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NurseTwain

Geriatrics can Squat, too

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Geriatric syndrome is a term that encompasses several clinical manifestations in the elderly that are not otherwise classified under a particular or singular disease or condition. These include falls, delirium, incontinence, and frailty.

The degree of muscular strength and endurance is a strong determinant of long-term overall health. It is common and unfortunate that the public often disregards these ailments and simply contribute them to old age or accept the fact that this is the way it is because one is getting older.

Did you know that 1 in 3 older adults fall at least once in a year? These falls are most often contributed to a decrease in walking speed or gait, impaired balance, or dizziness. Observe how your parents or grandparents are walking. Do they walk slowly? Is that because they are having trouble balancing themselves or are they just being cautious? How long does it take them to walk from room to room in their home? An older adult who walks slowly and has poor gait quality (hunched over, swaying to maintain balance, shuffling feet, etc) has a lower life expectancy than another older adult who walks more swiftly, upright, and who picks up their feet.

The World Report on Health and Aging has developed a tool that assesses the degree of skeletal muscle mass, which is especially important for a functional older adult. The tool assess hand-grip strength, walking speed, time up and go (how fast one can stand up and begin walking), and a short physical performance battery score (combined results of said tests).

The act of movement is critical for any body- whether it be walking, running, Yoga, cleaning, shopping, etc. Movement lowers BP, cholesterol, anxiety/depression, pain, and so much more! Add resistance training such as squatting, leg lifts, glute bridges, etc to the mix and older adults can have such a higher quality of life. The problem with Western Medicine is that our culture values the Youth, claims that a pill can cure all, and has such a large focus on tertiary medicine- treating, rather than preventing disease. With higher life expectancies, thanks to medical advances, we also need to maintain/increase the quality of life for older adults. Educating and demonstrating the 70-80 year olds to squat may just be one solution.

Until next shift,

Shania

Articles:

Click to access v10i3_2-amh-2019-07-016.pdf

https://www.mdpi.com/1660-4601/18/5/2723/htm

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2409147/

Patient prayers

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Every morning during huddle, the off going shift provides updates to the oncoming shift and then we say a prayer to start off the day right. Nowadays, there is less news and more avid prayers.

We pray for peace and healing to ourselves and patients as everyone is emotionally drained.

We pray for unity and strength for both ourselves and patients to fight the unrelenting covid virus.

We pray because it’s all we have right now.

Last Sunday night was such an emotional day. Several patients coded, one died that family was not ready for, 3 patients were placed in restraints.

Nurses spend their entire shifts watching oxygen monitors and running into rooms when numbers drop.

We expand critical care to 3 different floors, place two patients in one room, compromise oxygen supplies because we don’t have enough supply, and we pray that machines become available as patients need them.

Confused patients pull off their masks and some die because of it.

Adults in their 30s and 40s are intubated and will never leave the hospital.

The average patient stay is roughly 10 days inpatient.

Patients ask if they are going to die. Some come in with their family members and are discharged alone.

Right now is not a fun time to be a nurse, so we pray.

Until next shift,

Shania

A neverending nightmare

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Shania Lynn The Cure For The Common Read Photo

Tonight was one of the worst nights I have had taking care of Covid patients. Nearly our entire 52 bed unit is covid and majority of them are either on high flow oxygen or optiflow. Patients are now put on a list to transfer off the unit as step down and CCU beds become available.

One of the patients I was caring for, was maxed out on optiflow plus a nonrebreather and interchanging those with a CPAP. This is all while she is at rest. We finally got a step down bed for her and was in transport to her new room when her oxygen dropped to the 40s (a normal being 90-100%, her baseline in the 80s). RT put her on a nonrebreather for transport but it was not enough to sustain her for the short transfer downstairs. We called a code and she was quickly placed on a CPAP continuously and her sats gradually improved.

The CCU charge nurse informed me that there are currently 5 patients among their many covid who will most likely not survive… including a patient in their 30s. All the charge nurses now must keep each other informed of our most critical patients to plan for transfers.

