Oncology Clinical I

Hoo-boy.  I just got up from my post-clinical-crash.  As I've previously posted, what makes us so unbelieveably tired is that we go to the hospital at 4pm on Thursday, write down pertinent info for our preplanning paperwork, and then stay up til 12 or 1 AM doing the preplan. And concept map. And med cards for each. Med. On. The. MAR. (medication administration record).  I get it though; we need to be totally prepared to provide really good care to our patients.  When we are knowledgeable, our patients accept us as students much more readily.  They trust us.

And then we are at the hospital all bright and shiny for report at 6:30 AM at St. Big Dog's Hospital. (I'm done with Hospital-of-Changing-Church-Affiliations for now.)
Clinicals are done at 3pm, ahem, 1500.  Last night, my preplanning ran out before my caffeine did, so I was in bed at 12:45 spinning out and tossing and turning about getting up in 5 hours.  By 1:30, I had downloaded an ambient-sounds-maker App for my iPhone to listen to, to distract my mind.  Guess it worked; I awoke at 2 when ‘sounds of the ocean’ shut off, unplugged my headphones and awoke to my alarm 3.5 hours later.

Three of us tag-teamed a bed bath for an independently living  88 year old little-old-lady.  When my cohort was scrubbing her rear end and privates, she asked the patient, “Now I’m not hurting you, am I?” to which said patient replied, “No, that feels good.” Bwah!hahahahahaha.  I think she meant the amount of scrubbing force was good…not that she LIKED it, LOL.  Completely professional, the three of us exchanged knowing glances with one another, never cracked a smile, and filed that one away in the “things to laugh about in post-conference” drawer.

My actual patient today has Breast Cancer that a radical Left mastectomy failed to cure, mets to everywhere (aka it has spread. BAD.), and malignant ascites (cancer in a belly full of fluid where fluid doesn’t belong) blowing up her abdomen like a balloon.  Lower pitting edema  (swelling) 3 or 4+, (not sure due to my inexperience), and almost liver failure. As many of my patients who have already faced their mortality, she was a dear.  And you know what my big nursing interventions were today?  To teach her to not let pain become intractable, because when pain gets out of hand, it’s tough to stop, and speak up about getting pain meds.

Tip:  she was over 60 years old.  To those of her generation, you MUST teach this-- you will NOT become an addict if you start pain meds when you actually have pain!  Bless her heart; accepting a couple of Tylenols was really difficult for her today, even though she rated her pain on the high side with a 7 out of 10.  What a tragedy—to be dying in pain.  Teach your loved ones, too.  Even tolerance and physical dependence related to PAIN will not an addict make.  People become “addicted” in an unwholesome way when they take meds for which they have unequal levels of pain.  I had to convince her it wasn’t a bother either—those things are usually already on your med sheet for ‘just in case.’

She could not sit up in bed without becoming short of breath.  Most people can’t lie DOWN when they’re having breathing troubles.  Her pain of her swollen belly and the pressure from sitting up made it almost impossible for her to sit up any higher than 15 degrees.

…and then she had rectal bleeding today.  Which is a new thing for her.  And it scared her—a lot.  After the primary nurse showed me, and was gone, I was tucking her back in because she had been SO cold, and I could tell she wasn’t good.  I asked her if she was upset about the bleeding, and of course she said yes.  And then I used good ol’ nursing therapeutic communication and asked her, “Want to tell me more about that?” and she opened up and just cried and cried about the uncertainty of her future.  I dabbed her eyes with a tissue, tucked her in even more securely, and wanted to tell her that everything would work out.  But I can’t give someone false hope; never-ever.  Especially for her.  I stayed with her a few more minutes, patted her knee and told her that we would just get through the next hours, hour by hour.  She told me how great I was.

When I left for the afternoon, I made my way back to her room to say thanks for letting me care for her and goodbye.  By that time, her family was at the bedside.  I told the family “You’ve got a special lady here!”  They said they knew. J  I introduced myself to the family, who asked if I was a med student or a nursing student?  I told them “Nursing.”  The sister said, “Good!  You seem to actually care about your patients.”  They wished me luck.  I wished my patient luck.

