EP 212: A Patient’s Perspective of Delirium With Amelie Susanne
What is a patient’s perspective of delirium? An induced coma is also known as MIC or medically induced coma, barbiturate-induced coma, or drug-induced coma.
It is also called as temporary coma or a deep state of consciousness controlled by an anesthetic drug.
Often, barbiturates like pentobarbital or thiopental are used to help patients. It can also be intravenous anesthetic drugs like midazolam or propofol, but what happens when a patient goes through an induced coma and wakes up from it?
Can a patient recall any memory while they are in a coma? This episode will talk about a patient’s perspective of delirium and many more.
In this episode, we would like to introduce you to Amelie Susanne Roth. Susanne is a coma survivor. After an initial bacteria infection, Susanne had to be placed into an induced coma that lasted 16 days.
We talk about her time in the ICU and her experience of being in a coma and suffering from it. In this episode, we flip the script and learn firsthand about the patient’s experience.
Questions for Our Guest
The questions below are some we’d like to tackle. We often go off-topic, so we don’t expect to hit them all. If you have any ideas, please let us know.
Looking forward to our conversation!
These are the questions you had in Calendly. We’ll go off our questions, and wherever else our conversation goes.
Please give us a little background about yourself.
How did you end up in the hospital? And can you go a little in-depth into what happened?
Do you know what kind of infection it was? Where it came from?
3. Can you put us through the course of your hospital experience? Before this, coming from the day you came in?
What you heard, what were you told, and how did you feel?
4. You going into a coma and being intubated; was this something you expected?
5. When you were intubated and unresponsive, what was happening?
Do you remember any of it?
How did it feel?
Were you able to hear anything?
Was it just like a dream state?
6. When you came out of the coma, were you mentally back to normal?
Were you aware of the whole extubation process? For example, when nurses say, can you open your eyes, squeeze my hand, weaning process?
Did you suffer from any delirium or confusion?
How did you feel during everything that was going on?
7. Where do you think healthcare providers can improve?
Do you want to learn more about a patient’s perspective of delirium? Watch the full episode here 👇👇
TIMESTAMPS:
00:00 Introduction 01:32 About Amelie Susane Roth 02:38 How it all started 07:25 Experiences of Being Under Sedation and in a Coma 13:40 How does it feel to be in delirium or a coma? 15:57 A better understanding of why a patient gets agitated 18:14 The post-coma experience 25:03 Medicine Failing Patients and the Need for a Different Approach 27:50 Coping with Traumatic Experiences After a Coma 35:00 Life’s outlook after coma 40:48 Amelie’s life prior to becoming a patient 44:27 The Life Lessons While Traveling The World 47:18 Wrapping up the show
How do you earn your patient’s trust? Earning our patient’s trust is vital to us nurses. We can provide them with the best nursing care if they trust us.
But how can we gain our patient’s trust? Is there a magic word to use?
Every Patient is Different
Not all patients are the same. They all have different personalities, moods, and preferences. Sometimes, it’s hard to guess what kind of mood our patients are in, especially when they’re in pain for some time.
As nurses, we must adjust our personalities to our patients. We cannot be angry or grumpy when the patient screams at us.
We have to be firm but gentle towards them at the same time. Seeing them beyond their pain and complaints is the first step to earning their trust.
So how can we gain our patient’s trust? Here’s how
#1. Introduce yourself and address your patient by their name
The first thing you must do in building any relationship is to introduce yourself. An introduction is an obvious thing to do, especially in a healthcare setting where you care for different patients. Just like building a relationship, an introduction is the first step.
However, introducing yourself to your patient is sometimes forgotten in a busy healthcare unit or setting. But remember that you will be the patient’s first point of contact for their concerns, calls for help, or inquiries.
It is vital that they feel like they know you and are receiving personal care from you. We cannot always remember every patient’s name, so an initial introduction is crucial.
Introduce yourself and shake your patient’s hand. Tell them your name and who you are. Ask them what they prefer to be called and take note of this on their chart.
It will ensure a consistent level of care even when staff changes. It will also help the patient feel at ease, knowing they have someone to call if needed.
#2. Always dress professionally
You’ve probably heard the phrase, “First impressions always last.” This phrase is accurate, so how your patient sees you is essential. How you introduce yourself is one thing, but how you show up is another.
As nurses, we must dress appropriately. Wearing a nurse’s uniform is one way, as most people will think that a person wearing that uniform has the proper training and knows what they’re doing.
But make sure that your scrubs or uniform are clean and pressed. It will create the right impression. Avoid showing up in your patient’s room with blood-stained scrubs or drenched in puke or body fluids.
