Sunday, July 17, 2011

ICU last week was actually good.

I previously have [nearly] hated the teacher who was our clinical instructor.  She was pretty alright this go around, I must admit.  By the way...her last name starts with an 'A.'  I think it is hilarious that the class sometimes calls her MRSA. (Mrs. A.   MRSA is methicillin resistant staphylococcus aureus.  A really bad infection causing bug. HA.)  Now to see how she graded us last week.

I worked at a different hospital for this clinical and they have a really good team in ICU.

If you've never been to an ICU before, many are set up like this.  Private rooms, secluded by sliding glass doors and/or curtains, with a dedicated table in front of each room for charting and for nurse perching.

My clinical experiences were with a woman who was heaven-bound in the throes of Septic Shock, who was very low on the Glasgow Coma Scale, a woman in CVICU post Femoral-Popliteal graft surgery, and a woman who let bronchitis/sinusitis go too long and ended up very dehydrated which caused Acute Renal Failure.

Thank god this very educated, prim and proper mother started hallucinating and talking about crazy stuff, or her kids may never have made her go to the hospital.

Lets see...what all did I see....
When you're dying of Septic Shock, you may third-space all of your fluids.  That means fluids aren't in the veins (vascular space) and your kidneys no longer work (organ failure), so you're not peeing it out.  So it seeps into your tissues until it weeps out of the skin or splits the skin.  I was glad she was unconscious and had plenty of morphine ordered.

Fem-Pop graft surgery may change your life.  If you have intermittent claudication (pain from lack of oxygen getting to your extremities) ask your doc about this surgery.  My patient who had this was really doing well only 1 day post op.

Dehydration is serious.  SERIOUS.  Please don't kill your kidneys with infection and too little water, thanks.
If you do hurt your kidneys, I'll be forced to give you Sodium Bicarbonate.  Heh, that's the same stuff as Arm and Hammer, you say.  Yes, you're right, but putting that in a vein IV is pretty darn painful.  The sodium bicarb is to help you not be acidic while your kidneys are unable to do that for you.

Not my patient, but saw a woman decompensate before my eyes.  That was full blown Metabolic Acidosis, and she had no blood pressure.  Pretty exciting.  Everything was just like they taught us in class.  Rapid, deep breathing (Kussmaul breathing) to blow off all the carbonic acid from the acidosis.  We put her on her head (in bed, head lower than feet, "Trendelenburg" position) to try and get blood perfusion to her brain.  She had a non-rebreather at 100% oxygen, and as they said, she kept trying to pull it off, saying she was smothering. We had to keep trying to tell her that she MUST keep the oxygen mask on.

The nurses got her going again, after the Hospitalist came down and ordered a couple of code-type drugs to be pushed.  Except she wasn't in a code yet, so there were some questions.  And then there was the almost-mishap in which the nurse pushed the med but did not flush the line after putting the med in the line...So the patient did not get better right away.  Thank god she had fluids going and the fluids eventually flushed the medicine from the line and into her body.
It just goes to show how crazy things can get when a patient is circling the drain.

Oh, also, if you insert a PICC line into a patient, and the tip should be in an Atrium, and it ends up too far in, in a ventricle, you'll have a patient in V-Tach...one very small step away from getting a shock to fix the heart.  7 x-rays later and a pull-back on that line TWICE, the guy's heart quit with all the irritability and beat normally.  Yay!

Also, when your mom was almost dying, treat your nurse with respect, you high-and-mighty-investment-banker types.  You never know...your nurse may have been one, too.

Sunday, July 10, 2011

A post to a friend about something I was glad to know I wasn't the only one was experiencing...

