Reprieve...

Our quiz for today was cancelled because the instructor was ill. We still had class with our theory class with our clinical instructor substituting but it was more low-key and material that we were going to address later in the semester. Sweeeeet. This lightens the load over the coming week/weekend due to most of the work already being done for next Tuesday.

We are also off tomorrow (Wed) so I have lots of personal errands planned. I have been getting ahead with little projects we have assigned this semester. One was the A.A. meeting I attended a week or so ago. The other was we had to write a letter to some type of legislative member on an issue we feel strongly about in regards to Nursing. I wrote to the California State Board of Licensed Nursing and asked that the IV curriculum be added to our program so we don't have to take an extra class after graduation and pay more $.

Few loose ends. Hat requests ...thanks y'all for asking. I may post a picture of the hat but probably not on me. I have tried to remain anonymous to protect myself, the facilities I train at, my patients and my school due to the privacy laws in my state of California. I may put the picture up for one day for my fateful readers (you know who you are) and then remove it. Still mulling that over.

And for Mona and her request for instructions on a Foley catheter insertion. That made me laugh not only because it would be hard to explain BUT weird too. Let's just put it this way everyone's anatomy is wildly different. I did make light of it in class saying how our one male student must have an easier time inserting a female catheter because he has had a birds eye view of the female anatomy before, whereas most of us women have most likely not experienced that. He did blush a bit but with a sly smirk also :o)

Voting has began for Nursing blog for the month of February at Mediblogopathy just in case you feel the need to VOTE for a great student nursing blog you know, HINT, HINT.

I also did some cleaning of cobwebs on the blog (very minor). I am not a whiz with HTML so that's as good as it gets.

Toot....toot....

I have had a great week and I wanna too my own horn.

First, my clinical instructor was lecturing on Tuesday and practically stopped mid-sentence to say to the whole class.... "Student Nurse, prn; I want to say something to you... (me getting nervous assuming I was about to be made an example of in a not-so-good way).... I want to mention how far you have come since you were in my 'Careers in Nursing' class way back when and how much you have grown, I am so pleased"

Shock!! Pick me up off the floor!!! She's not one to single folks out so blatantly. She will give students kudos for getting a question right, etc. but this was just odd, unexpected and very flattering :o)

and there is MORE!....

Lastly, during our post-clinical session on Wednesday, one of my fellow students, said she HAD to give another student kudos because an RN in the ER was just RAVING about last weeks student and how exceptionally CONFIDENT she was (<--that was ME!) in her skills and overall abilities. It was the same RN that I mentioned was so great to me.

Gasp! Knock me over with a feather!!!

Isn't it odd when other folks can see the confidence in you that you honestly don't feel that you have? Food for thought.

AA Meeting...

One of our assignments this semester is to attend a local A.A. meeting. I went on Friday night last week ..... What a great experience!

I went with a friend who has been sober since summer of last year. It was an open meeting where they welcome friends, family and non-members, most of the meeting attendance was members. I had an opportunity to introduce myself during the announcements.

I learned a lot about how A.A. works for those in need an one main thing I walked away with was that the members have a huge sense of camaraderie with each other.

The ER, part deux.....

......I got to go back. I was thrilled. I won't leave a long list of the types of patients we saw but needless to say it was similar to the previous week.

Best part was on Friday I got to work with an RN that is a natural teacher. She was EXCELLENT. She knew exactly just where to lead, mentor and teach. I felt at ease around her. Her confidence gave me confidence. She asked me questions without seeming overbearing or condescending. I wish I could return.

One of the LVN's said something interesting to me...he said the ER is different. Normally on a Med/Surg floor we know the treatment plan, patients diagnosis, medications, history, etc. He said the difference with the ER is they work backwards, they have to find out the diagnosis, the medications and history of a patient then they can treat them. He said you must adopt this backwards thinking before you can be effective in the ER.