It was a good day.

Honeymoon OVER

So I pretty much hate nursing school right now. Hell of an opening post after all this time, I know. Lol..
But for real. I am tired of studying so much, tired of feeling stupid at clinicals, tired of it. Actually, the book work and paperwork isn't so bad to me.
Sigh. Its an accelerated program, that's all. Our class is at the moment worse for the wear. We had or first class fight , for lack of a better term. It was basically front of class vs back of class, participators vs non-participators. Via facebook. Puh-lease. Juvenile bull shit from one girl. The only one on the class I totally do not trust.  That has simmered down.
Now we're all exhausted on the weekends because we have class and Healthy Aging clinic on Thursday, then have to go to Hospital-of-changing-Church-Affiliations on Thursday night to get patient assignment.  We spend two hours writing down everything relevant in their chart, all their meds, all their labs. Then we go home, do a med sheet on each med, and then a concept map on our patient. A glorified flow chart, really. Do that takes us to 12:30, or 1:00 if your lucky and your patient doesn't have 32 meds like Astronaut's did this week.
Clinicals start at 6:45 sharp at Hospital-of-changing-Church-Affiliations; be there ten minutes early.
Oh yeah, and we' ve got a Med Surg exam and pharm exam every Monday. Phew.
My patient this week had acute delirium. And lots of heart probs.  no one on a regular floor likes or wants anything to do with a crazy patient. Well, I like psych, so I was good with it. But at the end of a good day, I hated it.
I've thought about that all weekend, and I * think* it is because it was boring. Gave three meds and the rest of the day was patient care tech stuff. A freaking important job, but not why I'm in school learning about assessment and delegation. Sigh
I know, crawl before walking.
I was able to get my patient in a more lucid state by talking with her, bathing her, and brushing her poor matted hair. So funny, girls are girls, even when delirious, and she loved getting all dolled up. Which amounted to a bath, hair brushing, and getting the dried blood out from under her nails. Oh yeah, forgot to say, she was in wrist restraints  due to pulling out her IVs.  with a stage two pressure ulcer.
Sigh.
A doctor hit me with a random act of meanness, too. Said "yall are going to have to move (from nurses area station!) because I've got to make rounds."
Really?
Without missing a beat, I got up, and said " Have a seat." I guess I was so stunned at what a prick out of nowhere he was being, my speaking-filter just turned off.
People are pricks because they are allowed to be, jussayin.
Going to go read some of my fav nursing blogs and go to sleep now.

Ready to be done

I am SO ready to get down the road 7 months to the part where I know what the hell I'm doing and am done with bring a student.
More details to follow.
Sent from my iPhone

Death

So today's chapter is entitled "The worst day of my life."

My little Twinkie, one of my two blessed herd of blitzing Bichons had a stroke in my arms and died today.

She was diagnosed last Friday with autoimmune hemolytic anemia. Her body was chewing up the red cells faster than she could make them.

I can't make the tears stop. I've never felt such loss. Three years was such a short time with her but I would do it all again. I don't have kids, so this loss is the insurmountable loss of a child to me.

I know time will help but right now I just want to sleep until that day when it only hurts half as much.

Tater, my other bichon, is sleeping on her blanky tonight.
Prayers for all of us please.

Sent from my iPhone

Stuff that hits me right

So I’m talking to Goatee Man this afternoon.  As I am oft to do, I’m talking about everything I love about being in nursing school, about being a nurse, yadda yadda.

And I told him, even though I can’t hone in on what I *do* want to go into at this point, I can at least cross some stuff off my list:

No OB

No Operating Room

No One-Day Surgery

No PACU

To which he replied, “You love nursing so much, you basically don’t want to do anything you’ve learned thus far.”

Much laughter.