Your patients may not be comfortable with you and may not cooperate with you at all. Always keep your appearance as positive as possible.
#3. Listen to your patients.
Going in and out of your patient’s room is easy, especially when you’re taking their vital signs. You can mutter a few words while writing information on their charts but earning your patient’s trust is more than that. If you want to build trust:
Talk to them.
Make eye contact and actively listen.
Ask questions, and converse with them.
Pay attention to your body language, sit in front of them, and make it clear that they have your attention.
Sometimes, taking a break from your usual nurse routines and being present with the patient. Take time to hear them out and listen to them express themselves.
When a patient knows they’re being listened to will make them feel confident that their concerns are addressed. That makes them trust you as their nurse.
#4. Keep your word
It’s tempting to comfort a distressed patient by telling them that things will be okay. However, you must make sure that you act with integrity and honesty at all times.
Patients and their families appreciate honesty even though your honesty can sometimes be hard to accept. Avoid making false promises. Keep your word by following through with what you tell your patient. It is one of the best ways to earn their trust.
You don’t have to promise anything significant. Following through with simple acts can help your patient feel they can rely on you. If you say you’ll be back in an hour, then be back in an hour.
Again, keep your word. If you can’t guarantee this, tell them you’ll likely be called away to an emergency or other tasks. Again, don’t make any promises you can’t keep.
Our work demands are unpredictable, especially in a busy healthcare setting. If this happens, ask someone to speak with your patient, maybe another colleague familiar with your patient, and keep them updated on what is happening. These are a few ways to earn your patient’s trust.
Your honesty may not always be a comfortable place to be in, but your patients and their families will appreciate it.
Always keep your word, and do not promise anything you can’t do. When your patients trust you, building a relationship with them can help improve their recovery time, making administering treatment more manageable.
Therefore for your patients to trust you, you must also put in the effort and show them that you’re genuine with your intentions to help them.
Looking for more nursing and travel nursing information? Check out these helpful links!
EP 210: ER Nurse to Viral Content Creator With Stephanee Beggs
Can one become a viral content creator? The short answer is yes. Our profession gives us the freedom to become an inspiration to others. Whether it be through bedside nursing or content creators, we have the means to help others.
It is unsurprising to see many healthcare professionals rise to the ranks of online personalities as they help educate others about health and well-being. If you’re a nurse interested in making digital content, this episode is for you.
In this episode, we would like to introduce you to Stephanee Beggs. Stephanee is a content creator, Forbes 30 under 30, and Emergency Room nurse.
She unintentionally became viral on social media for her quick, concise educational tools that led to the creation of RNExplained, Inc.
The questions below are some we’d like to tackle. We often go off-topic, so we don’t expect to hit them all. If you have any ideas, please let us know.
Looking forward to our conversation!
These are the questions you had in Calendly. We’ll go off your questions, and wherever else our conversation goes.
Please give us a brief background about yourself and your nursing experience.
What made you decide to get into emergency nursing?
Let’s address the elephant in the room, do you have any beef with ICU nurses?
What is the day in the life like of an emergency nurse?
Has your life changed significantly being a social media influencer?
Did you get any backlash from your employer?
How did you create RNExplained? What inspired you?
You became the 30 under 30 on Forbes for the education category.
How do you juggle multiple roles as a nurse?
How do you prioritize self-care as a nurse?
Ending Questions
Before we end the show, we have one last question we like to ask all our guests. If you had the opportunity to have a Cup of coffee with anybody one last time, who would it be & why?
Connect and catch up with Stephanee through her socials at:
Want to become a viral content creator too? Watch the full episode here 👇👇👇
TIMESTAMPS:
00:00 Introduction 01:39 About Stephanee Beggs 05:08 What causes the conflict between ER and ICU nursing? 07:24 What does an ER nurse’s shift look like 11:19 Traumatic experiences as a nurse 16:03 The love of helping and nursing patient 18:05 How RNExplained started 18:47 What is it like to be an entrepreneur and a social media influencer? 19:46 Secrets on how Stephanee balances her life 21:29 Nurse Influencers are being misunderstood by hospital administration. 27:51 Tips on how to avoid trouble with what you post on social media 29:13 Setting Boundaries with Employers and Social Media Influence 30:47 How Stephanee grew RNExplained 33:11 Stephanee’s future business plans 34:30 The importance of self-care? 35:52 Wrapping up the show
Patient falls are one of the many incidents that could happen to patients in hospitals, and as much as nurses do their best to prevent this from happening, it cannot be avoided. It does happen. But can you avoid this incident?