Originally Posted by XXXXXXXX
"... I felt clinically and scientifically neutral, I recognized it as a learning experience. However, another part wonders if it was normal for me to feel virtually nothing. Am I in shock, professionally mature, or just plain cold? I should mention that my behavior with new experiences has been very strong and I am always surprising my self. In nursing school I have seen, smelled and done some very nasty and gruesome things. Most of the time I was aware of what I was about to do or witness. I would panic at first and then tell myself its part of the job, just do it. When it came down to it, I have always done the difficult job as if on autopilot. When I was done, I would be surprised that I was not crying, vomiting, fainting, scrubbing my eyeballs etc. Maybe that strength is included in seeing the dead body? I am just confused about my experience. Any thoughts, comments, similar experiences appreciated."

Me:
I really REALLY appreciate your post. I can relate to the question of shock? maturity? cold?

I have recently been questioning myself, too, in regards to an afternoon in the med room with another nurse and an extremely dehydrated 2 month old. I was at first worried about participating in the cath and IV stick, and yet, when it was time to help position and hold him down, I went into auto-pilot, much as you mentioned. I felt nothing. (being honest.)

I came home and cried later...not because of my nursing actions, because I knew getting fluids running had already helped the little fella. I cried because I asked my husband, "What kind of monster doesn't hurt inside when doing a procedure on a baby?" And of COURSE, I didn't want the baby to hurt, but I knew that the end (re-hydration) justified the means (an IV start.)

Anyway, I fought the same feelings you're expressing about seeing the deceased and wanted you to know you're not the only one. It helps to just talk about it and debrief a little. We're not cold; we're doing our job and helping people...and many can't do what we do.
Hugs,

Saturday, July 9, 2011

Update 2 of 2

So I got to do 2 12 h shifts in the ER.  LOVED IT.

There is such a swagger, a don't-stress-out-about-this-sh*t attitude there, and I was instantly in love.
When the floor realized they had a willing student, I got 8 IV starts and I hit 7.  What a confidence boost!!!!!  I've not started IVs in like MONTHS, seriously.
I learned how to do blood draws with the vacuum tubes, butterfly blood draws, and set up chest leads for EKGs.  I gave injections, pushed a helluva lot of Dilaudid (super great/strong pain med), I coordinated with CT on people who were finished with their Contrast-Lemondade, and I discharged patients.
A total blast.  I didn't have any patients who had extreme trauma, so I don't know how I would've been in that situation, but I did get to help set people up with severe chest/abdominal pain in the triage, slamming bp cuffs, leads, oxygen, you name it, on folks to determine where we're at.  LOVED IT.
(side note: I also applied to the ER, but they are done hiring new grads there for the minute, and so they told me in my interview that they would be declining me on that. Fine.  I've got a lot to learn; may be best to learn it in a less extreme environment.)
So for ER, they had us do 11a to 11p so we'd get to see lots.  Because a lot of the best stuff creeps up in the night. ;-)
And it did.  We had a tweaker who had rubbed all the skin off of his nose (crank-bugs, anybody?) but was there for a real reason; he'd had abd surgery a week ago, didn't rest after the surgery (tweaking!) and now has probable infection.  That crap gets serious in a second.  This was my miss in the IV department.  Hard to hit a vein when they are all burnt up and gone.
We had another suspected psych/tweaker who claimed to have suicidal ideation...who was bored and decided to put an insulin syringe in her vajayjay.  *sigh.  Really?  The on-call doc spent 15 minutes trying to convince a nurse to do the pelvic exam, lol.
The verdict?  NOTHING.  I know, right?
Anyway, I love the craziness, the crazy people, and the fast pace of the ER.  Maybe I'll work there some day.

Which almost brings me up-to-date.  In between all the good stuff I've posted about, I've been doing Med/Surg on a Bone and Joint floor.  I actually like it quite a bit, but I do not want to do Med/Surg, really.  Heh heh, looks like I don't have to, huh? (though I know that Sainted Big Dog Hospital is really bad about floating nurses from floor to floor, so I may do more than a little Med/Surg afterall...)

I had a day in Simulation Lab to learn how to hang blood and watch for transfusion reactions.  I also got to learn Central Line care and how to do blood draws from Central Lines.  Cool.