In other news, Goatee Man has probable early pneumonia.  Nice urgent care doc (Urgent-Care-Affiliated-with-Hospital-of-Changing-Church-Affiliations) today who works at a nearby VA.  Xrays have been sent to radiology.

No tellin’ what other stuporous pearls he’ll have for me the next day or two until the antibiotics kick in. J

Flu Clinic Day

I got to participate in our Community Flu Clinic at El Humongus Arena of Podunk U.  I don’t know why we weren’t busier, except that it was poorly marketed.  I don’t think enough people knew about it.  All in all, I did give about 40 flu vaccines today, so not too shabby.

Another beautiful memory:  One of the clients that I’ve worked with a lot at Big Mental Health Day Service (where  I’ve been at for my Psych rotation) came to me today for his flu shot!  Bless his heart, he was nervous and was holding the LPN’s hand who brought him for dear life, but wanted me to be the one who did it.  He did great.  My heart overflows with all kinds of gushy emotions. J

By the way, I’m loving my Psych rotation.  They day service I’ve been at the last couple of weeks is awesome.  So awesome, I’m even considering a career in Psych.  And I never saw THAT one coming.   My problem, as usual, is I like everything.  Well, at least I know I won’t be an OB nurse.  Don’t think that one is for me, though I did have a successful rotation.

I digress.

My Community Health teacher took me and a couple of the guys to a couple of our ritzy/eclectic/cool shops in town today to give flu shots, too!  So we were the traveling flu clinic service today.  We gave a bunch of shots at a florist/boutique owned by a lady…then went down the street and gave shots to a bunch of guys at a Music/Guitar/Guitar Lessons shop…owned by her husband!

So when you give 40-50 shots in a day, you’re bound to hit bone.  Yup, bone.  I did…a few times.  I am glad they prepared us for the possibility because it makes you bounce back the first time you do it.  Stream of consciousness: “ok, little stick…needles going in great, see that wasn’t so WHOA WHAT THE HELL WAS THAT?”  It’s like hitting a brick wall.  And amazing that the patient doesn’t know it.  Of course, I hate it when it happens, because you never know what kind of soreness someone may have later, but it often cannot be helped in thin arms and in the emaciated.

We used these cool needles today that retract when you give a little more pressure on the plunger at the end of the injection.  All in a blink, it withdraws the needle from the skin and retracts into the barrel.  Because most needle stick injuries happen after you withdraw the needle, ya know. J  So we were taught.  Every 8^th one didn’t retract as it should, so we had to discard of it in the usual way; carefully.

Hmmm, what else?

I’m doing Weight Watchers again to get off the 10 pounds I gained as a Bank Trainer and the 5 I gained as a Credit Analyst before that.  Almost 8 lbs down the drain so far.  WW is a great program for teaching boundaries, eating healthy foods, getting in your dairy and veggies, etc.  It is also great because it teaches you to have NO taboo foods.  Which is great, because other ‘diets’ I’ve done have created cravings out of deprivation.  Now if I want birthday cake, I have a piece of cake coated in Lard and Powdered Sugar!  And I count the points honestly, and budget my balance for the remainder of the day.  It just works for me.  Calorie counting doesn’t.

So this semester, Pharm is great, albeit hard.  Mental Health’s teacher is from New York and puts off a lot of my classmates.  I had a boss years ago from Boston and she’s much like her.  I ‘get’ her and we get along great.  She is dumpy, though she can be pretty, has a decent limp, and is overweight.  And I feel very at home with her. J  She let me help her lead a stress class in Group Therapy at Big Mental Health Day Service this week – yea!  Community Health is good—it’s Dr. Community Health that took me and the guys to the florist and the music shop.  She is…brilliant.  And Californian.  And odd.  I think she has breast implants.  No condemnation here; I love plastic surgery.  She is very different, and I think I will like her.  She is super dry, so it is hard to get a read on Dr. Community Health.  So 3 classes and 2 clinicals right now.

That’s all for now.

email to Mom

I went and saw the Nurse Pract at the Student Clinic on Monday.  She agreed with me that it was either a virus or allergies and wrote me a script for Zyrtec (which I already had OTC) and Sudafed (in case I had trouble getting it.)

