Archive for October, 2009

So since my OR observation this past week didn’t include seeing an actual surgery, the director of our clinical experience was able to reschedule us for next Friday!  She rules.

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This afternoon was my day of the semester to go into the OR and observe.  Here’s what happened:

  • 12:40PM:  Show up at the hospital and take the elevator to the OR floor.
  • 12:42PM:  Introduce myself to the charge nurse, who hands me a pair of purple OR scrubs with a nonchalant, “Hmmm, I’m really sorry, but we don’t have any surgeries really going on this afternoon, but I’ll see what’s cooking.”
  • 12:43PM:  Walk into the locker room and change into my nifty purple scrubs, wondering what I am doing here if there aren’t any surgeries to observe.
  • 12:44PM:  Scrub top:  XXL.  Scrub pants:  XXXL.  Maybe when I introduced myself, I said, “Hello, I am Ken, and I am a giant bottlenose dolphin.”
  • 12:50PM:  Charge nurse takes me to the post-anesthesia care unit (PACU) and says, “Maybe today we’ll do things a bit backwards during your observation.”  I take this to mean I’ll actually start my observation in the PACU and then move over to the OR once a procedure is ready to start.
  • 12:52PM:  Stand by one of the patients in the PACU, who’s just now coming out of anesthesia.  He’s super groggy but can tell us whether he’s having any pain.  No pain.  Good sign.
  • 12:55PM:  Still standing around staring blankly at the monitors above GroggyGuy’s bed.
  • 1:08PM:  Wondering if any surgeries will magically appear.
  • 1:09PM:  Instead of a surgery magically appearing, it’s a Circulating Nurse magically appearing to answer our questions.
  • 1:30PM:  Another Circulating Nurse takes us (another student is assigned the same shift as I am) on the Grand Tour de OR — we enter every OR suite and she shows us all the equipment.  There is a boatload of stuff in there, as well as sitting in the halls and other various nooks and crannies.
  • 1:48PM:  We pass an OR suite with a surgery going on!  What?!  I thought there weren’t any!  Maybe this one started prior to our arrival.
  • 2:40PM:  Tour is over — actually very cool.  Saw the ICU as well, which has these amazing windows where the patient can have instant privacy with the flick of a switch.  When the nurse demonstrated this, I said, “Wow, that’s like alien technology or something!”
  • 2:40PM:  Circulating Nurse Tour Guide doesn’t think I’m funny.
  • 3:00PM:  Arrive back in the PACU and sit down some more.
  • 3:03PM:  Mmm … Skittles and M&Ms.
  • 3:04PM:  Wonder whether I’m supposed to be eating candy in the PACU.
  • 3:06PM:  Am allowed to pick the music playing in the PACU — I choose “Somebody to Love” by Queen.
  • 3:07PM:  Patient B says, “I think I’m about to throw up.”  I guess she doesn’t like my choice in tunes.
  • 3:15PM:  Another nurse mentions in passing, “They have something brewing in the ER … looks like a subarachnoid hemorrhage … could be coming up here soon.”
  • 3:16PM:  The other student and I perk up a bit, thinking we might be in luck.  Brain surgery, nonetheless!  Could we be so fortunate?
  • 4:00PM:  Still waiting.  Current musical selection?  “Jukebox Hero” by Foreigner.
  • 4:25PM:  I kinda like these purple scrubs.
  • 4:45PM:  One of the nurses says it’s only a 10% chance the hemorrhage case will even come upstairs, so that we should leave.
  • 4:55PM:  Turn in my scrubs to the charge nurse (bye-bye, purple scrubs!) and head out the door of the hospital.

When I got home I e-mailed our course director to see whether she can reschedule me for another day … maybe at one of the other OR centers would be nice, since they have surgeries going ’round the clock.  I’m very interested in the OR, so hopefully it’ll work out.

As an aside, The 2-Year Penis Count has officially reached … 3.

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Ok, so I know you’ve totally missed me, judging by the thousands of people clicking on this here site to see whether I’ve returned.  Mmmm hmmm that’s definitely what’s been happening.

So lots been going on in the past few days when I was on family hiatus:

  1. We had our first meeting with our Health Mentor.  I’ll detail this more in another post, but the Health Mentor Program is basically one in which we are paired up with someone in the community who has a chronic illness, and we “follow” that person for the next 2 years.  Each Health Mentor is assigned a group, of which I’m the Nursing student.  There’s also other specialties represented, but I’ll go into this much more later.  It was a great meeting, and I think this program will be absolutely worthwhile.
  2. Had a wonderful day in clinical today, and did so many new things.
  3. My patient was a 47-year-old male who is having surgery in the near future.  Because of this, he was pretty low-maintenance.  However, there was a lot of monitoring to do today.  No injections to give, but I was able to give him his oral medications at 5PM.  And I forgot to ask him his name and birthdate!  D’oh!  Didn’t matter all that much, because I have only one patient, and I knew it was him from being with him all day, but still — it’s something I need to get into the habit of doing.  We were monitoring his Inputs and Outputs (I&O), so I made sure to check on him all day and see what he was drinking as well.  After each time he urinated, we had to perform a bladder scan to see whether he was retaining any urine in his bladder.  So that was fun to learn.  On top of this, today was just a day to attend to my patient — getting him an extra slice of dessert from the pantry downstairs; getting him lots of juice and soda; assessing his vital signs and other things throughout the day.
  4. I had my midterm evaluations done today by my instructor!  She was definitely positive about my performance so far, but agreed with me that I need to show more confidence in my “maneuvering” around a patient’s room.  She did allow that this kind of thing comes only with practice, though.  She also mentioned that I need to be more assertive in not worrying about bothering my patients.  I can’t help it!  🙂  For example, my one patient was talking on the phone with someone, and I needed to assess her vital signs to put them into the computer by 4, but she was talking for-EV-er, and my instructor said I should have just walked in and started doing the vitals.  Of course I thought that I didn’t want to bother her when she was on the phone.  Again, I’ll get more confident with this kind of problem over time.
  5. Midterms are coming up next week, so everyone is thinking about that.  Our school sets it up as 3 exams in 1 class period (2.5 hours).  So next Tuesday we have 8AM-10:30AM, and in that period we take 3 exams (100 questions total) — Pathophysiology, Pharmacology, and Nursing Management.  All multiple choice, and all in the NCLEX style — they’re starting us out early on figuring out these questions.

