It's been a while...life gets crazy, but everything happens for a reason and inevitably works out for the best.
Only a few more days of class left. Mental health is over, only one more exam next Thursday for Adult Nursing, and plowing through Maternal Child to finish in time (a class that went from being 5 credits last year to 3 now). I'll probably pull through with B's in each, which I am more than happy with (especially when the nursing adage is "C's get degrees...").
I'm finished with clinical for the semester, and my last clinical went out with a bang. Lessons learned...don't tell an adolescent girl who came in with a compound tib/fib fracture that your more than happy to entertain her, especially because she is the only patient and you have nothing else to do. Not thirty minutes later, she seized and a code blue was called for her...(Another lesson learned: crash carts are plugged in...so it's advantageous to unplug them before you try to fly down the hall with them!!) Her twin sister had epilepsy, but her family never knew the patient may have it also. (They were doing a work-up when I left clinical that day to rule out electrolyte imbalances, etc.) She was a sweetheart, and I hope everything turns out well for her. Taking care of teenage girls in the healthcare setting, you either love them or hate them.
There was one other patient on the unit, but she was a 1:1 because she'd try to kill herself with Tylenol a few days prior. Her boyfriend had gotten into some serious trouble and landed himself a nice, long-term, all-expense paid trip to prison, and she didn't know how to cope. This is so tragic to me...I could never fathom suicide, but this was an older girl with a crappy home life, parents that argued over who got to "deal with her" because they were "too busy", no idea what she wanted to do with her life, and who based everything in her life around her boyfriend. Once the Mucomyst clears up her liver function tests, (if it will, completely) she's supposed to go to a mental treatment facility out of town, to which she adamantly refuses. Tylenol is such a horrible way to die...people don't realize how horrible it is on your body, and how badly it screws up your liver, followed by so many other health problems.
So that was Peds...definitely not boring! I loved observing on labor & delivery, much to my surprise. the nurses were great, and when they found out I was contemplating eventually becoming a nurse anesthetist, hooked me up with Jeff, the CRNA for the floor. He went out of his way showing and explaining what he was doing with the epidurals. I also got to watch three C-sections. I'm not sentimental, but watching the babies come out and take their first breaths was pretty cool. The last patient had a severe case of gestation diabetes. The surgeon was literally elbow deep in her abdomen, and the baby ended up weighing over 11 pounds!!
I also got to walk through the NICU with my instructor, and saw this tiny little baby who weighed one pound when she was born. She was so incredibly tiny. I talked with her nurse, who noted that it was the "feisty" ones who seemed to have the best prognosis.
When I was observing in the newborn nursery, we had a newborn detoxing. The mom admitted to using marijuana, but who knows what else she took. She said she smoked three times a week to help alleviate the nausea. The nurse mentioned that since the medical marijuana laws went into effect, the general public had seemed to believe that it wouldn't have any harmful effects on pregnancies.
I wish every high school girl could spend an hour with this poor baby. He was clearly agitated, with a high-pitched cry that reminded me of newborn puppies. He couldn't be comforted, and only wanted to self-comfort by sucking on his hands. I found out a week later that he ended up in NICU. I wondered what kind of life this baby would have, and couldn't help but think about hat anti-drug commercial, where the boy is supposed to be watching his little sister, who is about 4. He gets high, and eventually realizes she's drowned in the family pool. I asked if the social worker would be contacted, and the nurse said she would, but the SW was so tied up with meth babies that nothing would come out of his case.
Don't judge the parents...educate them. Easier said than done sometimes...
Post-partum was my least favorite clinical, because there really wasn't anything to do. I definitely don't want to work in OB. The nurses were good, but it was a little too relaxed. Maybe I saw a down day, but it also seemed repetitive. It would be great for a nurse who liked educating parents, but it's not for me.
I had another observation at a local peds clinic. I don't think that would be my thing either, because I hate giving shots to kids. There was one girl who had to come in over three days for IM antibiotics, and she took one look at the nurse and screamed.
Losing my social life over weekends spent doing patient work-ups, bibs for diseases, and making med cards, getting up at 5:00am to make it to the hospital by 6:00am for Monday and Tuesday clinicals, cramming Tuesday, Wednesday, and Thursday for the three consecutive Wednesday, Thursday, and Friday exams, and repeating this crazy schedule every weekend...it's torture, but you're almost too busy to even notice how stressed you are. You just focus on the next thing that needs to get done, and try to stay away from the people who chronically complain about everything.
And then all of a sudden it's over, and you have five days all to yourself, and you're so bored you don't know what to do... =) (not that I'm complaining!!)
Friday, April 24, 2009
Sunday, March 8, 2009
musical directions for a nurse...
i found this just now from http://www.impactednurse.com/?p=793 , and love it:
Nursing, like music, is a science best served as art.
But unlike musicians, we often loose our way. We are not very good at finding our voice, or for that matter, in providing direction to our nursing kin on the subtitles of timbre and pace that flux and dance across our shift.
Is it any wonder that some wards end up resonating with dissonance and disharmony?
Lets have a look at some of the notations used to guide the musicians through their own score and transpose them into out own profession.
Anima Soul
Appassionato Passionately
Oh gosh, don’t just be a 9-5 nurse. Be a Beethoven. Be a Bono. Be a Miles Davis.
Look at what you have. Nursing can move and lift and heal. How many other professions can make the sort of differences to people that ours can. You know what I mean. Find your instrument and find your muse.
Nurse with bravura.
Bravura (With) boldness and spirit
Colla voce (lit. with the voice.) To follow the solo instrument or voice
There are times when you will have your own solos, and there are times when you must follow others. Whether it be senior staff, doctors, hospital policy, or patients wishes.
Appreciate the talents of your fellow musicians. Learn when to listen, and when to provide an expert accompaniment to the voice.
