Archive for December, 2009

Prepare ye for stream of consciousness.  The following will make no real sense whatsoever.

So, the last week.  What’s happened?  Lots.  Last Wednesday I was the “team leader” for clinical, meaning I helped delegate the patients the other students would see, and decided when people would eat dinner, and generally stood around asking if anyone needed help … and that’s pretty much it.

Then on Thursday was our very last clinical day of the semester.  Med/Surg I was coming to an end.  My patient was an elderly woman who was in the hospital for a revision of her ileostomy.  Also, she wasn’t all that with it.  AAO x1 or x2, maybe.  (Awake, Alert, and Oriented to Person, Place, and Time — so she was certainly awake and alert, but oriented only to Person and sometimes Place.  She didn’t seem to have any mastery of time.)

My favorite line from this elderly woman, when the occupational therapist was in her room, asking her questions:  “You just shut up or I’ll sock you in the face.”

She was perfectly fine most of the day; however, I did have to empty her ileostomy bag, because it had ballooned up with some gas, and when I did … well, let’s just say I think I was having some flashbacks, because I could feel the saliva coming up into my mouth and was about to throw up.  (For those of you who don’t know, I once had an ileostomy for about 3 months.)  My stomach’s been super strong all semester long, and a simple bag change makes it turn somersaults.  Oh well, goodbye, chance of becoming a Wound, Ostomy, Continence Nurse.

After clinical, around 6PM, we all went out to a local restaurant, where a ton of other students started pouring in.  Was good to just let loose a bit and celebrate the end of clinical for the semester.  This party moved on to the local student hangout, where I finally left around 12:30AM.  I felt old — can’t keep up with these young whippersnappers.

Friday night was The 7th Annual Mustache Bash.  That’s right.  A party celebrating the allure of the lip sweater.  I had grown out my beard for about a month, so it was fun shaving it into a giant handlebar with super-large mutton chops.  Again, stayed out too late and got to bed around 3:15AM.

Monday and Tuesday class — the last classes, thank goodness.  Monday night completed my online final exam in Epidemiology.  Wanted to do it Sunday night, but got back from dinner a bit too late, and wanted to get to bed earlier.  Got an 89.5% on the Epi final, which wasn’t too bad, I suppose — left me with an A- for the course, I believe.  It consisted of 60 multiple-choice and true/false questions.  And that took me about 2 hours and 40 minutes.  A sample question:

The President invites a dozen or so of his dearest friends, prominent rival legislators, to a formal luncheon.  The salmon mousse is even more popular than highlights from the health care reform movement.  Within 24 hours, 11 of the 17 diners experience abdominal pain, vomiting, and diarrhea.  The President, who happens not to like salmon because it deadens the taste buds to the subtleties of beef jerky, feels fine.  In fact, he goes jogging.  Of the 11 guests with symptoms, 4 have fever and 7 do not; 5 have an elevated white blood cell count and 6 do not; 6 ate shrimp bisque and 5 did not; 9 ate salmon mousse and 2 did not; and one goes on to have surgery for acute cholecystitis due to an impacted calculus in the common bile duct.  All of the cases recover within 3 days, with the exception of the senator who underwent surgery; she recovered over a longer period of time.  The people at this luncheon had shared no other meals at any time recently.  An early priority in investigating this outbreak would be to:

A. perform stool tests
B. submit food samples to the laboratory
C. temporarily close the kitchen
D. define a case
E. perform a case control study

The correct answer was D, by the way.  (I picked B.)

Last night was able to go out again and celebrate another local university’s nursing program’s last day of finals.  My friend Will (you can see his blog here) and his friends were celebrating, so got to meet some cool people from another program.

Today we had our first Simulation Day.  We all met up in the simulation labs, where we were put through a patient case.  We were divided up into groups of about 6, and sent into a room with a “patient.”  We were told a bit of information and were then prodded to just “go ahead and do what you would normally do.”

It felt a bit more like an ER to me than a patient’s room, so we were all a bit flustered, having been on the floor for only several weeks.  In any event, the patient presented with fever of 102, chills, nausea and vomiting, and severe abdominal pain.  The “patient” actually talked to us, in the form of some guy standing behind a one-way mirror.  The mannequin playing the patient was a Sim-Man, so he was actually breathing and had real bowel sounds, etc.

Since we were instructed beforehand to brush up on our disease states, specifically hypertension, diabetes, and appendicitis, I pretty much figured out from that + his symptoms that he must be suffering from acute appendicitis.  However, my “role” was to document his pain relief after a 2-mg IM injection of morphine, so I kind of stayed back and watched the other students perform their roles.  No one was really suggesting that his symptoms were indicative of appendicitis (and to further throw us off, one of the clinical instructors had his sister playing the role of “patient’s wife” and she was asking us a million questions).  I saw one of the students gently press on his upper abdomen, about 3 inches above his umbilicus, but that’s it.  I figured, I might as well do something here, even though it’s not my role.  The patient’s BP was climbing steadily, and the morphine was taking a long time (in my head) to come; the patient was complaining of severe pain.  So I went, washed my hands, put on some gloves, and moved in, saying, “Mr. Sun, I’m going to take a quick look and feel of your abdomen, ok?  Tell me when it hurts the most.”  Then I gently palpated his abdomen, starting with the left lower quadrant, then below the belly button, then above the belly button … and then finally moved to his right lower quadrant.  I remembered vaguely from some questions that you always palpate that area last in cases of suspected appendicitis.

