Student Nurse, prn

Saturday, December 31, 2005

Can it really be 2006?

Happy New Year!!

After catching up on a few blogs that I read regularly I am very melancholy today. Can a new year really be about to begin?

Wow. Time is so intriguing . What will the next year bring? Hopefully a graduation in May for me. Followed by a graduation from the 8th grade in June for my eldest daughter. (*gasp* I can't possibly be the mother of a child in high school! Wasn't I just there myself?) Then I will tackle the CA state board exam for nursing licenseure in the early summer and then the ultimate goal getting a job in nursing. Can all this happen? It seems so long ago (Spring of 2003) that I decided to pursue another career path. Then there is my personal life which I don't blog about here but as a single gal I always wonder what life has in store for me.

All this reminds me of this very cool project I did in my Human development class in the fall of 2003. My instructor has us do a time line of our life. What you say? *ppstt* You are not dead.

Well, that was the kicker, we were to list all the major things that had happened in our lives so far. Birth, siblings births, graduation from high school, marriages, divorces, family deaths, --the big events. Then we had to continue the time line and add things that hadn't happened yet. Predict the future persay.
Our graduation from college, parents deaths, children's marriages, grandchildren, remarriages, spouses deaths,, etc... you get the idea and yes, we had to decide when we were going to die. I decided I was going to die at the ripe age of 88.

When I had the project all lined up (it took three pieces of 8 1/2 x 11 paper laid end to end) I was glancing at my past and a fictional future. How very surreal.

The thing that struck me the most was how I felt I was struggling so much with the current chaos of my life. Going back to school, relocating to a new city, the recent divorce, etc. BUT when I looked at my life as a whole (all 33 inches of it on paper) and narrowed in on the
very very small seemingly insignificant span that would take place while I was in school and compared to the past and future. It made me realize that this crazy time was very short and that I could handle it.

I can handle it ....I am not super woman I am just doing what I need to so that I can support my family and enjoy giving to others.

Tuesday, December 20, 2005

Holiday Cheer...

Last year I worked in a facility over the holidays that is 1/2 long term care and 1/2 acute rehab. The rehab side where I work is for folks mostly sr. Citizens that need intensive physical rehab post surgery or stroke (cerebral vascular accident -CVA/brain attack) before they can go home or possibly their significant other/family is unable to care for them during this rehab stage. I ended up working Thanksgiving Day, Christmas Day and New Years Day. *gasp* I know what you are thinking, poor Student Nurse. But don't, due to my arrangements for shared custody with my daughters I would have been alone during those days/times anyways.

So, it was something I enjoyed a lot to be able to care for these folks during the holidays. I really get a kick out of putting a smile on someone's face or making them laugh. I have a knack for an infectious smile, if I do say so myself.

If you are looking for a feel-good holiday gift I would like to suggest to get yourself some small trinkets (candies are not recommended because of some folks dietary restrictions or swallowing precautions) and deliver them room to room with a personal greeting. Lots of these folks do not leave their room except for therapy. I nice warm holiday greeting could make their day. It would be wise to get permission/rules from the administrator of the facility first because remember for some of the long term care patients, this is their permanent home.

This year I get to spend more time with my family over the holidays due to not working during the school year. But I will go back to work on the 28th for a day of work and then some sporadic days in January.. I am looking forward to it. I miss the smiles.

I wish you all the all the joy the holiday season has to offer, may the blessings of life warm your heart

Thursday, December 15, 2005

Hallelujah !!!!!! Whooohoooo!!!!! Yipeeeeeee!!!!!

I PASSED!! What a glorious feeling.

I did great on my clinical exam. Missed only one very small thing. After I did my initial focused assessment on the patient (a mannequin) I had to go prepare an IM injection and administer that. Well, I had already identified my patient and had him state his name and checked his ID wristband BUT when I came back to give the IM injection I was supposed to check his ID wristband again. I did not. *ugh* It was not something that prevented me from passing but just protocol. My instructor reminded us that if we do that next semester with a patient in the hospital it is grounds for an 'educational contract' because it is something that is mandatory. But I know exactly why I did it...because the facility we are doing our clinicals at now is very technologically advanced. Patients wear ID bands that have bar-codes on them, meds have bar-codes on them, student/employee's ID's have bar-codes on them and meds are listed in a computer thereby forcing you to scan all three things before ANY meds can be given. It is GREAT for patient safety but a bad habit because most facilities do not have this system.

My 'patient' was an 85 y/o with pneumonia
and a history of Type I diabetes (NIDDM) and Parkinson's Disease. He had copious amounts of sputum and a right lateral leg wound proximal to the ankle bone. Upon entering the room I immediately noticed his oxygen was not on and the head of his bed was not raised (extremely unsafe patient safety issues). I did my focused lung assessment and the patient was complaining of pain 7/10 on the pain scale. The patients current medication record did not include a back-up pain med. Therefore, a call to the Dr. to get a new med was needed. After receiving a phone order from the physician I needed to prepare and give the mixed IM injection (which included the math calculations on the dosages). After that I had to reevaluate the pain level and proceed with a sterile dressing change on his wound. I managed to do that all within sterile technique. Then I had to give a mock oral report on my 'day' and write a nursing note on the dressing change. It was over in 45 minutes, all under the watchful eye of my instructor. This is pass/fail system, no letter grades.

My med/surg theory final exam was not such a breeze but my overall class grade (a combination of 20% weight based on a Peds final we had earlier in the year and this med/surg final with all other mid-term and quiz scores at an 80% weight) this enabled me to pass with the required percentage.