Really, I went to see her so I could stay home!  I felt too bad to be in class, but you have to have a REALLY good reason. :)

I have been taking lots of Vit D and using my Nasopure (nose irrigation), and I bounced right back.  I'm still blowing gross stuff out and I don't SOUND great, but I feel fine.

I got to start my Mental Health rotation today, and it went really well!  I just felt like I was doing ministry work with the Bus Ministry, or half of the folks that used to come to church, LOL.  No problems at all with that.  Woot for Group Therapy, Pizza, and Uno!

There's a LOT of money in Psych Nursing...who knows?  I get two more 8 hour days to see if I really like it or not.  Then on to Community Health!  Which will be the Health Dept and the Church Health Center and places like that.  I'm REALLY excited about that one!

the Facebook Wall Says it all

Facebook status updates from Fall I say it all:

(both my own personal and from friends at our Accelerated Nursing private group page)

hey everyone....Elizabeth and I are going to the Coffee House at 6 to study for a few hours if anybody wants to join. if you need directions just let me know

Well I finally got the correct time for Wednesday class.....now if I can just find the correct classroom...... :-)

what are retractions? i forgot.....

Do y'all think that everything but the EFM stuff will pretty much be multiple choice?

 

one more question, do stork bites disappear when crying, or deepen in color? because i read both....

 

Grades are up!

 

I forgot how to get to the OR the front way.... can get there the back way from PACU, but am thinking that will look kinda silly.

 

Hey, here's some APA help. I used it a TON my last go-around. Thought you might like it since we are getting into Journals...

 

i just feel like i'm gonna blow the assessment for the final. and don't even get me started on the advanced assessments!

 

Would anyone with a scanner mind to email me the diabetes handouts? I just remembered I never picked them up!

 

Is it just me or does the diabetes chapter drag on and on and on ......

oh and which sets of meds did she say to know real good?

 

someone just shoot me now! i'm totally sucking at these health assessment chapters. esp cardiac....holy cow!  Honestly, I don't feel much better about the OB test.....

 

Thanks in advance to everyone who sends their Childbearing notes to Stephanie. :)

 

I had a good day with *ONE* baby, but I don't forsee me becoming a Nursery nurse. :)

 

so is tactile fremitus good or bad?

 

OB Notes have been sent to everyone's email.

 

"Marijuana cigarettes, that's not right, uh joints, and smoking that meth, hoffing, uh huffing..." Laughed out loud in the library computer lab, even though y'all warned me it was coming. Love that Ms. Miller!

 

Y'all! This is going to be a disaster.

 

I went ahead and emailed everyone the typed Perioperative Questions from class today cuz i didn't know who was taking notes or not. Lemme know if i accidentally skipped anyone :)

 

Reminders:
Do G&D module questions for School Age and Adolescents on Blackboard
Tomorrow's exam will cover Labor & Delivery (Physiology and Care of Laboring Patient), 5 questions about Neonatal transition (CV adaptation, respiratory adaptation and jaundice), and 10 G&D questions. It will NOT cover Nutrition (this will be on the final).
8:30 a.m. Exam in 602
Lecture will follow (9:30-11:20 & 12:30-3:20) Need these notetaking outlines and ppts: Bleeding in Pregnancy, Hypertensive Disorders - HELLP AND DIC, Preterm labor

 

 

Um...anyone else think that the G&D questions are super hard to find?

 

let's all take a minute to pray to the OB gods...

 

Dilatation!

 

Freakin' overwhelmed!!!!!

 

so which pelvis is BEST for vaginal delivery? 

 I know she said it like 10 times in class, but I never filled in the blanks of the first sentence in the myometrial study guide.. Can someone help me out?!

 

BRING YOUR CALCULATORS TOMORROW since 'all good nurses have a calculator on them at all times' or whatever she said, LOL

               Ladies, I will pack 2 extra! One is solar powered...hope it works there in the cave! It should. :)

 

there must have been several item analyses. anybody else pleasantly surprised to see your grade for OB?

