Muchas Fotos…

Here are some photos from the last few days… including but not limited to: pyramid trip, clinical brigade, corn festival, learning to suture on pig’s feet, city trip, etc. etc. etc.

 

 

Mexico City Update

Greetings from Mexico City! My apologies that we haven’t been able to update you sooner, our schedules have been jam packed with various adventures.  Adventures which included a trip to the pyramids, a corn festival, a coffee house, a southern gospel version of “This Little Light of Mine,” stained glass window depicting Spanish Conquistadores wearing Nike and Converse tennis shoes and the list goes on!

The last brigade was held yesterday which was probably a good thing as we ran out of vitamins to distribute to those who came.  I believe the last update was written right after the first brigade. I’ll attempt to fill you in starting from that point.  Our second brigade was held at a new location, the base of a rock quarry in an area called “Aldea.”  Aldea is a very poor area and is apparently notoriously difficult to evangelize (as we were told by our hosts).  Worship death and the dead is also prevalent in this area. Overall the day went well, we saw somewhere around 70 patients and had the opportunity to encourage and be encouraged by our host church. 

Wednesday was set aside as a “play day.”  We visited the ancient Aztec pyramids at Teotihuacan. It was an amazing experience to be able to have team devotions atop the Pyramid of the Sun.  As we walked through the ruins of the great Aztec City we were reminded of Isaiah 40.  Verse 8 says, “The grass withers, the flower fades, but the Word of our God stands forever.” 

Thursday and Friday were spent doing more brigades but this time at Ezekiel and Eva’s church (our housing hosts) here in Chalco.  All went well with the clinics and many people were served.  Our patients ranged from newborns to the elderly presenting with a wide range of problems from heartburn to the more complex problems including diabetes and glaucoma. 

This morning at church three of us were able to share testimonies.  Zanna spoke about dreams that God lays on our hearts, Alex spoke about God’s purpose in our lives and I spoke about the vulnerability and about how God wants us to know Him and to be known to Him.  I don’t think any of us knew what the other was going to talk about but as it turns out they all fit together perfectly, especially with the message that Carlos (our host) had prepared for the service.  Carlos spoke about God’s call for all of us to share our hope with others whether in our own neighborhood or other countries.  Some are called to be missionaries near and some are called to faraway lands.  The church here is just beginning to send out missionaries to other people groups.  They have access and unique connections that could make them effective in this work beyond what many Americans have.  It was amazing to be able to encourage them in that.  After the message we able to pray for all the young people and encourage them to live out God’s purpose in their lives.  What an amazing day! 

Tomorrow we begin our work with the Red Cross. The students are excited but a bit nervous.  It’s the start of the second leg of our journey full of potential for exciting new adventures.  We will keep you updated as time and internet access allows.

 

Mexico City Update

We’re here!   We arrived in Mexico City on Sunday morning after a rather uneventful flight.  Customs was an adventure as Janell and Sarah were both stopped and our mountains of medical supplies were searched through.  In the end all we lost was a few boxes of syringes but hundrends more made it though! 

After the customs fiasco, our wonderful hosts Carlos and Carrie, were waiting for us on the other side and we were able to have first meal in Mexico at lovely little café on the way to the church.  We are staying with Carlos’ aunt and uncle, Eva and Ezekiel.  They pastor a small church in the outlying area of Chalco.  What wonderful gracious hosts they are! 

Yesterday we began work at or first brigade.  Between Mr. Peck and Dr. Luna we got through about 60 patients, most of them children.  Janell did a lot of the translating for her dad while working at his clinic station.  Julie and Sarah did a lot of vital signs and triage and also worked with Dr. Luna.  Alex and Zanna were “flexico in Mexico” and helped out with an unmet need by cutting hair for school children as the school year here in Mexico begins next week. 

After the clinic experience we headed to a pharmacy to pick up some medications that wished we would have had at the clinic during the day.  While at the pharmacy, 5 more children showed up needing medical certificates for school.  (apparently they do this at the pharmacy?)  The pharmacist, a friend of Carlos and Carrie’s, “invited” us to help him out with the assessments.  So… There we were assessing school children on the side of the street outside the pharmacy window, why not!

