About Andrea Scibana Expertise Medications--uses, side effects/general health information, including home care/cardiac issues/caring for aging parents at home, including health issues of the aging/testing procedures/emergency medicine from a nursing standpoint, and issues involving procedures, courses in the ER
Experience Sixteen years as a cardiac nurse, seven years in the emergency room setting, five years working as the sole nurse for an internist/infectious disease physician (I had many responsibilities not usually done in office nursing/working as a telephone triage nurse currently for several pediatric and IM practices. My years seem many, but my ER and telephone triage have overlapped.
Education/Credentials Bachelor of Nursing degree from Kent State University in Kent, Ohio. I am certified in PICC line placement, and have my credentials for my ACLS, TNCC, PALS
Awards and Honors Nominated several times while in cardiac nursing for nurse of the year
Question I sent this to you yesterday but for some reason it is not showing that it went through. The nurse also said that her pupils were responsive to light when they shined it in her eyes. One thing I do not understand is when she was brought in, after the first CT scan was done and they had her stablized and we got to go in and see her, she was very restless and moving constantly. She was literally trying to pull herself off of the table, kicking her feet, raising her arms and it was constant movement. That is why they switched her to the Ativan to sedate her more. I believe what she was originally sedated with was Propofor? and it was not keeping her sedated well enough. So I don't understand why since she had so much movement then and not now. She is moving some but not nearly as much as she was before they sedated her and all the sedation is out of her system. I just don't understand. But I am continuing to pray about...Thank you for everything.
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Thank you so much! You will never know what a blessing you have been to me. The nurse had to give her a shot of insulin tonight because her blood sugar was a little high but they also had to give her one last night. Well when they gave her the shot last night she did not move when he injected the needle and tonight she did. She jumped and moved her arm! It's not much but that does show that she felt it tonight. Her fever is gone and her blood pressure is stable. They are giving her an antibotic because they found bacteria in her urine. They also said they would be moving her out of the SICU to the MICU in the next day or so. Because she is not considered a trauma patient anymore since she has been stabilized. Thank you so much and continue to pray for her. I will keep you informed. Kim
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The ER doctors said she was intubated for her safety because she was unresponsive and not able to communicate with them. They did do a CT scan that revealed two small bleeds, one in the area that was impacted and one in an area in the back of her head. They have done several follow-up CT's and said the bleeding has not progressed and seemed to be healing itself. She is 77 years old, she has had congestive heart failure twice in the past and 3 silent heart attacks. She is on medication for her heart and for high blood pressure, also blood thinners and lasix. She has been in SICU since Thursday night. She was taken off of all sedatives at 5:00 p.m. on Thursday. She is still unresponsive. Although, she did yawn today and move her legs around and move her head around. She is also breathing great on her own but they will not remove the tube until she wakes up. They also began giving her food throught a tube today, which she is tolerating well. I am concerned that they are not giving her any of her medications (ex. heart, blood pressure, cholesterol) and she has not had any of those since Wednesday. She began to run a low grade fever today and her blood pressure dropped significantly. They do not have an explanation for this as of yet. They have also given her frozen plasma to help clot her blood. She has been on blood thinners many years. I believe I have given you all the information that I have been given. Please pray that she wakes up soon, I don't know what I would do without her. Thank you so much, Kim
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I was wondering how long to it takes for effects of Ativan to leave an elderly person's system. My grandmother suffered a traumatic blow to the head as a result from a fall Wednesday. She was admitted, intubated, and sedated with Ativan until Thursday at noon, then she was switched to propofor?? for about 4 hours. She has been completely off of all sedatives since Thursday at 5 p.m.- she still is not responsive...is this normal? could the ativan still be in her system?
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Dear Kim,
First of all, let me say that I am so sorry about your grandmother. My prayers to her for a complete recovery, and to you and your family.
Ativan does have a tendency to create a longer sedation period in the elderly, those with debilitating illnesses, liver problems, etc. After 48 hours, though, from my readings on Ativan and the half life, while she may still have some effects, I am wondering if something else is going on.
You don't mention any cat scan or MRI results, and what happened that caused her to be intubated? Was it because her airway was compromised? To keep her sedated for her safety?
I wish I could answer your question in regards to "normal". Elderly people who suffer from traumatic head injuries sometimes have a problem arise called a "subdural hematoma". Their veins and arteries are more fragile, due to age, and sometimes there is a tear in what are called the "bridging veins", causing a slow blood leak that develops into a collection in a certain area. Without knowing the full extent, I would be inclined to ask the physician if he feels there is a possibility of an SDH. But, remember, also because she is elderly (does she have any major health problems?), her body takes much longer to excrete medications, particularly with decreased kidney and liver function. I am not sure how much or what all exactly was given.
