Care plans ....

We have two care plans to finish before the end of the semester.

I just finished one from on of my last weeks patient. I will do another this week, that relieves one major item to not think about over spring break.

Patient info, medical diagnosis, pathophysiology of disease, diagnostic exams, medications, assessment, patient problem, nursing diagnosis, nursing interventions, goal, evaluation, goal met.

My instructors version of the scientific nursing process called ADPIE.

The HAG yelled at me!!!!......

OK, I'll calm down now. Some people have no social skills at all.

Here's the scoop...I am passing by the nursing station and the unit secretary says to me, "Patient in Room 100 needs something right now" (it's not a stat I'm dying, just a get here ASAP).

I make a quick bee line for the room. When I get in there the patient has pulled out her IV (I think her chair got caught on it) and her forearm is bleeding and the IV is spurting out saline fluid. The patient has her hand over the blood source.

I put some gloves on pronto, grabbed an unopened roll of curlex (rolled gauze) that happened to be sitting on her bedside table and placed the whole roll on her arm and then had her bend it at the elbow. Whew, priority #1 --stopped the bleeding. Then, I took the IV and placed it on the incontinence pad on the bed (I'm not allowed to touch the IV pumps yet) I did this so it wouldn't get the floor all wet. I told the patient I'd be right back and went to get the assigned RN.

She was on her break, so I get her break-nurse and we went back into the room and took care of the issues. (Stopped the IV, properly put a small dressing over the site of bleeding) then I went back to my previously scheduled whatever I was doing.

About a 1/2 hour later the assigned RN sees me at near the crowded nurses station and yells loudly at ME, "no one ever told me about my patient's bleeding!!!!!!"

Then at least 5 people in the vicinity say, "shhhhhhh", very sternly at her.

Of course, I look like a deer caught in the headlights and stammer something like, "the break-nurse (who's name I couldn't now recall) knew all about it".

The assigned RN says something unintelligible and the break nurse looks dumbfounded, shrugs and we all walk away.

I was pissed off. People now think I am an idiot for something that I did correctly. It was the responsibility of the break-nurse to report anything she did while the assigned nurse was gone.

I stewed about it. Notified my instructor. Then my instructor talked with the HAG today and she said, (and I quote) "Oh, I wasn't mad at your student I was angry at the break-nurse, I knew it wasn't your students problem"

WTF?

Drug seekers...

Not sure I should have used that title after the one from a few days ago ...this blog has gone to the gutter.

But seriously that is the subject today. I had a patient the last two days with a disease called Crohn's (click on the link for a detailed description) but in a nutshell it's a very painful chronic inflammatory disease of the large bowel. She, the patient, (47 y/o, white) was in for the diagnosis of GI bleed (symptoms were massive blood in her stool). Her discharge diagnosis was listed as exacerbation of Crohn's. She has been to the hospital many times before because the disease can flare up and have increased symptoms at any time.

My RN that I was reporting to today was rather flippant that I chose her as a patient. Mumbling that there were better patients for learning experiences than a 'drug seeker'. Well, first of all when I chose her it doesn't exactly say on her chart/care plan "DRUG SEEKER". It lists her medical issues not the nurses perceived psychosocial ideas.

Now granted this chick was on massive doses of opioid drug derivatives but hey, she said she was in pain. The description of pain, we are told by our instructors, is exactly as our patients perceive it. Nothing more, nothing less. Pain is very SUBJECTIVE. And granted I may have had my doubts but I certainly didn't treat this patient any differently because of her history. I mean has my RN today ever had Crohn's? --I don't think so.

I can understand how in the ER they get fed up with folks coming in with pain issues on a constant basis but this gal was in the hospital for days with pain.

I know I have lots to learn but I hope I never get jaded like my RN was today.

Pimpin'....

When you got something good, share it.

My good friend is brilliant. One of his most recent ventures is a company called VisiStat.com. Don't think medical STAT, think site visitor stats. His site is very user friendly and they send you a daily email with a re-cap of the previous day. I highly recommend it. And no he did not ask me to post this, I did it because I believe in his products.

But, of course, see for yourself here at VisiStat

Just to clear things up...

I appreciate all the nice comments from my most recent post.

I blogged about this long ago (but briefly) on my career path. So, I just want to clear things up.