Now I'm in ICU.  They save the most critical patients for last, and as you can imagine, that is the smartest way to do it for students.  The crap I thought was hard 7 months ago doesn't hold a candle to 1:1 care of an acutely ill person in  ICU.
My first week of ICU was this past week and my little old lady was pretty much palliative care only. (YES. = comfort care only)  So I got off easy the first week.  No, I'm not happy she was almost dead, I'm just saying I was able to get all of my nursing tasks and my mountain of paperwork that Ms. Acute Care teacher requires each shift.
Poor patient.  You name it, she had it, and she finally just couldn't fight anymore.  She had cancer and the treatments pretty much left her susceptible to the really CRAZY sh*t that only people with full-blown AIDS get.  In a week's time, she'd gone from just ill and confused, to completely unresponsive to anything but pain, and only then would  moan.  She was in Septic Shock, which at that point, you have multi-organ failure...and you usually don't come back from that.  So I kept her weeping extremities dry and bandaged, and kept her morphine coming, and that was pretty much my day with her.  I had lots of time to do the stupid paperwork for my instructor.

PRECEPTORSHIP
So that is the final block in the wall, the final jewel in the crown, ha.  Pick someone in nursing to follow around.  I have a friend who is a Nurse Practitioner, and she was an easy choice.  She works in Internal Medicine and huge practice and it was REALLY neat to follow her Friday.
We saw a crap-ton of upper respiratory/sinus/ears problems (for which I have a crap-ton of steroid shots), a case of Bacterial Vaginosis, a huge mass on a shoulder, and a 40 something woman who is rapidly losing her ability to breathe. She got a CT - hope I get to see the follow up on that.
Monday, I'll follow a doctor's RN from the same practice (thanks to my NP buddy for setting  that one up) as she makes hospital rounds.  I have really wondered about how that works, an RN making rounds...as opposed to a Nurse Pract.

So I've got RN hospital rounds and a pee test to look forward to tomorrow on my 'day off,' and then 3 12 hour days in the 60-degree ICU, followed by another day shadowing my NP friend on Friday.  Busy week.

July 2011, already? Update 1 of 2

Gotta do another 'catch-up' entry.
I helped welcome the new Accelerated BSN class at my university.  Can't believe that almost a year has gone by and now I'm giving info to the next hopeful and excited class. ;)
I gave them good info like BUY A PARKING SPOT (super limited at my university), actually study, etc.  It was fun.
I applied to 6 jobs.  I applied to 2 jobs that are an hour away, one in Respiratory nursing, another in Transplant.  Hey, shoot for the moon and be happy with a star.  3-4 weeks later, got  the ol' rejection email.
I also applied for a job at St. Jude Children's Research hospital.  Super glad that I was "not selected."  I got to spend 2 days at my state's own research hospital, and while is is an AMAZING hospital, and a ridiculously AMAZING with kids, I hate it.  I'll go into the whys sometime. :)
I applied at a local hospital's One Day Surgery/PACU.  It was only a part time position, but I REALLY loved PACU (see above posts) so I thought, "hey, good foot in the door."  Yeah...still haven't gotten a call from them.
Which leads me to Sainted Big Dog Hospital.  They told us in a recruitment luncheon, that they would be actively pursing our class of Accelerated students, and she wasn't kidding.  I applied on a Friday night and received a call Monday morning at 9 am!!!

The Interview
I interviewed the following Friday.  Talked to the HR/Nurse Recruiter lady for an hour about my past work experience, best parts and worst parts of me, times when I was able to work through conflict, yadda yadda.
Guess she liked me.  She had me watch the Big Dog customer service expectation video, and when it was over, retrieved me from that room, handed me a packet of drugs and calcs to know for an exam, and asked if I had time to  meet the manager of the Unit I'd applied to.  ErrrrmYES.

