Student Nurse, prn

Saturday, April 29, 2006

Before disaster strikes... have a drill.

At the hospital they have a HUGE one. A county wide disaster preparedness drill.

People volunteer to participate as both professional responders (MD's Paramedics, EMT, Law enforcement, Fire fighters, Nurses) OR victims. This one, I believe, will be a biohazard situation.

So, on Wednesday of next week we get to participate as Nurses. So cool. Actually, being a victim playing the injured roll might have been more fun but this is going to be great experience from an educational point of view.

Tuesday is our very last lecture class (with a quiz on renal). The following Tuesday is our final exam. This weekend involves lots of studying....

Update: Mom...

She's home, after having to stay an extra night in the hospital due to a low grade fever.

She did have a first semester nursing student (RN) assigned to her, which I thought was hilarious. I am sure she talked the guy to death. Poor fella was having a hard time just getting her BP (he couldn't manipulate the automatic machine).

Treatment plan: Rest, q 6 hour Percocet (oxycodone and acetaminophen)

The only PT she received in the hospital was she was taught how to do a log roll to get out of bed. No brace or anything else.

She seems in good spirits. Talking on the phone 24/7! Typical of my Mom. She also wanted to take a shower when she returned home but was referring to the shower as the "den of doom...where the evil happened..." --all in jest of course. I told her to get a shower chair just in case.

Wednesday, April 26, 2006

Distance sucks....

I don't normally blog about personal stuff but this crosses the line from personal to nursing/medical ...

I just found out my Mom is in the hospital. *ugh* and My folks live 2 hours away (by car). Mom is only 60, very lively, spry, those seem like weird words to describe her let's put it this way ...she's the HIP Grandma, (as in COOL) get the picture? Totally close with my two daughters.

Well, she had the stomach flu. Was up all night before last with typical symptoms, emesis and diarrhea, yesterday she gets in the shower at 6pm-ish after my Dad had returned from some errands. He's watching the boob-tube and hears a crash. Calls out. Nothing. Gets up finds Mom in a crumpled pile in the shower (small square glass enclosure) ...not responsive, she has had a syncopal episode (passed out). He lifts her eyelids and her eyes roll back. Calls 911. Go Dad. She's unconscious for maybe total of 2 mins. Paramedic/EMT's come get her up and transferred to a gurney and to the local hospital.

Trip to the ER. Xrays, CT scan. Diagnosis: Cracked vertebrae L5 (Lumbar 5 the last one before your sacrum and coccyx) and low potassium level. Start pain meds. 11pm agree to admit to hospital. 2am in room.

Talked to her at 10:30am she had just gotten breakfast (WTF). Asked her the name of her nurse, she had no idea, no one had introduced themselves! (WTF) She's in a ton of pain and getting morphine IV and now Percocet PO (by mouth) and potassium PO. Dr. says rest you will go home tomorrow AM.

Her potassium (K+) was most likely low due to the emesis and diarrhea from the flu.

It sucks to be far enough away I can't go and give her a hug but my bro lives close and my Dad is very capable. I just can't concentrate on anything right now.

Welcome faculty, family and friends....

OK it really doesn't start that way but GUESS WHAT? ............

I am going to speak at the pinning ceremony. ME. Little ol' me. A 'speech' and I volunteered to do it. My classmates do not know the content. It's a surprise. They do know I have something planned. But be assured it has lots of the word DREAMS in it and required poignant moments.

I do not think I am a good speaker. I am NOT the type to want attention. A few weeks back I was in an especially emotional state (read: PMS'ing) and decided to start writing. This was the result of my 'moment'. I hope that the passion I felt at the moment shines through in my 'speech'.

As the saying goes anything that doesn't kill us will make us stronger. I'm going to be one tough chick.

Pray for me. Please.

This could get interesting.

Monday, April 24, 2006

I am *the* Enema Queen....

Two more weeks of clinical time left and I never had to do this. Rectal medication, yes. Enema, no. But now I can say I have the had the joy of not only administering ONE but FOUR enema's in one day.

#1 Mineral oil enema -- no results
#2 Saline enema -- no results
#3 Saline enema -- no results
#4 Warm tap water with Castile soap enema (gravity fed) -- no results

Next step? Digital disimpaction -- results, unknown, I was headed to post-clinical wrap-up and the next shift gets to handle it :o)


Saturday, April 22, 2006

Senior-itis ......

I have it bad. Here is the disease process....

Super Seven Study Guide - Senioritis

Definition: Acute inability to concentrate during class

Etiology: Pending pinning ceremony/graduation

Pathophysiology: Increased levels of epinephrine and norepinephrine

Symptoms: Altered level of conscience, lack of concentration, persistent day-dreaming, tachycardia, blurred vision, restlessness, twitching, fresh manicures/pedicures

Diagnostic studies: Check blood level of euphoria, CT and MRI scans of the brain

Medical Management: Daily doses of common sense and reminders of final exam

Nursing Management: Patient education in regards to effects of not passing final exam.

Monday, April 17, 2006

Fastest week ever...

Just like a vacation week to zoom by so fast.