Some patients look terribly sick and others look fine but their lungs are just not exchanging the nutrients needed to sustain their blood saturations. Lungs are often clear with their sats in the 80s or lower. O2 can change from 2L- 15L and higher in the matter of one hour.

I know we are gripe, complain, and beg for people to stay healthy etc., but it truly is a terrible never ending nightmare

Until next shift,

Shania

Covid-19: Misinformation Kills; All about Vaccines

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Before I begin to provide evidence-based, accurate information on all three different types of the Covid-19 vaccines, I want to paint a real-time picture for you.

  • If you saw what healthcare workers see every day, would you change your mind?
  • Currently, hospitals are at full capacity and resembling the peak of the previous Covid-19 strain. We are diverting medical cases elsewhere, we are expanding nursing units, we are converting surgical/orthopedic floors into medical overflow units and training non critical care nurses on how to care for critical care patients, we often have to move patients into a different room in the middle of the night to make room for an influx of covid patients, we are losing nurses as patient ratios have increased from a safe 4 covid patients per nurse to upwards of 5-6 because we don’t have staff.
  • The worst feeling is seeing multiple patients in need of a bed, but no nurses to care for them. The charge nurses end up taking a full group of patients and there is no help for the unit.
  • Last weekend, we had to double room two different sick couples, putting even an additional strain on staffing as we still only have 52 beds, not enough to staff those, but now upwards to 54 patients.. it is a nightmare.
  • I have had family members yell at me because “I don’t believe in Covid. I am not leaving the bedside.” Security was called to escort them out of the hospital.
  • I have had family threaten to kill nursing staff if anything happens to their family member. A police report was made.
  • I have had family yell at me because it took 8 hours to get a bed.. Sorry, sir, the hospital is full… Comments like this are ridiculous and I do well to not get myself in trouble.
  • I have had multiple patients crashing at the same and some who need a higher level of care, but there are no beds available, so they risk dying due to lack of critical resources.

So, what can the public do to help? Not call us heroes. Covid is back and just as bad, if not worse than before. Take a global pandemic seriously, wear your mask (at the very least), and get the vaccine if your medical doctor encourages you to.

PFIZER/ BIONTECH

  • FDA Approved
  • 2 doses 21 days apart, Booster recommended for immunocompromised 28 days after completion of 2 doses.
  • 12+ y/o
  • Possible Adverse Effects: injection site pain, allergic rxn, flu-like sx, *myocarditis/pericarditis in young men 12-17 y/o (RARE), syncope
  • Ingredients: Nucleoside-modified mRNA encoding the viral spike (S) glycoprotein of SARS-CoV-2, 2[(polyethylene glycol (PEG))-2000]-N,N-ditetradecylacetamide
  • https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html#Appendix-C

MODERNA

  • Emergency Use Authorization (EUA)
  • 2 doses 28 days apart, Booster recommended for immunocompromised 28 days after completion of 2 doses
  • 18+ y/o
  • Possible Adverse Effects: injection site pain, allergic rxn, flu-like sx, *myocarditis/pericarditis in young men 12-17 y/o (RARE), syncope
  • Ingredients: Nucleoside-modified mRNA encoding the viral spike (S) glycoprotein of SARS-CoV-2, PEG2000-DMG: 1,2-dimyristoyl-rac-glycerol, methoxypolyethylene glycol
  • https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html#Appendix-C

**Effectiveness of both Pfizer and Moderna were very similar with efficacy of preventing severe illness from Alpha (first strain) at 93.7% and Delta 88%. https://www.nejm.org/doi/full/10.1056/NEJMoa2108891

JANSSEN (JOHNSON & JOHNSON)

*Patients will be observed for 15 minutes post vaccination.

*Neither of the vaccines contain metals, eggs, latex, gelatin, or preservatives.

