{"id":642,"date":"2023-12-04T10:27:22","date_gmt":"2023-12-04T15:27:22","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/dcbiol2200\/chapter\/day-2-medical-ward-2\/"},"modified":"2023-12-04T10:27:22","modified_gmt":"2023-12-04T15:27:22","slug":"day-2-medical-ward-2","status":"publish","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/dcbiol2200\/chapter\/day-2-medical-ward-2\/","title":{"raw":"Day 2: Medical unit","rendered":"Day 2: Medical unit"},"content":{"raw":"\n
\n

Day 2<\/h2>\n<\/div>\n
\n

Time: 07h00<\/h3>\n<\/div>\n
\n

Place: Medical Unit<\/h3>\n<\/div>\n
\n\n \n\nTracie walks into the nursing station and heads to her usual chair. She moves the assignment book towards her and sees that she has the same assignment as yesterday. \u201cThat\u2019s okay,\u201d she thinks, \u201cAt least I know the patients.\u201d She looks up at the patient board and sees that there have only been two admissions since yesterday and one discharge. \u201cLooks like it could be a busy discharge and admissions day.\u201d\n\n<\/div>\n
\n\n \n\nJim comes down and pulls his chair close to Tracie\u2019s. \u201cHi Tracie, how\u2019s it going?\u201d\n\n<\/div>\n
\n\n \n\n\u201cSo far so good, how was your night?\u201d\n\n<\/div>\n
\n\n \n\n\u201cNight was quiet. Ms. Huang required some adjustments in her Optiflow which the RTs took care of. Mr. Alex had a bit of sundowner syndrome and was quite restless, but otherwise the night was pretty quiet.\u201d\n\n<\/div>\n
\n\n \n\n\u201cGreat. Okay, let\u2019s do the report so you can get home.\u201d\n\n<\/div>\n
\n\n \n\n\u201cYeah, I have to get out of here quick. I\u2019m taking the kids on a field trip later in the afternoon. Twenty-six Grade 2 kids. I can\u2019t believe I volunteered to chaperone after a night shift.\u201d\n\n<\/div>\n
\n\n \n\nTracie laughs, \u201cLucky you.\u201d\n\n<\/div>\n
\n\n \n\nJim then walks Tracie through the night and updates her on changes to her patients. After reporting, Jim heads out, while Tracie quickly looks through the charts to plan her morning. Tracie notes that she has a lot of 08h00 medications so she decides to prepare these meds and then do her patient checks at the same time.\n\n<\/div>\n
\n\n \n\nTracie makes her rounds and drops off all her medications. With that done, she notes to herself, \u201cEveryone seems all right now, having breakfast. I didn\u2019t see any issues off the top. I\u2019ll give everyone a few minutes and then do vitals, assessments, and discharges.\u201d\n\n<\/div>\n
\n\n \n\nTracie sits down to check the RT\u2019s note on Miki Huang when Miki\u2019s call bell rings. She gets up from her chair and walks down the hallway to her room.\n\n<\/div>\n
\n\n \n\n\u201cHi, Ms. Huang. Hi Linda. How can I help?\u201d She notices Linda\u2019s disheveled appearance and dark moons under her eyes with slight concern.\n\n<\/div>\n
\n\n \n\nLinda herself is frantic. \u201cMy mother said she couldn\u2019t catch her breath shortly after we took off her oxygen to eat. Can you help us put it back on please?\u201d\n\n<\/div>\n
\n\n \n\n\u201cI want Miki to take some deep breaths. Tell her in through her nose and out her mouth. Remember to close the lips slightly as she breathes out. I\u2019m going to get the vitals machine and be right back.\u201d\n\n<\/div>\n
\n\n \n\nMiki watches Tracie walk briskly out of the room and is annoyed. What good is she if she\u2019s not going to help? She then hears her daughter speaking to her and turns around to realize that she\u2019s telling her how to breathe. \u201cWhat\u2019s the point of staying in the hospital if I\u2019m just going to breathe on my own without the oxygen?\u201d She thinks to herself. \u201cI can literally do this at home.\u201d\n\n<\/div>\n
\n\n \n\nMiki reluctantly follows Linda\u2019s instructions and continues to take deep breaths, although she makes it a point to glare at her daughter throughout the entire process. Linda, weary and frustrated herself, glares back.\n\n<\/div>\n
\n\n \n\nTracie grabs a vital signs machine from the hallway charger and brings it into Miki\u2019s room to take her vital signs.\n\n<\/div>\n
\n\n \n\n\u201cOkay, let\u2019s start checking you out.\u201d Tracie wraps the blood pressure cuff around Miki\u2019s left arm, pulse oximeter on the right forefinger, and temperature probe under the tongue. About 30 seconds later, she notes that the blood pressure is up a bit, and the oxygen saturation is down. Temperature is unchanged with the same low-grade fever. Respiratory rate is up as well, and heart rate is above 110 bpm. \u201cThis is not going in the right direction,\u201d she thinks, \u201cI may need the RT to come see her.\u201d\n\n \n\n\n\n\n
Day: 2<\/strong><\/td>\nPulse Rate<\/strong><\/td>\nBlood Pressure<\/strong><\/td>\nRespiratory Rate<\/strong><\/td>\nTemperature<\/strong><\/td>\nO2<\/sub> Saturation<\/strong><\/td>\n<\/tr>\n
Time: 07h30<\/strong><\/td>\n112<\/td>\n165\/90<\/td>\n22<\/td>\n36.5\u00b0C<\/td>\n83% on RA<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n
\n\n \n\n\u201cOkay, Ms. Huang, let\u2019s listen to your heart and lungs.\u201d\n\n<\/div>\n
\n\n \n\nTracie systematically auscultates, thinking, \u201cNot any change from what I remember yesterday.\u201d\n\n<\/div>\n
\n\n \n\n\u201cHow are you feeling now?\u201d\n\n<\/div>\n
\n\n \n\nLinda conveys the question to her mother, who answers: \u201cNot great, but maybe a bit better.\u201d\n\n<\/div>\n
\n\n \n\n\u201cAlright, I\u2019m going to ask the RT to come and see you right away.\u201d\n\n<\/div>\n
\n\n \n\nLinda instantly becomes alert. \u201cWhy? Is she okay? Is she...dying?\u201d\n\n<\/div>\n
\n\n \n\n\u201cGosh no, Linda. The respiratory therapist is here to help both your mother and me. They manage the oxygen and help with breathing.\u201d\n\n<\/div>\n
\n\n \n\n\u201cOh,\u201d Linda replies. \u201cGood.\u201d\n\n<\/div>\n
\n\n \n\n\u201cI will be right back.\u201d Tracie moves quickly again out to the main hallway to the nursing station. She then asks for the RT to be paged and to come to Miki Huang\u2019s room.\n\n<\/div>\n