So she walked me up the hill to the hospital and to that Unit and I had another interview on the spot.  This manager seemed REALLY cool.  A really great conversation, even if I *did* get a little excited in talking with her.  She seemed not to mind, and even commented that she thought that I was very much a people-person (indeed!).
The verdict?  She offered me a 7p-7a position right on the spot.  YAY!
I'm going to be working the Clinical Decision Unit.  It is a unit for people who aren't sick enough to still be taking up real estate in the ER, but the docs/nurses aren't comfortable with sending them home just yet, either.  A lot of it will probably be late night chest pain, and holding them until AM for stress testing.  That's ok by me.  Manager says that they TRIED to have this unit in the past, but it really just ended up being an overflow.  They shut it down, did the research, and are trying to do it right this go-around.  I think that is why they brought her on board; to start it.
So yay, I think I'll be able to see a lot and see it fast in this unit, and I'm SUPER excited to already have employment.
Tomorrow, I go in for the obligatory pee test, physical, hand in my mountain of paperwork and copies of cards (cpr, social security, etc) and take my darned meds/calc test.  I am fine at dose calcs but it does make me nervous.
They are giving a huge leeway.  You can make an 80%.  Which I can't believe, because you're technically killing or harming 20% of people, but it definitely is in my favor.
I told my classmates on our private group page on Facebook that I had a position, but I'm not announcing to the world until tomorrow is all done.

Friday, June 17, 2011

Wow, I saw a lot of shit this week.

Week in review

Tues at PACU

*TEE (transesophageal echocardiogram)
*Cardioversion (shocking someone to make heart beat in proper rhythm...in a person who didn't gave fatal arrhythmia.
Should be done in those who could have better quality of life from it. This lady had terrible skin wounds, morbid obesity, & renal failure.  I'm like, really? Funny beats were this lady's lowest priority. We got her out of arrhythmia, alright, but she was so bradyed down (slowed) she wasn't hardly getting blood around. (perfusing).
*Art line (arterial) in wrist
*TURP (trans urethral resection of prostate)
Murphy drip (major irrigation after *TURP)
*Dopplered a lady's pedal pulses after total knee

Wednesday

*Personally tried/failed 2 IVs for lady in renal failure
 (made me feel better when 2 other RNs failed. She's in renal failure for crissakes, & has no veins).
*Miscommunication with primary on meds, gave meds late. Boo.
*Gave 40 meds. FORTY. IN. ONE. DAY.
*Learned more about sickle cell crisis as I cared for a guy w/ it.
Sickle cell guy was *arrested* in the hospital! lmao. What a day.

Thursday

*Discharge on terminally ill guy ( who got the majority of yesterday's 40 meds), who hugged me and said he'd remember me. (aw!)
Pedi experience:
*Post surgery care on girl who just turned 16 & had a near fatal car wreck.
(She had a 'headband' of staples from ear across head to other ear. Way better through the hair than on forehead, scar-wise. VERY important for 16 year old, too.)
* Discharged her home, yay! I think she'll be ok.
*Assisted w/ 2 failed IV starts on a toddler
*Assisted w/ 3 failed in-and-out caths on infant. (on a failure-to-thrive baby)
*Assisted w/ 4 failed IV starts on same infant.
*Saw first hand how well sucrose drops work for pain relief in babies! Short term, but oh-so-helpful in procedures.

(He was bone dry. We fed him 3-4 oz of formula, a LOT for such an itty bitty...& then he projectile threw all of it up. Poor little guy.
Baby's 2nd admission in the last couple weeks. His mom was feeding him sugar water. Only. Not formula.  Grrrr!)

So it was interesting working on & with  children this week. Still sorting out how I feel about it.

Really great week, experience-wise.

Wednesday, June 15, 2011

I loved PACU!

And today, off to the pediatric/urology/ where-we-put-you-when-you're-dying-huge-private-room Floor today.

I applied for a Pedi job recently, so I'm hopeful I actually get a pedi patient to see if I actually like it.

:-)

At 144 lbs today. Yay!