Procedurally, I did a female Foley catheter, administered a suppository medication (I see you holding your hiney cheeks together!) ....and visited the special procedures room to watch a bronchoscopy (a procedure that a camera on the end of a tube is inserted into the nose or mouth and into the lungs which provides a view of the airways and lungs and to collect secretions/tissue specimens for a biopsy) and a EGD (esophagogastroduodenoscopy- an examination of the esophagus, stomach, and upper duodenum with a small camera inserted down the throat).

Next week I am on the surgical floor for several weeks on end....off to hip and knee replacement land.

Oh and lastly, we all got our hats we bought for the pinning ceremony. I sure hope I don' t look like the flying nun in this thing.

Grey's Anatomy...

...the book has nothing on the ABC show.

I don't have much time for TV viewing but Sunday night is usually one where I put down the text books and stop studying to indulge in a mind numbing dose of the idiot box. I have to say this particular show, Grey's Anatomy ROCKS and not just because it's a semi-medical related show and that I grin when I understand the medical jargon.... it is just a well written drama with all the *gasps* one can muster in one hour. Love it. Keep it coming. I am hooked.

We blew it....

Yesterday in class we all had the blahs... despite the beautiful day here in Cally and the tinge of love in the air, we couldn't muster any enthusiasm. We sat like bumps on a log, couldn't come up with simple information. Looked at each other like --sheesh, don't YOU KNOW THE INFORMATION?

We disappointed our instructor and made her a little pissy.

She told us we'd get senioritis but we didn't believe her.

Personally I started the day out great (thanks for the email Neil), practically whistling but once I sat in my chair I was drained of any energy. Not sure why but it happened. We need to step it up a bit.

Oh and yeah, I also messed up seems I am in the ER another week! I'm glad I was just starting to get the flow of the joint. At least when I go back I can be more efficient and effective.

The Big V

Happy Valentines Day to all and their loved ones.

Emergency Department

After all my teasers I feel guilty. As sometimes it is the case real life, it is not how it is portrayed on TV mostly because it would make a boring TV show. The average small hospital ER is kind of slow, dull and then an occasional excitement gets in the mix. Keep in mind I was there for about 8 hours starting at 6:30am on two weekdays.

When I arrived there is one MD working and by 11am there are two . There are usually 6 nurses (including one in triage-checking patients in and one charge nurse helping when&where he/she can).

Here are some of the down and dirty stats:

Thursday

(age, sex, chief complaint, possible diagnosis or reason- some of which I state as unknown because I was either not involved in their care or they were discharged with status as unknown)

55 M - Bladder, possible UTI
94 F - Fall, head lacerations&concussion (transferred to her primary hospital)
20 M - jaw dislocation, from altercation
9 F - headache&fever, unknown
23 M - cough, pneumonia
11 F - cough&fever, pneumonia
89 F - nausea&vomiting w/hematuresis (blood in urine), unknown
35 M - dizziness, vertigo
89 F - altered level of conscious, unknown
22 M - ear laceration, earring caught in car door (13 stitches)
5M - red eye, not conjunctivitis-unknown

Keep in mind we had a two hour stretch in the AM without ONE patient. That is known as the student syndrome. I made labels for a ear/nose/throat cart. Yipeeeeee (*not*). I am missing a few in my log as we got busy towards the end of the day. In report I heard they had a total of 51 patients for this entire day.


Friday

83 M - chest pains, admitted for observation
4 month old M - fever&red eye, unknown
50 F - bad day, psych referral
73 F - seizures or stroke, admitted to ICU for probable stroke
49 M - R wrist swollen, sprain
3 M - bloody nose, bloody nose
46 M - R hand swollen, arthritis
41 F - knee pain, unknown
38 F - pelvic pain, UTI
51 F - flank pain, unknown
41 F - cold, unknown
62 F - shortness of breath, unknown
16 F - "5150" came in with a sheriff, suicide attempt-psych referral
45 M - extremely combative brought in by Highway Patrol officers-gurney prepared with restraints, unknown
18 F - severe asthma, unknown
83 F - shortness of breath/ weakness/altered level of conscious, unknown
2 month M - shaken baby syndrome/shortness of breath-unknown
56 M - infected toes-complications of diabetes

We also had about an hour+ with no incoming patients in the AM. I missed logging several more towards the end of the shift because it got swamped with at least one patient waiting in the hallway.