Dolore Grief, sorrow
Managing grief whether it be a patients or your own, is yet another skill you will need to play the piece well. The secret is, that it is no skill at all. As long as you are authentic the right music will come. And in its own time, the grief will fade.
Duo A duet
Dont forget to buddy. Two of you is far more powerful than one of you. Drawing up drugs, debriefing, planning care, performing interventions. Always look for the duet.
Legato . Smooth
Lento Slow
Smooth and slow, some of the best direction you will get. Even when the situation calls for rapid, urgent response the trick is to stay in the music. Smooth and slow will ultimately be much quicker and far more effective than hurried and rough.
The ability to remain focused and calm as others around you blow up in an uncontrolled crescendo, is one of the hallmarks of a great nurse. It is a skill like any other. And with practice it will improve. That’s what separates a great musician from a hack. Practice, practice, practice.
Lontano As from a distance
There is time for getting in real close, squeezing the juice out of every note. Pressing your cheek against the ink of the staves. But there are also times when it is important to maintain a little professional distancing from your work. There are instances when the best thing you can do for your patient is to remain off stage. Dont get caught up in their drama, even when its particularly…er…dramatic. By keeping some internal perspective, the correct course of action will be far more evident.
Of course, there are times when you need to maintain a very physical distance from the music. The orchestra can be a dangerous place. Exit stage left.
Lunga pausa A long pause
Perhaps one of the most powerful communication techniques there are. When talking to your patients or taking a history make sure you give them space to tell you what they want to say as well as what you want to hear.
If a patient is trying to tell you something important, or if your own gut feeling is that there is something else going on that for whatever reason has remained unspoken, wait till they have finished speaking and then leave a long attentive pause. If they don’t speak, remain with it. Just wait quietly.
Alternatively, ask them if there is anything else they need to say and then pause at the end of their reply.
Often this space will open a much deeper level of conversation, cutting through to the important stuff.
Its not easy to do, and shouldn’t be used all the time, but just as in a piece of music: the space between the notes can sometimes be more important than the notes themselves
Misterioso Mysterious
There are great mysteries within the hospital. They run quiet counterpoint, often far below the dense chords of science and technology that pulls at our attention with all its sharps and flats.
Being open to this mystery is an important part of the art of nursing. Listen carefully.
Obbligato Indispensable, cannot be omitted
There are things that you must do or must know that are indispensable. Know them and do them.
Prestissimo As fast as possible
This is the way you are going to have to eat your meals, ’cause there are twenty other things you need to be doing.
This is the way you are going to have to empty your maxed-out bladder, ’cause there are five patients all wanting a bedpan….now.
It has always been this way. It always will be.
Scherzando Playful
- Nurse soft. Play hard.
- Swap densities as required.
Senza Sordini Without mutes
Now, more than any other time in its history, nursing needs a voice. Speak up. Step up onto the rostrum and conduct.
Find your own drum and do not be afraid to hit it loudly with a big mallet if a strong beat is what is required. Gather your best players and go out into the world and show them your art.
Troppo . . Too much
Going Troppo is a real risk for nurses who fail to care for their instruments. You need to look after yourself and find your own balance point. Just like the strings of a violin, if the tension is too loose, everything sags, your work becomes sloppy. And it quikly effects the strings around you. But if you wind yourself too tighly, your sound becomes harsh and sctatchy, and at a very real risk of breaking.
Volti subito (v.s.) Turn the page quickly
You can never play the same sheet of music exactly the same twice. So, play the phrase and then move on. There is probably going to be something even more interesting just over the page.
surgical day care, palliative care rotations
i just found out it's daylight savings time, already! (that might explain how i slept in so late!) =) luckily chris is more on top of these things than i am...
i'm in the middle of my "community" clinicals, which has been like a vacation since we don't have to do our lengthy work-ups before we go. (for orth, surgical, medical, etc. we have to do a full patient work-up, which takes about 2 hours, then complete the bibs of all their medical diagnoses and highlight, which can take anywhere from 2 to 4 hours, do two care plans, which takes about 45 minutes to an hour each, and pull and highlight med cards for each med they're taking. if it's not in the nursing med deck, we have to make one. finding all the information is torture. so the weekend before clinicals (on monday and tuesdays) i do nothing but patient work-ups.
aaaand, if your patient leaves (either celestial discharge or goes home) before your two-day clinical rotation is up, you are lucky enough to get to do one of these for another patient. overnight. knock on wood, i've been lucky enough to not have to do this. (i try to pick patients who are obese and/or diabetic, because they seem to have longer hospital stays. so yes, i am greatly appreciating my two weeks of community clinical. :)
last week i went to the surgical day care at the community clinic and watched the ENT surgeon perform two tonsillectomies and two septoplasties. it was a pretty slow day, but i was happy to get to see something besides fifteen cataract surgeries in a row. the surgeon was awesome. "you can't see anything back there. get up here and take a look..." he explained what he was doing, and i enjoyed watching him with the patients. i was really impressed with the surgical tech. i thought the RN would be doing more, but she mostly did computer charting, away from the table. the surg tech however, seemed as if she could read the doctor's mind. she'd pick up an instrument and hold it out to him without him even asking for it. i'm sure she's probably assisted on so many of these cases she could probably do the surgery herself, but it was still impressive.
i heard several horror stories about people passing out in the OR, and i really did not want to be one of those people! one girl told me she passed out...right into the surgeon's sterile field. (she was a primary nurse on my ortho rotation). how embarrassing! i never eat breakfast (my stomach is not awake at 6am!) but i did eat three pieces of lunch meat, (very nutritious...) just to have something in my stomach. looking back i'm not sure if that was such a good idea. once the surgery started, my curiosity overtook my paranoia and i was fine. i like watching surgeries, but i don't think an OR nurse would be the job for me.