 

when I get upset I buy things. Bought myself a shiny red calculator today.

 

Hey Guys, Lori from the lab has given us the awesome opportunity for the chance at some extra lab hours for practice. 

 

Whaddya know? Ms. Miller's not in bed yet! :) Grades posted!

anyone know what's on the clinical exam next week?

 

Confirmed with Dr. Owens today that we do NOT have to wear uniform or lab coat on Wednesday when we do our BSE & TSE teaching check-offs. "You can dress as you usually do for class."

 

med surg exam 3 grades up in case you missed the email.

 

Ok, so what did they say was going to be on the Health Assessment quiz again? Equipment and what? 

 

Miller-ism: [on cerebellar functions] "...and this is where things start getting FUN, if somebody is drunk."

 

Can someone please tell me the lab hours?

 

Well kiddos i hope you all appreciate that this is our last full week of Fall 1!!!! I'm super excited!

 

Can someone help me with remembering which exams are comprehensive?

 

so...how is everyone studying for this Health assessment final on thursday? i'm looking for suggestions....

 

So for Cranial Nerves tomorrow...are we just needing to know what they innervate, or do we need to know how to test them?

 

which cranial nerve goes with vomit?

 

The health assessment quizzes are due by 5 pm!!!

 

Are there any study groups meeting tonight? I'd love to study with someone. Let me know!

 

can someone tell me what cards i need to make for the clinical drug test? i know of witch hazel and benzocaine, but what others? I'm confused.

 

Are y'all memorizing which spinal nerves elicit which deep tendon reflexes?

               NO.  nope, not memorizing those either. *crossing fingers w/ hope

 

so since i skipped on the test review, were there any controversial questions that came up?

               She told us she would tell us the answers, but would not debate

 

only 2 more Nursing Diagnoses & I'm done with my Clinical paperwork for the semester

 

not exactly feeling chipper after reading through the grief/loss powerpoint. boo for dying

 

health assessment final grades posted (shocker!) glad that one's out of the way!

 

Can anybody enlighten me on how the basic assessment by itself is supposed to be worth 80 pts.?

 

can anyone please motivate me to start practicing health assessment. my brain forgot that check-out time isn't until AFTER finals.

 

Can someone please post the day, time, and location of each test this coming week just to make sure that we are all on the same page.

 

do we wear our scrubs and etc for the check off's tomorrow?

 

I cannot WAIT for tomorrow's return to be over. That is all.

 

she did say we could premark our landmarks, rights? Cause poor Tim looks like he has a serious organized fungus with all the black marks over his body.

 

What advanced assessment did everybody pull? Hope you all did GREAT!

               blurry vision with no head trama...

                    Sinus problems and lymph nodes...

                    Kirsten did liver palpation! I was her videographer

9 a.m, right?

 

clinical grades up, well at least mine is

 

what's the hold up on the other grades? they act like they are busy or something ;)

 

OB Final Exam grades went up 5 minutes ago!!

 

And finally:  We're ONLY covering 12 chapters our first week of Patho-Pharm!!!

 

 

 

 

 

 

 

 

 

 

 

Done with Fall I!!!

OB in an Accelerated Program is HELL.  Especially when your teacher is also known as the Warden.  *sigh

Thank GOD that’s over.  On the plus side, there was absolutely NOTHING that they threw at me on the floor at Hospital-of-Changing-Church-Affiliations during OB/Newborn exams or Fetal Monitoring Strips that I didn't know about. (of course not experienced in it, but nothing I didn't already know about!)
Fall I semester-- I completed Health Assessment, Health Assessment Practicum, Med Surg I, Childbearing Family (OB with a couple of kid development quizzes thrown in), and my OB Clinical Rotation/PACU/One-Day Surgery.

And this semester, Mike the astronaut’s got nothing on you babe…na-na-nathing on you babe…ok, so nothing on ME this semester.