Thursday, June 9, 2011

Nursing school updates and "Scared Straight"

Howdy. :-)  So I'm now in 3 days a week, 12 hr day clinicals.  I have one online course I'm taking ("Professional Role) and lots of papers and paperwork with Clinicals.  I'm SO like...really? on the paperwork with clinical. But whatever.  I graduate in approx a month and a half. Double yay!

I'm applying for jobs too.  And for the life of me, I applied to a Pediatric Oncology position at a major children's research hospital.  I don't know why.  I have never felt like Peds was for me, but when I saw the job, I just thought I had to apply.  I have pediatrics this week in clinical (well, 1 day PACU and 2 days Peds) so maybe that will add some clarity to the whole thing.

That hospital is 1 hour away from home.  I guess I can commute.  My niece lives 35 minutes beyond the hospital. Who knows, maybe she'll allow me to rent a room 2 nights a week?  The husb better get ready to take care of the fur-babies, then, huh? ;-)

Hmm, what else...?  I got an 'A' in both of those horrific online classes I took in May.  WhewThankGod.

Went to our State Board of Nursing to see a hearing last week.  Also required for our program.  Kind like the show, "Scared Straight."  Keeping the new nurses on the straight and narrow, lol.
Well, the only woman who showed up was in contempt of her SECOND probation.  And they did not revoke her license.  They listened to her, gave her stricter criteria, and extended her probation.

Really? You can keep your license after failing a drug test during your probation?  This lady actually had extenuating circumstances.  She is prescribed an amphetamine for her fatigue due to MS, but she did test positive for alcohol, which she explained was Nyquil.  *shaking my head.  I dunno.  That is a hard call to make.

Two other people were 'tried,' but they didn't bother to show up.  So they were suspended.  AGAIN, not revocation, but suspension.  I just don't get it.

So some of our class asked at the end, when we were allowed to talk to the board.  They pretty much just said that revocation is FOREVER and so they are extremely reluctant to revoke.  Wow.

In other news, I'm doing the Dukan diet.  Down 2.6 in 2 days - Yay for me!

Sunday, May 29, 2011

Best friends at the Best party

Sanity Reclamation Party

We had a GREAT pool party at my dear friend Stephen's during-the-week-house.
It was for Memorial Day, finishing the horrid online classes, & to welcome summer. Yay for grilled salmon, veggies, booze, & best friends. :-)

Saturday, May 21, 2011

Week in review

Choir concert two nights this week in a town about 1 hr away. Went pretty well.

I'm too busy for that stuff right now. Glad I did it but glad it's over, too.

Reconsidering CNS for grad school. Looking at Family NP. With my background in Training, and masters in Health Ed/Promo (public health), & plans for getting a DNP, I think I'll get at least some of the aspects of a CNS. And as an (a?) NP, I'll have lots of great clinical hands on experience.

So I'm wallowing in that indecision for now.

Research. Love it in the real world; despise the class. About to take an exam.

Later.

Friday, May 20, 2011

What's up in my online world?

Wowza are these online classes ever full of busy work!

Not sad anymore...been seeing some of the local friends at the Library and The Edge Coffee Shop, so I don't feel as disconnected.  My Husb has been on the road for a week solid, so I've been a little lonely, but my days have been busy.

I'm about to have to diet again.  I diet for awhile, I quit for awhile, and when I start hovering around the magic number 150, I diet again.  I'm about 148 these days.

Let's see...what else...

I'm stressed every time I schedule my online bill pay.  Every time I take money out at the ATM.  My loan funds are getting smaller and smaller.  I hope I can find a job right after graduation.

And to that end, I am putting feelers out.  I have an interview with a total-senior-care, interdisciplinary-team-approach place in my town.  There isn't a specific job opening at the moment, but I am very thankful to the Exec Director who has agreed to meet me.  That'll be sometime next week; she gave me her number to call for an appointment, yay!

I am very thankful that the Husb has been blessed with a lot of work recently (it's contract kinda stuff).  One of my dear friends in our program just had to sign up for assistance.  I know they are under a LOT of pressure at the moment.  God bless 'em.