one thing that amazed me was watching the nurse anesthetist. he'd complete his assessments (about every 15 minutes) and then go back to his Sudoku puzzle. i didn't think it was that big of a deal really, because his machines would beep periodically if something was out of range. i started to wonder if he was really paying attention to his job though, when i noticed the patient's bag of LR was getting low. the nurse got a new bag and put it next to the old one so it'd be right there when his old one needed to be changed. i watched the bag drain from the "9" mark, to the very bottom, and decided i wouldn't say anything unless the bag was completely emptied. which...about five minutes later, the last drop had been squeezed out of the bag and the drip chamber was slowly draining. i asked the surgical tech if the bag was okay, and she looked at it, and told the CRNA to change it.
on tuesday i went back to the hospital to shadow the palliative care coordinator. i had no idea what to expect from this clinical, but i love the nurse who oversees it, Edie. I got to the hospice house at 8:30am, and we set off for rounds. she goes to the ICU, CCU, CICU, and PCU rounds, and is available for patients to speak with regarding hospice care, if their prognosis is poor, or for palliative care, if they have a chronic disease or condition. i don't think people really understand what the difference is between palliative and hospice care, and tend to freak out a little when someone comes into their room from palliative care.
I thought the ICU rounds were the best. the doctor truly seemed like he was the most organized, and arranged for multidisciplinary walking rounds. it was a crowd, but everyone was on the same page and knew what they had to do. it was the physician, the dietitian, Edie, the pharmacist, the chaplain, the respiratory therapist, speech pathologist, social worker, and two unit managers. i loved being on ICU, and still think that's where my calling is. being in the patients' rooms and actually seeing how much equipment they're hooked up to was a little daunting, but i really like the critical thinking aspect of it, trying to figure out what's going on, and how it's affecting other body systems.
once rounds were done, Edie had an appointment with a patient's wife. he wasn't doing well, and was being kept alive by the machines. his wife was in her mid-fifties, at the latest. two physicians were in the meeting, along with an RN, the chaplain, and Edie. she wanted to take her husband off life support on friday, when her family could be there. she seemed so calm, almost stoic for the first part of the meeting, and i started to wonder about her. halfway through the meeting she broke down, which was hard to watch. seeing other people cry always makes me tear up. she pulled herself together shortly, and we finished the meeting.
i asked Edie about her later on, because i was curious about her coping mechanisms and what Edie thought of them. she mentioned that she'd be worried if she hadn't broken down at some point during their conversations, but seeing that she had, and how well she pulled herself together made Edie think she was coping and not denying the whole ordeal.
it made me somber friday morning, writing my paper about these two clinical rotations for my instructor, and realizing that a couple blocks away, this woman was saying good-bye to her husband...
i'm in the middle of my "community" clinicals, which has been like a vacation since we don't have to do our lengthy work-ups before we go. (for orth, surgical, medical, etc. we have to do a full patient work-up, which takes about 2 hours, then complete the bibs of all their medical diagnoses and highlight, which can take anywhere from 2 to 4 hours, do two care plans, which takes about 45 minutes to an hour each, and pull and highlight med cards for each med they're taking. if it's not in the nursing med deck, we have to make one. finding all the information is torture. so the weekend before clinicals (on monday and tuesdays) i do nothing but patient work-ups.
aaaand, if your patient leaves (either celestial discharge or goes home) before your two-day clinical rotation is up, you are lucky enough to get to do one of these for another patient. overnight. knock on wood, i've been lucky enough to not have to do this. (i try to pick patients who are obese and/or diabetic, because they seem to have longer hospital stays. so yes, i am greatly appreciating my two weeks of community clinical. :)
last week i went to the surgical day care at the community clinic and watched the ENT surgeon perform two tonsillectomies and two septoplasties. it was a pretty slow day, but i was happy to get to see something besides fifteen cataract surgeries in a row. the surgeon was awesome. "you can't see anything back there. get up here and take a look..." he explained what he was doing, and i enjoyed watching him with the patients. i was really impressed with the surgical tech. i thought the RN would be doing more, but she mostly did computer charting, away from the table. the surg tech however, seemed as if she could read the doctor's mind. she'd pick up an instrument and hold it out to him without him even asking for it. i'm sure she's probably assisted on so many of these cases she could probably do the surgery herself, but it was still impressive.
i heard several horror stories about people passing out in the OR, and i really did not want to be one of those people! one girl told me she passed out...right into the surgeon's sterile field. (she was a primary nurse on my ortho rotation). how embarrassing! i never eat breakfast (my stomach is not awake at 6am!) but i did eat three pieces of lunch meat, (very nutritious...) just to have something in my stomach. looking back i'm not sure if that was such a good idea. once the surgery started, my curiosity overtook my paranoia and i was fine. i like watching surgeries, but i don't think an OR nurse would be the job for me.
one thing that amazed me was watching the nurse anesthetist. he'd complete his assessments (about every 15 minutes) and then go back to his Sudoku puzzle. i didn't think it was that big of a deal really, because his machines would beep periodically if something was out of range. i started to wonder if he was really paying attention to his job though, when i noticed the patient's bag of LR was getting low. the nurse got a new bag and put it next to the old one so it'd be right there when his old one needed to be changed. i watched the bag drain from the "9" mark, to the very bottom, and decided i wouldn't say anything unless the bag was completely emptied. which...about five minutes later, the last drop had been squeezed out of the bag and the drip chamber was slowly draining. i asked the surgical tech if the bag was okay, and she looked at it, and told the CRNA to change it.
on tuesday i went back to the hospital to shadow the palliative care coordinator. i had no idea what to expect from this clinical, but i love the nurse who oversees it, Edie. I got to the hospice house at 8:30am, and we set off for rounds. she goes to the ICU, CCU, CICU, and PCU rounds, and is available for patients to speak with regarding hospice care, if their prognosis is poor, or for palliative care, if they have a chronic disease or condition. i don't think people really understand what the difference is between palliative and hospice care, and tend to freak out a little when someone comes into their room from palliative care.