\n\n \n\nThe unit coordinator looks up. \u201cWhat should I tell them.\u201d\n\n<\/div>\n
\n\n \n\n\u201cMs. Huang is quite short of breath and has low sats on Optiflow. I\u2019m not sure what to do next.\u201d\n\n<\/div>\n
\n\n \n\n\u201cDone. If they have any further questions, I\u2019ll transfer their call to the phone outside the room.\u201d\n\n<\/div>\n
\n\n \n\n\u201cThank you.\u201d\n\n<\/div>\n
\n\n \n\nTracie heads back to Miki\u2019s room.\n\n<\/div>\n
\n\n \n\nTracie has the vitals machine to another cycle of vital signs but not the temperature. She reads the machine, thinking, \u201cHeart rate is down to slightly less than 100 bpm. Respiratory rate is still up and sats have only improved slightly.\u201d Tracie records all this information and her assessment into Miki\u2019s chart. Just then, Alexa, the RT, enters the room.\n\n \n\n\n\n\n
Day: 2<\/strong><\/td>\nPulse Rate<\/strong><\/td>\nBlood Pressure<\/strong><\/td>\nRespiratory Rate<\/strong><\/td>\nTemperature<\/strong><\/td>\nO2 Saturation<\/strong><\/td>\n<\/tr>\n
Time: 07h45<\/strong><\/td>\n98<\/td>\n165\/90<\/td>\n22<\/td>\n\u2013<\/td>\n85% on Optiflow<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n
\n\n \n\n\u201cHi...Tracie, right?\u201d\n\n<\/div>\n
\n\n \n\n\u201cYes, you remembered! So, you must also remember Ms. Huang then. And her daughter too?\u201d\n\n<\/div>\n
\n\n \n\n\u201cYes, I do. Have her sats not improved? You asked her to breathe deep like yesterday?\u201d\n\n<\/div>\n
\n\n \n\n\u201cYes. She has improved slightly but not very much with the deep breathing.\u201d\n\n<\/div>\n
\n\n \n\n\u201cOkay, let\u2019s take a look. Hi Ms. Huang and Linda, do you remember me?\u201d\n\n<\/div>\n
\n\n \n\nLinda, too tired to process, stares back. Miki, obviously not understanding, also stares back.\n\n<\/div>\n
\n\n \n\nAlexa chuckles awkwardly. \u201cI was in Emergency yesterday. Anyways, I\u2019m going to listen to your chest and then I may have to take some blood from your wrist again.\u201d\n\n<\/div>\n
\n\n \n\nLinda snaps out of it and tells her mother that they\u2019re going to check up on her again, and Miki nods solemnly. Alexa methodically assesses Miki\u2019s respiratory system.\n\n<\/div>\n
\n\n \n\n\u201cOkay, Ms. Huang. Your breath sounds don\u2019t seem much different than they did in Emergency, but obviously you are not feeling your best. I think I am going to have to change your oxygen treatment to a face mask. Have you had a face mask before?\u201d\n\n<\/div>\n
\n\n \n\nLinda shakes her head, \u201cI don\u2019t think so.\u201d\n\n<\/div>\n
\n\n \n\n\u201cIt\u2019s a mask that covers both your mouth and nose. It allows me to give you a bit more oxygen than the system you are currently on. I am going to get the equipment to do so, and we will see how you do with the new oxygen treatment and whether you need another needle poke in your wrist.\u201d\n\n<\/div>\n
\n\n \n\nAlexa steps out to the storeroom and selects a high flow mask with humidifier. Back in Miki\u2019s room, she sets up the equipment and turns the flow meter up as high as it goes. Looking at the humidifier bottle, Alexa notes a good amount of bubbling.\n\n<\/div>\n
\n\n \n\n\u201cMs. Huang, I\u2019m going to take away those nasal prongs and place a mask on your face.\u201d\n\n<\/div>\n
\n\n \n\nBefore Linda can translate, Alexa confidently changes the therapy and places the high flow mask on Miki.\n\n<\/div>\n
\n\n \n\n\u201cNow, take some deep breaths slowly and blow out through your mouth. How does that feel now?\u201d\n\n<\/div>\n
\n\n \n\nMiki turns to Linda, \u201cWell at least I don\u2019t think I\u2019m going to die anymore,\u201d she says sarcastically.\n\n<\/div>\n
\n\n \n\nLinda sighs. \u201cShe says she feels a bit better, thanks.\u201d\n\n<\/div>\n
\n\n \n\nTurning to Tracie, Alexa states: \u201cI have placed her on 65Fi02 high flow face mask. Can you do another set of vitals for me?\u201d Tracie hits start on the vitals machine.\n\n<\/div>\n
\n\n \n\nBoth health professionals, along with Miki, and Linda, turn to look at the numbers as they appear on the screen.\n\n \n\n\n\n\n
Day: 2<\/strong><\/td>\nPulse Rate<\/strong><\/td>\nBlood Pressure<\/strong><\/td>\nRespiratory Rate<\/strong><\/td>\nTemperature<\/strong><\/td>\nO2 Saturation<\/strong><\/td>\n<\/tr>\n
Time: 08h05<\/strong><\/td>\n98<\/td>\n165\/90<\/td>\n22<\/td>\n\u2013<\/td>\n092% on High Flow FM<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n
\n\n \n\n\u201cOkay, Ms. Huang, your oxygen level is better, and your other vitals look the same as they did when I first came on shift. I have another patient to see next door, but before I leave, I will come back and see how Ms. Huang is doing.\u201d\n\n<\/div>\n
\n\n \n\nTracie nods and follows Alexa out of the room. \u201cWhat do you think is going on? Why did her saturations drop, Alexa?\u201d\n\n<\/div>\n
\n\n \n\n\u201cHer pneumonia might be progressing a bit. Sometimes that happens even with antibiotics. Antibiotics take about three days to really work well. In the meantime, if she could stand it, we should see if Physio can see her and maybe get her moving, which will help with chest expansion. One of the worst things to do is just lie about. Is she due for a Chest X-ray (CXR)?\u201d\n\n<\/div>\n
\n\n \n\n\u201cYes, I saw that she will be getting one around 2pm this afternoon. Can she go down with that mask on?\u201d\n\n<\/div>\n
\n\n \n\n\u201cNo problem. I will make sure that there is a full tank available. Tony is the RT in Emergency and he also covers X-ray if need be. I will let him know in case there is an issue while she is down there.\u201d\n\n<\/div>\n
\n\n \n\n\u201cOkay, I will talk with the doctor about a physio order and let him know you have adjusted her O2.\u201d\n\n<\/div>\n
\n\n \n\n\u201cThanks. I will look in on her after I see my other patients on this floor. If her sats stay up where they are, I don\u2019t believe she needs a blood gas.\u201d\n\n<\/div>\n
\n\n \n\n\u201cAwesome. Okay, see you later.\u201d\n\n<\/div>\n
\n

