Patient Care Assistant Externship Program

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NURSING SCIENCE

Implementation Science in Nursing: Let’s Do The Thing!

Project Approval Process

Systems-based physical assessments: Earlier detection of clinical deterioration and reduced mortality

EDUCATION

Houston Methodist Nurse Residency Program: Empowering Newly Licensed Nurses

The Center for Nursing Research, Education, and Practice Multimedia Team

PRACTICE

Introduction to Chief Nursing Informatics Officer

Revitalizing CVICU Orientation: Charting New Milestones for Excellence

PROFESSIONAL DEVELOPMENT

Certification Review Courses

International Honor Society of Nursing

Nursing Certification Payment Programs at Houston Methodist

FROM OUR TEAMS

Patient Care Assistant Externship Program

ABOUT DISCOVERN

Case Study 1

A 25-year-old female underwent surgical reconstruction of the right fractured femur. Currently, she is on PCA pump morphine post-op. She is drowsy and the food services notified the RN of her drowsiness and incoherence. CERT team was initiated and the ABG results are as follows:

Normal Ranges

pH

7.26

(7.35-7.45)

PaO₂

83

(80-100)

PaCO₂

52

(35-45)

HCO₃

25

(22 – 26)

pH – 7.26 – Low – Acidosis

Cause of change in pH

PaCO₂ – 52 – High – Culprit of the change
HCO₃ – 25 – Normal

Results

Respiratory Acidosis

Discussion: In this case, respiratory depression is being caused by the side effects of Morphine. As a result, the body is no longer exhaling CO₂ at an acceptable rate, causing the CO₂ level to be high at 52. The CO₂ levels in the body are increasing and thereby altering the pH.

NOTE: If this process were to occur chronically, the body would eventually COMPENSATE by adjusting the HCO₃ levels.

Analysis

Case Study 2

ABG values of A 33-year-old male post-op day 3 are as follows:

Normal Ranges

pH

7.32

(7.35-7.45)

PaCO₂

40

(35-45)

HCO₃

20

(22 – 26)

pH – 7.26 – Low – Acidosis

Cause of change in pH

PaCO₂ – 40 – Normal CO₂ tension
HCO₃ – 20 – Low – Culprit of the change

Results

Metabolic Acidosis

Discussion: This patient is in metabolic acidosis. In this case, a clinical picture would be necessary to further determine the cause. From his blood gas analysis, we can recognize that the changes in his pH are due to a metabolic component, rather than respiratory. The surgery can cause a pH imbalance due to dehydration, trauma to certain tissues, or kidney disease.

Analysis

Case Study 3

A 27-year-old male patient is admitted with complaints of shortness of breath, chest tightness, and tingling of fingers and mouth. No past medical history. ABG results are as follows:

Normal Ranges

pH

7.49

(7.35-7.45)

PaO₂

94

(80-100)

PaCO₂

52

(35-45)

HCO₃

25

(22 – 26)

BE

+2

(-2 to +2)

pH – 7.49 – High – Alkalosis

Cause of change in pH

PaCO₂ – 25 – Low – Culprit of the change
HCO₃ – 22 – Normal
BE – +2 – Normal

Results

Respiratory Alkalosis

Discussion: Respiratory alkalosis is most commonly caused by hyperventilation. During hyperventilation, the patient is breathing too fast and releasing too much CO2. As a result, the PaCO2 level is low and the pH is high. Treatment for this patient would include slowing their breathing and treating the underlying reason for the hyperventilation.

Analysis

Case Study 4

A 58-year-old female admitted with complaints of profuse vomiting and abdominal distention in the last 24 hours. CT scan reveals a large mass causing bowel obstruction. ABG results are as shown below:

Normal Ranges

pH

7.51

(7.35-7.45)

PaO₂

95

(80-100)

PaCO₂

42

(35-45)

HCO₃

30

(22 – 26)

BE

+3

(-2 to +2)

Analysis

pH – 7.51 – High – Alkalosis

Cause of change in pH

PaCO₂ – 42 – Normal
HCO₃ – 30 – High – Culprit of the change

Results

Metabolic Alkalosis

Discussion: Metabolic alkalosis in this patient is most likely related to bowel obstruction, which is causing vomiting and excessive fluid loss. The bicarbonate level is high as the blood is more concentrated from free fluid loss and the kidneys are unable to eliminate the excess hydrogen ions. As a result, more bicarbonate is produced.

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FROM OUR TEAMS

Patient Care Assistant Externship Program:

Launching Healthcare Careers for Youth in Underserved Communities

By Hsin-Mei Chen, PhD, MBA

In 2008, the Patient Care Assistant (PCA) Externship Program was launched in collaboration with Communities in Schools. This non-profit organization aims to provide community support to high school students to help them achieve their goals. The program was inaugurated with a generous donation from the Hamill Foundation and has since received grants from the College Football Playoff (CFP) Foundation, the Whalley Foundation and the Union Pacific Foundation. The fund pays for the PCA externs' salaries, education and supplies.

During the eight-week program, PCA Externs work eight-hour days in the clinical setting while attending Certified Nursing Assistant courses in the evenings. The program is supervised by nursing educators and monitored by staff who express interest in working with the students. When PCA externs are on the units, they are managed by their PCA preceptors.

Luis Ruiz Toledo, who co-leads the program, is a former PCA extern. He appreciated how the program allowed him and others to enter the healthcare field, especially when they may not have had the resources to do so. As the co-lead for the program, Toledo serves as a role model for the students and shows them that success is achievable. Toledo believes leading this program contributes to the nation's future by creating and educating competent and success healthcare workers.

After PCA Externs graduate from the program, many are offered part-time or full-time positions in the hospital. Also, some decide to continue their journey by pursuing a college degree in the nursing field. Their overall satisfaction with the program during the summer of 2023 was 4.69 out of 5, and 94% were interested in working at Houston Methodist permanently.

This fall, the PCA Externship Program started a new collaboration with Memorial Assistance Ministries (MAM) Houston, the Office of Community Benefits, and the Office of Diversity, Equity, and Inclusion (DEI). Three students participated in the fall cohort, and at least one of the PCA Externs received a job offer before the conclusion of the program.

The program has attracted the attention of Houston Methodist advisory board members and several other executives. In 2024, there is a plan to expand the program to community hospitals by obtaining support from leadership. The PCA Externship Program provides an incredible opportunity for youth interested in healthcare while offering Houston Methodist the chance to build a strong relationship with our communities. Moreover, PCA Externs tend to stay with the organization for a long time. Although they might not remain in the PCA role, they navigate through different career opportunities with the benefit of support, such as tuition reimbursement, provided by the hospital. The PCA Externship Program is vital in creating the future of healthcare by lending a hand to youth in underserved communities.