Now I can focus on the holidays, my family and resting a bit before we get back to classes mid-January. I may post some random thoughts between now and then ...or not ...depending on my mood. ;o)

Tuesday, December 13, 2005

Day 0 .....

Not sure what to say today.... this test was even more what difficult than I expected. I felt like I studied A LOT and was prepared.

Best comment from a classmate today at the mid-exam break was (this is a fella who is normally very quiet)..."I fell like I am going to vomit", .....enough said.

Now it's time to concentrate on tomorrow's clinical skills exam. We have 45 minutes to perform in front of our instructor. We choose one of three taped nursing reports. The one tape will include information about 2 patients. We then pick the patient with the highest priority of care and do what is needed for that patient. There are 3 skills that we may have to perform based on the taped report we chose. Either insert a Foley catheter, insert an NG tube or do a sterile dressing change. Also, there will either a mixed insulin injection or a mixed IM injection. After all is done we must do a nursing note and verbal report to the instructor.

All while not forgetting to knock on the door, introduce yourself, check the patients name, ID band, inform the patient of the procedure, provide for privacy, gather the equipment, check the room for patient safety issues,
wash your hands and complete the task according to the proper technique.

Monday, December 12, 2005

Day 1 ... *sigh*

Tomorrow is the theory med/surg final. It's almost 9:30pm and all I have dancing in my head this holiday season is drug names, disease names, lab values and terminology.

Next on my agenda is a good nights sleep and a decent breakfast in the AM (hard boiled egg , 1/2 bagel and a big cup o'tea-decaf).

We had nice study group today, so I feel like I have done my best to study the material.... I had a instructor who once said so simply; "If you know it you know it, if you don't you don't", he was emphasizing that once you know something stop studying it and go on to what you do not. At this point it's too late to cram anymore in so... sweet dreams until tomorrow

Sunday, December 11, 2005

Day 2..........My signs and symptoms are ....

...nausea, sleeplessness, gastritis, anorexia, irritability, drowsiness, tachycardia, hypertension, increased respirations, headache, ALOC, and diarrhea.

Question: What do I have? (scroll down)

Wednesday, December 07, 2005

Day 6 ...can you spell pneumonia?

There are some words that no matter how often I write them down I can't remember the spelling. In fact I have always been a bad speller... I can spot a misspelled word in text but I couldn't tell you how to spell it correctly... and medical terms are just a accident waiting to happen. :o)

We are at 'Day 6'. Today in theory lecture the topic was supposed to be review. We did some miscellaneous stuff but got very little time for review. The good news is I did an hour + of time with my study buddy and went over Respiratory acidosis and alkalosis and I feel much better about it now. *whew*

Today was also clinical prep lab and I have two more new patients (both male) in the final week of clinical at the hospital. I'll write about them more tomorrow.

Right now I am in a combination of fear (for the final exam) and excitement (to have the semester over). I am looking forward to the 30 days off but I know it will go by like a flash with the holidays mixed in. I have a list as long as my arm of stuff I put on the back burner to focus on school.

Saturday, December 03, 2005

Day 10 .....Motivational kick in the arse

No study group today, gotta get up the gumption to do it on my own. Take books. Start up fireplace. Get warm beverage. STUDY.

Ohhh and before I forget a recap from Thursday ....

My female patient doing well tolerating solid foods having a few BM's, talking about going out shopping with her daughter and buying her "cute cancer scarves" for her potentially balding head. She said she is a planner and is glad that she has time to process and plan the coming weeks. I wished her luck before I headed out for post clinical.

My male patient I thought had turned the corner. His NG tube had been removed. He felt better in the AM wasn't using his PCA for pain meds any longer. He agreed to a shower and was Ok'ed to have 'sips of clear liquids'. About an hour before I was ready to head off to post clinical he complained of nausea and the RN gave him some IV meds for that. Right as his surgeon came by he immediately had copious amounts (over 200ml) of bile emesis. Sheesh, needless to say I was late to post clinical. And the MD said he wanted to do another upper GI CT scan. This fella is not outta the woods yet.

Thursday, December 01, 2005

Day 12 ...and bowel obstructions

So far, so good.

We did a 3 hour study session on Tuesday and one hour session Wednesday and today. We are taking off Friday because both my study buddy and I have plans that evening but we will be back to it on the weekend.
I am hoping that the concentrated daily sessions will help me retain all this material.

Today was also my middle clinical day this week. I have two patients with similar diagnosis. Both have bowel obstructions. One of the small bowel and one with the large bowel.

My male patient (SBO) is a very non-compliant with his care and recovery. He has been refusing his ADL's and complains of nausea in order to get out of walking the hallway. And he wonders why he can't pass gas! Walking will wake up the GI and help restore function. Instead of telling him what he had to do today, I said, "Would you like to take your morning walk at 9am or 10am?" That doesn't give him the option to decline and makes him think he is in control. :o)

My female patient (LBO) has not been as fortunate. After her colectomy they discovered the mass was colon cancer. I was with her today when her oncologist went over what to expect the next 12 weeks or so. She will have a port-a-cath inserted so that it will be easier to administer the chemotherapy. That will start in January. It is hard to watch a normally healthy woman in her late 50's be told that she has stage 3 cancer. Her comment was I can't even say the word "cancer". I have to admit the great bedside manner of her Doc helped her absorb all this new information.

Tomorrow I pick up a total hip replacement to make a total of three patients.