High Acuity Final. TOMORROW

It's a good thing I've waited until now to get a bad case if the "I don't wannas" because this is my last bricks-and-mortar class final.

(I have a couple of online classes to contend with, but that's somehow different in my mind.)

My instructor sent us the blueprint, so I at least will know where to focus my energy:

"The breakdown of questions for the final exam will be as follows:

Number of questions / Topic
17/Neonatal material
41/ ECG (Multiple choice-there will be strips on this portion also)
7/ Sepsis
9/ pacemaker
5/hemodynamics
3 /Heart surgery (CABG)
3 /Heart Surgery (valves)
3 /IABP
3 /Transplantation
5 /Mechanical ventilation
3 /ARDS
3 /Shock

Have a good weekend and I will see you on Monday at 9 am. Mrs. X"

So now you know what I'll be doing today (/have been doing for the last few days). :-)

How to Become a Nurse in One Year.

I'm still figuring that one out, actually.

My local University has a one year Accelerated program for people who have a bachelor's degree already. Pretty competitive, so imagine how excited I was to find out last summer (Memorial Day weekend 2010) that I had  indeed made the cut!

Twenty-four people out of 80-something applicants got that happy little letter. :-)

It's pretty tough at times. So tough, we lost 2 people in the first 2 semesters; Summer and Fall I. (oh yeah, I should mention, it's year-round school, too).

So as long as I pass my final in High Acuity Monday, I've about got it "whooped."
(no worries, I'm a big study geek. Well, some worries, this crap REALLY sucks. The sickest of patients and a whole semester of learning in 3 weeks...!)

May is two online classes, and June and July are 3, 12 hr workdays ea. week with a preceptorship squeezed in somewhere. They transition us into the workforce; my fav part of this program. I'll be managing 5-6 patients a day after the first couple weeks, so I'll be ready for the real world!
Clinicals up until this point have been 2 patients, max.

I am almost an RN. Wowza.

Oh yeah, did I tell you I want to be a Nurse Practitioner? ;-)

Tater has claimed my temp storage solution.

Recent Honors

I was invited to Phi Kappa Phi, the oldest academic honor society (non-departmental).  Pretty cool.

But *GIRL SQUEEEE!*   I was invited to Sigma Theta Tau, the “International Honor Society of Nursing!”  (STTI) YAY-YAY-YAY!  I have worked SO hard this year towards that goal.  And I thought having that one ‘B’ in nursing would exclude me, so when I was notified…wow.

The way that all happened, though, was a bit sad. Several of us were sitting at a Filipino restaurant in another town after the first part of a Nursing Research Day at Private-Beautiful-though-Church-affiliated University.   Each one of us around the table got an email…except one. *sigh.  We graciously put off the celebration until we were not with that person, but, STILL.  How on earth the stars line up for us to all get in but her?

Anyway, it is the top third of the class, and in a class of only 22, the spots are pretty limited…and coveted.

Induction into the societies are the next two Monday nights…yay!  I could not be more excited and humbled to be a part of them.

Musical Honor:

 I have been a guest singer with a band as of late.  As kind of a long story, one of my dear friends who is a Psych Nurse Professor at my Podunk U is married to the lead singer/bassist.  (She isn’t one of my teachers, so we get to be friends.  Can’t wait for a few more of my teachers to get to be friends, too, but I digress).  Anyway, the band was doing a wedding, the bride wanted Carrie Underwood’s “Mama’s Song,” and the band wanted a chick singer.  We had all hung out one night, they heard me sing a couple of bars to the Enzyte commercial (lol, another story) and I was asked!  I was really nervous, but now I LOVE it.  It went really well, and I was even tipped $100 to sing it again at the end of the reception night.  I sang it with them at a bar again the other night.

They guys gave me an open invitation to learn some more of their stuff.  FUN.

And I’ve joined a community choir that is working on the Brahms Requiem in English.  Quite a contrast from country music, huh? (that is the ONLY country music that both I sing or the guys in the band perform, btw.)  It is weird to be back in the professionally trained singer world, too.  But it is challenging, and it is good for me to work on something besides nursing all the time.

What an Accelerated Program is.

Just what exactly is an Accelerated Program, you ask?

A program in which:

• People who were brilliant enough to get in, can't hack it and get kicked out.
• People who don't make anything but 'A's now make 'B's.
• People who have never quit anything in their lives have to discontinue.
• People who have never had mental illness find themselves dealing with depression and anxiety.
• People go on Paxil and Xanax to make it through.
• People get divorced. Or hopefully just have to start marriage counseling.
• People struggle with tiptoeing around 'too much' alcohol.
• Sleep deprivation is the rule.

Because it is a whole year of crisis. And mental health is Never challenged more fully than in a crisis-state.
I had the ego to think when I joined, "*I* won't feel that way. Maybe THEY just didn't know what they were getting into."
Nope, they were right, and I hadn't a clue as to what *I* was getting myself into. ;-)

Dear reader, I'm still hacking it. Proudly. I haven't made all A's. My marriage has come out of a dark November-December. Some of my dearest friends in the world (dearest as a result of this program) are having some of the other points stated here.
I think it is the bootcamp of nurses, an Accelerated program. And this one is just a year, so it's just that much more tight.
Any other program, especially a 4 year program, though, would be exceedingly boring.

My Back and Almost Finals Again

Back - I swung my backpack around and under some stairs.  Small strain from bad body mechanics, is all.  A little less pain today, and probably better tomorrow.

Hurts right over my mid-to-low ribs on my Right back. 

Studying now for an EXAM tomorrow, can you believe that?  They are making our last clinical day for this semester a 1/2 day and then giving an exam.  Pooh.

So I still have all the night-before planning at the hospital and the diagrams to draw (CONCEPT MAP) before being there tomorrow, and a test! Thank God it turns out I am very, very good at concept mapping. 

Oh, well, that's just this program  And I seem to adapt pretty well to whatever they throw.  For the next 3-4 days, it will be all about finals.

Sent from my iPhone

Here's a lady like me! (Note to Mom)

She thinks like you, totally absorbed in it.  Only Thing different is her family, that is unless you include your furbabies☺☺☺

How is your back today? and what did you do??????

Love you, MOM

----- Original Message -----

From: Me

To: Mom 

Sent: Thursday, February 24, 2011 12:37 PM

Subject: here's a lady like me! Really MORE of a go-getter!

http://www.youtube.com/watch?v=wDbnk5mIR3A 

Sent from my iPhone

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!!!