OB Rotation 1

Here’s my paperwork that I had to turn in to give you an idea of what it was like.  Forgive the bullshit and the formality, won’t you?

       I arrived shortly after 07:00 and was assigned the patient mentioned above.  By 07:45, I had written down my patient’s history and started working with my assigned primary nurses.  One of the two nurses, Carlee, is a new orient herself, so she was very good for me to learn from as a nursing student; she was great at showing me things and teaching/explaining things to me throughout the day.

     At 07:45, I started patient care with my primary nurses.  I introduced myself to my patient, and then Carlee showed me how to increase the Pitocin running through my patient’s pump. We went in and increased it by 2 milliunits every 15 minutes all day.  Carlee allowed me to increase it all morning with her observation.

     The patient’s doctor broke her water with a fetal scalp monitor and then placed the monitor.  I was told that this doctor prefers to do this on most of his patients.

     The patient planned for an epidural for pain management and was ready for one midmorning.  We hung a Liter of fluid before the anesthesiologist administered the epidural. (I’ve learned that this is to help avoid a major hypotensive episode.)  Anesthesia doctor was great to the patient and was an incredibly good teacher to me, as well.  He talked me through his whole procedure and showed me that he did a combination spinal/epidural.  He explained the spinal portion gave more immediate relief; the epidural was for long term and had a catheter for administration of more meds later.

As far as support for the patient, the patient’s husband stayed at the bedside all day, though he slept most of the time.  He was also unable to stay for the spinal/epidural, but I think that was more out of being squeamish, and not a lack of support.  One set of the grandparents-to-be visited for a short time as well.

     The patient seemed to be coping well all day.  In the afternoon, she requested more pain medication which was administered by a SRNA.  When we asked her a pain scale, she said that she wasn’t experiencing pain, but much more pressure than she had earlier.  I also observed that she had a cough, but she wasn’t on any antibiotics or other meds for it while I was in clinical.

     I got to do an in-and-out cath on her!  I have only done ‘foley’ catheters, but my primary nurses assured me that the procedure was the same, just no balloon and removal of the catheter right after the bladder empties.  I was really glad they allowed me to perform the procedure. 

     I explained to the patient that it should be done because she wouldn’t feel the urge to void.  I also assured her it would not cause pain, (it really shouldn’t have for her because of the epidural) what the procedure consisted of, and that it would take longer for me to set it up than to actually perform the procedure.  (in the patient’s chart, she stated she learned best from 1-on-1 instruction.)

     I pulled the curtain for privacy, put on the sterile gloves, and felt great to be doing something that would keep the patient safe from bladder distention.  Christy, (the other primary nurse) talked me through it and really helped when I had a bit of difficulty. (side note:  I got to do another right away on the walk-in patient we were also assigned to and I felt really good about it.  No problems at all with the 2^nd one!) Christy also explained to me that this could possibly help the patient with her lack of progress in dilation; it would keep the bladder from potentially adding pressure that her body would have to work against.  I measured her output in the ‘hat’ in the commode, and Carlee charted it on the computer.

     I brought my patient ice throughout the day, since that was all she was allowed.  I changed her pads on her bed several times throughout the day.  Several times during the day, I asked her what I could get or do for her, and only one time did she request anything; more ice.  She was a quiet and reserved patient.  It was hard for me to tell if that was her personality or if she was a little unsure of having a student involved in her care, but she seemed to come around a little more after the nurses allowed me to do her cath.  I completely understood.

     At the end of the day, I observed Christy checking the progress of the patient’s cervix.  By the time I left the floor, 15:00, she had changed very little and was around 2.5 cm dilated. 

     I was also involved in the care of two walk-ins:  one was sent home, and one who came in dilated to 4. It was a busy, great day!

So, the patient I was assigned to was a bitch, but whatever, I cath’d her anyway, LOL.  She may have just been apprehensive, or maybe she was snotty because she was a speech pathologist who was already secure in her career.  Who knows?  I was terribly nice and helpful to her, so I have no regrets at the end of the day.

What I didn’t get to talk about was my walk-in.  This girl was FUN-NEEEE.  She works in the cafeteria in the same hospital.  She came in dilated to a 4 already, membranes ruptured!

She had a party going on in her room there at Hospital-of-Changing-Church-Affiliations.  There was a conversation going on around me and the two primary nurses I was working with. Something along the lines of, “Well, it’s gonna be a boy, because she was on TOP.”  And much laughter.  And I didn’t know if I could laugh with them or if I was supposed to maintain my professional distance, but my GOD, you can’t write this stuff.  The girl was like, “Can all ya’ll be quiet until my 3 nurses leave, please!”  She was laughing.

And I was smiling.  Her *3* nurses; me included!

I hope she ended up ok.  We had meconium by midmorning and we started amnioinfusion.  And when I took her temp at 14:00, she had one at 99.1.  Hope that little baby boy ended up ok.

That was a good day.  A good day indeed.

The Catch Up!

Gosh, I don’t even know where to start.  I never intended to not write at least weekly, but an accelerated program is, well, accelerated!  Who the heck has time?  I want to make time. :)

Well, let’s see…I had a 2^nd not mandatory orientation on Monday and Tuesday before class started, so I really didn’t work those last two days.  Just a couple of hours.  It was a really great way to transition my work life to school life.  My office threw me a great going away party.  I’ve been told by everyone that the office is not the same without my loud-ass laugh.  I’m glad I was someone to miss; that’s what I always want to strive to be.  Miss me instead of ‘good-riddance,’ ya know?