But thinking back and I did enjoy it a lot and with tons of variety:

  • paid bills (ok, it HAD to get done before I left)
  • traveled to the SF Bay Area to visit with family for three days
  • saw "Ice Age; The Meltdown" and had dinner at a yummy Mexican Restaurant with a friend
  • lovely relaxing lunch with another friend
  • Sunday night dinner with family (and found out I will be an Auntie AGAIN!)
  • went skiing twice at Lake Tahoe resorts (discovered I am TOTALLY out of shape, once while it was sunny and once while it was snowing (in CA in April!!)
  • went to Easter church services on Saturday night (and volunteered for the First Aid Team)
  • worked two shifts, one on EASTER morning (possibly my last shift EVER as a CNA..whoohooo)

Now I am trying to get my house back in order, do some laundry and catch up on homework for tomorrow. We have lots of lecture material to finish before the end of the semester. Crunch time folks!!

Friday, April 07, 2006

SPRING BREAK ..Whoooohooo!!!

I will NOT be basking in the sun at some tropical location in a bikini BUT I will relax a bit, visit with family and good friends, enjoy my kids, ski/snowboard for two days, see a movie or two, eat out, work a couple of days and most of all NOT pick up a textbook/lecture note/etc....

The weather is depressing in California. We expect rain for about a week (it's been raining non-stop lately) we have yet to have multiple days of sun. Very unusual spring.

See y'all next week.

Tuesday, April 04, 2006

Dress rehearsal ..."the HESI Test"....

So, today we took a test on the computer called a HESI Test (we paid for this privilege in our tuition).

This test is supposed to be VERY VERY similar to the state board exam we will take after graduation. Yeah, remember, I may graduate but I can't be licensed until the great state of California says I know how-to be a nurse.

The state exam is a bit tricky. Let me explain. Firstly, it's timed but I hear you have five hours and that is MORE than enough time. Secondly, it's all on computer. Next, once you answer a question you can not go back.

Also, there are several types of questions;

1) multiple guess (ops, I mean choice)

2) choose all that apply from a list of about 5-7 possible choices
3) then a fill in the blank (either a number or word)
4) an anatomy marker (put an X on this body part, etc.).

And here is the real kicker...if you get a question wrong and for example it is a pediatrics related question, the computer says to its mighty self, "humm, Student Nurse is weak in the Peds area, HA!, let's give her more questions on Peds" (insert devilish laughs).

Can you believe it!!! That's just cruel!!!

The test then continues until the computer just shuts off. At that point you have no idea if it shut off because you were doing well or because you were doing badly. Some folks can have theirs shut off after not too much time has passed and other sit for hours. Neither knows why. The results take approximately 30 days to be mailed to you. You are not issued a grade just pass or fail.

Anyways, today's test wasn't so sophisticated but it was 160 questions long and I got an 88%. Sweeeeeet!

*doing the happy dance*

..... it gives me hope, that's all.

Sunday, April 02, 2006

You DON'T want to be the interesting patient....

I was in the ICU this past week and I discovered one main theme. You never want to be the Doctor's 'interesting patient'. Trust me it just = bad news. And in the case of my patient it proved to be true.

My patient -- 72, f, Diagnosis: Atrial fibrillation.

History: She came through the ER over a week ago due to general malaise "I just don't feel well". She has a big history of COPD (chronic obstructive pulmonary disease) and is on 2 liters of oxygen at home (former smoker). Her quick diagnosis in the ER was Atrial fibrillation. She was in the ER for about a week having breathing problems in addition to the heart dysrhythmia. She had an NG (nasogastic) tube for feedings. Thursday AM in Telemetry she has an exacerbation of SOB (shortness of breath) while they tried to get her to sit on the side of the bed. Her O2 SAT's (saturation) goes down below 75 and they have respiratory therapy come and get her on a bipap machine to sustain the needed O2 level of over 90. So, she comes back to the ICU. Now she is being assisted by the bipap machine (it's not a ventilator, it forces the air in via a mask without a tube).

Her in-house Doc orders a pulmonary consultation for that night which they do a bronchoscopy and can't "see much" due to some possible clots. They have to put her on a ventilator to sustain her breathing. So, they reschedule for Friday AM to repeat the procedure.

They do this procedure in the room and I got to be there. Essentially they put a tube with a camera attached down the mainstem bronchial tube to look in her lungs. Well, what they find is a fistula in the mainstem bronch that the NG tube can be seen laying in. Keep in mind the NG tube is in the esophagus and the bronchoscopy tube is in the lungs (past the epiglottis the two never shall meet). It seems the wall of her brochial tube has eroded due to a massive amount of cancer and the erosion goes into the esophagus. The Doc removes the NG tube at which point he moves the camera into the hole and looks into the esophagus! He also backs the camera up and shows the massive cancer spreading over her mainstem bronchial tube. He takes a few biopsy samples, photos from the camera and exits.

And then repeats the infamous words, "in 20 years of doing this type of procedure I have never seen this."

During the procedure many nurses from ICU and Tele are filing in for a look and I feel like I hit the student jackpot.

Unfortunately, for the patient, Doc says they can not remove her other lung because of the end stage COPD she couldn't function on one already compromised lung. This is a terminal diagnosis of lung cancer and this patient will never get off the vent besides the fact she can not eat unless a tube is placed into her stomach. Prognosis is to remove the vent and see how long until she passes.

I also got to experience her Doc tell her daughter the prognosis. It was hard to keep my composure. Friday was an interesting day.