Think I'll go drink with my friend Psych-PhD.  Her husb is in a band.  They let me sing with them occasionally; it's a blast.  I still get a bit nervous, (I used to get REALLY sick-nervous back in the day if I had to sing...like only a couple years ago) but now it is more fun than not.
Psych-PhD is getting to teach the next group of accelerated students.  She would've been great to have as my teacher, but I'm really glad she wasn't, because we get to be friends this way!  I have 3-4 other really great teachers that I can't WAIT to be done with school so I can be their FRIEND, not STUDENT.  Professional boundaries, and all that jazz.  It's cool; I totally get it 'cause I've been on the other side of that fence before.

Diet Mt. Dew Voltage...ugh, how gross.  Wish I hadn't of bought a 12 pak. ;-)

Wednesday, May 18, 2011

What is YOUR personality type? Ima ENFJ!

That's Extroverted iNtuitive Feeling Judging!!!

http://www.humanmetrics.com/cgi-win/JTypes1.htm

That's the link! Take the quiz, get to know yourself; it is really fun!

So to get to know me better:
"ENFJs are global learners. They see the big picture. The ENFJs focus is expansive. Some can juggle an amazing number of responsibilities or projects simultaneously. Many ENFJs have tremendous entrepreneurial ability.

ENFJs are, by definition, Js, with whom we associate organization and decisiveness.

ENFJs are blessed through introverted intuition with clarity of perception in the inner, unconscious world. Dominant Feeling prefers to find the silver lining in even the most beggarly perceptions of those in their expanding circle of friends and, of course, in themselves.

 ENFJs are continually looking for newer and better solutions to benefit their extensive family, staff, or organization. *totally me*

Other famous ENFJs include our Pres, Barack Obama, Diane Sawyer, Oprah Winfrey, and Peyton Manning!

Tuesday, May 17, 2011

Online classes; no stranger.

I've taken a disproportionate amount of online classes. My first BS and MS degrees (bs...ha!) were from the best online college, Western Governors University.  (they really are the best; they keep winning awards to substantiate that claim.)

So I knew that these classes, Health Care Admin and Research, had great potential to be huge pains the ass.

Well, they are. :-)

You really end up doing a LOT more work in most online classes. Where an in class discussion would suffice in the brick-&-mortar world, online you get a project.
X 5 days a week (seriously) & then X 2 classes. A lot of it is busy work, too.

But I do like Health Care Admin because it is the business side and, well, up until this year, I've known nothing but business.

I was asked to take the Myers-Briggs personality test. (its a Carl Jung test, really.)

I LOVE stuff like this, and I've taken it before, so I couldn't wait to see who I was NOW.

I took it twice. *blush
I was ENTJ and then ENFJ. ENFJ is what I was the last time I took it. I feel like that is probably me.

I'll post info on what that means next. I'll post a link to the test, too.  REALLY cool for self discovery and for understanding others. I really believe in the stuff.

Well, I'm off for now to look up a clinical research article, write a paper on the ORID method, and join discussion board debate on delegation of an LPN.

Monday, May 9, 2011

Not-So-High-Acuity

Double yay for the last day of High Acuity. My final exam didn't go as well as I would have liked it to. *sigh    
But at least I am done.

I will unfortunately have a B for the course.

And with the closing of one door, comes the opening of another door. We started orientation to our next class; Research. Done it. *snore

There has been much hope that there will be much beer at the end of today...Celebratory beer.

So I might have texted my good friend in class today. I might've said something like "my liver is growling".

And my friend, well, I heard him silently panicking about how he was uncontrollably laughing. And then he might've proceeded to text me back, "oh my, I think I may snort."

Dear reader, a coughing fit could *not* cover up how hard I was laughing.  I had to run out of the room, coughing and pretending to be choked.
Good times!
So a bunch of us are going to our local pub later, to have a *really* good time; well deserved.

And then I have a rehearsal with the community choir that I'm in. So I may go a little drunk tonight, LOL. Brahms Requiem will never have sounded so good!