I am so sorry I cannot be more definitive for you. Every head injury is totally unique in many ways. If you and your sister and your father all break your finger, the course of treatment may vary slightly, but you can count on certain things to be "the norm". The brain and head have so many varying factors, that one course of recovery cannot be counted on. Some people recover faster, some have longer lasting unresponsiveness, if they have any, some have complications, some have other problems down the road.
Perhaps if, during the courses of your visits, if you can get any other information, I might be able to help you more in knowing how your grandmother is doing clinically.
Again, just based on the facts you have given me, I would ask the physician if he/she feels that her mental status is residual from medications, or is, in fact, a physical problem present.
Once more, I will keep your grandmother in my thoughts and prayers.
Andrea
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Kim,
I am so sorry about the delay in me answering. Actually I DID answer early today, but for some reason, when checking my letters, the one I wrote you, somehow, did not go through. My prayers to you still, and to your grandmother. I thought of her often last night and today, and sent up many prayers.
Thank you for telling me why she was intubated. Since airway status is the first thing in any situation that you have to make sure is stable, I am sure the physicians did the best thing for your grandmother. It also helps with sedation, because you know you are keeping their bodies oxygenated in spite of making them sleep.
Please do not get concerned that she is not receiving her home medications. She may never take blood thinners again based on her injury. That is up to the physician who knows her and her case, but to give her blood thinners now would be not in her best interest. When people are in intensive care, many of their medical problems are handled through IV medications. Blood pressure, her congestive heart failure, etc. can well be handled that way. Many oral medications are extended release, meaning one pill in one day is enough. Because they are slowly dissolved in the intestines, you cannot crush them safely. The person would received a whole day's worth of medication in one fell swoop, which could be very dangerous. Missing cholesterol medications for a short time is not going to do any harm, or change anything dramatically.
I am very glad she is breathing well on her own. That is a great step. The other signs may or may not be improvements, but may be part of her head injury. Yawning can indicate head trauma, as can restlessness. On the other hand, since she is still intubated, they can also indicate she is waking up more and is not liking the tube.
Fresh frozen plasma is very common in cases such as this, and I wouldn't be concerned about that.
The fever is troublesome, but not alarming. Your grandmother has had numerous tubes, blood draws, IVs, etc. It may be something as small as a mild bladder infection. The low blood pressure is something I don't like to see, but most times it can be overcome with a little time and help. I am so glad the CT scans show improvement and stability, and that she is taking the nourishment well. All those are good signs.
I wish, dear heart, that I could see your grandmother and see how her progress is, and I could tell you more. I don't know what to tell you to expect at this point. Sad to say, those of us in the medical fields sometimes forget that our grim faces that don't portray anything good or bad is scary to a family that is already scared. We don't mean to scare you. Our minds are so busy thinking of taking care of someone and not miss anything, that we tend to become very business like. That doesn't help that loving family that is not as aware of what is going on as we are, and is tired of feeling frightened and hopeless.
From what you have told me, it sounds like your grandmother is receiving excellent care, and is being monitored very closely.
Kim, I wish I could tell you the progress from here, but everyone is different. Please keep me informed as to how you all are doing, and let me know if there is anything I can clarify for you. Remember, stop the doctor's and nurses and ask them questions. They want you to be informed and feel free to ask for explanations. They all want her to get better. You are as much a part of the team as they are. Your grandmother needs YOU as much the medical staff.
Continued best wishes and prayers.
Andrea
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Oh Kim,
You don't know how happy you have made me to read how much your grandmother has improved in one short day. I am sure you are all going to sleep a little bit easier tonight. I think moving her arm and jumping when she got a shot is fantastic, and I am so pleased it was a bladder infection.
Please do keep me informed on her progress. I will continue to keep her, and you, in my prayers, and many more happy days to come for you all.
Andrea
Answer Kim,
I don't know what happened either. Seems we both got wrote but got lost in cyberland. I do know we are both up way too late...lol. I am in Ohio, so is after 2am here.
The reason your grandmother was so restless then, was her brain was "stunned", and she had a buildup of blood, and also of fluid, called edema. It happens when there is a head injury such as your grandmother's. They give steroids, usually, in that case, to decrease the inflammation and the swelling. And, not knowing if your grandmother is diabetic or not, but steroids will raise blood sugars. So, if your grandmother is not diabetic, you can see why she had to get insulin. Because blood sugars are high, people, especially women, have a tendency to get bladder infections. Glucose will spill into the urine. Just like yeast in bread (yeast is a bacteria), bacteria love moisture, darkness and sweetness. So, they grow. And anyone who has a catheter (very necessary in your grandmother's case to protect her skin and to keep an eye on kidney function), is more prone to bladder infections.
Don't know why our "mail" didn't connect, but finally we got it all straightened around.
Thank you, also, for the lovely comments. You are a very sweet and caring person, and I know you are a blessing to your family.