While assessing the children at the pharmacy, Carlos got a call from his uncle who hosts a Christian radio show.  He was inviting us to be on his show!  I wasn’t quite sure how the girls would feel about this but I thought it would be a great opportunity so I said yes; after all, Mexico is flexico.  What a hoot, we were on the Mexican equivalent of Focus on the Family being interviewed about missions!

Thank you to all of you who are praying for us at home. God’s hand of protection as truly been upon us and we are so blessed to be a small part of what He is doing here in Mexico. 

 

Enfermeras y Mexico City

Day 3 in Mexico City.

Looking back on some of my personal journal entries this week I read things like, ¨God give me passions that make my heart beat fast” and “Be the change you wish to see in the world”…. this is so what Ivé been waiting for.

Being my 4th time in Mexico, my 1st in Mexico City we have hit the pavement running. Beginning with the local clinic, and ending with time in the Red Cross Trauma I am once again aware of the purpose God has placed nursing in my life. In situations like these you feel a whirlwind of emotions. We have met some incredibly wonderful and hospitable people and are practicing our Spanish every day.

Some of my more recent experiences include; giving haircuts (my first ever), listening to a woman´s stomach only to find out she was carrying twins, being asked to speak on spanish radio, and sorting out millions of tiny pills into individual sized packages. The care we are providing seems so basic and mostly having to do with nutritional complications, and it reminds me how passionate God has made me for human rights.

Everyone should have the right to be healthy. To have a toothbrush and clean water and antibiotics when sick. I realize this problem is not just in Mexico but really a worldwide topic and pursuit. For me, I feel the beginning of a lifelong journey We will be trying to post photos and information during the next week or so. You can email me at Alexandra.McInerny06@northwestu.edu if you´d like. I Love you all terribly

” 1 thessalonians 5:14-19 and we urge you, brothers, warn those who are idle, encourage the timid, help the weak, be patient with everyone. Make sure that nobody pays back wrong for wrong but always try to be kind to each other and to everyone else. Be joyful always, pray continually, give thanks in all circumstances for this is God´s will for you in Christ Jesus.”

 

Please keep us updated on your experiences in Mexico! God bless! Sarah’s Mom

 

Soft Tissue Case Study: Alex

• Suggest emergent interventions that would have been conducted in the field to stabilize JB

*One of the first things to do in this situation would be to immediately intubate the patient in case of swelling.

*Keep warm and comfortable

*Stabilize with pain medications

*Insert Foley Catheter

*Give 1-2 central lines to provide Lactated Ringers for an extensive amount of fluids to pt . during the first 12-15 hours. (you may use the formula for pt. weight to determine the amount needed)

*Labs are important to obtain to see things such as white blood cell counts, and electrolyte levels (hypovolemia, and/or hypervolemia).

•  Estimate the percentage of burn using ‘The rule of Nines’:

*88%

• Generally, what challenges to fluid resuscitation would be present in a patient with extensive burns and large surface area (due to muscle development, large stature or obesity)

*The possibility of burn shock is very present in patients who have extensive burns. It is important to provide enough fluids in the time frame given. Using larger bore needles and central lines can help get more fluid to the body.

•  What complications might be expected in this patient? 

*There is a risk for infection due to open and seeping burn injuries.

*Rejection of skin grafts

*Inability to communicate

*System Failure

*Compartment syndrome is a large possibility due to the significant percentage of the body burned in this case. 

*Significant pain and discomfort is also very commonly associated with burn victims.

• As a nurse caring for this Soft Tissue Trauma burn patient, what would be some of the challenges in caring for the ‘whole person’ (including the family) in a situation like this? 

*Since this particular patient cannot talk, it would be very important to see what both the family suggests, and come up with some way to communicate needs with the patient himself. Many times the emotional scars of burns need extra sensitivity and consideration from the nurses point of view. I feel it would be very challenging to know how to provide the right balance in the amount of sympathy and/or encouragement to this patient. Giving hope and inspiration without avoiding the grief and difficulty in the healing process. A patient will eventually be curious of the damage and extent of injuries, so it would be crucial to prepare the environment and conditions by which to do so. Even though family members are genuinely concerned, it is always the patients right to know his own care. As his nurse you should never withhold information regarding his health. I feel as though therapeutic and thorough communication could actually help a patient deal with grief and loss of his/her body or image.  Focusing on the patients sense of self and treating them as a whole person is really important with traumatic physical changes.

