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Archive for January, 2010

Nursing School Quotes #3

“During sex, the cardiac patient should always be on top.”

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So this semester I’m working on the cardiac care unit.  There are different types of patients here, but consist mostly of people in heart failure, people with breathing problems due to heart problems, and people waiting for heart transplants.

It’s this last group of patients who I’ve seen all semester.  They have their own rooms, obviously, and these rooms are very much like rooms you’d see in a dorm.  They’re decorated with Christmas lights.  They have flat-screen TVs hanging up on the walls.  They have their own bedding and furniture (sometimes) and photos in frames hanging on the walls.  These are the folks who walk around with fanny packs containing all the wires hooked up to their cardiac monitor leads.

And they have their own little corner of the unit, which is reserved solely for them.  There’s a few couches there, and a table, and a big-screen TV, and a Wii.

That’s right.  A Wii.

Every time I’m on the floor and come around the corner, I see the same guy down there swinging an imaginary golf club.  Or throwing an imaginary bowling ball.  I’m glad they have stuff like that to occupy their time.  I can’t imagine sitting around in a hospital waiting for a heart.

On this floor there are multiple flat-screen monitors, which detail all the different heart rhythms the patients are experiencing.  We’re tasked to keep tabs on their rhythms to ensure nothing freaky is happening.  Anytime anything abnormal happens with a patient’s rhythm, all sorts of bells and whistles go off.  I’m starting to hear them in my sleep.

My last patient was an elderly woman admitted to the unit with severe shortness of breath.  When I walked into her room, she was wearing what they call a non-rebreather mask (NRB).  There’s a one-way valve on this oxygen mask, which prevents the patient from breathing room air as well as re-breathing the air she had just exhaled.  In my patient’s case, she was breathing 100% oxygen.  As far as I’ve been instructed, this is the most oxygen a patient can receive.

So.  I had gotten report from the student before me, and walked into her room, and knew what to expect.  Whenever she removed her mask for about 10 seconds, her oxygen levels (pulse ox) would start plummeting into the 70s.  (Normal is anything above 95%, and should ideally be as near to 100% as possible — unless you have a chronic respiratory condition like COPD, in which you live in the low 90 percents.)  Anyway, this made taking care of her pretty difficult.  She’d ask for a sip of water, and when she took a drink, her pulse ox would dive quickly and we’d have to get her mask back on.)

Not sure what her future holds, but we shall see.  She was the sweetest woman, and was really an awesome patient.

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Medical Fact of the Day #10

The heart pumps out about 5 liters of blood per minute, depending on heart rate, blood pressure, and other things.  That’s more than 1.5 gallons of blood per minute!

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“A good nursing diagnosis is, ‘Knowledge Deficit related to blah blah blah as evidenced by The Patient Has No Clue.'”

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Starting a new series here at AiNS, and that is to list some ridiculous and/or ridiculously funny quotes that come out of the mouth of one of our amazing instructors.  Taken out of context, these certainly seem more than bizarre, but we all love this instructor to pieces, and it feels good to honor her awesomeness in this here space.  These might not make a whole lotta sense to you if you’re not familiar with the terminology, but that’s ok, maybe you’ll laugh anyway.  So without further ado, the first entry goes to the following:

“Sometimes you look at the monitor and you think you see V-fib, and you call a code, but you didn’t check the patient first, and you go into the room and he’s eating sausages.”

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The HESI is this coming Friday, and I haven’t started studying for it yet.  For those of you not in nursing, the HESI seems to be some sort of standardized, computerized exam, whereby we are tested on various … uhh, things.

Terrificly vague, right?

We’ve been given some prep questions to study, and were told that our Fundamentals will be absolutely vital on this round of the HESI.  I suppose it’s constructed to gauge where we stand at this point in our careers.  It counts for only 5% of our grade this semester, but we “have” to get an 850 (out of what, who knows?) in order to pass.  Or else?  I’m sure, knowing me, I’ll start Thursday night after clinical.

Woe is he who procrastinates in nursing school.

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So.

What’s up, y’all?  It’s now Friday night, and I’m going to take a loooooooong break from schoolwork and write some words on this page.  Let’s start from the beginning, shall we?

Judging from this post, I had quite the ambitious plans for myself over Christmas break, didn’t I?  Let’s see how I did:

  1. Lots of sleepy.  Check.
  2. Fix up my bicycle all nice and purty.  Umm, not quite.  Got a tasty little white saddle, but it’s not comfortable at all.  Yuck.
  3. Experimenting with making my uncle’s delicious bread (he taught me last week!).  Triple check!  Success was had!
  4. Working.  Sort of check.  Not a whole lot was done due to some technological issues.  Booooooo …
  5. Lots of Slurpees.  Check.  Check like, 8 times.
  6. Re-learn how to play the piano.  Not at ALL.
  7. Study for the HESI.  Total non-success there.  Decided to not do a lick of work and enjoy the break.
  8. Watch at least 2 seasons of ER on Netflix. Check!  Dr. Green is my hero.
  9. Find new glasses.  Check … but they’re not quite comfortable yet.  Adjustments to commence tomorrow.
  10. Call Comcast to get me new cables and get rid of the humming in my TV.  Not necessary — was a problem I fixed with my TV.
  11. Get back into the gym.  Check.  My legs are screaming right now.

