Author Archives: Rita Asamoah Osei

Reflection

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In my placement area, patients were on many types of medications and medications were mainly administered through PEG. I have had the experience of administrating through PEG at previous placement areas but my experience of PEG administration in this ward was in-depth. I understand that PEG administration is not just a skill, but a holistic process requiring empathy and precision. Reflecting on the procedure, one must consider the patients’ comfort, communicate effectively and maintain effective hygienic control methods. I will continue to read more on PEG management to gain understanding of potential risks or complications associated with the procedure.

Most of the patients had tracheostomy in place due to swallowing issues and not necessarily because they could not breathe. Patients with swallowing issues can easily aspirate which makes it crucial for the need of a tracheaostomy. For tracheaostomy patients, AIRVO 2 was used to improve comfort, optimise airway hydration and reduce secretion. AIRVO 2 is a humidification system mainly used in respiratory care, providing high-flow therapy to patients. Patients normally experience discomfort due to dry air passing through the tracheostomy tube so the AIRVO 2 delivers humidified air, reducing irritation and improving comfort. Humidification provided by AIRVO 2 helps thin and mobilises secretion, making it easier to clear.

I have gained knowledge about the C-reactive protein test (CRP). I understand the test is conducted to measure the level of CRP, a protein produced by the liver in response to inflammation. High levels of CRP may indicate inflammation in the body, however the test does not pinpoint the source of the inflammation. CRP levels rise in response to inflammation and helps identify underlying issues. The test helps track the progress of inflammatory conditions like infections, autoimmune diseases and chronic inflammatory disorders. CRP test guides treatment by aiding in monitoring the effectiveness of treatment for inflammatory conditions.

I understand that undertaking swab tests of your patient before surgery is crucial for infection prevention. Nasal, groin and wound cultures help identify potential infections that could pose risks during or after surgery. Addressing these infections beforehand reduces the chance of complications.

Most of the patients in my ward were non-verbal so could hardly express their feelings. For this reason, identifying bruises on patients was considered a safeguarding issue which needed to be investigated. Investigating bruises included identifying if the patient inflicted themselves with the bruise, if the bruise was caused by staff member or if bruise was caused by an accident. Investigating bruises on non-verbal patients is crucial as it may indicate potential abuse, neglect, or underlying health issues. Identifying the cause helps ensure patients safety, provides necessary medical care, and allows appropriate intervention or reporting if abuse is suspected. This is essential for the well-being and protection of vulnerable individuals who may not be able to communicate their experiences verbally. Bruises identified must be monitored for 14 days. Pictures must be taken and there must be proper documentation detailing how well bruise is healing.

Skills

 

I have gained skills in changing Percutaneous endoscopic gastrostomy (PEG). It is important to get the right catheter size for the patient and undertaking a pH testing. I am able to aspirate a small sample of the stomach content through the catheter for the pH during PEG change to verify proper placement in the stomach. I use the pH strips and pH is usually acidic around 2- 5.0 due to the acidic content (gastric juice) of the stomach. If pH is within range, it suggests correct placement. If the pH is alkaline or inconsistent with gastric pH, it may indicate incorrect placement. Proper placement is essential to ensure catheter functions as intended and to prevent complications. I have acquired skills in changing water in the PEG balloon which is part of the weekly maintenance recommendations for patients in the ward. This helps ensures balloon remains inflated properly , which is crucial for keeping the PEG tube securely in place. Regular maintenance helps prevent complications and ensures tube functions effectively. I will further like to gain skills in nutritional management for Patients on PEG feeding where I am able to document nutritional assessments, feeding regimes, tube patency check and adjustments to feeding schedule to optimise patients nutrition and hydration.

Brain injury patients may experience urinary retention or bladder dysfunction due to neurological deficit or immobility. Undertaking bladder scan on them helps assess the volume of urine in the bladder non-evasively, aiding in the determining the need for interventions like catheterisation. I have gained skills in the use of the bladder scanner machine. During the procedure, I perform all my infection control measures like wearing my PPE and performing my hand hygiene to minimise the spread of infection. I lay the patient comfortably on their back and apply a small amount of gel to the skin to ensure good contact between the scanner and the body. I then position the scanner to the lower abdomen, specifically the pubic bone to get a clearer view of the bladder. The scanner emits high frequency sound waves into the body which bounce off the bladder and surrounding tissues. The scanner then detects the returning echoes and uses them to create an image of the bladder on the monitor. The bladder scan machine analyses the image and calculates the volume of urine in the bladder based on the shape and size of the bladder on the monitor. The scan results determines if the bladder is adequately empty or if there is retention of urine. This helps guide further intervention or management like the need for catheterisation or fluid intake adjustment or medication.

Attitudes and values

 

I understand the emotional impact of PEG administration to patients and their care givers. Patients undergoing PEG administration may go through physical discomfort, emotional distress, or frustration. I always remain patient and understanding towards their needs and show compassion which tends to alleviate their anxiety and foster trust. I keep myself updated about PEG care protocols to boost my confidence with the procedure and stay attuned to patients needs to provide compassionate and effective healthcare. I have demonstrated professionalism and competence in performing PEG administration procedures and have always provided safe, effective and compassionate care. I have demonstrated competence and attentiveness through my provision of care which has fostered trust and instilled confidence in my patients. It has become essential for me to always maintain my patients privacy and dignity by respecting their personal space, ensuring confidentiality, and preserving their autonomy. During procedures or discussions, I close curtains or doors. I only share patients relevant information with health professional involved in their care. Communication is crucial when providing patient care. I explain procedures thoroughly to patients and obtain informed consent before proceeding. I validate patients feelings and concerns, and offer support as needed.

Feedback

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Rita has gained knowledge in many areas including tracheostomy and PEG care and management. Rita is very pro-active and keen to learn and has gained more knowledge on different procedures performed in the ward. She has gained knowledge of different medication types administered to patients, including their side effects and contraindications. Rita involves herself in all aspect of patient care and uses the opportunity to practice on her skills.

Rita has had the opportunity to practice in tracheostomy and PEG management and care. She has had the opportunity to perform tracheostomy suctioning and care under supervision. She has gained confidence in the the preparation and administration of medication through the PEG tube. Rita has improved on her communication skills with patients considering the fact that most of the patients are non-verbal.

Rita has a good attitude towards work. She works in a professional way by respecting the rights and dignity of patients. She works well with members of the team and makes use of every opportunity presented to her. Rita always makes her self available and always offers to help. She provides safe, effective and compassionate care for patients.