Time: 09h00 <\/span><\/h3>\n<\/div>\n
\n\n\u201cHi Dr. Hunicutt, I\u2019m Tracie. One of my patients, Miki Huang, is under your care.\u201d\n\n<\/div>\n
\n\n \n\n\u201cAw, yes, the older lady with COPD and pneumonia. How was her night?\u201d\n\n<\/div>\n
\n\n \n\n\u201cNight was pretty good, needed some adjustment on her Optiflow but otherwise slept well. My concern is what happened this morning. She became quite short of breath and anxious; I called the RT, and we made some adjustments and moved her to high flow face mask at .65. Sats responded and she improved to 93% and has stayed there for the past hour. Appears quite relaxed now. No other changes in breath sounds or temperature.  Very little sputum production.\u201d\n\n<\/div>\n
\n\n \n\n\u201cVery good. Let\u2019s go and see her now and see if I need to make any further adjustments.\u201d\n\n<\/div>\n
\n\n \n\nBoth Tracie and Dr. Hunicutt walk down the hall to Miki\u2019s room. As they enter, they see Miki sitting in bed with a green oxygen mask on, flicking through the TV channels. Linda is also sitting in the corner of the room, eyes fixed on the TV and occasionally making comments on the programs.\n\n<\/div>\n
\n\n \n\nLinda notices the pair enter the room and immediately stands up out of formality. \u201cHiI everyone. My mother keeps complaining about the mask blocking her view. Do you know how much longer she needs to keep it on for?\u201d\n\n<\/div>\n
\n\n \n\n\u201cHi Ms. Huang, and you must be her daughter. My name is Dr. Hunicutt, and I am a doctor helping to care for you. I see you are less short of breath right now. Would you mind if I listen to your chest?\u201d\n\n<\/div>\n
\n\n \n\nHe gestured towards Miki as he spoke, and Miki, understanding, nodded but sighed.\n\n<\/div>\n
\n\n \n\nDr. Hunicutt takes his stethoscope out and systematically listens to Miki\u2019s heart and lungs. Then he proceeds to examine the rest of Miki.\n\n<\/div>\n
\n\n \n\n\u201cVery good. Thank you, Ms. Huang.\u201d\n\n<\/div>\n
\n\n \n\n\u201cIt can\u2019t be too good, otherwise we wouldn\u2019t be stuck here,\u201d Linda muttered under her breath.\n\n<\/div>\n
\n\n \n\n\u201cMy apologies. It is okay. Your mother\u2019s lungs are not the healthiest due to the COPD, and by listening to your chest I can see that she does have lots of consolidation in both lower lobes.\u201d Dr. Hunicutt points to where he heard the bronchial breath sounds.\n\n<\/div>\n
\n\n \n\nLinda\u2019s face flushes red. \u201cI\u2019m so sorry, doc. I didn\u2019t know you would hear what I just said. I don\u2019t know what came over me, I\u2019m just so tired.\u201d\n\n<\/div>\n
\n\n \n\n\u201cIt\u2019s okay, Linda, I understand. I do believe that Miki is on the right antibiotics. We are still waiting for the sputum test to tell me that, and we will also do a chest X-ray today to confirm that the pneumonia is not spreading more. Tracie, is there anything you would like to add?\u201d\n\n<\/div>\n
\n\n \n\n\u201cI would like to have Physio come over to see her and get her moving a bit more.\u201d\n\n<\/div>\n
\n\n \n\n\u201cI think that is a very good idea. I will write the order. They may not come today, but that doesn\u2019t mean Ms. Huang cannot sit in a chair or stand at the bedside. I don\u2019t want her doing too much, but she does need to move a bit more.\u201d\n\n<\/div>\n
\n\n \n\n\u201cWe can do the chair. What about the bathroom?\u201d\n\n<\/div>\n
\n\n \n\n\u201cCommode at bedside until she is below 50% oxygen. Anything else?\u201d\n\n<\/div>\n
\n\n \n\n\u201cAlexa the RT said she would wait to do another blood gas as her sats are okay right now.\u201d\n\n<\/div>\n
\n\n \n\n\u201cI agree. But I will write an order for another blood gas tomorrow morning to see how we stand with CO2 and PaO2. I want to ensure that her COPD does not get worse as well. At this point, our other option is BiPAP (a non-invasive ventilation device which applies different levels of positive pressure in the airways during inhalation and exhalation to allow for easier ventilation), which I\u2019m pretty sure Ms. Huang will not be happy with, so let\u2019s see if we can manage her without going to intensive care.\u201d\n\n<\/div>\n
\n\n \n\n\u201cThank you. I think that will do. Ms. Huang and Linda, do you have any questions?\u201d\n\n<\/div>\n
\n\n \n\n\u201cNo, I think we\u2019re good for now,\u201d Linda answers. Miki, who hadn\u2019t been translated for this entire time, remains silent. She was trying hard not to be irritated as she knew that her daughter was already trying her best, but it was not easy constantly being out of the loop especially when she was the topic of discussion.\n\n<\/div>\n