I thought the ICU rounds were the best. the doctor truly seemed like he was the most organized, and arranged for multidisciplinary walking rounds. it was a crowd, but everyone was on the same page and knew what they had to do. it was the physician, the dietitian, Edie, the pharmacist, the chaplain, the respiratory therapist, speech pathologist, social worker, and two unit managers. i loved being on ICU, and still think that's where my calling is. being in the patients' rooms and actually seeing how much equipment they're hooked up to was a little daunting, but i really like the critical thinking aspect of it, trying to figure out what's going on, and how it's affecting other body systems.
once rounds were done, Edie had an appointment with a patient's wife. he wasn't doing well, and was being kept alive by the machines. his wife was in her mid-fifties, at the latest. two physicians were in the meeting, along with an RN, the chaplain, and Edie. she wanted to take her husband off life support on friday, when her family could be there. she seemed so calm, almost stoic for the first part of the meeting, and i started to wonder about her. halfway through the meeting she broke down, which was hard to watch. seeing other people cry always makes me tear up. she pulled herself together shortly, and we finished the meeting.
i asked Edie about her later on, because i was curious about her coping mechanisms and what Edie thought of them. she mentioned that she'd be worried if she hadn't broken down at some point during their conversations, but seeing that she had, and how well she pulled herself together made Edie think she was coping and not denying the whole ordeal.
it made me somber friday morning, writing my paper about these two clinical rotations for my instructor, and realizing that a couple blocks away, this woman was saying good-bye to her husband...
Friday, February 27, 2009
it's friday!
another week of clinicals to cross out. =) i did my turn on surgical, which wasn't as hectic as ortho. the patient i picked up had an NG, which wasn't as complicated as i expected. i did ask another student to show me how to empty the container, because with my luck, had i done it by myself, i would've ended up with 300cc's of slimy green mucous all over the floor. not fun!
he was an awesome patient. i told him i was so extremely impressed with him because throughout nurses pushing his NG tube further down so it was where it was supposed to be (which caused him to gag and cough), repeated ultrasounds (where he had to 'take a small breath, annnnd hold' seriously about 25 times each ultrasound), changing his PICC line (a catheter threaded from his arm to his heart for IV fluids) to the other arm, and putting up with student nurses (two of us, two weeks in a row!) he never once complained. not once.
i enjoyed talking to him about his daughter. she came from out of town, and when she saw him her eyes welled up. as i helped him shower and get back into bed, i asked about her. his eyes lit up, and he just said, "isn't she beautiful?" i told him i could tell she was a daddy's girl as soon as she came in.
this week was the first week i really dealt with a lot of family members hanging around the room with my patient. it wasn't bad, but when i had to get a stool sample from his colostomy, i was happy they left. i don't have any problems with working with patients, but i feel awkward working around the family....
i loved helping his primary nurse change his dressing on his abdomen. he had no stitches or staples. it was an open wound that we assessed, then put tegaderm over the intact skin, cut out holes for where the wound was open, and cut a sponge to fit the open wound, then placed a clear adhesive drape over the whole thing. last a "foot" is put in the center of the sponges and hooked to the vacuum. once the wound vac was turned on, the negative pressure sucks the sponge down into the wound bed and helps pull the wound edges together.
speaking of wounds, i heard of a division the Army added a few months ago called "AFIRM". According to the Newsweek article,
"War may be hell, but it has a way of accelerating medical research. World War I brought methods for collecting and preserving blood for transfusions. World War II saw the introduction of penicillin into medical practice. One day, medical historians may remember Iraq and Afghanistan for spurring regenerative medicine, a grab bag of techniques that share the same end—to repair human bodies by helping them regenerate living tissue, rather than relying on artificial parts."
the article showed pictures of a spray gun that sprays a person's own stem cells over an area that needs new skin growth, and a few weeks later, the person has regenerated their own skin. they're in the process of working on kidneys, etc.
imagine what that research will lead to in the next 20 years.... :)
he was an awesome patient. i told him i was so extremely impressed with him because throughout nurses pushing his NG tube further down so it was where it was supposed to be (which caused him to gag and cough), repeated ultrasounds (where he had to 'take a small breath, annnnd hold' seriously about 25 times each ultrasound), changing his PICC line (a catheter threaded from his arm to his heart for IV fluids) to the other arm, and putting up with student nurses (two of us, two weeks in a row!) he never once complained. not once.
i enjoyed talking to him about his daughter. she came from out of town, and when she saw him her eyes welled up. as i helped him shower and get back into bed, i asked about her. his eyes lit up, and he just said, "isn't she beautiful?" i told him i could tell she was a daddy's girl as soon as she came in.
this week was the first week i really dealt with a lot of family members hanging around the room with my patient. it wasn't bad, but when i had to get a stool sample from his colostomy, i was happy they left. i don't have any problems with working with patients, but i feel awkward working around the family....
i loved helping his primary nurse change his dressing on his abdomen. he had no stitches or staples. it was an open wound that we assessed, then put tegaderm over the intact skin, cut out holes for where the wound was open, and cut a sponge to fit the open wound, then placed a clear adhesive drape over the whole thing. last a "foot" is put in the center of the sponges and hooked to the vacuum. once the wound vac was turned on, the negative pressure sucks the sponge down into the wound bed and helps pull the wound edges together.
speaking of wounds, i heard of a division the Army added a few months ago called "AFIRM". According to the Newsweek article,
"War may be hell, but it has a way of accelerating medical research. World War I brought methods for collecting and preserving blood for transfusions. World War II saw the introduction of penicillin into medical practice. One day, medical historians may remember Iraq and Afghanistan for spurring regenerative medicine, a grab bag of techniques that share the same end—to repair human bodies by helping them regenerate living tissue, rather than relying on artificial parts."
the article showed pictures of a spray gun that sprays a person's own stem cells over an area that needs new skin growth, and a few weeks later, the person has regenerated their own skin. they're in the process of working on kidneys, etc.
imagine what that research will lead to in the next 20 years.... :)
Sunday, February 15, 2009
DNR???
