PPI Use

https://www.ncbi.nlm.nih.gov/pubmed/25730198?log$=activity


As I have participated in clinicals over the past two semesters, I have noticed that the majority of patients I have taken care of were prescribed a proton pump inhibitor daily for GI prophylaxis to prevent stress ulcers. PPIs work by stopping the final step of acid production in the stomach. While this is effective in prevention of gastric ulcers, it increases the risk of bacterial growth because the PPI causes the gastric secretions to be more alkaline. C. Diff is one of the major bacterial infections in hospitalized patients and using a PPI with patients with c. Diff leads to a higher occurrence of reinfection. In the above study, 754 patients with an initial episode of health care associated c. Diff infections were evaluated to determine if PPI use was associated with c. Diff infection recurrence. Quiz Ref IDRecurrence was common, occurring in 193 of 754 patients (25.6%) within 90 days. The article also states that possibly preventing recurring c. Diff infections could end with stopping the over prescribing of PPIs. It also states that PPIs are potentially unnecessary and over prescribed. I believe that PPI prophylaxis is easier than having a patient develop a gastric ulcer and then having to also treat that on top of the primary diagnosis. PPI use should be carefully considered when dealing with the care of patients with higher risk for infections and those with previous c. Diff infections.

On 10/3/16, I participated in iStan SimLab. I drew a CBC and BMP for the patient and sent them over to the lab. I assisted with Ambu bagging the patient when the O2 sat dropped below 92%. The physician had ordered acetaminophen for fever >102F and mild pain. The patient reported pain and had a fever of 103F I pulled meds. Pt reports she cannot swallow pills so I called and requested a oral liquid suspension. Pt cannot swallow liquid suspension. Pharmacy suggested calling physician and getting order for suppository. Team members called physicians office and got an order for route change. Order was changed in MAR and sent to pharmacy. The patients linens were soiled upon shift change. I assisted with cleaning the patient and changing the linens. During our SimLab I learned just how important communication is between a team of healthcare workers. Without proper communication time is wasted and the patient doesn't receive the care they need and deserve. I also learned that I need to assess my patient and not just provide care based off the information the previous shift provides. Next time in SimLab, I will ensure the patient gets a full assessment and know my patient from head to toe. Watching my peers, I learned that good communication is key in success. I also learned that patient care is not a one man show. It requires teamwork equal on all parts. During this simulation we were able to adapt to the patients communication needs, Our patient was non-verbal so communication was more difficult than normal. Asking the patient yes and no questions was really the only way to communicate. A source we could have utilized was the patients sister to confirm birth date and allergies, with the patients permission of course. Overall, I believe simulation went well and served as a great learning tool.

Hi paige!!