So there ya have it.  Nurse Kenny’s Christmas Break in Review.  Basically, I ran a ton of errands and slept and drank Slurpees.  It was quite glorious.  Oh, and I got one case of either a) food poisoning or b) a nasty 18-hour stomach virus.  Which happened to fall on Christmas Eve, negating my lofty plans to visit the g-parents and Mom.  Nothing more romantic than a Christmas Eve date with the bathroom, followed by a Christmas morning train ride through West Philly.  At least I got to see my Mom and cousin and Aunt and Uncle for a few hours.

And that brings us to the present day.  Lots has happened.  Classes started Monday.  Clinical rotation started yesterday.  Here’s my schedule until the end of February:

  • Monday:  9AM-12PM (Pathophysiology II), 2:30PM-4:30PM (Pharmacology II)
  • Tuesday:  9AM-12PM (Nursing Management of Adult Acute/Chronic Diseases II), 1PM-4PM (Health Assessment)
  • Wednesday:  2PM-10PM (Clinical Rotation In-Hospital)
  • Thursday:  2PM-10PM (Clinical Rotation In-Hospital)
  • Friday:  Off
  • Saturday:  Off
  • Sunday:  Off

I also have one online graduate course (Informatics for Advanced Nursing Practice), which goes the entire semester.  The rest of the above schedule will all change come March, when I start my OB rotation.  Because of that, Patho, Pharm, and Nursing Management all disappear, and we add a Nursing Management in Childbearing Families class, which I believe takes place on Tuesday mornings.  So, in essence, come March, I will have 4-day weekends every week!  Sweet!

As an aside, I believe S.A.N.L.O.P. might be taking place either a) on Friday or b) Sundays after church.  More to come on that.  Actually, nope.  No more to come on that.  Nothing really to say about that.

Other extracurricular activities this semester include the ongoing student government work, as well as something new I’ve gotten involved in:  Colleges Against Cancer.  Ever since I started working a bit in my former life with the world of cancer, I’ve grown pretty fond of the entire field.  Add to that knowing some people who’ve been affected by cancer (seems to be everywhere these days, sadly enough), and I’m starting to think seriously about seeing where that path might take me in nursing.  Have to look into that more.

Anyway, Colleges Against Cancer.  It’s an organization tied to the American Cancer Society, and we’re attempting to run our own Relay for Life this Spring.  It’s a huge undertaking, and somehow I find myself the Co-Chair of the event.  It’s kind of exciting, but also a lot of work.  We’ll see how we do.

Now, about clinical for these 7 weeks.  I’ve been assigned to a Cardiac Care Unit, which is pretty fascinating so far (after one whole day).  It’s basically filled with quite a few people who are either a) waiting for heart transplants or b) recovering from transplant surgery.  As you can imagine, some of these people are quite sick.  Our instructor seems very cool, and she’s been a cardiac nurse for a few years, so I’m looking forward to learning quite a bit from her.

Last night was our first night on the unit, and we basically just became oriented to the layout; got to know the different supply closets and the codes to get in them; learned the nurses’ names; found out where the ice machines were; and looked at all the cardiac monitors.

Ahhh, the cardiac monitors.  So many beeps and boops and blips going on all day long.  All of these patients are hooked up to cardiac monitors, which display above their beds as well as on various monitors displayed throughout the hallways.  So you can walk around and see what’s going on with each patient’s heart rhythms.  One of our major assignments each night on the unit will be to learn how to interpret rhythm strips.  These look like this:

http://kcsun3.tripod.com/id190.htm

We’re supposed to print out a few of the patients’ rhythms and figure out what’s going on in there.  The fun part is, if the patient is basically moving around, the strip looks like crazy lines flying everywhere — they call this “Artifact.”  As you can imagine, the patients aren’t usually just lying there quietly so we students can analyze their heart rhythms.  Examples:

  1. Patient A’s monitor shows me something that looks suspiciously like Ventricular Fibrillation (the kind of rhythm where, on TV shows, they yell, “He’s in V-fib!  Get the paddles!” and then shock the patient back into normal rhythm.  We stride purposefully over to the patient’s room, prepared at any moment to call a code and watch in horror as everyone tries to revive Patient A, only to find him … brushing his teeth.  Hmmph.
  2. Patient B’s monitor suddenly says, “Leads Off.”  We all think, “Oh crap, the patient fell over and is dead on the floor and her leads fell off her body.”  Student runs over to find Patient B … in the bathroom.  Hmmph.

So yeah, this will be a very challenging/exciting/strange/nerve-wracking 7 weeks.  Take your pick of adjectives.  I think it’ll be fun, though.  Interpreting these strips will be pretty fun, I think.

I basically shadowed a nurse last night for a few hours, then took some vital signs for her around 8PM.  The 2 patients I saw were both quite different.  One was a middle-aged gentleman who had come back from the cardiac cath lab earlier in the afternoon.  Because of this, we had to make sure of a few things:  he had to lie flat for the first hour, then no more than at a 30-degree angle for the next 5 hours or so; we had to check his femoral artery near his groin for any signs of complications, such as bleeding or hematoma; and we had to make sure he urinated sometime after coming back, which he finally did near the end of my shift.  He was getting quite a bit of fluids in him, so we wanted him to urinate sooner rather than later.

The other patient was a woman with Down syndrome, who seemed pretty sweet … until we had to perform any kind of procedure on her.  We had to insert a new IV in her arm while I was there, so I got to help with supplies, as well as help to hold her arm and legs down, because She. Was. Not. Happy.  In fact, she was calling us every dirty name in the book she could come up with.  Of course I didn’t take it personally, and the nurse was kind of cracking up at this woman’s ginormous potty mouth.

But yeah, nothing like starting a first day, walking into your first patient’s room, and she calls you a ******* bigot.

Ahhhh, nursing school!

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