I went to the surgical floor to pick up my next patient this afternoon. Since Monday is President's Day, we don't have clinicals and i'll only have this patient for one day, so i took my instructor's advice and picked someone easy. (and from what i work i did, she is the epitome of easy). she was in for post-lap gastric ulcer, had two meds (protonix and morphine PCA). she does have two JP drains from her surgery and an NG (nasogastric) tube attached to LIS (low intermittent suction), which i haven't worked with yet, but i'll read up on those before i go in Tuesday morning.
so i come home after going to Starbuck's for my venti caramel machiatto, hoping that'll wake me up a little so i can get some studying done. i watch "gangland" (no wonder LAPD are so squirrely; look at what they're dealing with...) and fall asleep for like, 2 hours. i've always dreamed vividly, and i ended up dreaming about my patient. except in my dream she was a guy, and instead of him being in a hospital room, his patient room is located in my school. i'm getting ready for clinical, and everything seems to be going well. i leave to go to lunch,and i hear "code blue, [pt room #]". uh oh...i run back to the room and a doctor and some nurses announcing his time of death. because he was a DNR. in typical dream fashion his body is no longer there, and i'm picking my nursing books up off his bed, and feeling weird about the fact that he was there one minute, and gone the next, and dreading the idea of having to complete an entire new work-up overnight.
i wake up, disoriented, until i realize that my patient is actually female and that it was just a dream. but it got me to thinking about how much i don't understand DNRs, which is something i definitely need to brush up on...
btw, my paranoia of losing my clinical patient before clinicals are finished isn't completely unfounded...a girl in my class had her patient die right before her Rehab clinical, and she had to do another workup. overnight. ugh. Who dies on rehab? (it's not drug rehab, but physical and occupational therapy rehab).
i went in and talked to my nursing instructor about the whole situation with the young patient on rehab last week. i'm glad i waited to write about it and talk to my mom about the situation before talking about it in class. i don't think i would've said what i was feeling coherently and probably would've pissed some girls off in my class. my teacher was great. it helped talking about it, and she said she wanted to bring it up in next week's mental health class to see what the rest of the class thought of it...(blaming the pathological process, not the patient).
i did get a few hours of studying in (maternal-child nursing).
i never knew giving birth entailed giving up so much dignity.
so i come home after going to Starbuck's for my venti caramel machiatto, hoping that'll wake me up a little so i can get some studying done. i watch "gangland" (no wonder LAPD are so squirrely; look at what they're dealing with...) and fall asleep for like, 2 hours. i've always dreamed vividly, and i ended up dreaming about my patient. except in my dream she was a guy, and instead of him being in a hospital room, his patient room is located in my school. i'm getting ready for clinical, and everything seems to be going well. i leave to go to lunch,and i hear "code blue, [pt room #]". uh oh...i run back to the room and a doctor and some nurses announcing his time of death. because he was a DNR. in typical dream fashion his body is no longer there, and i'm picking my nursing books up off his bed, and feeling weird about the fact that he was there one minute, and gone the next, and dreading the idea of having to complete an entire new work-up overnight.
i wake up, disoriented, until i realize that my patient is actually female and that it was just a dream. but it got me to thinking about how much i don't understand DNRs, which is something i definitely need to brush up on...
btw, my paranoia of losing my clinical patient before clinicals are finished isn't completely unfounded...a girl in my class had her patient die right before her Rehab clinical, and she had to do another workup. overnight. ugh. Who dies on rehab? (it's not drug rehab, but physical and occupational therapy rehab).
i went in and talked to my nursing instructor about the whole situation with the young patient on rehab last week. i'm glad i waited to write about it and talk to my mom about the situation before talking about it in class. i don't think i would've said what i was feeling coherently and probably would've pissed some girls off in my class. my teacher was great. it helped talking about it, and she said she wanted to bring it up in next week's mental health class to see what the rest of the class thought of it...(blaming the pathological process, not the patient).
i did get a few hours of studying in (maternal-child nursing).
i never knew giving birth entailed giving up so much dignity.
Wednesday, February 11, 2009
predatory criminal or TBI patient?
i'm sitting in mental health this morning, and my teacher brings up the code white incident from yesterday. she was upset because she felt like her students were in danger, which is understandable. she encouraged us to talk about what happened with the rest of the class. (five of us were there, the other 15 were at other clinical sites) i don't say anything, but two of the girls do. the first one doesn't even wait for my teacher to finish her sentence, and jumps in with how the kid made all these sexual innuendos to her, and then would follow with, "just kidding." the other would elaborate, "man, i don't even know how i jumped over that desk to get the phone..." and both egged each other on, happy to be in the spotlight and dishing out all the juicy details.
yes, he was endangering others, including patients.
yes, he was inappropriate with his comments and actions.
yes, i agree that maybe a rehab unit is not the best place for him to be.
but he is still a patient...not someone to criticize and judge and talk about restraining like some predatory criminal. after he was in soft restraints, tied to his bed, he actually said, "thank you..." almost as if he was aware of how out of line he was being, but didn't know how to control himself.
