Student Nurse, prn

Saturday, November 05, 2005

Straight cath/vaginal culture and a subQ... or two

I spent Friday in clinical in an locked Alzheimer's unit. I enjoyed it; great staff, nice music and activities/GAMES! I had three patient's to administer meds to and do treatments.

One of my patients gets a M-W-F sub-Q (subcutanous) injection of Procrit (for anemia due to hepatic failure) this wasn't my first time. She had to receive two injections, thankfully, she was too tired to object. I'd done at least two other sub-Q's and this one went well. Technically it's NEVER our first time, we are told to tell patient's that because we practice in the lab on an injection pad--so technically our first time on a HUMAN is our real first time. But in this case I had done 2 other patients. My first was on an elderly gentleman with severe dementia. Unfortunately for him the force at which I 'stabbed' him in the abdomen was not enough and the needle/syringe bounced off the epidermis and he said, "ouch". I felt awful but didn't realize he gets regular abdominal injections which tends to toughen up the external layer of skin and makes it harder to inject over time.

My treatment was a dressing change on a stage two pressure ulcer on the lateral malleolus (ankle bone). That was quick and easy. A bit of cream and an underneath pad along with kerlix around the ankle/foot to keep it all in place.

Lastly, another patient was experiencing the symptoms of UTI (urinary tract infection), burning on urination, itching, etc. She is incontinent so an straight cath was ordered to obtain a urine sample for testing. This is sterile technique so my instructor had to be present. It went well, I got it in on the first try (finding the right place isn't as easy as you'd think especially on an elderly woman who doesn't want anything to do with this procedure) and I didn't break the sterile field, yipeee! After the cath a vaginal swab was done. This involves a longer q-tip like stick inserted and swabbed momentarily into the vagina and then placed into the lab vial. She didn't much care for this either.

The Alzheimer's unit is small, only 18 patients (9 rooms) ...they offer structured activities but I am told the only thing that that patient's must do is be toileted on a schedule. Everything else they do or don't do is their choice. Some participate in the group activities, some do not, some wander/pace the hall back and forth, some sleep a lot, some ask you over and over, "what should I be doing right now?". Most of the patients are pleasant and cooperative, they just are at risk for wandering.


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