So... school!  It is GREAT.  I’ve already had plenty of “the thrill of victory; the agony of defeat.”  Aug Interim was 3.5 weeks of 8-5, Monday through Friday.  I worked really hard, did several Returns aka Check-Offs.  On female/male cath or sterile wound dressing, I drew sterile wound dressing.  And I left that return barely holding it together.  I broke technique twice without reporting it (without NOTICING it) and though my teacher was very nice and I took it gratefully, by the time I got down to my locker and a sympathetic friend saw the look on my face, I started bawling.  I don’t want to potentially hurt someone by breaking sterile technique!  I don’t want an 85 either! And I don’t know why I didn’t get a worse grade than that.  Sigh.  That was a very hard afternoon.  I actually asked the teacher before she gave me my grade when I could retest because I am very hard on myself.  Glad it wasn’t necessary; she said I had the principles, I just needed more practice.  So.  I hate even reliving that day here in words.

The weekend before our finals/final grades, we all went to happy hour at a great local bar.  Well, not all of us, but like, 12 of us.  What a blast.   We all got quite drunk. J Good times.  Steph reported to us Monday that she was parading around her house naked afterwards, looking to see if her grade had posted from the test we took earlier that day.  LOL 

My dear Indian friend who comforted me that day didn’t make the cut at the end of Aug Interim.  It was too sad.  She didn’t make the grades.  All of our tests are in NCLEX format to teach us to test that way AND she has the language barrier.  She’s incredibly brilliant – she was going Pharm until she tried out for this program.  But her grades weren’t good enough and she was eliminated.  We were all so dismayed.

I ended up with a 93 in the Fundamentals class that I screwed up the sterile wound dressing.  And I didn’t do good enough on my final for Essentials.   I couldn’t believe it when the final grade posted; an 89.3.  Are you kidding?  89.3!!???  The College of Health Professions has a college wide agreement that there is no rounding.  So I got a big fat B in my Essentials course.  I didn’t study nearly enough on the different theorists and stages of development:  Freud, Erkison, Piaget. (This whole going back to college thing is TOTAL Identity vs. Role Confusion, LOL) And it totally burned me.  My fault—I have to work harder next time. 

Here’s the kicker.  We have a guy in class, Mike, that is a big work-avoider, laid back, dry humor—really a lot of what I was used to in my IT Office that I used to work in.  So his humor is great, but his laziness isn’t.  First day of class, he was dubbed “Astronaut” and the freaking Astronaut got all A’s.  And I got an 89.3.  That pissed me the FARTHEST off.  I did worse than the freaking Astronaut.  *Sigh  J

Other things…

God, I LOVE the GEICO commercial “did the little piggy cry wee-wee-wee all the way home!”  I am so Maxwell, the piggy. :D Weeeeee!  Weee-weee-weeee!!!!!

What else.  OK, so Fall I started.  I have Med-Surg, Health Assessment online, Health Assessment Lab, Childbearing Family (ob), and my FIRST CLINICAL ROTATION! Weeeeee!

OH, our Childbearing teacher.  Man.  She is…something.  She can be so funny, and then so damned strict and sharp tongued, you just never know where you are with her.  So we all had to RE-check off on doing IVs with her before we went to clinicals.  And we’re all like, “we just checked off on this with our other two teachers in Fundys.”  But in Fundys, they allowed us to use the fake IV arms.  They bleed and everything, but according to Ms. Childbearing, it ISN’T the same.

So what was told to us to be a voluntary stick-clinic, was quickly changed to an INVOLUNTARY stick clinic once we got in Ms. Childbearing’s class.  It created a bit of an uproar, honestly.  And after belly-aching on the part of many in our class, we did get the option to do our (re)check-off on either the fake arm again or the living.  Our classmates.  A choice…sort of.  No one wanted to admit that they were one of the ones who bitched to the program coordinator, so everyone chose to stick a classmate. J  Ms. Childbearing said, “There is nothing like doing the real thing.”  And as much as I on-again-off-again don’t like her, she was absolutely right.  I planned from the beginning to stick a real person, because I need the experience, but I was really, really glad that I did. 

My bestie in Nsg school is a LPN.  For some, this might add some performance anxiety, but she is a great teacher and encourager, so she really is great for a partner.  As it turns out, she is also an exceptional bleeder.  I had her blood all over everything and the floor when I stuck her.  I got the cathalon kinked, so I didn’t get to do the whole thing.  It was fine for the check off, but not enough for ME.   So I hung around and there was another girl who wanted to do a 2^nd stick at the end.  I was so glad, because I felt like I had to redeem myself.  So we restuck each other.  Two bruised hands later, we felt great.

My first exams, ‘A’s in everything except Childbearing.  89 in that one.  Goatee Man had a hypoglycemic episode the night before (diabetic) and I lost 2 hours of study time the night before.  Thank goodness that was the first test; still have time to make that B an A, hopefully.  

My first rotation is OR/One Day Surgery/OB at Hospital-of-Changing-Church-Affiliations.  We do one day in OR, 4 in OB, and one in One Day Surgery.  So I observed my first week, in the OR.  Pretty cool.  I saw a C Section and a total hysterectomy on a girl younger than myself.  Enjoyed it, but OR is not for me.  I don’t want to look at the same 5 people all day long.

OB was this past week. FAB.  I, after panicking internally the first hour, fell right into my role.  The more you act like who you are, the more you are treated like who you are.  Same applies in nursing.   See my next post for a glimpse into what happened.

I’ve spent around 18 hours this weekend studying for various tests coming up this next week.  I really want those ‘A’s.  And I really want an invite to Sigma Theta Tau.

Guess that’s it for now.  I’ll catch you up as I remember stuff.  I am so honored to be among the chosen, everyday.  Of course this is hard work, but I love it.  I'm going to be a RN!