did no one else see that this is a young kid, stuck on a unit with a bunch of people several times his age, all of whom are recuperating from strokes and brand new hips, who is becoming increasingly agitated because he has nothing to do? he walked from person to person, and literally begged to help. and as each person shrugged him off and walked away, he became more upset.
i totally agree with my teacher, and i appreciate that she's so protective of us. maybe i'm more sensitive about the TBI thing because of Iraq and because of a close family member that had a bad brain injury when i was young, but it was hard sitting there listening to comments about this patient.
what if all nurses treated patients with brain injuries this way?
yes, he was endangering others, including patients.
yes, he was inappropriate with his comments and actions.
yes, i agree that maybe a rehab unit is not the best place for him to be.
but he is still a patient...not someone to criticize and judge and talk about restraining like some predatory criminal. after he was in soft restraints, tied to his bed, he actually said, "thank you..." almost as if he was aware of how out of line he was being, but didn't know how to control himself.
did no one else see that this is a young kid, stuck on a unit with a bunch of people several times his age, all of whom are recuperating from strokes and brand new hips, who is becoming increasingly agitated because he has nothing to do? he walked from person to person, and literally begged to help. and as each person shrugged him off and walked away, he became more upset.
i totally agree with my teacher, and i appreciate that she's so protective of us. maybe i'm more sensitive about the TBI thing because of Iraq and because of a close family member that had a bad brain injury when i was young, but it was hard sitting there listening to comments about this patient.
what if all nurses treated patients with brain injuries this way?
Tuesday, February 10, 2009
code white...
second week on rehab. i picked up a man who suffered a right cerebral artery infarct (aka stroke) in the beginning of last december. reading his H&P, i was amazed he made it to rehab. he was supposed to go to hospice because he declined so rapidly, but then started getting better. now he almost has regained use of his left arm and can walk with assistance. before his stroke he didn't have anything major going on...it's hard to imagine going from being completely independent to that disabled overnight. he was pretty easy to take care of. i'm hoping i'll get a more challenging patient on my next rotation (surgical). i loved the nurses on rehab, but i doubt i'd want to end up working there. it's not as hectic, but it's too laid back for me.
there was a young male on the unit with a TBI (traumatic brain injury) who seemed fine at the beginning of the shift. he kept asking to help...eventually he just got frustrated and started spitting and hitting his CNA. he was restrained, but refused to walk, and laid on the floor instead. a woman came in wearing a pink shirt...pretty much a red flag to a bull. he went after her, which was scary because he's so much bigger than her. eventually they got him in soft restraints, after calling a code white and having 10 people barrel through the door. after it was over and i knew everyone was okay, i couldn't help feeling bad for him. it's through no fault of his own that he's injured, and he's cooped up with a bunch of people four times his age and has little to keep him occupied besides TV. one of the girls in my clinical group said he belonged in a mental facility, which i don't agree with. i don't think he needs something to that extreme, but yet he could clearly be a threat to himself and others on that unit. what do you do when you don't have an appropriate facility for a patient?
there was a young male on the unit with a TBI (traumatic brain injury) who seemed fine at the beginning of the shift. he kept asking to help...eventually he just got frustrated and started spitting and hitting his CNA. he was restrained, but refused to walk, and laid on the floor instead. a woman came in wearing a pink shirt...pretty much a red flag to a bull. he went after her, which was scary because he's so much bigger than her. eventually they got him in soft restraints, after calling a code white and having 10 people barrel through the door. after it was over and i knew everyone was okay, i couldn't help feeling bad for him. it's through no fault of his own that he's injured, and he's cooped up with a bunch of people four times his age and has little to keep him occupied besides TV. one of the girls in my clinical group said he belonged in a mental facility, which i don't agree with. i don't think he needs something to that extreme, but yet he could clearly be a threat to himself and others on that unit. what do you do when you don't have an appropriate facility for a patient?
Monday, February 2, 2009
1st clinical on rehab...
rehab clinical today...went well but i was a little bored. my patient was an older lady with osteoporosis and rheumatoid arthritis, post-total hip arthroplasty (she had a prosthesis put in). i hope i'm as healthy as she is when i get to be her age...it seems like a lot of the patients i've had have diabetes, are obese, and have other conditions stemming from poor nutrition. i asked what her secret was and she said it's important to eat well...no fast food and very little sugar. i'm pretty much screwed.
it was hard trying to get my assessments done and give her pills to her in between her occupational and physical therapy sessions, but i finally got them done. her doctor came in while i was getting ready to give her the meds. she was oriented x3, but when he came in she said, "hello Father!" (he did look a little like a priest because of the way he was dressed), which made us laugh. the other nurse made a joke about his head getting even bigger. he was really good with her, and i asked him about the vitamin D she was taking. (she's a big believer in vitamins). he was really patient with my questions, but i wasn't expecting him to start grilling me about her other meds...he wanted to know what her last INR lab value was (1.93), what it should be (2.0-3.0), why she's on Coumadin (prophylaxis of blood clots because of her immobility relating to her hip surgery), and what vitamin shouldn't be given with it (vitamin K, because it's the antidote and will counteract the Coumadin). my brain froze when i realized he was putting me on the spot, but eventually it started working again...i was blushing because i was embarrassed, but at least i managed to spit out the answers. =)
i'll have her again tomorrow. i enjoy talking with her, but i wouldn't mind a little more of a challenge. my group will be on rehab again next monday and tuesday, and i think i'll pick a patient who isn't so independent. i like the adrenaline rush of being busy, and rehab is pretty mellow. it's not quite as mellow as a LTC setting, but it's definitely not acute care either. at least with rehab, the patients usually always get better and go home.
