories.

References
Agarwal, A. K., Raja, A., & Brown, B. D. (2022, August 8). Chronic obstructive pulmonary disease. National library of medicine.

Chronic obstructive pulmonary disease (COPD). (2022, May 20). World Health Organization (WHO). https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)

Lung foundation Australia. (2021). Emphysema. Department of Health. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/emphysema#structure-of-the-lungs

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Working together in our team to show the pathophysiology of asthma

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Difference between Oxygenation and Ventilation

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Difference between Oxygenation and Ventilation

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Oxygenation - Supplying oxygen to the bodies cells assessed through the use of a pulse oximeter, clinical assessment and blood gases.

Ventilation - The movement of air in and out of the lungs which removes carbon dioxide from the body.

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Medication errors and shared accountability?

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Medication errors and shared accountability?

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Unsafe medication delivery is the leading cause of patient harm worldwide (Wandmieneh et al., 2020). In Australia it is estimated that between 2-3% of hospital admissions are medication related and errors occur during prescribing, dispensing and administration. As future Registered Nurses, it is important to be aware of our inexperience, workload, the distractions of working in a busy hospital with sometimes unsafe staffing levels. These factors are the most prominent reasons why errors occur, therefore utilising the 7 rights of medication before administration, will limit the risk to the patient and self. It is common for people who are older and/or have multi-morbidity to be taking more than four or more medications, often a couple of medications for the same disease. One article I found suggested patient centred care was the approach to reducing errors along with integrated pathways such as technology and shared accountability.
Do you agree with shared accountability?

References
Australia joins international push to halve medication errors. (2023). Australian Commission of Safety and Quality in Health care. https://www.safetyandquality.gov.au/about-us/latest-news/media-releases/australia-joins-international-push-halve-medication-errors
Masnoon, N., Shakib, S., Kalisch-Elliot, L., & Caughey, G. E. (2017). What is poly-pharmacy? A systematic review of definitions. National Library of Medicine, ₁₇(230). https://doi.org/10.1186/s12877-017-0621-2
Australia joins international push to halve medication errors. (2023). Australian Commission of Safety and Quality in Health care. https://www.safetyandquality.gov.au/about-us/latest-news/media-releases/australia-joins-international-push-halve-medication-errors

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Reflection of patients trauma presentation

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Reflection of patients trauma presentation

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Prior: What do i know about trauma? I regarded trauma as a life threatening injury that required treatment urgently from a specialised team at the hospital. My opinion of trauma came from watching television shows that I now know sensationalised the idea for the viewer.
During: As I watch Danilo and the staff attend to him I feel that the team is well organised and that each medical professional has their own specified role allocated  to them and they do it well. The staff seem very adept at their job. I struggle at this stage to put myself in the nurse's position, as I would require many years of practice to feel confident enough to achieve this level of performance. Can I put myself in Danilo's partner's position? Honestly I don't want to, as the anxiety they would be feeling would be phenomenal. Reflecting on my comment, I can see how valuable compassion and reassurance to not only patients is but also to their families.
After: What am I interested in learning more about after watching this video? Blood. I would like to learn how to draw blood correctly from the vein. Knowing how to draw properly reduces the risk of incorrect results.

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Gunghalin Mental Health Unit - picture courtesy of Canberra Health Services.

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I'm excited for PEP to start next week and look forward to learning more about mental health. The Gunghalin mental health unit help people that predominantly live in this area who suffer from moderate to severe mental health. My clinical preparation for this PEP was extensive as I wanted to come into placement with a sound knowledge of what type of anti-psychotics are available, signs and symptoms of schizophrenia and what assessments are used. The MSE was what i found to be the predominant assessment used. (Reflecting back on this comment while on PEP, I realise now that I had only scratched the surface of the research needed to understand mental health.)
Preparation for PEP personally was a lot harder. I was fortunate that the clinical staff at GMHU were prompt in sending my roster, parking limitations and what to wear. Wearing uniform here could intimidate patients so its encouraged to wear neat casual. Due to this, I got to have fun finding some professional but casual clothes to wear at the shops!

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 Concepts that are new learning for me on this weeks module

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 Concepts that are new learning for me on this weeks module

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Chest injury pathways

Learned from this weeks research:
Blunt walled trauma accounted for over 15% of all emergency department admissions worldwide
50% of rib fractures remained undetected
29% Mortality rate of the above , dependant on certain risk factors.