\n\n \n\nBoth Dr. Hunicutt and Tracie smile, nod at the mother-daughter duo, and then leave the room.\n\n<\/div>\n
\n\n \n\nOutside the room, Dr. Hunicutt asks if anything else needs to be done. Tracie points to a couple of other rooms where she has patients and explains that two patients need discharge orders, and two others need lab work looked at, as pharmacy is stating that antibiotic coverage may not be appropriate. Dr. Hunicutt nods his head and gives her the thumbs up sign as he heads to the chart rack to begin the process of discharge and looking at labs.\n\n<\/div>\n
\n\n \n\nTracie begins the process of recording the interaction with Dr. Hunicutt and Miki, making sure to include Linda\u2019s role and presence.\n\n<\/div>\n
\n\n \n\nOver the course of the day, Tracie was able to get Miki up twice to the bedside commode and twice to a chair for 30 minutes each time. Miki\u2019s saturation stayed stable along with her other vitals signs.\n\n<\/div>\n
\n\n \n\nWhen the shift change rolled around, Tracie was very happy to see Jim come into the unit. \u201cWow, I did not think I would see you tonight.\u201d\n\n<\/div>\n
\n\n \n\n\u201cMe either. They called me for overtime during my chaperoning of a school trip.\u201d\n\n<\/div>\n
\n\n \n\n\u201cMan, you must be exhausted.\u201d\n\n<\/div>\n
\n\n \n\n\u201cYeah, but no more than usual. Got some shuteye before coming in. Anyway, how was your day?\u201d\n\n<\/div>\n
\n\n \n\nTracie gives an overall report of two discharges and two new admissions. She updates Jim on changes to Miki\u2019s oxygen levels and her increased orders for activity.\n\n<\/div>\n
\n\n \n\n\u201cAwesome, thanks. Will I see you in the morning?\u201d\n\n<\/div>\n
\n\n \n\n\u201cI believe you will. I\u2019m doing four days in a row. I traded my night shifts so I could attend a play with my husband. We have had so little time together with him finishing his PhD, and my shift work. He promised not to talk research and take me out on a real date if I would change my night shifts.\u201d\n\n<\/div>\n
\n\n \n\n\u201cWow, I am so jealous. Well, have a good sleep and we will see you in the morning.\u201d\n\n<\/div>\n
\n\n \n\n\u201cGood night!\u201d\n\n<\/div>\n
\n\n \n\nWhile this exchange was happening, Miki and Linda are having their own conversation, or rather, altercation, back in the room.\n\n<\/div>\n
\n\n[caption id=\"attachment_5797\" align=\"aligncenter\" width=\"2560\"]\"Miki Day 2 - While wearing a breathing mask, Miki is arguing with Linda. Image created by Sarah Pinault under a CC-BY-NC license<\/span>[\/caption]\n\n\u201cWhat\u2019s the point of having you here if you\u2019re not going to tell me anything they\u2019re saying?\u201d Miki says in an accusatory tone.\n\n<\/div>\n
\n\n \n\nLinda throws up her hands, \u201cI don\u2019t know what you want me to say! You can\u2019t actually expect me to translate word for word every single thing that\u2019s going on. It\u2019s too much, you should know that.\u201d\n\n<\/div>\n
\n\n \n\n\u201cThe very least you could do is not act like I\u2019m not even here. Would an actual translator do that?\u201d\n\n<\/div>\n
\n\n \n\n\u201cMaybe we should just get you an actual translator then. You think I\u2019m having fun right now?\u201d Linda snaps back. \u201cI have missed how many days of work now and you haven\u2019t even uttered a single \u2018thank you\u2019.\u201d\n\n<\/div>\n
\n\n \n\n\u201cWorks for me. At least an actual translator wouldn\u2019t consent to things on my behalf without consulting me first.\u201d Miki answers scornfully.\n\n<\/div>\n
\n\n \n\n\u201cThat wasn\u2019t even that big of a deal!\u201d Linda cries out. \u201cThat was literally just to take your blood. If you want to be involved so bad, maybe you should\u2019ve learned English then!\u201d\n\n<\/div>\n
\n\n \n\nTaken aback by the volume of her normally quiet daughter\u2019s voice, Miki pauses. \u201cI don\u2019t know. I\u2019m sorry. Everything is just so different here, but I know how tired you must be. I miss home.\u201d\n\n<\/div>\n
\n\n \n\nSomehow, Linda knew that the home her mother was referring to was Taiwan and not their townhouse a few blocks away. \u201cI\u2019m sorry too. I shouldn\u2019t have said that. I know you\u2019re doing your best to adjust to this new environment. I\u2019ll try to keep you in the loop more from now on. Say, even the food is making it difficult, huh?\u201d\n\n<\/div>\n
\n\n \n\nMiki cracked a small smile. \u201cOh god. What is it with these people and their Jell-O. Don\u2019t they know the perfect desserts shouldn\u2019t be too sweet?\u201d\n\n<\/div>\n
\n\n \n\nSmiling herself, Linda reaches out to pat her mother\u2019s wrinkled hand. \u201cDon\u2019t worry, Mom, we\u2019ll be home before you know it.\u201d\n\n<\/div>\n