jen just called...she had her clinical in the ER fast track, which is staffed by LPNs and PAs, and designated for colds, stitches, shots, headaches, and other non-emergent situations when other clinics might not be available. just listening to her made me jealous, but i'll get there in the beginning of march. i love hearing stories of the ER...she was telling me about debriding an ankle wound almost 2 inches deep. gross, but interesting (to me, at least).
i caught up on the three episodes of grey's anatomy i'd dvr'ed a while ago. i don't know if i could handle working on peds, especially after watching the episode where the little boy almost dies from liver failure. i talked to one peds nurse when i was working as a pharm tech and asked her how she liked it. "you get used to little kids hating you..." she was joking, but it would be hard taking care of sick children who don't understand that you're trying to help them. i really shouldn't say i don't want to work in peds until after my clinical on that unit, so we'll see...
it was hard trying to get my assessments done and give her pills to her in between her occupational and physical therapy sessions, but i finally got them done. her doctor came in while i was getting ready to give her the meds. she was oriented x3, but when he came in she said, "hello Father!" (he did look a little like a priest because of the way he was dressed), which made us laugh. the other nurse made a joke about his head getting even bigger. he was really good with her, and i asked him about the vitamin D she was taking. (she's a big believer in vitamins). he was really patient with my questions, but i wasn't expecting him to start grilling me about her other meds...he wanted to know what her last INR lab value was (1.93), what it should be (2.0-3.0), why she's on Coumadin (prophylaxis of blood clots because of her immobility relating to her hip surgery), and what vitamin shouldn't be given with it (vitamin K, because it's the antidote and will counteract the Coumadin). my brain froze when i realized he was putting me on the spot, but eventually it started working again...i was blushing because i was embarrassed, but at least i managed to spit out the answers. =)
i'll have her again tomorrow. i enjoy talking with her, but i wouldn't mind a little more of a challenge. my group will be on rehab again next monday and tuesday, and i think i'll pick a patient who isn't so independent. i like the adrenaline rush of being busy, and rehab is pretty mellow. it's not quite as mellow as a LTC setting, but it's definitely not acute care either. at least with rehab, the patients usually always get better and go home.
jen just called...she had her clinical in the ER fast track, which is staffed by LPNs and PAs, and designated for colds, stitches, shots, headaches, and other non-emergent situations when other clinics might not be available. just listening to her made me jealous, but i'll get there in the beginning of march. i love hearing stories of the ER...she was telling me about debriding an ankle wound almost 2 inches deep. gross, but interesting (to me, at least).
i caught up on the three episodes of grey's anatomy i'd dvr'ed a while ago. i don't know if i could handle working on peds, especially after watching the episode where the little boy almost dies from liver failure. i talked to one peds nurse when i was working as a pharm tech and asked her how she liked it. "you get used to little kids hating you..." she was joking, but it would be hard taking care of sick children who don't understand that you're trying to help them. i really shouldn't say i don't want to work in peds until after my clinical on that unit, so we'll see...
Saturday, January 31, 2009
clinicals...
i thought about starting a blog when i first began nursing school last august, but honestly, i didn't have much to write about. the first semester was mostly studying nursing skills, starting with bed making (boring) and ending with how to give injections and take care of various drains and tubes (feeding, etc).
we had one clinical rotation in a local nursing home, which wasn't too exciting. i have respect for nurses who choose to work in long term care...but it's not for me. both of my residents were sweet, and i learned a lot from my second resident, who had diabetic neuropathy from her diabetes.
my class is made up of 20 students, 2 of them guys. there are a few strong personalities in my class, but not too much drama. girls will get upset, but usually nothing happens. last year's class was a little different...from what our instructors said, a cat fight broke out in the girl's room that had to be broken up. thank god that's not our class.
i have three instructors, each of whom i enjoy for different reasons. they're not intimidating or demeaning, unless you're not pulling your own weight. they're great in clinicals. i haven't figured out how they manage to make sure 4-5 students aren't getting into trouble.
for the first semester we took gerontology, pharmacology (being a pharmacy tech came in handy for that class), and adult nursing. this semester we have mental health (an eye-opening class...it's humbling to realize how ignorant i am regarding this subject), maternal-child nursing, and adult nursing. Maternal-child nursing is a great form of birth control for me, because not only are we learning about the birthing process (complete with pictures) but also about everything that can and will go wrong throughout pregnancy.
i love, love, love clinicals. my first rotation last week was on ortho. my patient was sweet but definitely told me what was on her mind. when i asked if she knew what her name was (to see how oriented she was) she told me something like Minnie Mouse, then laughed. she has poorly managed type II diabetes, diabetic retinopathy (she's legally blind), diabetic nephropathy (leading to end-stage renal failure and dialysis x3 week), and was in the hospital because tripped and fell, breaking her left femur and right humerus. her care plans were easy...risk for skin breakdown and immobility.
she was also noncompliant with her insulin. her blood sugar was 191 (normal is 70-110), which needed insulin to bring it down (the insulin drives the sugar into the body's cells and out of the blood...the cells need the sugar for energy to carry out their various functions). i think she had a couple episodes of "crashing" when maybe the wrong insulin was used (a long-acting instead of a regular-acting) and her blood sugar plummeted, which is not fun. she blatantly refused the insulin, and so i had no choice but to waste it (after i talked with her primary nurse and my instructor). on the second day her sugar was high again, so i drew it up, told her what i was doing, and gave it. she'd had dialysis that morning, and had received dilaudid also, so she was pretty out of it. (the night nurse gave her dilaudid while we did rounds, even though she had no pain...grrr, but not really my place to say anything to her. i did tell the primary nurse i thought my patient was overly sedated and she agreed to call the doctor and get her something else besides dilaudid).