And what are the usual or common causes of patient falls? Knowing these can help save your patient’s life and your license. It’s best to be prepared at all times.
In today’s episode, we will discuss our experiences when a patient fell. We’ll also discuss how it happened, how we felt, and what we had to do. In addition to that, we will also discuss what to do when a patient falls and the most common causes of it.
What to Do When a Patient Falls
Call for help and stay with the patient
Assess the patient for any injuries
Ask what happened and if they have any pain or hit their head
If the patient is unable to respond appropriately, assume they hit their head
Are there any visible injuries?
Notify MD, Charge, house supervisor
Take the patient to CT
Notify family if needed
Make the patient a forever high fall risk
Chart what happened
File an incident report
Reports on Patients Falling in Hospitals
Each year, somewhere between 700,000 and 1,000,000 people in the United States fall into the hospital. A fall may result in fractures, lacerations, or internal bleeding, increasing health care utilization.
Falls occur at a rate of 3–5 per 1000 bed-days
Resulting in around 250,000 injuries and up to 11,000 deaths
Approximately one in four falls result in injury, with about 10% resulting in serious injury.
Most Common Causes of Patient Falls
We looked at several websites to see the most common causes of falls. According to some law firms, the most common causes of falls are:
To avoid this situation, watch the full episode here 👇👇👇
TIMESTAMPS:
00:00 Introduction 03:02 Matt’s Patient Fall Experience 10:20 Peter’s Patient Fall Experience 16:46 Who is liable for patient falls 20:26 What to do when a Patient Falls 24:55 LAW FIRM: Most commons reasons why patients fall 28:44 Healthcare Joint Commission: Most commons reasons why patients fall 37:52 Wrapping up the show
The renal system produces, stores, and eliminates urine. Kidneys make urine by filtering wastes and extra water from the blood. Urine travels from the kidneys through two thin tubes called ureters and fills the bladder.
When the bladder is full of urine, a person urinates through the urethra to eliminate the waste.
Functions of the Kidneys
The kidneys are located on either side of the spine at the lowest level of the rib cage, consisting of the functional unit called a nephron.
There are about one million nephrons in each kidney; these nephrons consist of tiny blood vessels called glomerulus attached to a tubule.
When blood enters the glomerulus, it is filtered, and the remaining fluid passes to the tubule. In the tubule, minerals, elements, chemicals, and water are absorbed or filtered according to the body’s needs to create the final product, urine.
Our kidneys maintain a delicate balance of water and electrolytes in the body and remove excessive waste:
Remove wastes, urea, and ammonia, from the blood.
Maintain fluid status balance in the body by holding or retaining water and releasing and removing water from the bloodstream
It maintains the electrolyte balance of the blood.
Maintain acid-base/pH balance of the blood
Assist with endocrine functions such as the production of erythropoietin and calcitriol.
It is needed to produce red blood cells and calcium reabsorption, respectively.
Produce the enzyme renin
Help regulate blood pressure.
Convert vitamin D into its active form
Fun Fact:
Every 24 hours, your kidney filters 200 quarts of fluid. About two quarts are removed from the body, and 198 quarts are returned to the bloodstream.
The right kidney sits lower than the left kidney.
It helps accommodate the large size of the liver, right above the right kidney.
We call it REabsorption rather the just absorption because the substances filtered from the glomerulus were already absorbed through the GI tract and taken into the bloodstream.
Then the substances travel through the body via the heart and are sent to the kidneys through the renal artery to be filtered out. Therefore, our body reabsorbs these nutrients based on their needs, and the leftovers are excreted in the urine.
Anatomy of the Kidney
As a nurse and a nursing student, you’ll need to know these most critical parts of the kidney to understand how the renal system works.
Renal Capsule
The outer layer of the kidney protects the kidney from outside organ infections.
Renal cortex:
A layer outside contains the renal corpuscles, which house the glomerulus and Bowman’s capsule, whose primary functions are to FILTER the urine and renal tubules.
Renal medulla:
The inside layer is located within the renal pyramids. It is hypertonic and very salty. Along with the nephron, these conditions help maintain water and salt balance in our body, specifically the Loop of Henle.
Renal artery:
The renal artery takes oxygenated blood from the heart and moves it to the kidney to be filtered. It branches off around the renal columns into the renal cortex, into arterioles, and finally to the peritubular capillaries.
Renal vein:
The renal veins take filtered blood to heart for re-oxygenation and are pumped throughout the body. It comes from the efferent arterioles.
Renal pyramids:
Lie Within the renal medulla contains the loop of Henle and parts of the collecting tubule.
