Digest

This episode of the Straight A Nursing Podcast focuses on assessing skin signs in individuals with darker skin tones or yellow toned skin. The host, Nersmo, emphasizes the importance of learning how to assess for jaundice and pallor in these individuals, as traditional methods taught in nursing school often focus on white skin. The episode uses a case study of a patient, Mr. Abrams, who presents to the ED with shortness of breath, weakness, dizziness, and dark tarry stools. Through a detailed analysis of Mr. Abrams' vital signs, labs, and physical assessment, the host highlights the challenges and nuances of assessing skin signs in individuals with darker skin tones. The episode concludes with Mr. Abrams being intubated and transported to the ICU for close monitoring, demonstrating the importance of recognizing and responding to changes in a patient's condition.

Outlines

00:00:00

Introduction

This Chapter introduces the Emotional Badass Podcast, hosted by Nikki Eisenhower, a psychotherapist and life coach. The podcast aims to empower listeners with emotional education and provide mental health tips and tricks for building emotional resilience, practicing mindfulness, and cultivating gratitude. It encourages listeners to join every week for new episodes to achieve a more grounded state of well-being.

00:00:42

Straight A Nursing Podcast Introduction

This Chapter introduces the Straight A Nursing Podcast, hosted by Nersmo, a nurse who teaches concepts and shares tips on how to thrive in nursing school. The podcast is designed for both nursing students and practicing nurses, as it emphasizes the importance of lifelong learning in the field. The host expresses excitement about the episode and thanks a listener for their positive feedback.

00:01:06

Listener Shoutout

This Chapter features a listener shoutout from Jaren, who shares how the Straight A Nursing Podcast has helped them prepare for the NCLEX exam. Jaren praises the host's engaging and knowledgeable approach, highlighting the podcast's relevance and helpfulness in reviewing forgotten information.

00:01:49

Assessing Skin Signs in Individuals with Darker Skin Tones

This Chapter delves into the topic of assessing skin signs in individuals with darker skin tones. The host emphasizes the lack of education on this topic in nursing school and the need for greater equity and inclusion in healthcare. The episode uses a case study of a patient, Mr. Abrams, who presents to the ED with altered skin signs and a history of non-alcoholic liver cirrhosis.

00:03:44

Mr. Abrams' Case Study

This Chapter presents the case study of Mr. Abrams, a 63-year-old black male with a history of non-alcoholic liver cirrhosis, esophageal varices, and other medical conditions. The host guides listeners through the assessment process, analyzing Mr. Abrams' vital signs, labs, and physical assessment findings. The episode focuses on identifying potential concerns and discussing the significance of each finding.

00:21:32

Mr. Abrams' Home Medications

This Chapter focuses on Mr. Abrams' home medications, which his wife brings to the ED. The host reviews each medication, discussing its purpose and potential implications for Mr. Abrams' current condition. The episode highlights the importance of understanding a patient's medication history and identifying potential drug interactions or contraindications.

00:29:25

Mr. Abrams' Physical Assessment

This Chapter details Mr. Abrams' physical assessment findings, including his lethargy, disorientation, weak and fast pulse, tachypnea, and abdominal distention. The host explains the potential causes of these findings and emphasizes the importance of recognizing subtle signs of hypoxia and circulatory compromise in individuals with darker skin tones.

00:38:54

Mr. Abrams' Hemorrhage

This Chapter describes Mr. Abrams' sudden deterioration, as he begins vomiting bright red blood. The host discusses the significance of this finding, highlighting the need for immediate intervention. The episode details the medical team's response, including the administration of blood transfusions, insertion of a central line, and intubation.

00:46:53

Gastroenterologist Consultation and Interventions

This Chapter focuses on the gastroenterologist's consultation and interventions for Mr. Abrams' GI bleed. The host explains the purpose of medications like pantoprazole and octreotide, as well as the use of a Blakemore tube for temporary hemorrhage control. The episode also discusses the importance of an EGD (esophagogastroduodenoscopy) for definitive treatment.

Keywords

Q&A

• What are some key considerations when assessing skin signs in individuals with darker skin tones?

  Traditional methods of assessing skin signs, such as checking for blanching erythema, may not be reliable in individuals with darker skin tones. It is important to look for variations in skin color, temperature, texture, and firmness, as well as any signs of edema or pain. Additionally, assessing for jaundice in darker skin tones may require looking at the sclera of the eye and the hard palate, while pallor may be observed as an ashen or grayish tint in the mucous membranes.

• What are some common causes of GI bleeding in individuals with liver cirrhosis?

  Individuals with liver cirrhosis are at increased risk for GI bleeding due to the development of esophageal varices, which are enlarged veins in the esophagus that are prone to rupture. Additionally, medications like NSAIDs (non-steroidal anti-inflammatory drugs) can contribute to GI bleeding in these individuals.

• What are the key interventions for managing a GI bleed in a patient with liver cirrhosis?

  Immediate interventions for managing a GI bleed include stopping the bleeding, restoring blood volume, and preventing further complications. This may involve administering blood transfusions, inserting a central line for rapid fluid administration, and intubating the patient for airway protection. Medications like pantoprazole and octreotide may be used to reduce gastric acid secretion and inhibit vasodilatory hormones, respectively. In some cases, a Blakemore tube may be placed to temporarily control bleeding from esophageal varices.

• Why is it important to understand a patient's medication history when assessing their condition?

  Understanding a patient's medication history is crucial for identifying potential drug interactions, contraindications, and adverse effects. In the case of Mr. Abrams, the host highlights the importance of recognizing that naproxen, an NSAID, is contraindicated in individuals with liver cirrhosis due to its association with GI bleeding.

• What are some key considerations when assessing a patient's vital signs?

  When assessing a patient's vital signs, it is important to consider their baseline values and any potential factors that may be influencing their current readings. For example, a blood pressure of 92/63 may be considered mildly hypotensive in an individual with a normal blood pressure range, but it may be significantly low in an individual with a history of hypertension. Additionally, it is important to monitor vital signs closely for any changes that may indicate a deterioration in the patient's condition.

• What are some common complications associated with liver cirrhosis?

  Liver cirrhosis can lead to a range of complications, including jaundice, ascites (fluid accumulation in the abdomen), portal hypertension, esophageal varices, and impaired renal function. These complications can significantly impact a patient's health and quality of life.

• What are some key nursing interventions for managing a patient with liver cirrhosis?

  Nursing interventions for managing a patient with liver cirrhosis include monitoring vital signs, assessing for signs of complications, providing education about the disease and its management, and promoting patient comfort and well-being. Nurses play a vital role in educating patients about the importance of avoiding alcohol and other substances that can damage the liver, as well as adhering to prescribed medications and dietary restrictions.

• What are some key considerations when assessing for pressure injuries in individuals with darker skin tones?

  Assessing for pressure injuries in individuals with darker skin tones can be challenging because traditional methods, such as checking for non-blanching erythema, may not be reliable. It is important to look for variations in skin color, temperature, texture, and firmness, as well as any signs of edema or pain. Additionally, nurses should be aware that pressure injuries may not be visible in individuals with darker skin tones, so it is important to perform thorough skin assessments and document any findings.

• What are some key takeaways from this episode of the Straight A Nursing Podcast?

  This episode highlights the importance of recognizing and responding to changes in a patient's condition, particularly in individuals with darker skin tones. It emphasizes the need for greater equity and inclusion in healthcare education, as traditional methods of assessing skin signs may not be applicable to all patients. The episode also demonstrates the importance of understanding a patient's medication history, as well as the role of nurses in providing education and support to patients with chronic conditions like liver cirrhosis.

Show Notes