Clinical update: 3rd clinical day.
This day was pretty good too. There even earlier, prepared, checked on the patient in their room, check on the am labs (none), and then sat down in pre conference. I reported off my patient and then left pre conference to start the day
This week was supposed to be my week to do the head to toe assessment with the teacher. Unfortunately, this did not happen. My classmate I was supposed to do it with was not in clinical this week and another classmate moved into her spot. The instructor wanted to delay until noon so she could get everyone’s meds passed with them. When I spoke with the teacher she said that she had already done it with her and another girl. So essentially someone else took my place probably because they were on the same floor (she’s on 9 and I’m on 10). So I passed my meds with her (all PO) , well actually I reviewed all the medications with her at the computer, told her what they were for and why my patient was taking them and then she left me to give the meds myself. Which is fine, it was just a bunch of pills.
For post conference I presented Beta blocker and how there were Non specific (effecting Beta1 and Beta2 receptors) and how there were Specific or relatively specific Beta1 blocker. And why it was important to know this if your patient has any kind of reactive airway disease or chronic obstructive disease.
“Beta-blockers are drugs that bind to beta-adrenoceptors and thereby block the binding of norepinephrine and epinephrine to these receptors. This inhibits normal sympathetic effects that act through these receptors. Therefore, beta-blockers are sympatholytic drugs. Some beta-blockers, when they bind to the beta-adrenoceptor, partially activate the receptor while preventing norepinephrine from binding to the receptor. These partial agonists therefore provide some “background” of sympathetic activity while preventing normal and enhanced sympathetic activity. These particular beta-blockers (partial agonists) are said to possess intrinsic sympathomimetic activity (ISA). Some beta-blockers also possess what is referred to as membrane stabilizing activity (MSA). This effect is similar to the membrane stabilizing activity of sodium-channels blockers that represent Class I antiarrhythmics.
The first generation of beta-blockers were non-selective, meaning that they blocked both beta-1 (β1) and beta-1 (β2) adrenoceptors. Second generation beta-blockers are more cardioselective in that they are relatively selective for β1 adrenoceptors. Note that this relative selectivity can be lost at higher drug doses”
My source of information was: (and for further reading and a list of relatively specific and non specific Beta Blockers)
http://www.cvpharmacology.com/cardioinhibitory/beta-blockers.htm
My patient this day had an ileostomy. This is my first experience with an ileostomy and what I can say about that is that output from an ileostomy smells horrible. It was necessary for me to keep track of and measure this output for the Input and output totals for the day.
An ileostomy is a diversion of the ileum to a stoma on the outside of the body. Semisolid waste flows out of the stoma and collects in an ostomy pouch, which must be emptied several times a day. An ileostomy bypasses the colon, rectum, and anus and has the fewest complications. An ileostomy can be placed in different sites on the abdomen. An incision is made and the ileum is pulled though the incision. A rod is placed under the loop and the loop is cut open and one side is stitched to the abdomen. This portion of the intestine is flipped open to expose the inferior surface and the opposite side is stitched into place.
We got out of post conference a half hour early because we had an exam this week on Friday.
