Transitional Residency to Acute Care (TRAC) Program

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Transitional Residency to Acute Care (TRAC) Program

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The Role of the Patient Care Assistant in Transforming Nursing at the Bedside

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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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PROFESSIONAL DEVELOPMENT

Transitional Residency to Acute Care (TRAC) Program

By Deepa Lalu, MSN, RN-BC

Houston Methodist recognizes the need for a flexible and adaptable nursing workforce, especially in the recent nursing shortage. They have introduced the Transitional Residency to Acute Care (TRAC) Program to address this challenge. This innovative program is designed to prepare qualified, experienced nurses who may not have prior inpatient hospital experience to successfully transition into the hospital setting.

TRAC bridges nurses from different healthcare settings, such as nursing homes, clinics, long-term acute care hospitals, skilled nursing facilities, and rehabilitation centers, to the inpatient acute care setting. It aims to equip nurses with the necessary skills and knowledge to thrive in the hospital environment. By providing an extended orientation, TRAC ensures that nurses receive comprehensive support and a high-quality onboarding experience.

The program employs a blended approach to education, combining didactic courses, simulation exercises, and hands-on clinical experiences. This multifaceted approach allows nurses to develop their clinical practice while enhancing their critical thinking abilities. Through TRAC, nurses gain valuable exposure to the complexities of acute care, enabling them to provide effective and efficient patient care.

Houston Methodist's commitment to transforming the nursing workforce is evident in the implementation of TRAC. By recognizing the diverse experiences and expertise that nurses bring from different healthcare settings, they can tap into a broader talent pool and address the shortage of experienced nurses in the hospital setting. This program benefits nurses and improves patient outcomes and overall healthcare quality.