If you’re wondering what NCLEX-style is, they basically do this:

Question #1:  If you had a patient with [insert medical problems here etc etc], what would you monitor first in this patient?

A.  Incorrect answer.    B.  Right answer.   C.  Incorrect answer.    D.  “Righter” answer.

So you can see that they often give you many right answers in the possibilities, but you have to figure out which one is “righter.”  Critical thinking, grrrr.

More to come tomorrow … for now it’s back to the Phillies game!

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Apologies for the non-posting these past few days — have had some family stuff come up, so will hopefully be posting some more stories shortly!

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So I’d like to think that I’m pretty decent with the medical terminology.  Combine several years working as a pseudo-medical editor with one class in college with some nursing school, and I should be halfway competent with abbreviations and acronyms, right?

Yeah … ummm … well, sorta.  Reading these charts is like trying to read another language.  No, strike that.  It is another language.

One other thing I realize every time I’m in the hospital is just how much muscle memory is involved in nursing.  I say this because I see the experienced nurses just maneuvering around their patients without any second thought to their actions … because they’re SO used to them.  For example, I witnessed my nurse tonight giving our patient his medicine through his nasogastric (NG) tube.  She crushed up the meds with a mortar and pestle, then we went to the patient’s room.  She had everything she needed right at hand, and just went through the motions like she’d done this a million times … because she probably has.  I have to continue to remember that this kind of thing will become second nature for me as well, but for now I’m gonna have to put up with not knowing what I’m doing.

A lot of experienced nurses tell me, “You know, I learned a lot in nursing school … but I didn’t learn how to be a nurse until after I graduated.”

So very true!  The actual method of pushing meds through an NG tube isn’t that difficult:

  1. Discontinue suction of NG tube.
  2. Flush NG tube with approximately 30 cc of tap water.
  3. Mix medication with tap water and suck up into syringe.
  4. Inject medication/water mix into NG tube.
  5. Flush NG tube with approximately 30 cc of tap water.
  6. Wait 20-30 minutes to hook up suction again (to let meds get absorbed).

That’s simplifying it, but it’s pretty much like that!  Not a whole lot to it.  But my nurse had everything at hand — extra “chucks” (absorbent pads) in case of seepage/drainage/general messes; cylinder of water to use in syringes; extra syringe in case of mess; paper towels.  Someday that’ll be me.

My patient tonight was coming off of prostatectomy, and was having a tough time of it.  As I came on the floor, he was coming back from CT to check for why his abdomen was so distended.  I didn’t get to eat my dinner because we were pretty busy.  But 3 important milestones tonight:

  1. Administered my first injection! Woo-hoo!  It was a subcutaneous injection of insulin for my patient — into the fat in the back of the arm.
  2. Started emptying catheter drainage bags and Jackson-Pratt (JP) drains by myself and charting the output amounts into the computer.
  3. Heard my first crackles in the bases of the lungs.  Possibly indicative of impending pulmonary edema, given the additional accumulation of fluid in his feet?

All in all, a very busy evening — but one good for an education.

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I was elected Recording Secretary of my class today!  No huge feat, because … ummm, well, no one really ran against me.  So technically I wasn’t even elected.  More like, appointed, by default.  My campaign speech/e-mail included the following:

I will make a good Recording Secretary because … blah blah blah … and also, “I have terrific penmanship, so if a bear walks into our lecture and mauls me, the new Recording Secretary will be able to very easily read my minutes.”

No one said my campaign had to be professional.  🙂

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For my Intro to Nursing class, I had to give a brief (2-3 minutes) presentation on myself — why I want to be a nurse, where I come from, etc.  Seeing as I am absolutely terrified standing in front of a large group of people, I decided to put together a pseudo-PowerPoint presentation and use an ole’ standby defense mechanism I often employ — humor.

Instead of just standing up there talking, I drew goofy little pictures (depicting the day I was born, all 10 lbs. 1 oz. of me), inserted photos of things I like (Coke Slurpees) and things I dislike (when bread gets wet; puppets and marionettes), and generally decided that, if I’m going to be embarrassed up there, I might as well do it on my own terms.  Right?  Right.

I think it got a pretty nice reception among the students.  It clocked in at considerably longer than 2-3 minutes, but people seemed interested, I suppose.  Or maybe they were just being nice.  I even got some high-fives on my way back to my seat.  In any event, count this as a good first step in getting over my confounding stage fright.

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