Things to consider:

,We will not shame you for choosing not to get the vaccine, but we do encourage it. At this time, children are not at a risk for serious illness, however they should be vaccinated to protect the vast public. We all need to work together to protect society. Yes, we all have freedoms, but we also have the civic duty as humans to protect our fellow neighbors. Covid is real, rampant, deadly, and why can’t we all work together to resume our pre-covid lives? Let’s be mindful of our actions. Lets continue to mask, get the vaccine, and fight the pandemic together.. Then, we can all be heroes.

Until next shift,

Shania

Crash Carts and Comfort Measures

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How does one determine the end of another’s life? How does one know when the best option is really to let nature run its course and allow the body to naturally shut down? When do fervent prayers for a miracle need to be shifted into prayers for hope, strength, and healing in the years to come?

Questions like these are frequent in the hospital setting. Many patients come in for a slight pain or elective procedure and are diagnosed with terminal illnesses. Some never leave the hospital and others are readmitted shortly after discharge. Many patients do not fill out advanced directives before terminal events, making family decisions challenging and burdensome for the appointed surrogate who must make the above decisions.

Imagine a middle-aged woman being diagnosed with metastatic, stage IV cancer. She is a “frequent flyer” back and forth from the hospital to the nursing home. She is “call-light heavy” and asks for minor things every thirty minutes such as her pillow fluffed, right leg moved in the bed, or to be pulled up a couple more inches to the top of the bed. Then, imagine family issues as she has no advance directives, is borderline confused, and the family disagrees on the plan of care. It is a disaster.

Now, the patient has returned, each time getting progressively weaker and lethargic. She doesn’t call as much and staff is concerned because we know she is far from her baseline. Her prognosis, originally at one year, now at only a few weeks.

Discussions about hospice and comfort measures were repeatedly getting declined by family. The patient remained a full code as she was actively dying with her respirations becoming slower and labored, blood pressure in the 70s systolic, level of consciousness decreasing, and PO intake next to nothing for several days.

Nurses would sit outside of her room with a crash cart just watching her breathe and observing the fluctuating O2 sats. We realized at the end, that her family did not want to be the one to make the decisions about neglecting CPR and opting for comfort measures. Eventually, the doctor strongly encouraged and at roughly 14 days inpatient, actively dying, the patient was transitioned to comfort care.

This is not a story of simply ordering a DNR/DNI because staff didn’t want to participate in a code; it was a matter of the patient being under serious trauma and probably wouldn’t survive CPR alone, let alone intubation for the prolonged future. Media often portrays a false sense of CPR effectiveness and does not consider the trauma that comes along with compressions, defibrillation, and subsequent ventilation. In-hospital CPR survival- discharge rates on average are roughly 25% according to the NIH. The patient was dying, but her prognosis was originally set for several more months and the family kept repeating that “she had more time.” They held on to this hope in the midst of the patient’s rapid decline.

Speaking to patients about advanced directives before they are in these situations is so important. It was heartbreaking following this case for weeks with no progress and false hopes.

Until next shift,

Shania

The rise of Delta: not the airlines.

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Due to a high number of unvaccinated individuals and anti maskers, hospitals are now hit with a second covid-19 surge. I, as well as many other nurses, have experienced the nightmares of covid returning as beds are full, patients are sick, and staffing is strained.

The Delta variant is now the major strain in the US. It is about 2x more contagious and transmissible than the original covid-19, meaning that one infected person can infect upwards to 5 other people. Those who are unvaccinated including children are most at risk for infection and hospitalization.

Loss of taste and smell are less common with this variant and typical signs are symptoms resemble that of the flu including headache, sore throat, runny nose, and congestion.

Even with the variant, vaccination prevents 88% of people from having symptoms and 96% of people from ending up in the hospital.

Take home points:

Get vaccinated!

Wear a mask in public places.

Prevent the spread and help the strain on the hospital system.

Until next shift,

Shania

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615-856-8181
shania@shanialynnvo.com