 

Musculoskeletal Case Study: Alex

Question #1

• Provide blankets and comfort measures to keep pt. warm
• Spinal immobilization and proper splinting
• Administer pain medication PRN
• Give oxygen via mask (NRB)

Question #2: Priorities and Measures to take

• Continue emergency care for this patient. Continue application and assessment of above interventions. Take labs and assess specifically Hct. and Hgb.
• Provide airway management with continued supplemental O2 therapy and possible ventilation preparation if needed. 
• Assess patient comfort and use non-pharmacologic techniques if needed. Provide pain medication PRN when needed. Check on family and answer any questions raised.
• Ask witnesses one at a time questions relevant to the patients care. Questions may include; does that patient have any known allergies? How was he hit? Was he in a car at the time of accident? Are there any previous injuries we should know about? Significant medical history?   Was the patient driving the car?  Was he wearing a seat belt?  Was he thrown from the car? What does the windshield look like? Were there others in the car? How fast was the bus going? How long ago was the accident? 

Question #3

• Decrease in anxiety after being stabilized
• Possible internal bleeding can decrease blood pressure 
• Increased O2 saturation, can then decrease O2 demand

Question #4

 Injuries which may be present in this case study:

• Flail chest
• Several broken bones/ribs
• Abrasions/contusions to chest
• Possible internal bleeding

Interventions which can be used:

• X-ray to find exact injuries before continuing
• immobilize fractures to prevent further injury
• Continue with pharmacologic interventions
• Give Supplemental O2
• Assess for internal bleeding/further damage

Question #5

• After reviewing the patients x ray, notice possible broken ribs 2-5 on the left side along with the clavicle. 
• Hard to see past rib 6 but may also have slight displaced fractures as well.

 

Last reading thoughts Alex: week 11-12

Chapter 21: Adaptations

“There is a place for intercessory pain, in the Body of Christ”- Although at the beginning of this chapter I was unsure of my thoughts of animal research, I found it interesting how Brand was able to describe the adaptation of our pain in our bodies.  I am very glad he raised the topic of the church and its hurting. I would describe “real love” as a love that like Jesus, is patient, forgiving, and kind. He describes that similar to the “Head”, we must constantly evaluate cells that need special attention or perhaps even redeployment.” This could be talking about redirection of those in the church, or specific individuals hurting amongst one another. I think this chapter was a great precursor to the next two chapters finishing up his discussion on pain. How we handle pain amongst ourselves and in context of others greatly shows where we stand with the “head”.

Chapter 22: Chronic Pain

Chronic pain is something that we see so commonly in the hospital and in life. I think about how most of us know someone in our life suffering from pain. I think that learning about “pain management” is one of the most important areas of the church. Many times people are turned away from the church by the response to pain. The body is the perfect example of how to deal with cells or people “in pain”. “The poor you will always have with you” Mark 14:7 reminds me that we will always have people who hurt, and those who need healing. By taking care of ourselves before taking care of others is something nurses have considered many times. To not be worn down or discouraged by the world’s hurts. At times I find the world’s problems to be overwhelming. What sort of difference can I make? How will this ever resolve itself? I think it important to know that many small changes ( like in the body) can make for a general improvement in the well being of those in contact. Mexico city is a way for us to be sensitive to the body, to reach out and touch others in a practical way.