I finished this semester with a pocket full of ‘A’s.    I have never worked harder.  Or had to work so hard in…my…life.

The class before us told us at our orientation that if we could just make it through Fall I, we would have smooth sailing.  I now know, that was her way of telling us that if OB doesn’t kill you and once you adapt to the study schedule, you can do this.  Well, one of us couldn't do it.  She didn't have a 75 for OB and she's out.  That's two gone from our original 24.  Sad shit.  The plus side is that she was admitted into the traditional program, but she can't jump in until January, because we're ahead of the trads!  Or the 'generics,' as some of our teachers call 'em, LOL

Health assessment, we made videos.  It was GREAT.  It made me much more confident, because for my Assessment, I felt like I was teaching on a video instead of being inspected in a Practicum return by a bunch of teachers. (which I still was…by video.)  In exchange for getting to make videos, we agreed to the use of our videos for future teaching! 

So, here’s the final:  Do a basic head-to-toe exam on your partner, and draw out of a hat a scenario for an Advanced Health Assessment.  So we had to know ALL the advanced health assessment things, like deep tendon reflexes (where and how to assess), testing and naming all the cranial nerves (which I could already name; I loved Anatomy.), proper use of ophthalmoscopes and otoscopes…let’s see, what else?  Hearing tests with tuning forks like Weber and Rinne.  Sight exams like Snellen and Rosenbaum.  Lymph node palpation and their names.  Inspection, Palpation, Auscultation, and Percussion of chest, lungs, and abdomen.  It is really cool all of the assessment techniques I’ve learned.

So I had to know it all so I would be able to draw a scenario out of a hat and be able to assess for the scenario.  Loved it!  I absolutely adore Health Assessment.

I like Med-Surg a lot.  We got to do a lot about Diabetes, Electrolytes, and Fluid Imbalances.  That was the majority of Med-Surg I, which is pretty important shit. 

OB.  That rotation was pretty cool.  Got me feeling like a nurse.  Really pissed me off seeing my first episiotomy/first live birth which was on my last day of the OB part.  I couldn’t even enjoy the childbirth because I was so pissed at the cutting.  The baby was not having trouble; why are all these doctors so cut-happy?  I know there are two sides to this divide:  Those Who Like Episiotomy and Those Who Don’t.  I am of the “Those Who Don’t” persuasion.  I think a tear is injuring what was necessary, where an episiotomy is quite possibly more injury than was necessary, but we won’t ever know BECAUSE YOU’VE INFLICTED IT ALREADY.

OK, so there are times and places for being cut.  But the docs at this particular hospital LOVE to cut.  Boo. 

Also, I hate the nursery.  HATE.  It felt more like babysitting than working with a patient.  This medical center is not set up for sick kids; they all get packaged and shipped to a higher level 2.5 hrs away at a BIG children’s hospital.

My most memorable experience in OB was the day I got to stay with one patient from pre-op, to wheeling her down to surgery holding area, to surgery, WATCH the surgery/baby born/Daddy cry, and wheel her back to her room afterwards.  Really cool to be there for her throughout the whole experience.  As we were going back to her room, one of the ‘real’ nurses was talking about the rest of the day’s events, when the patient interrupted her.  “Where’s my nurse?”  The nurse talking to her stated, “Hon, I’m right here.”  And the patient said, “No, my NURSE.”  She meant ME!  That made me feel unbelievable. J  The ‘real’ nurse kinda scoffed, “Oh, you mean your STUDENT nurse?” but it didn’t matter to me at that point.  The point had been made; I was a good at taking care of  my patient, she trusted ME, and ‘student’ status be damned, I am good at this.

*happy sigh

One Day Surgery.  It was a great experience…except for at the very end.  Which soured the whole day.  So let me explain.

