Understanding Arterial Blood Gases

by Theresa Steckel | Apr 5, 2019 | Post-Conference, Uncategorized

Arterial Blood Gases

Introduction:

Arterial Blood Gases (ABGs) provide a wealth of information for the differential diagnosis of many respiratory and metabolic diseases, but how can nurses use this information as part of the physical assessment and reporting of key events? Changes in oxygenation and acid-base balance are key to understanding the acuity and progression of illnesses such as respiratory failure, sepsis, liver and renal failure, burns and other acute and chronic conditions. Keep in mind there are also complex and mixed presentation acid-base conditions. Although being book-smart is helpful, developing an intuition, gut-feeling or a clinical picture is key to responding quickly when faced with emergent patient changes.

Associated Diseases and Presentations:

Respiratory Acidosis-Hypoventilation
• COPD/Asthma
• CNS Depression
• Malignant Hyperthermia

Respiratory Alkalosis-Hyperventilation
• CVA, Brain Trauma, Brain Tumor, CNS Infection
• Pulmonary Embolus
• Pregnancy, Liver Disease, Sepsis, Hyperthyroidism

Metabolic Acidosis
• Methanol Intoxication, Ethanol Or Ethylene Glycol Intoxication
• Salicylate Intoxication
• Diabetic Ketoacidosis

Metabolic Alkalosis
• GI Or Renal Loss Of H+
• Heart Failure, Cirrhosis, Nephrotic Syndrome
• Severe Hypokalemia

Conclusion:

Consider what ABG results might be associated with various diseases and how changes in ventilation, metabolic status or fluids might change the patient presentation. Further study into acute versus chronic, compensated versus uncompensated, and anion gaps will provide more challenging detail to discuss with students in critical care rotations.

Download your FREE ABG Post Conference Lesson Plan Today!

Download your FREE Critical

Thinking Post Conference

Activity Today!

Complete with ABG Case Study examples, critical care clinical activity to help your students understand and compare their patient’s ABG results, and ABG reference guidelines on pocket card.

References

1https://www.thoracic.org/professionals/clinical-resources/critical-care/clinical-education/abgs.php
2.https://patient.info/doctor/arterial-blood-gases-indications-and-interpretation#nav-4
3https://medlineplus.gov/ency/article/003855.htm
4https://emedicine.medscape.com/article/301574-overview

The Truth about Empathy

by Theresa Steckel | Apr 4, 2019 | Post-Conference, Uncategorized

The Truth about Empathy

“Empathy is the most powerful connecting and trust building tool we have.”
Brene’ Brown

Empathy is not about connecting or understanding a patient’s experience. Empathy is about understanding the feelings or emotions that underpin the experience.

And isn’t that a relief? Empathy is feeling with our patients. We don’t have to experience cancer, trauma, or congestive heart failure to understand fear, anxiety, and vulnerability. Empathy is about connecting to the feelings and emotions that go along with those experiences. We don’t have to give birth to understand joy or walk down the hall with our rear end hanging out to understand embarrassment. And who of us does not understand what it feels like to be judged?

Teaching
If empathy is a skill, then we can teach it.

It’s valuable for students to understand empathy looks different for each of us. Ask them what it looks like for them.

During post conference ask them to answer the following questions. Check out the post conference handout: Empathy Handout

When I share something private and personal, and I feel “seen” or understood, I feel:
When I share something private and personal and I don’t think anyone understands me, I feel:
When I share something private and personal, I prefer you:
Make eye contact.
Hug or touch me.
Nod your head.
Ask more questions.
Listen quietly.
Respond to me.
Look away.
When someone shares something private or painful with me:
I worry I will say something dumb.
I try to think of something really comforting to say.
I want to solve the problem.
I become very nervous.
My heart begins to pound.
I start to sweat.
I just prefer not to know and wish they hadn’t shared with me.
I am afraid I won’t feel anything.

Post Conference Materials

Post-Conference Handout

Reference & Recommended Reading

Empathy and Perspective Taking Post Conference Resource

by Theresa Steckel | Mar 29, 2019 | Uncategorized

How can we teach perspective taking to our students?

Merriam Webster defines perspective as “the interrelation in which a subject or its parts are mentally viewed.” To put it simply perspective is “point of view.” Perspective taking, the ability to see the world as others see it, is perhaps the foundational skill to practicing empathy.

What impacts our perspective?
The lens we see through is shaped by our interaction and experience with the world around us. Age, sex, level of education, ethnicity and language are the obvious factors, but our lenses are more colorful than this. Family dynamics, sexual orientation, birth order, and faith are just a few additional influencing factors.