I will be an LVN when I am finished with my current program. For some folks they are thinking what's the difference? Other are thinking why would you do that?-- RN's make more $.

So, first I'll explain the difference to non-medical folks. RN is Registered Nurse and LVN or LPN in some states is Licensed Vocational or Licensed Practical Nurse. I can only speak for the difference in California. An LVN can do all the same stuff an RN can do when licensed except for anything IV related. We can however take an IV certification course and do some of the IV stuff. To keep it simple. An LVN can NOT inject anything directly into an IV catheter (even if certified). After certification we can hang IV fluids and blood. Again this is the simplistic version. Procedurally there are some very technical and specialized things also but as far as routine tasks that is the difference.

Now the better question is why did Student Nurse, prn choose LVN and not RN? A number of reasons. First, I am changing my career mid-life. This is primarily because I am a single parent.

I had a career before my divorce that I LOVED. It was the best job I ever had. I was a Corporate Concierge at HP in Silicon Valley. Catering to the elite HP executive guests in a high tech customer briefing center. I have always been in the travel/hospitality field and loved it. I am a people person and calm problem solver. My career path however did not pay well. Perks were off the charts--dining out comp, theatre in San Fran, wineries, you name it but I was never going to be able to raise two girls on that salary in the Bay Area.

I also knew I never be able to handle the stress of school, working and my girls at the same time. So, logically the job went bye-bye. I moved to an more affordable area of California bought a house and started my pre-requisite classes at a local community college. I had budgeted that funds would be able to last the length of the program if I got in quickly but only for the LVN program because the classes required for the RN program are more of the harder sciences and etc. I didn't have time to wait to complete them while not working.

I finished my pre-req's, worked for a while as a nursing assistant, and applied for the LVN program. I got in on the FIRST try (it's lottery based so luck is the only factor).

So, here I am ALMOST broke (haven't touched my IRA yet) and applying for a student loan to get me through the last few months but the sanity base is the equity in my house is AWESOME, gotta love CA.

Once I finish this and I am licensed I will go back and take the remaining pre-req's for the RN program --one night class at a time. And then apply for the step-up program geared for LVN who want to be RN's so I will get there someday. For now I will earn a decent salary in the field I want to be in while I get to my ultimate goal, RN.

Light at the end of the tunnel.....

I can see it, it's not bright but it's there.

This week marks the 8 week mile stone until our pinning ceremony/graduation. If you factor in one week of spring break in April that leaves only 7 weeks of class time. Wow.

Tomorrow we take a class picture in our complete uniform.

I have been on the surgical floor for the last two weeks and will be this week too. I have had a several folks with the knee replacements. A back surgery. An appendix burst (19 y/o new Mom only 23 days post partum). Gastric by-pass, etc. This week should be more fun. I have two care plans to complete before the end of the semester. I think I may tackle one this week. I tend to prefer surgical floor to medical. The medical floor is like the investigation team. Lots of sick/miserable folks and not sure what they have going on, so lots of tests, labs and nausea/vomiting/febrile folks until the mystery is solved. The surgical folks on the other hand are post surgery and just in need of recovery. First most patients are still tired/loopy and sleep a lot. Second day is always better and by the third they are itching to get back home.

I also put in a request to go to the ICU, originally I said no, because I have no interest in that area of care. But I have changed my mind for two reasons. One is as a part of the continuum of care I think it's best I see that part of a patients stay. Secondly, I have been surprised in the past about what I enjoy and I promised myself to keep an open mind.

Lastly, my intentions all along were to keep my blog school related. I think I have managed to keep that goal but I have the desire to continue to blog. I find it cathartic. So, to those sweet fateful readers who maybe interested don't fret, Student Nurse, prn will resurface in another light. I will find a way to lead you to the new place while still trying to protect my anonymity.

Coming up for air.....

*gasp* I am alive.

I have been immersed in studying for the past few days. I was up till 1am last night (technically that was today still) because we had our mid-term exam today.

96 multiple guess questions. One math calculation. Eight short answer essay questions.

I passed. *whew*

Tag, you are it..........

Well, it turns out I've been tagged by Dustin over at Desert Imaging. So here it goes:

Four Jobs I've Had in My Life:
1. Sales at The Gap
2. Receptionist in a Hair Salon
3. Reservations/Inside Sales/Operations Supervisor for a Tour Wholesaler
4. Corporate Concierge at HP (best job I ever had!!!)