I got to get SEVERAL patients ready for their various surgeries that morning.  Had to be there at 0530…woo, that’s early.  So I got my first IV (woot!) but the nurse I was following was kinda in the middle of it too.  She thought she had enough pressure on the site (which she DIDN’T) and I was trying to work AROUND her, and my patient bled everywhere.  I’d been fine if the nurse would’ve just let me do it.  So then, we finally get her hooked up to her LR and now I’ve got to clean up blood that is all over everything.  *sigh.  That lady was really nice.

So I set up lots of tubing and fluid kits and antibiotics.  I started 3 or 4 more IVs and had to have help ‘getting’ about half of them.  So I’d miss and my nurse in charge of me would salvage it.  So I’m not really happy with my performance there just yet.

Then there was the patient that just whined and cried and belly-ached when I stuck her.  It was all I could do to keep from rolling my eyes.  What I WANTED to tell her was that I was using a 20 gauge and that the folks in the OR wouldn’t even like THAT because they want an 18! (bigger, for you non-medicals, in case they need blood).  God, what a fucking baby.

I started an IV on a 17 year old an hour later, and even though said over and over before I stuck her that she hated needles, once I actually did it, she was really pretty good with the whole thing.  Faced her fear and all that.  I just kept her talking about playing clarinet in band.  So how’s that for therapeutic communication, eh?

So the sour part.  The really GREAT nurse that let me come assist (ahem, observe) with a bronchoscopy, and who had let me do all kinds of great stuff all morning used tape on the end of an IV.  And was written up for it.

The back story:  she and I both went to another floor to pick up the fairly demented patient for her procedure.  We were going to take her down, and the cap was somehow no longer on the end of the IV tubing.  I even had another CAP in my pocket that we tried to use, but it was for a different set.  So, instead of scrapping the tubing, she taped it.  With my tape.  Yeah, I felt sick, because it didn’t seem correct.  Like Jo says, if you have to fuck with it, it’s wrong.  Well…tape is NOT STERILE.  Had we plugged the lady into that, it would have been a possible portal of infection. 

So my assigned nurse got an ass chewing and a write up by her other associates in that area.  Well, there’s a lesson I’ll never EVER have to learn firsthand.

Know what? When you act like a nurse, everyone treats you as a nurse, and I’ve found it quite easy to take on the role.  Most people found out at the END of their time with me that I was a student, and that is good. 

The upside to my 8 hrs on One-Day was that I got to do discharge on the Bronch patient, and it was gratifying to get her dressed and wheel her downstairs to her awaiting brother-in-law’s truck.  She told me she hoped to see me at Walmart or somewhere out shopping, and never here again.  And I told her I’d love to see her out shopping and never here again either!  …Bless her heart.  We were looking for mets to her lungs on a cancer that had almost taken her once already, and it was looking promising for good news.

So that leads me to now.  I’ve just come off a very lovely Fall break in the amount of 4 consecutive days off with no homework, assignments, or tests to study for.  I am now in Fall II and I am taking Mental Health, Community Health, Mental Health rotation, Comm Health rotation, and Pathopharmacology.  Hmm.  I think that is it.

I like it all so far.  I missed the first day back to my first cold of the year.  To be continued.

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!

Do I really want to go into nursing?

So I’m traveling with the bank today…well, tonight.  I was pissed as hell yesterday.  All day, I knew that my overly sanguine boss would not think of making plans for this sub-region of our bank until the last minute. 

I have chemistry due every other night since I am taking a freaking summer school class.  I was hoping to fly under the radar and stay home.  Not so much.

At 5:45 last night (yes, unplanned working late because no one was prepared with the presentation we had to start using the NEXT DAY) she, in her passive aggressive way, told me that she wanted me to go to one of our sub-regions.  Tomorrow…which is today.  GOD that pissed me off.  I like to plan things at least a day ahead--at the least.  With chemistry looming and a very sick little Taterdoggie (started heartworm treatment yesterday) I did not want to make this trip.

But last night, I got all of the Chemistry work done that was due today. That changed my attitude MUCH for the better. I got up extra early this AM and showered, got ready, and packed.  Very low key.  My first two training sessions I held today went very well.