i loved the primary nurse. lindy is an old school nurse, complete with starched white uniform and hat. maybe a little overbearing to some people, but i knew if anyone could help me learn to be a good nurse, it would be her. she's there first and foremost for her patients, and she doesn't care whose toes she steps on, as long as her patients get what they need. one thing i learned from her is the cleanliness of a patient's room indicates how good of nursing care they're receiving. after we repositioned our patient, she had me go through and get rid of the clutter, put away the extra pillows (ortho patients have tons of pillows), and i realized she was right. my patient's husband enjoyed the room being picked up, and it looked a lot better.
i'm skipping around, but i got to see her get dialysis that morning. the dialysis RN came in with her machines and was awesome at answering my questions and explaining to me what was happening. my patient had a fistula (where they have an artery and vein surgically attached for dialysis). every shift i had to check for the "thrill" (which it really was amazing!) just by barely touching the fistula. it feels like a lot of water rushing through a really thin hose. i was afraid i was going to bump something while she was having her dialysis, (which would be bad...that much blood going out of the body would not be a good thing) but the RN reassured me as long as i was careful she'd be fine.
another thing i learned was the importance of checking patient identifiers. i gave meds on monday, and had spent the first 2 1/2 hours with her prior. i forgot to check her nametag (MAJOR mistake) and my instructor told me that might result in a U (U's are bad...get two in a row and you're out of the program). after i got my evaluation i realized she didn't give me the U after all, thankfully. i hate making mistakes, but i have to admit, i learn the best from them. i'll never do that again...
it's stressful getting the work-ups and care plans done for clinicals, and trying to study for everything else on top of clinicals, but it's worth it. six months left...(we have nursing management and IV therapy in the summer) and i'll finally be a nurse. :)
we had one clinical rotation in a local nursing home, which wasn't too exciting. i have respect for nurses who choose to work in long term care...but it's not for me. both of my residents were sweet, and i learned a lot from my second resident, who had diabetic neuropathy from her diabetes.
my class is made up of 20 students, 2 of them guys. there are a few strong personalities in my class, but not too much drama. girls will get upset, but usually nothing happens. last year's class was a little different...from what our instructors said, a cat fight broke out in the girl's room that had to be broken up. thank god that's not our class.
i have three instructors, each of whom i enjoy for different reasons. they're not intimidating or demeaning, unless you're not pulling your own weight. they're great in clinicals. i haven't figured out how they manage to make sure 4-5 students aren't getting into trouble.
for the first semester we took gerontology, pharmacology (being a pharmacy tech came in handy for that class), and adult nursing. this semester we have mental health (an eye-opening class...it's humbling to realize how ignorant i am regarding this subject), maternal-child nursing, and adult nursing. Maternal-child nursing is a great form of birth control for me, because not only are we learning about the birthing process (complete with pictures) but also about everything that can and will go wrong throughout pregnancy.
i love, love, love clinicals. my first rotation last week was on ortho. my patient was sweet but definitely told me what was on her mind. when i asked if she knew what her name was (to see how oriented she was) she told me something like Minnie Mouse, then laughed. she has poorly managed type II diabetes, diabetic retinopathy (she's legally blind), diabetic nephropathy (leading to end-stage renal failure and dialysis x3 week), and was in the hospital because tripped and fell, breaking her left femur and right humerus. her care plans were easy...risk for skin breakdown and immobility.
she was also noncompliant with her insulin. her blood sugar was 191 (normal is 70-110), which needed insulin to bring it down (the insulin drives the sugar into the body's cells and out of the blood...the cells need the sugar for energy to carry out their various functions). i think she had a couple episodes of "crashing" when maybe the wrong insulin was used (a long-acting instead of a regular-acting) and her blood sugar plummeted, which is not fun. she blatantly refused the insulin, and so i had no choice but to waste it (after i talked with her primary nurse and my instructor). on the second day her sugar was high again, so i drew it up, told her what i was doing, and gave it. she'd had dialysis that morning, and had received dilaudid also, so she was pretty out of it. (the night nurse gave her dilaudid while we did rounds, even though she had no pain...grrr, but not really my place to say anything to her. i did tell the primary nurse i thought my patient was overly sedated and she agreed to call the doctor and get her something else besides dilaudid).
i loved the primary nurse. lindy is an old school nurse, complete with starched white uniform and hat. maybe a little overbearing to some people, but i knew if anyone could help me learn to be a good nurse, it would be her. she's there first and foremost for her patients, and she doesn't care whose toes she steps on, as long as her patients get what they need. one thing i learned from her is the cleanliness of a patient's room indicates how good of nursing care they're receiving. after we repositioned our patient, she had me go through and get rid of the clutter, put away the extra pillows (ortho patients have tons of pillows), and i realized she was right. my patient's husband enjoyed the room being picked up, and it looked a lot better.
i'm skipping around, but i got to see her get dialysis that morning. the dialysis RN came in with her machines and was awesome at answering my questions and explaining to me what was happening. my patient had a fistula (where they have an artery and vein surgically attached for dialysis). every shift i had to check for the "thrill" (which it really was amazing!) just by barely touching the fistula. it feels like a lot of water rushing through a really thin hose. i was afraid i was going to bump something while she was having her dialysis, (which would be bad...that much blood going out of the body would not be a good thing) but the RN reassured me as long as i was careful she'd be fine.
another thing i learned was the importance of checking patient identifiers. i gave meds on monday, and had spent the first 2 1/2 hours with her prior. i forgot to check her nametag (MAJOR mistake) and my instructor told me that might result in a U (U's are bad...get two in a row and you're out of the program). after i got my evaluation i realized she didn't give me the U after all, thankfully. i hate making mistakes, but i have to admit, i learn the best from them. i'll never do that again...
it's stressful getting the work-ups and care plans done for clinicals, and trying to study for everything else on top of clinicals, but it's worth it. six months left...(we have nursing management and IV therapy in the summer) and i'll finally be a nurse. :)
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