To answer Neil and Chelle: nothing worth casting in Hollywood but I wouldn't have kicked a couple of them out of bed for eating crackers *grins*

From a student perspective it was a really good two days. I got to do a PPD injection, two In&Out catheters, NG tube medications, a splint, IM injection, focused assessment, one unsuccessful Foley catheter, dip several urine samples and absorb the overall environment. I was calm under the chaos when it started to get busy. I was complimented by the staff for my skills and ability to learn quickly and was told "I would do well in the ER".

Think I should join the Screen Actors Guild? or stick with my nursing career path?

Acid-base balance ...pH...HCO3, PCO2, CO2...*ugh*

In lecture/theory this has proven to be a difficult subject. So darn confusing to figure out if a patient in congestive heart failure is in respiratory acidosis or metabolic acidosis. It is all rattling around giving me headache. I turned to the 'www' for help some good stuff out there but on a quiz I just end up thinking in circles.... *ack!.....any suggestions?

Tomorrow--off to the ER...and yes, Neil and Chelle I'll be checking out the Doc's for you both to see their Hollywood 'factor' and let you know.

The Teaser....Reality ER vs Television ER....

Thought I'd set the stage a little in advance for next week in the ER, it's my only rotation in the ER and it lasts for just two days.

The ER is located in a hospital in a small mountainous Northern California town that has a population of 12,500 --according to the 2000 Census. The other two closest hospitals are 30 minutes in either direction (east and west). One of those two takes the local life fight trauma patients. They do not take life-flights at this smaller hospital. They have about 10 beds total in the ER not including the 3 they can put on gurneys in the hallways.

Today I took a tour of the place today it was suppose to last 30 minutes. It took only 15 minutes then I spent the next 15 minutes in a patient room taking vital signs of a patient with abdominal pain of 8 on a 1-10 pain scale (10 is the worst pain you can imagine).

I love procedural stuff and I multi-task well. I think I may like this experience. I am not a TRAUMA JUNKIE that lives off the adrenaline rush. So, I go into this rotation with open eyes and hope that I will enjoy it.

(and *pssst* I am not even going to mention the 'student syndrome' which is when students show up the department gets quiet and they have "the slowest days we have have in months" because that is not going to happen when I am there, not it will not)

Status check ...pulse...

Yup, I have a pulse. Still adjusting to being back in the classroom and clinical site.

We are at a different clinical facility this semester. So, they have been giving us time to get adjusted to the new place. Slowly ramping up. It's kind of like waking up on the wrong side of the bed or having someone rearrange the furniture in your house. Same but different.

Clinically this semester they keep an eye on you like a hawk. One slip up and you get written up. Wash your hands, check your ID wrist bands, knock on the door, provide privacy, etc.. no room to slip up. And if you perform a skill that we have been 'checked off' for ..like inserting a foley catheter and you make an error, you get written up, regardless if you catch it.

I haven't had any exciting patients to speak of ...one needy lady in with back pain after a fall. L2 compression fracture. Hospitalized 26 times in the last 6 years. She readily admitted to me it's like family here and that she love's all the attention and people to talk to. Sad. My other patient had an 'accidental' ingestion of a toxic substance. (RV septic cleaner?) but she was already drunk on beer so RN said that probably saved her life because the ethanol alcohol and the toxic substance go for the same receptor sites in the cells and therefore her cells/organs were not so affected by the toxic substance.

I do go the the ER next week --so check back !!

In lecture theory, we go back over stuff we have already learned (and hopefully still retain) and dive deeper into each area. All with keeping in mind the final goal --graduation and passing the state board exam.