Adaptations<\/h1>\nThis section has been from Health Case Studies<\/a> by Glynda Rees, Rob Kruger, and Janet Morrison.\n","rendered":"
\n

Day 2<\/h2>\n<\/div>\n
\n

Time: 07h00<\/h3>\n<\/div>\n
\n

Place: Medical Unit<\/h3>\n<\/div>\n
\n

 <\/p>\n

Tracie walks into the nursing station and heads to her usual chair. She moves the assignment book towards her and sees that she has the same assignment as yesterday. \u201cThat\u2019s okay,\u201d she thinks, \u201cAt least I know the patients.\u201d She looks up at the patient board and sees that there have only been two admissions since yesterday and one discharge. \u201cLooks like it could be a busy discharge and admissions day.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

Jim comes down and pulls his chair close to Tracie\u2019s. \u201cHi Tracie, how\u2019s it going?\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cSo far so good, how was your night?\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cNight was quiet. Ms. Huang required some adjustments in her Optiflow which the RTs took care of. Mr. Alex had a bit of sundowner syndrome and was quite restless, but otherwise the night was pretty quiet.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cGreat. Okay, let\u2019s do the report so you can get home.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cYeah, I have to get out of here quick. I\u2019m taking the kids on a field trip later in the afternoon. Twenty-six Grade 2 kids. I can\u2019t believe I volunteered to chaperone after a night shift.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

Tracie laughs, \u201cLucky you.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

Jim then walks Tracie through the night and updates her on changes to her patients. After reporting, Jim heads out, while Tracie quickly looks through the charts to plan her morning. Tracie notes that she has a lot of 08h00 medications so she decides to prepare these meds and then do her patient checks at the same time.<\/p>\n<\/div>\n

\n

 <\/p>\n

Tracie makes her rounds and drops off all her medications. With that done, she notes to herself, \u201cEveryone seems all right now, having breakfast. I didn\u2019t see any issues off the top. I\u2019ll give everyone a few minutes and then do vitals, assessments, and discharges.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

Tracie sits down to check the RT\u2019s note on Miki Huang when Miki\u2019s call bell rings. She gets up from her chair and walks down the hallway to her room.<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cHi, Ms. Huang. Hi Linda. How can I help?\u201d She notices Linda\u2019s disheveled appearance and dark moons under her eyes with slight concern.<\/p>\n<\/div>\n

\n

 <\/p>\n

Linda herself is frantic. \u201cMy mother said she couldn\u2019t catch her breath shortly after we took off her oxygen to eat. Can you help us put it back on please?\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cI want Miki to take some deep breaths. Tell her in through her nose and out her mouth. Remember to close the lips slightly as she breathes out. I\u2019m going to get the vitals machine and be right back.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

Miki watches Tracie walk briskly out of the room and is annoyed. What good is she if she\u2019s not going to help? She then hears her daughter speaking to her and turns around to realize that she\u2019s telling her how to breathe. \u201cWhat\u2019s the point of staying in the hospital if I\u2019m just going to breathe on my own without the oxygen?\u201d She thinks to herself. \u201cI can literally do this at home.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

Miki reluctantly follows Linda\u2019s instructions and continues to take deep breaths, although she makes it a point to glare at her daughter throughout the entire process. Linda, weary and frustrated herself, glares back.<\/p>\n<\/div>\n

\n

 <\/p>\n

Tracie grabs a vital signs machine from the hallway charger and brings it into Miki\u2019s room to take her vital signs.<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cOkay, let\u2019s start checking you out.\u201d Tracie wraps the blood pressure cuff around Miki\u2019s left arm, pulse oximeter on the right forefinger, and temperature probe under the tongue. About 30 seconds later, she notes that the blood pressure is up a bit, and the oxygen saturation is down. Temperature is unchanged with the same low-grade fever. Respiratory rate is up as well, and heart rate is above 110 bpm. \u201cThis is not going in the right direction,\u201d she thinks, \u201cI may need the RT to come see her.\u201d<\/p>\n

