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. :)