In a previous post I wrote:

As nurses we interact with patients and colleagues different from ourselves every day. We care for patients whom have committed crimes or interact with parents who neglected or intentionally harmed their child. The patient’s religion, sexual orientation and social background may be different than our own. Additionally, in the United States the demographics of the nursing work force does not reflect that of the general population. Currently, 36 percent of the U. S. Population are white females; while 65 percent of the nurses under the age of 42 are white females.

To read more click here.

The nursing demographic does not reflect that of the general population. If you grew up in majority culture (white, straight, middle-class and Christian) like many nurses, you may have been taught that your perspective is the right perspective and everyone else needs to adjust their lens (Brown, 2018). Many of us were taught what perspective is, but not all of us were taught the skill of perspective taking.

Empathy Myth: We can take our lenses off.

The truth is, no matter how hard I try I cannot remove my white, female 40-something lens. It is welded to my head. So, how can we learn and teach the skill of perspective taking?

Be curious.
Ask questions.
Be learners.
Honor our patients, co-workers and students with respect.

Post Conference Activities

1. Review article: Nursing Workforce Projections by Ethnicity and Race
2. Complete Handout: Perspective Taking Handout
3. Play Video (2 minutes 37 seconds): How can Providers Elicit Patient Perspective and Respond with Empathy?
4. Discussion Question: What questions can we ask our patients to help us understand their point of view?

Four questions students can ask patients to gain perspective:

Tell me more..
What about this concerns you the most?Help me understand.
What are you thinking?
What is most important to you today?

Resources:

Article Link: Nursing Workforce Projections
Video: How can Providers Elicit Patient Perspective and Respond with Empathy
Handout: Perspective Taking
Brown, B. (2018). Dare to lead: Brave work, tough conversations, whole hearts. New York, N.Y.:
Penguin Random House.

Free Meningitis Case Study Resource

by Theresa Steckel | Mar 28, 2019 | Uncategorized

Nursing Case Studies is Nurse inspired and is Nurse driven. Nursing Case Studies has been developed to assist professional nurse educators in their everyday responsibilities of teaching, mentoring and maintaining the best in critical thinking, patient care and collegial relationships. Our students are our future and through education we can assure continued commitment to our profession and our patients.

Our vision is to create resources and references that come from REAL clinical experiences. We want to assist you in preparing newer nurses for the ever-increasing complexity of healthcare while maintaining the essence and art of nursing. We hope you join us on our journey!

Bacterial Meningitis
The patients being seen in our Emergency Departments, Urgent Cares and Primary Care offices are no longer local, nor do they come from a homogeneous background. Bacterial meningitis is a global health concern which results in significant morbidity and mortality. Fifty per cent of cases can be fatal if left untreated. Even with early diagnosis and treatment, 8–15% of patients die, often within 48 hours of symptom onset and 10–20% of survivors develop permanent sequelae including brain damage, hearing loss, and learning disabilities.1

The age groups afflicted by bacterial meningitis vary with the causative bacteria and geographical location of the patient. Knowing some of these facts including travel or home of origin, typical bacteria, typical age of onset and the signs and symptoms of disease progression are key for the early diagnosis and treatment of these patients, many of whom may also have language or age limitations complicating their ability to communicate clearly.

Teaching students and newer nurses to recognize the subtle signs within given populations is key to successful identification and treatment of these patients. Thoughtful and timely communication is also key to a successful treatment plan.

History: Consider the following for group or classroom discussions: What questions should be a priority? Who are the best historians? What is (are) the patient’s chief complaints? What was the time of onset? Does the patient appear or behave differently according to those familiar with them? What are key V.S. changes or assessment findings that may assist in a differential diagnosis? What lab work or other diagnostic tests may be helpful in determining the cause or severity of this patient’s illness? Are there infectious disease considerations that may impact family, friends or acquaintances? When is infectious disease reporting required?

Treatment: What orders should the nurse expect and prepare for? How does the nurse determine treatment priorities? What assessment changes should the nurse look for to assist in determining treatment effectiveness? How does the nurse determine if and when the physician should be contacted? What changes should trigger a Rapid Response/SWAT Team deployment within the facility? What is the facility or local protocol for reporting communicable diseases?

Conclusion: An experienced nurse who is curious and determined is the patients best advocate. Teaching and mentoring students to develop critical thinking skills will prepare them to connect-the-dots, identify trends and assure positive patient outcomes.

Resources1: Global etiology of bacterial meningitis: A systematic review and meta-analysis (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995389/; Journal ListPLoS Onev.13(6); 2018PMC5995389)