 <\/p>\n\n\n\n\n
Day: 2<\/strong><\/td>\nPulse Rate<\/strong><\/td>\nBlood Pressure<\/strong><\/td>\nRespiratory Rate<\/strong><\/td>\nTemperature<\/strong><\/td>\nO2<\/sub> Saturation<\/strong><\/td>\n<\/tr>\n
Time: 07h30<\/strong><\/td>\n112<\/td>\n165\/90<\/td>\n22<\/td>\n36.5\u00b0C<\/td>\n83% on RA<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n
\n

 <\/p>\n

\u201cOkay, Ms. Huang, let\u2019s listen to your heart and lungs.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

Tracie systematically auscultates, thinking, \u201cNot any change from what I remember yesterday.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cHow are you feeling now?\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

Linda conveys the question to her mother, who answers: \u201cNot great, but maybe a bit better.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cAlright, I\u2019m going to ask the RT to come and see you right away.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

Linda instantly becomes alert. \u201cWhy? Is she okay? Is she…dying?\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cGosh no, Linda. The respiratory therapist is here to help both your mother and me. They manage the oxygen and help with breathing.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cOh,\u201d Linda replies. \u201cGood.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cI will be right back.\u201d Tracie moves quickly again out to the main hallway to the nursing station. She then asks for the RT to be paged and to come to Miki Huang\u2019s room.<\/p>\n<\/div>\n

\n

 <\/p>\n

The unit coordinator looks up. \u201cWhat should I tell them.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cMs. Huang is quite short of breath and has low sats on Optiflow. I\u2019m not sure what to do next.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cDone. If they have any further questions, I\u2019ll transfer their call to the phone outside the room.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cThank you.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

Tracie heads back to Miki\u2019s room.<\/p>\n<\/div>\n

\n

 <\/p>\n

Tracie has the vitals machine to another cycle of vital signs but not the temperature. She reads the machine, thinking, \u201cHeart rate is down to slightly less than 100 bpm. Respiratory rate is still up and sats have only improved slightly.\u201d Tracie records all this information and her assessment into Miki\u2019s chart. Just then, Alexa, the RT, enters the room.<\/p>\n

 <\/p>\n\n\n\n\n
Day: 2<\/strong><\/td>\nPulse Rate<\/strong><\/td>\nBlood Pressure<\/strong><\/td>\nRespiratory Rate<\/strong><\/td>\nTemperature<\/strong><\/td>\nO2 Saturation<\/strong><\/td>\n<\/tr>\n
Time: 07h45<\/strong><\/td>\n98<\/td>\n165\/90<\/td>\n22<\/td>\n\u2013<\/td>\n85% on Optiflow<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n
\n

 <\/p>\n

\u201cHi…Tracie, right?\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cYes, you remembered! So, you must also remember Ms. Huang then. And her daughter too?\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cYes, I do. Have her sats not improved? You asked her to breathe deep like yesterday?\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cYes. She has improved slightly but not very much with the deep breathing.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cOkay, let\u2019s take a look. Hi Ms. Huang and Linda, do you remember me?\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

Linda, too tired to process, stares back. Miki, obviously not understanding, also stares back.<\/p>\n<\/div>\n

\n

 <\/p>\n

Alexa chuckles awkwardly. \u201cI was in Emergency yesterday. Anyways, I\u2019m going to listen to your chest and then I may have to take some blood from your wrist again.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

Linda snaps out of it and tells her mother that they\u2019re going to check up on her again, and Miki nods solemnly. Alexa methodically assesses Miki\u2019s respiratory system.<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cOkay, Ms. Huang. Your breath sounds don\u2019t seem much different than they did in Emergency, but obviously you are not feeling your best. I think I am going to have to change your oxygen treatment to a face mask. Have you had a face mask before?\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

Linda shakes her head, \u201cI don\u2019t think so.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cIt\u2019s a mask that covers both your mouth and nose. It allows me to give you a bit more oxygen than the system you are currently on. I am going to get the equipment to do so, and we will see how you do with the new oxygen treatment and whether you need another needle poke in your wrist.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

Alexa steps out to the storeroom and selects a high flow mask with humidifier. Back in Miki\u2019s room, she sets up the equipment and turns the flow meter up as high as it goes. Looking at the humidifier bottle, Alexa notes a good amount of bubbling.<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cMs. Huang, I\u2019m going to take away those nasal prongs and place a mask on your face.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

Before Linda can translate, Alexa confidently changes the therapy and places the high flow mask on Miki.<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cNow, take some deep breaths slowly and blow out through your mouth. How does that feel now?\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

Miki turns to Linda, \u201cWell at least I don\u2019t think I\u2019m going to die anymore,\u201d she says sarcastically.<\/p>\n<\/div>\n

\n

 <\/p>\n

Linda sighs. \u201cShe says she feels a bit better, thanks.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

Turning to Tracie, Alexa states: \u201cI have placed her on 65Fi02 high flow face mask. Can you do another set of vitals for me?\u201d Tracie hits start on the vitals machine.<\/p>\n<\/div>\n

\n

 <\/p>\n

Both health professionals, along with Miki, and Linda, turn to look at the numbers as they appear on the screen.<\/p>\n

 <\/p>\n\n\n\n\n
Day: 2<\/strong><\/td>\nPulse Rate<\/strong><\/td>\nBlood Pressure<\/strong><\/td>\nRespiratory Rate<\/strong><\/td>\nTemperature<\/strong><\/td>\nO2 Saturation<\/strong><\/td>\n<\/tr>\n
Time: 08h05<\/strong><\/td>\n98<\/td>\n165\/90<\/td>\n22<\/td>\n\u2013<\/td>\n092% on High Flow FM<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n
\n