Four Movies I Could Watch Over and Over:
1. Somethings Gotta Give
2. Dirty Dancing
3. Shawshank Redeption
4. The Everlasting Lightness of Being

Four Places I Have Lived:
1. Tucson, AZ (born there)
2. Menlo Park, CA (grew up there)
3. Plano, TX
4. Lexington, KY

Four TV Shows I Love to Watch:
1. The Real World (someday I will grow up)
2. Grey's Anatomy
3. American Idol
4. ER

Four Places I Have Been on Vacation:
1. Hawaii, all islands (and more times then I can count)
2. Jamaica
3. Europe (Spain, Africa, Italy, Switzerland, France, England)
4. Lake Tahoe

Four Websites I Visit Daily:
1. my Yahoo home page
2. Dictonary.com
3. my blog
4. Craigslist.org (Sacramento)

Four of My Favorite Foods:
1. Sushi
2. Mexican
3. Ribs
4. Chocolate

Four Places I Would Rather Be Right Now:
1. Greece
2. Fiji
3. My cabin near Tahoe
4. with my niece (she's 8 months old)

Four Most Wonderful Places I've Ever Been:
1. Barcelona, Spain
2. Kona, Hawaii
3. Big Sur, CA
4. Wright's Lake, CA

Four Books I read Over and Over Again:
1. Drug Guide for Nurses
2. Diseases and Disorders, A Guide for Nurses
3. Shel Silverstein, A Light in the Attic or Where the Sidewalk Ends
4. John Steinbeck, East of Eden

Four Songs I listen to Over and Over Again:
1. Making Memories of Us, Keith Urban
2. Linger, The Cranberries
3. Kiss You All Over, Exile
4. Sunday Morning, Maroon 5

Four Reasons Why I Blog?
1. to capture for posterity my experiences as a student nurse
2. to share my experiences with other students
3. to help me think
4. to Rant and to Rave

Four people I tag to do this?
1. Mona
2. Neil
3. Monika
4. Bear

Mundane...You want mundane?...Here's is my morning....

No school on Mondays...up at 8am ...wake the youngest kidlet ....tell her to get her rear in gear...get newspaper off porch...turn on heat for teapot...make the bed....turn on the Today show...plop in comfy chair...teapot boils...pour cup of tea.....sit down in chair...turn on 'puter...watch news...get distracted.....remember time...yell at kidlet to HURRY UP!!.....get out of chair ....to make oatmeal for kidlet now that she has 'NO TIME' to eat and get to school...in process of turning teapot on for the oatmeal spill entire cup of fresh tea onto counter and floor....*sigh*....finish with oatmeal, making a lunch, driving almost-late kidlet 2 BLOCKS! to school...return....fire-up teapot again...clean up entire spilled mess...SIT in comfy chair...get up......put hot water over teabag....get distracted by post-Oscars news and email, blogs....get up for tea to discover teabag leaked and now tea-leaf flakes are floating in tea....get new cup, strainer and pour tea into new cup...take that first sip of warm tea, was it not ment to be?

All I all wanted was a hot cup of tea with my newspaper and Today show before I have to study. I tried hard not to RANT but hopefully this is NOT my regular 'mundane'.

Health and Wellness Fair...

I volunteered today at a Health and Wellness Fair...sponsored by a large church in my area.

I was doing blood pressure checks for folks and sitting at the First Aid station. I had a good time. Meet some nice people. There was community law enforcement (sheriff, highway patrol, search and rescue), other local agency's (SPCA, Mediators, Recovery specialists), folks promoting good health (vitamins, chiropractors, health clubs), a blood drive, speakers, and food vendors.

One thing I learned, I LOVE a MAN in UNIFORM they give me tachycardia.

My personal claim to fame for the day was I put a Cat-In-The-Hat bandaid on a two year olds finger. She had a small cut. I felt like a hero.

Hope everyone has a great weekend.

Snow day in Cally?.....

I wish!!

Actually, two of my classmates had that pleasure today.

I live in area that is very unique. Two hours west of me, the sound of the ocean, one hour east of me, snow.

Our clinical location this semester (a hospital) is 30 minutes east of where I live (and where our school's campus is) ...go an additional 30 minutes east and that is where they get snow a few times a year.

Can you take a guess at what city I might live in --approximately?