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This video explains what trauma is. It can be an emotional, physical or mental occurrence due to violence, abuse, neglect accidents or natural disasters.

According to this video, 70% of people will experience some form of trauma in their life. I related to the video when it stated that feelings of guilt and anxiety occur when trauma is experienced and its also important not to misunderstand or down play a persons trauma as this reflects back on the person who is experiencing it making what they are or have experienced, inferior. It can often increase their experience of dealing with their trauma.

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Reflection:
This week scenario we had the chance to explore how to ask questions in reference to someones gender identity. At first I thought it would be quite easy as I feel as if I'm a very open minded person, but actually I was quite unsure on how to initiate the conversation. Jemima was quite adamant about not sharing her sexual proclivities so we had to ask questions trying to work out why she had abdominal pain. Once the flow of questions from other students started I was able to define my own and speak up. But why did I find it difficult? I have no issues with a persons sexual orientation but I realised I had no idea on how to talk to someone that had previous bad experiences and was afraid to give what I consider pertinent information for a correct diagnosis. To further help me work through my issues I have discovered I could enrol in LGBTQ+ eLearning which explains the facts and understands the lived experience. This is a manageable goal as its three modules in length and takes an hour to complete.

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Selected to be team leader in this weeks seminar

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This week during class we had to select a team leader and that person would allocate roles to the other student nurses. I was chosen, and it was a defining learning moment for me.
I felt uncomfortable and unsure. A team leader is someone who motivates and ensures positive communication ("5 roles and responsibilities of a team leader"., 2023) so our patient can receive the best possible care in a short time frame. I was fortunate that the group i'm in discussed the priorities together and once we worked out this, I had no trouble delegating. Confidence is key and although I'm usually out spoken, being put in a position of leadership to ensure patient care made me nervous and forgetful. I was fortunate that the other students were supportive.

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Learning opportunities at Gunghalin Mental Health Unit

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My responses to group discussion posts :

U3191154 discussion post on Semiglutide.

U3200866 discussion post on polypharmacy amongst older people.

U3227571 discussion post on post operative pain management.

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A fun fact to consider before delving deeper into this discussion post is that the delivery of vapours through inhalation dates back to 1554 BC when a piece of parchment was discovered between a mummies legs depicting a patient's struggle to breathe, and how it was treated (Stein & Thiel, 2017). Black hens-bane, which contains atropine, was heated over hot rocks, and a stone jar with a small hole in the top was placed over the plant so the vapours produced could be inhaled through a long thin reed (Stein & Thiel, 2017).
Thousand of years later, 1956 specifically, the spacer was developed to address the misuse of metered inhalers due to a patients poor dexterity/coordination and the efficacy of the medication. It was found that large droplets of the medicine inhaled were staying in the mouth and throat and not moving to the lungs where it would actually be useful (Inhaler technique, 2022). Patients complained of throat irritation and mild infections without the use of spacers.
However, in one systemic review which spanned over four decades a study found that only 31% were using the chamber correctly despite the fact that instructions were available in the pamphlets (Morton et al., 2020).

What do you think of spacers? Do you think people need more education?

References.

5 Roles and responsibilities of a team leader. (2023, March 14). Indeed. https://au.indeed.com/career-advice/career-development/responsibilities-of-a-team-leader

How to avoid an asthma inhaler-induced sore throat. (2019, April 22). Asthma.net. https://asthma.net/living/avoiding-inhaler-induced-sore-throat

Inhaler technique. (2022, January 6). Lung Foundation Australia. https://lungfoundation.com.au/patients-carers/after-your-diagnosis-title/inhaler-devices/

Morton, R. W., Elphick, H. E., Craven, V., Shields, M. D., & Kennedy, L. (2020). Aerosol therapy in Asthma- Why we are failing our patients and how we can do better. Frontiers, ₈. https://doi.org/10.3389/fped.2020.00305

Stein, S. W., & Thiel, C. G. (2017). The History of Therapeutic Aerosols: A Chronological Review. J Aerosol Med Pulm Drug Delivery, ₃₀(1). https://doi.org/10.1089/jamp.2016.1297

Vincken, W., Levy, M. L., Scullion, J., Usmani, O. S., Dekhuijzen, P. R., & Corrigan, C. J. (2018). Spacer devices for inhaled therapy:Why use them and how? ERJ Open res, ₄(2). https://doi.org/10.1183/23120541.00065-2018