 <\/p>\n

\u201cOkay, Ms. Huang, your oxygen level is better, and your other vitals look the same as they did when I first came on shift. I have another patient to see next door, but before I leave, I will come back and see how Ms. Huang is doing.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

Tracie nods and follows Alexa out of the room. \u201cWhat do you think is going on? Why did her saturations drop, Alexa?\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cHer pneumonia might be progressing a bit. Sometimes that happens even with antibiotics. Antibiotics take about three days to really work well. In the meantime, if she could stand it, we should see if Physio can see her and maybe get her moving, which will help with chest expansion. One of the worst things to do is just lie about. Is she due for a Chest X-ray (CXR)?\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cYes, I saw that she will be getting one around 2pm this afternoon. Can she go down with that mask on?\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cNo problem. I will make sure that there is a full tank available. Tony is the RT in Emergency and he also covers X-ray if need be. I will let him know in case there is an issue while she is down there.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cOkay, I will talk with the doctor about a physio order and let him know you have adjusted her O2.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cThanks. I will look in on her after I see my other patients on this floor. If her sats stay up where they are, I don\u2019t believe she needs a blood gas.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cAwesome. Okay, see you later.\u201d<\/p>\n<\/div>\n

\n

Time: 09h00 <\/span><\/h3>\n<\/div>\n
\n

\u201cHi Dr. Hunicutt, I\u2019m Tracie. One of my patients, Miki Huang, is under your care.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cAw, yes, the older lady with COPD and pneumonia. How was her night?\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cNight was pretty good, needed some adjustment on her Optiflow but otherwise slept well. My concern is what happened this morning. She became quite short of breath and anxious; I called the RT, and we made some adjustments and moved her to high flow face mask at .65. Sats responded and she improved to 93% and has stayed there for the past hour. Appears quite relaxed now. No other changes in breath sounds or temperature.  Very little sputum production.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cVery good. Let\u2019s go and see her now and see if I need to make any further adjustments.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

Both Tracie and Dr. Hunicutt walk down the hall to Miki\u2019s room. As they enter, they see Miki sitting in bed with a green oxygen mask on, flicking through the TV channels. Linda is also sitting in the corner of the room, eyes fixed on the TV and occasionally making comments on the programs.<\/p>\n<\/div>\n

\n

 <\/p>\n

Linda notices the pair enter the room and immediately stands up out of formality. \u201cHiI everyone. My mother keeps complaining about the mask blocking her view. Do you know how much longer she needs to keep it on for?\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cHi Ms. Huang, and you must be her daughter. My name is Dr. Hunicutt, and I am a doctor helping to care for you. I see you are less short of breath right now. Would you mind if I listen to your chest?\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

He gestured towards Miki as he spoke, and Miki, understanding, nodded but sighed.<\/p>\n<\/div>\n

\n

 <\/p>\n

Dr. Hunicutt takes his stethoscope out and systematically listens to Miki\u2019s heart and lungs. Then he proceeds to examine the rest of Miki.<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cVery good. Thank you, Ms. Huang.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cIt can\u2019t be too good, otherwise we wouldn\u2019t be stuck here,\u201d Linda muttered under her breath.<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cMy apologies. It is okay. Your mother\u2019s lungs are not the healthiest due to the COPD, and by listening to your chest I can see that she does have lots of consolidation in both lower lobes.\u201d Dr. Hunicutt points to where he heard the bronchial breath sounds.<\/p>\n<\/div>\n

\n

 <\/p>\n

Linda\u2019s face flushes red. \u201cI\u2019m so sorry, doc. I didn\u2019t know you would hear what I just said. I don\u2019t know what came over me, I\u2019m just so tired.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cIt\u2019s okay, Linda, I understand. I do believe that Miki is on the right antibiotics. We are still waiting for the sputum test to tell me that, and we will also do a chest X-ray today to confirm that the pneumonia is not spreading more. Tracie, is there anything you would like to add?\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cI would like to have Physio come over to see her and get her moving a bit more.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cI think that is a very good idea. I will write the order. They may not come today, but that doesn\u2019t mean Ms. Huang cannot sit in a chair or stand at the bedside. I don\u2019t want her doing too much, but she does need to move a bit more.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cWe can do the chair. What about the bathroom?\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cCommode at bedside until she is below 50% oxygen. Anything else?\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cAlexa the RT said she would wait to do another blood gas as her sats are okay right now.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cI agree. But I will write an order for another blood gas tomorrow morning to see how we stand with CO2 and PaO2. I want to ensure that her COPD does not get worse as well. At this point, our other option is BiPAP (a non-invasive ventilation device which applies different levels of positive pressure in the airways during inhalation and exhalation to allow for easier ventilation), which I\u2019m pretty sure Ms. Huang will not be happy with, so let\u2019s see if we can manage her without going to intensive care.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cThank you. I think that will do. Ms. Huang and Linda, do you have any questions?\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cNo, I think we\u2019re good for now,\u201d Linda answers. Miki, who hadn\u2019t been translated for this entire time, remains silent. She was trying hard not to be irritated as she knew that her daughter was already trying her best, but it was not easy constantly being out of the loop especially when she was the topic of discussion.<\/p>\n<\/div>\n

\n

 <\/p>\n

Both Dr. Hunicutt and Tracie smile, nod at the mother-daughter duo, and then leave the room.<\/p>\n<\/div>\n