Chapter 23: Pain of God

I had a bit of a hard time towards the close of this book. I understand where Brand was going with the topic and how utterly impossible it would be to address all of “pains” issues in one book. This last chapter is for those who wonder “where is God in suffering?” He suggests that because of the Trinity, Jesus’s death on the cross was a way to relate to human suffering and pain. Those who think God cannot relate to our pain, forget the way he died on the cross. God can understand grief, loss, and pain. This was put to light for me when I saw 2 Cor. 4:10 “We always carry around in our body the death of Jesus, so that the life of Jesus may also be revealed in our body.” This is the only way I can endure I hard time or stay joyful in times of trial. Like Brand suggests, in the hands of God is where we are safe. Hands are my favorite part of people. I remember looking at my moms hands, and my dads. My dad’s permanently cracked and dirty from hard labor, I can see the hours of work and dedication he has put into what he does. I like to think of the Lord guiding us and directing us with sturdy hands. I am thankful for his direction in my life.

 

ProM’s Week 12 Musings

As I mentioned in a previous post, I once did a study on the word “compassion” while in nursing school.  In a previous chapter, Brand noted that ‘compassion’ breaks down into two words which have the meaning “share” and “pain.” I think of all the scriptures in the Bible that include the word compassion. 

These are only a few:

Psalm 103:13 (New International Version)  ¹³ As a father has compassion on his children,
       so the LORD has compassion on those who fear him.

Psalm 145:7-9 (New International Version) ⁷ They will celebrate your abundant goodness
       and joyfully sing of your righteousness. ⁸ The LORD is gracious and compassionate,
       slow to anger and rich in love. ⁹ The LORD is good to all;
       he has compassion on all he has made.

Matthew 20:34 (New International Version) ³⁴Jesus had compassion on them and touched their eyes. Immediately they received their sight and followed him.

 Each time I see the word compassion in relationship to God, I see an example of how God relates to us by sharing in our pain.  Take a look at these verses:

Hebrews 4:14-16 (New International Version)   ¹⁴Therefore, since we have a great high priest who has gone through the heavens,^[a] Jesus the Son of God, let us hold firmly to the faith we profess. ¹⁵For we do not have a high priest who is unable to sympathize with our weaknesses, but we have one who has been tempted in every way, just as we are—yet was without sin. ¹⁶Let us then approach the throne of grace with confidence, so that we may receive mercy and find grace to help us in our time of need.

Isaiah 49:15-17 (New International Version) 

¹⁵ “Can a mother forget the baby at her breast
       and have no compassion on the child she has borne?
       Though she may forget,
       I will not forget you! 

¹⁶ See, I have engraved you on the palms of my hands;
       your walls are ever before me.

What a wonderful Savior is Jesus my Lord! We have no better example of compassion.  I pray that we will be His Compassionate hands extended…

^{Collosians 3: 12-13 12}Therefore, as God’s chosen people, holy and dearly loved, clothe yourselves with compassion, kindness, humility, gentleness and patience. ¹³Bear with each other and forgive whatever grievances you may have against one another. Forgive as the Lord forgave you. ¹⁴And over all these virtues put on love, which binds them all together in perfect unity.

 

Janell’s MSK Case Study

Question #1

• Administer O2 via mask
• Assure that equipment is available to maintain patent airway if it should deteriorate
• Administer pain medication
• Keep patient warm

Question #2

Interventions:

• Continue application and assessment of above interventions
• Airway management with continued supplemental O2 therapy and possible ventilation preparation

Needs of the family

• Assure them that everything is being done to care for patient and that pain medications are being given to help him feel more comfortable

Information:

• Ask witnesses how the man was hit.  Was he in a car at the time of accident? If so, what seat was he in? Was he driving?  Was he wearing a seat belt?  Was he thrown from the car?  If not, was he hit directly by the bus?  How exactly was he hit?  While walking? How fast was the bus going? Was the patient thrown? How long ago was the accident?  Any known allergies?   

Question #3

• Possible decrease in anxiety with medical care and stabilization
• Increased O2 saturation and less anxiety related to air hunger

Question #4

 Possible Injuries:

• Flail chest
• Possible fracture of left femur
• Abrasions to chest

Interventions:

• Continued pain maintenance
• Supplemental O2
• Reexpand the lung
• Ice, wrap and immobilize fracture
• X-ray and set fracture
• Assess for internal bleeding/further damage

Question #5

• Broken ribs on left side (# 2-5?)
• Although not in x-ray, a fracture to the left femur is possible