Archive for the ‘Nursing Physiology’ Category

The Bright Side Of The Electronic Medical Record

November 18, 2010

Clients and their families having satisfaction with their hospital experience has taken it’s place at the forefront of patient care. Although this is not a new concept, it is having more emphasis placed upon it than ever before.

With the emergence of the electronic medical record there have also emerged new ways to bring satisfaction to our clients. Nurses have much more information at their fingertips than ever before, we rarely have to leave a patient’s bedside to answer their questions. If they have a question concerning one of their medications, the nurse can click the icon on their computer and find the answer the patient seeks, and can just as easily print out this information for the client to refer to. A client that is on a fluid restriction who wants to know how many more glasses of water they are able to have can have their answer instantly with a click on the input and output tab, where an up to the minute tally is readily available.

In many instances the nurse also benefits, if a client asks for pain medication, there is now a colored line that shows up next to the medication as to what time the medication can be given, there is no more searching for the last dose and counting the hours between doses.

The newer versions of the electronic medical record have a client’s lab values and allergies, not only a click away, but automatically have a pop up box that warns the doctor or nurse who orders or is about to administer a medication, such as potassium, that there is a contraindication with the daily lab results or the clients allergies.

As a profession, nurses go through many transitions in the daily care of their clients. Some of these transitions may be difficult to adjust to, others have flaws and need to be adjusted to better serve the nurse and client. Our attitude can make all the difference, looking at the bright side with a positive attitude can make our work experience a more positive one. One thing is for certain the electronic age is not going to go away, it is here to stay.

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Informatics and the Ventilated Patient

August 23, 2010

ICU nursing frequently involves caring for the patient who is artificially ventilated.  This could be for numerous reasons: i.e. failure to wear off ventilator following surgery, respiratory failure, PE, pneumonia, etc.  Without advances in informatics, care of this difficult patient would be made even more difficult.  Assist controlled ventilation is the most often used.  In this mode, tidal volume and rate are pre-set.  In other words the ventilator is taking over the work of breathing, filling the lungs with air and enabling gas exchange to occur so the patient remains well-oxygenated.  If the patient does indicate respiratory effort, the ventilator is programmed to respond though it still delivers the preset tidal volume.  Nurses must be attentive to the patient’s respiratory rate and the ventilator’s assistance in order to avoid hyperventilation and subsequent respiratory alkalosis.  Generally, the nurse checks and records ventilator settings and respiratory effort frequently throughout the shift.  The patient will be monitored with vital signs, cardiac rate and rhythm, respiratory rate and pulse oximetry, via electronic monitors which transmit information directly to nurses in preset intervals (often as frequently as 2-5 minutes) and alarm when abnormals occur.  Without this form of monitoring, care of this patient would be much more difficult.  If the ventilator is alarming, the nurse attends to the patient first, then, if all is well, attends to the alarms which may indicate water in the tubing or a loose connection.  The patient should be assessed for skin color (nail beds and lips particularly), lung sounds, bilateral chest expansion, need for suctioning and respiratory effort.  The physician may order labs, arterial blood gases, chest x-ray or alteration of settings.  Again, thanks to computerized information retrieval continuity of care on a multi-disciplinary level is more accessible than in the past.  In most ICUs, physicians, nurses and respiratory therapists have access to electronic bedside charting to allow for continuous monitoring.  This form of charting makes the work of documentation and information retrieval safer for the patient.  Simply put, breathing supplies the human anatomy with life-giving oxygen a necessity for every cell in the human body; thus the “A” in ABCs.  Nurses always must attend to airway first, for without a patent airway, no other intervention could help the patient achieve homeostasis.

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Stress and workload, comment

October 7, 2009

My upcoming workload is a bit overwhelming, during the next two months, with out the added stress of my online course. Although I only have to complete Advanced Anatomy, Physiology, and my Capstone project, I truly feel no end in site or even worse, the fact that I may not pass my A&P. I now feel that I must register for my last course when I am about to start my second half of this course, just to finish prior the end of November. This is because hopefully I can relax and enjoy the holidays with my family and be done by the deadline of the end of the year. Each day I work to do the best job an educator can do, and try to accomplish each of my tasks in a rather timely fashion, but in nursing, there are always speed bumps in the road to prevent you from getting out on time, which is usually around 4-5pm. I can function pretty well with my computer but I am having quite a bit of trouble at times accessing the Evolve website. I really do not have the time to call tech support as that usually means an entire evening is wasted trying to solve a computer problem. When I finally can get on, it is either to take a quiz, or submit my forum post. Taking a quiz. (Alternatively, mid-term or final) is extremely stressful to me. Not only do I generally freeze up during quizzes or tests, but also, there is a little clock in the right hand corner, quietly ticking down the time left before my test should be complete. In addition, if that is not enough stress on my plate, every now and then, a small box appears in the center of my test questions, letting me know exactly how many minutes I have left. This, I do not need on top of my already high anxiety level. I talk frequently to a few of my fellow clinicians that are in the same boat as I, trying to obtain their BS in Nursing before the end of the year and they are stressed to the max. With both the flu epidemics fast approaching, we all wonder what kind of condition we all will be in by the time we are done. We will all push on to do our jobs, do our homework, complete our quizzes and hopefully finish in time to meet our dead lines.

Original Post
July 15, 2009
Title: Stress and workload
Stress and workload; I thought it was appropriate to discuss stress because that’s exactly what I am feeling about my degree program. It does feature online interaction and computer use. The purpose of my degree program was to prepare myself on how to be a better Community Health Nurse; I did not think it was to send time on academic work. I went to bed last night feeling very stressed. My workday is already 9 hours long and by the time I get to my computer at night I am already tired and stressed. What am I going to do about it? I don’t know. I am sure I am not the only one feeling this way. Many Nurses are already feeling the strain of work, family, education etc. I graduated from Nursing in 1982 at the ripe age of 19; it was a 3-year diploma program. Now it’s all about the degree and it is becoming increasingly difficult for diploma nurses to move forward in their career. With the national nursing shortage one would think the government would concentrate on more effective ways for diploma nurses to bridge over to their degree. I can’t afford to take 2 years off to go back to school and taking a course at a time I will be ready to retire by the time I get my degree.

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Brain Physiology

May 28, 2009

Chapter 1 of Montague: Physiology for Nursing Practice, 3rd Edition was a great review of cell structure and function as well as a basic review of the human body. In my day to day practice which is a critical care level post anesthesia care unit we utilize the computer for everything, medication administration, charting, diagnostic study results as well as communicating with our anesthesiologists for stat orders and updates on patient conditions. I noticed that I integrated the information in Chapter one when reviewing diagnostic data (i.e., labs, ABG’s, Chest X Rays etc). I was more cognizant of how the amounts of fluid given during the operative period impacts healing and recovery. I thought longer about the patient’s pre surgical state of health and where it was in comparison of homeostasis. I am a very visual learner and online learning allows me to quickly research different aspects of topics I am studying and find sites that put my topic in a visual format. For example, there is a site for kids called BrainPOP.com that, while it is for kids (through high school) it presents, for example, cell division so that I can see it step by step. There are several other sites I will also utilize for this course taught by Dr. Johnson. I don’t think a nurse can practice in a healthcare setting today without utilizing computer/electronic data systems.

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