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.... :)

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.

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?

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?

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...