\n

 <\/p>\n

Outside the room, Dr. Hunicutt asks if anything else needs to be done. Tracie points to a couple of other rooms where she has patients and explains that two patients need discharge orders, and two others need lab work looked at, as pharmacy is stating that antibiotic coverage may not be appropriate. Dr. Hunicutt nods his head and gives her the thumbs up sign as he heads to the chart rack to begin the process of discharge and looking at labs.<\/p>\n<\/div>\n

\n

 <\/p>\n

Tracie begins the process of recording the interaction with Dr. Hunicutt and Miki, making sure to include Linda\u2019s role and presence.<\/p>\n<\/div>\n

\n

 <\/p>\n

Over the course of the day, Tracie was able to get Miki up twice to the bedside commode and twice to a chair for 30 minutes each time. Miki\u2019s saturation stayed stable along with her other vitals signs.<\/p>\n<\/div>\n

\n

 <\/p>\n

When the shift change rolled around, Tracie was very happy to see Jim come into the unit. \u201cWow, I did not think I would see you tonight.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cMe either. They called me for overtime during my chaperoning of a school trip.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cMan, you must be exhausted.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cYeah, but no more than usual. Got some shuteye before coming in. Anyway, how was your day?\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

Tracie gives an overall report of two discharges and two new admissions. She updates Jim on changes to Miki\u2019s oxygen levels and her increased orders for activity.<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cAwesome, thanks. Will I see you in the morning?\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cI believe you will. I\u2019m doing four days in a row. I traded my night shifts so I could attend a play with my husband. We have had so little time together with him finishing his PhD, and my shift work. He promised not to talk research and take me out on a real date if I would change my night shifts.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cWow, I am so jealous. Well, have a good sleep and we will see you in the morning.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cGood night!\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

While this exchange was happening, Miki and Linda are having their own conversation, or rather, altercation, back in the room.<\/p>\n<\/div>\n

\n
\"Miki
Day 2 – While wearing a breathing mask, Miki is arguing with Linda. Image created by Sarah Pinault under a CC-BY-NC license<\/span><\/figcaption><\/figure>\n

\u201cWhat\u2019s the point of having you here if you\u2019re not going to tell me anything they\u2019re saying?\u201d Miki says in an accusatory tone.<\/p>\n<\/div>\n

\n

 <\/p>\n

Linda throws up her hands, \u201cI don\u2019t know what you want me to say! You can\u2019t actually expect me to translate word for word every single thing that\u2019s going on. It\u2019s too much, you should know that.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cThe very least you could do is not act like I\u2019m not even here. Would an actual translator do that?\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cMaybe we should just get you an actual translator then. You think I\u2019m having fun right now?\u201d Linda snaps back. \u201cI have missed how many days of work now and you haven\u2019t even uttered a single \u2018thank you\u2019.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cWorks for me. At least an actual translator wouldn\u2019t consent to things on my behalf without consulting me first.\u201d Miki answers scornfully.<\/p>\n<\/div>\n

\n

 <\/p>\n

\u201cThat wasn\u2019t even that big of a deal!\u201d Linda cries out. \u201cThat was literally just to take your blood. If you want to be involved so bad, maybe you should\u2019ve learned English then!\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

Taken aback by the volume of her normally quiet daughter\u2019s voice, Miki pauses. \u201cI don\u2019t know. I\u2019m sorry. Everything is just so different here, but I know how tired you must be. I miss home.\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

Somehow, Linda knew that the home her mother was referring to was Taiwan and not their townhouse a few blocks away. \u201cI\u2019m sorry too. I shouldn\u2019t have said that. I know you\u2019re doing your best to adjust to this new environment. I\u2019ll try to keep you in the loop more from now on. Say, even the food is making it difficult, huh?\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

Miki cracked a small smile. \u201cOh god. What is it with these people and their Jell-O. Don\u2019t they know the perfect desserts shouldn\u2019t be too sweet?\u201d<\/p>\n<\/div>\n

\n

 <\/p>\n

Smiling herself, Linda reaches out to pat her mother\u2019s wrinkled hand. \u201cDon\u2019t worry, Mom, we\u2019ll be home before you know it.\u201d<\/p>\n<\/div>\n

Adaptations<\/h1>\n

This section has been from Health Case Studies<\/a> by Glynda Rees, Rob Kruger, and Janet Morrison.<\/p>\n","protected":false},"author":103,"menu_order":6,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":["aliao01"],"pb_section_license":""},"chapter-type":[],"contributor":[68],"license":[],"class_list":["post-642","chapter","type-chapter","status-publish","hentry","contributor-aliao01"],"part":631,"_links":{"self":[{"href":"https:\/\/pressbooks.bccampus.ca\/dcbiol2200\/wp-json\/pressbooks\/v2\/chapters\/642","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.bccampus.ca\/dcbiol2200\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.bccampus.ca\/dcbiol2200\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/dcbiol2200\/wp-json\/wp\/v2\/users\/103"}],"version-history":[{"count":0,"href":"https:\/\/pressbooks.bccampus.ca\/dcbiol2200\/wp-json\/pressbooks\/v2\/chapters\/642\/revisions"}],"part":[{"href":"https:\/\/pressbooks.bccampus.ca\/dcbiol2200\/wp-json\/pressbooks\/v2\/parts\/631"}],"metadata":[{"href":"https:\/\/pressbooks.bccampus.ca\/dcbiol2200\/wp-json\/pressbooks\/v2\/chapters\/642\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.bccampus.ca\/dcbiol2200\/wp-json\/wp\/v2\/media?parent=642"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/dcbiol2200\/wp-json\/pressbooks\/v2\/chapter-type?post=642"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/dcbiol2200\/wp-json\/wp\/v2\/contributor?post=642"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/dcbiol2200\/wp-json\/wp\/v2\/license?post=642"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}