When I got to his right lower quadrant, the patient yelped a bit when I pressed down … and then screamed bloody murder when I released the slight pressure.  Hmm, a pretty clear rebound tenderness, which we were also taught is a classic sign of that appendicitis.  Then suddenly, just as soon as were in there, we were told our round was over, and return for debriefing.

In our debriefing, one of the instructors said that I probably shouldn’t have palpated the patient’s abdomen a second time, since the other student had already done it, because I could have easily ruptured his appendix.  Here is what I said in my inner monologue:  “Whaaaa?  You mean that little press the other student gave on his upper epigastric region counted as palpating over his appendix for rebound tenderness?”  Here is what I said out loud in the room:  “Ok, that makes sense.”

Whatever.  You pick your battles.  And I didn’t want to call out my fellow student in front of an instructor.  It was supposed to be a fun exercise anyway.  Maybe she did palpate the entire abdomen and I just missed it — who knows?  Point is, it was chaos chaos chaos.

Eleven different groups went into that room and had their own little scenarios.  Turns out our patient did indeed have acute appendicitis and a ruptured diverticulum.  He went to the OR and returned with a bleeder.  I felt bad for some groups — one group went into the room and the patient was screaming about pain and was bleeding out of his incision site; another group went into the room and found the patient on the floor after transport left him to get into bed by himself after some testing.  And then some groups had easy tasks like checking his vital signs in the PACU.  All in all, a pretty fun day.

And did I mention that, while one group was in the room, the rest of us were watching them via closed-circuit TV?  So fun to be observed making mistakes by 60 of your peers.  Best line of the day goes to one male student:

STUDENT:  “Ok, Mr. Sun, we’re gonna put in your catheter now.”

PATIENT:  “Catheter?  What is that and where are you putting it in?”

STUDENT:  “Umm, it goes up your Johnson.”

Seriously!?!  Johnson?  Ok, that’s a semi-hilarious, and not-nearly-close-to-okay, thing to say to your patient.  We all had a good laugh.  One of the instructors felt compelled to come back and say to our group, “Umm, in the hospital, in the real world … none of us have ‘Johnsons,’ okay?”

A bunch of meetings tomorrow, then studying for finals commences.  Three finals on Tuesday (another set of integrated exams, which are, thankfully, not cumulative).  I’ll keep y’all posted on how things are going, because I’m sure you’re dyin’ to know.

So let’s see, the schedule for the upcoming days:

FRIDAY:  Sleep in, meeting, study, meeting, dinner, study, maybe some live music if I’m feeling ambitious.

SATURDAY:  Sleep in, study, groceries, study.

SUNDAY:  Church?, study, Sunday Night Movie Night with J.

MONDAY:  Sleep in, study.

TUESDAY:  3 finals, out with classmates to celebrate!

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So umm, yeah, didn’t really get to that long post I was promising, did I?  Nope.  Life happened, and I’m all set to complete my online final exam tomorrow night after class, so I won’t be posting until Tuesday.  Until then, be good.

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Wow, 3 days without posting?  Whatta disgrace.  I should be ashamed of myself.

Truth is … clinicals ended Thursday evening, and ever since then … well … it’s been pretty much one non-stop celebration.  I don’t think I’ve gone out 3 nights in a row since college.  And last night was The 7th Annual Mustache Bash, for which I had, admittedly, a pretty sweet Handlebar/Horseshoe/Sideburns/Soul Patch something-or-other going on.  I’d post a photo … but then y’all would know what I look like, and that would be terrifying.  So I won’t.

But I digress.

I will have a nice long post up this weekend or Monday, I hope.  For now, I’m headed to bed.  Tomorrow entails the following:

  1. Getting up somewhat early.
  2. Going grocery shopping.
  3. Taking my 3-hour, online final exam for Epidemiology.
  4. Going to Royal Tavern for dinner with some good friends!  (Yay for the Royal Tavern burger!)
  5. Writing a quick 1-page paper on a spiritual assessment I did on a patient.
  6. Going to bed early to prepare for the long Monday.

Oh yeah, and writing a nice lil’ tasty blog entry for y’all’s viewing pleasure.  Or disgust.  Or whatever.

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I Got a D+!

Ok, so it was just a fake NCLEX test, but still.

As part of our Nursing Management class, we’re charged with submitting 250 NCLEX questions.  It’s the first step, I suppose, in getting us ready for the NCLEX after we graduate.  For those of you who don’t know, the NCLEX is the certification exam we take after graduation in order to officially become licensed as a Registered Nurse.  It’s like “the boards” or whatever.

So I started off tonight with 75 questions from the NCLEX4000 computer program.  Results:  52 correct out of 75 questions.

Granted, about 10 of those questions were on topics that we haven’t covered yet, but I counted about 5 that I definitely should have gotten right.  So I suppose that’s a good enough start.  150 more to go before next week.

In other news, tomorrow and Thursday are my last 2 clinical days in Med/Surg!  Unbelievable.  Tomorrow is my day to be the “Team Leader,” I think.  Basically I’m in charge of delegating patients and seeing whether people need help with anything — in other words, I won’t have a lot to do tomorrow.

Wednesday/Thursday clinical days; then Sunday/Monday an online final exam; then Monday/Tuesday last classes; then Thursday Simulation Day in the lab; then December 15 is 3 finals in one day (not cumulative, thank goodness); and then we’re done!

I believe next semester we have 7 weeks of Telemetry, and 7 weeks of OB.  Should be awesome.

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