Renal papilla, minor and significant calyx:
Pointed projections of the renal pyramid play a role in draining urine along with the renal pelvis, ureters, bladder, and urethra.
Nephrons:
The functional part of the kidneys.
Filters the blood via the renal corpuscle
Reabsorbs minerals/water and secretes waste via the renal tubule
Produces urine which drains down into the ureters, is stored in the bladder, and voided out via the urethra.
Each nephron is composed of
Renal corpuscle (glomerulus within Bowman’s capsule)
Proximal tubule
An intermediate tubule (loop of Henle)
A distal convoluted tubule, a connecting tubule, and cortical, outer medullary, and inner medullary collecting ducts.
Glomerulus:
Lies within the nephron
Circular capillaries that have incredibly high pressure helps perform ULTRAFILTRATION.
Bowman’s capsule
Forms a cup-like sack around the glomerulus
It helps the glomerulus filter blood
The Nephron and blood supply
Blood enters the afferent arteriole and sends blood to the first part of the nephron, called the glomerulus.
In the glomerulus, blood will be filtered, and filtrate will be created, a liquid consisting of the collection of fluid and particles from the blood.
The filtrate will “drip” down into a capsule surrounding the glomerulus called Bowman’s capsule.
Bowman’s capsule collects the filtrate.
Water, NA, CL, CA, K, Mg, Phos, Bicarb, amino acids, glucose, creatinine, and urea.
Then the filtered blood exits via the efferent arterioles to the peritubular capillaries surrounding the nephrons.
Peritubular capillaries carry the reabsorbed nutrients from the filtrate back into the body’s system to the renal vein. They secrete urea, ions, and drugs in the blood into the tubules.
The created filtrate then flows through the proximal convoluted tubule (PCT); here, the tubule reabsorbs most of the parts of the filtrate that we need to function that just came from the Bowman’s capsule.
Then the filtrate enters the Loop of Henle; we are now in the renal medulla. The loop of Henle has a descending limb and ascending limb. Its goal is to concentrate the urine via the renal medulla.
The renal medulla’s interstitial fluid is hypertonic, helping reabsorb water from the filtrate to maintain the body’s water and salt balance.
Descending limb is only permeable to water.
Ascending limb is only permeable to ions.
The filtrate then enters the distal convoluted tubule, where more substances are reabsorbed and secreted.
Then it travels to the collecting tubule, where parts of the filtrate are reabsorbed.
Finally, the filtrate leaves the collecting tubule as urine which flow through the renal papilla, minor/major calyx, renal pelvis, ureters, bladder, and urethra.
Kidney and Blood Pressure Management
The renin-angiotensin-aldosterone system (RAAS) is the system of hormones, proteins, enzymes, and reactions that regulate your blood pressure and blood volume long-term.
It regulates your blood pressure by increasing sodium (salt) reabsorption, water reabsorption (retention), and vascular tone (the degree to which your blood vessels constrict or narrow). The RAAS consists of three major substances including:
Renin (an enzyme).
Angiotensin II (a hormone).
Aldosterone (a hormone).
RAAS System
Increases blood pressure when it drops too low by activating Angiotensin II
Angiotensin II increases vasoconstriction, causing an increase in blood pressure. Conserves sodium and water to increase volume. Aldosterone and ADH are released.
The sympathetic nervous system sends nerve impulses to Juxtaglomerular Cells in the kidneys to release RENIN.
RENIN present in the blood will activate ANGIOTENSINOGEN in the liver.
ANGIOTENSINOGEN then turns into ANGIOTENSIN I causing a release of ACE
ACE is Angiotensin-Converting Enzyme. ACE converts Angiotensin I into ANGIOTENSIN II
ANGIOTENSIN II activation will cause
Vasoconstriction
Increases systemic vascular resistance (SVR) and blood pressure.
Increase Blood Volume
Kidneys will keep water and sodium.
The adrenal cortex gland will be triggered by angiotensin II to release aldosterone. Aldosterone will also cause the kidneys to keep sodium and water and excrete potassium.
Angiotensin II triggers the pituitary gland to release ADH. It causes the kidneys to keep water.
2. Increased blood pressure
To learn more about the renal system, click here for the full episode 👇👇👇
TIMESTAMPS:
00:00 Introduction 02:10 The functional parts of the kidney 03:18 What does a kidney do 04:40 Kidney fun facts 05:40 Anatomy of the kidney 10:00 The nephron and blood supply 15:48 Kidney and blood pressure management 17:39 How the Renin-Angiotensin-Aldosterone System (RAAS) works 21:50 Further views on the episode 24:02 Wrapping up the show
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