So I am traveling on the banks dime, by myself, and feeling pretty satisfied about it all.  And I have had a couple of dissenting thoughts about my future plans.  What if I just stayed in my current job?  What if I did not go to nursing school?  I am really having a good time right now, having a place of influence.  I’ve been in this position for almost 2 years, so people are starting to trust my work and my word.

Even in this crazy line of thinking, I couldn’t convince myself to back out of nursing.  But I couldn’t convince myself completely to NOT back out.

Why would I do this to myself?  All I’ve been working towards, just to up and stop the process?

I drove to the nearest wet county so I could have a couple of drinks with dinner after work.  To Goatee Man, in a very dry voice, “Help, Help, I’m spending the night in a dry county!!!’  I actually had to drive 35 minutes to get into another county so I could eat at a Chili’s with a bar! Craziness.  But, my chemistry is done, so what else did I have to do? 

So I drove, listened to ReachMD.com podcasts, and had some surprisingly yummo salmon and broccoli, with a skinny margarita and one Miller Lite.  Nice and lowcarb…until I got back to the hotel.  Chocolate cake happened.

All of that to say this:  I saw a PBS special on African women and fistulas.  These women are extra tiny, short, and small due to hard work and little food.  They said it was decent food, but not nearly enough.  So they are very small in stature.  And they are married at 8-10 years of age.  And of course, that means babies as soon as they start menstruating.  Which is anywhere from 10-14 in these poor girls. 

All THAT adds up to babies that are next to impossible to birth, due to cephalo-pelvic disproportion.  They will be in birth for 5 or 7 DAYS.  And all of that pressure leads to tissue damage in their urinary bladder and their rectum.  They are plagued with insatiable incontinence.  Once they have a fistula, they are then banished from their community.

These poor, poor girls.

What was wonderful about this documentary was the nurses and doctors who formed a makeshift hospital and started surgically repairing these women.  Once they are restored, the women are allowed back into their communities.  Learn more about fistulas here:  http://www.fistulafoundation.org/aboutfistula/

These are the types of things that called me to study public health and now that call me into nursing.  Thanks God, for the reminder.

hey-hey-are-you-ok?

Took the CPR course with 3 lifeguards today.  FUN!  6 AM wasn’t quite so fun, especially when I found out that the Red Cross told half of us 6, and the other half 7.  We waited until almost 7.  No one else showed!

But after that cluster, it was a pretty cool class!  My teacher was a teeny-tiny girl probably 10 years my junior. Barring a few blips in her oral communication flow, she did a really good job.

We practiced adult, child, and infant choking, rescue breathing, CPR, and AED administration.  All together now, tapping a mannequin on the shoulder, "Hey-Hey-are-you-ok?"  That was our teacher's cheer phrase for starting the initial assessment. Funny.  Funnier still was that even though she was from Iowa, she positively DRAWLED her "hay-e hay-e are you oh-kay-e?" 

Cool stuff.  Hope I never have to use it (I know I will) but glad that I now have that knowledge.

I had to do CPR on a girl in my building about a year ago.  Of all things, they ran from one side of our building to the other to come and get me.  And I had my last official first aid class in 5^th grade girl scouts.

She needed one little puff and she resumed breathing. (She had been actively seizing for about 5 minutes, prior.) Our firemen EMS folks arrived and took over.  She ended up fine.

I did better on my Chem quizzes tonight.  I have quizzes every other day until the end of this month.  Exams every Sunday.  I hate chemistry.  I know it is important.  I think I could be good at it.  My teacher is too smart to teach. Same guy from last semester.

Let's see, what else...I eat low carb mostly. I eat lots of veg, so I don't want anyone to think I'm unhealthy. I am eating low carb strictly for the next couple of weeks.  I’d really like to get a few nagging pounds back off before nursing school starts.  Lord knows I won’t have time to actively deal with them then.
I'm going to go cross CPR off of my marker board.  If you don't have one, you should go get one tomorrow.  Three computer home network and iPhone be damned, physically crossing things off of my deadlines and goals list is GRATIFYING.