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Posts Tagged ‘catheter’

I’m starting to pick up loads of little things.  Such as … make sure everything is done before proceeding.

Like, when you get a new admission, and the patient’s family is waiting in the lounge to come in and see her when she’s all set up in the room … and you’ve put on all the leads on her and set up her telemetry pack and started her on cardiac monitoring … and you’ve set up her call bell and bedside table … and you’ve gotten her vitals … and you’ve gotten her blood sugar … and you’re pretty sure everything is all set up … and she asks to see her family …

And you go out, with a smile on your face, and say, “She’s all set up and ready to see you!”  And the family looks so happy, and they all start to file in, and you follow them down the hall.

And then you see the nurse about to walk into the room with the foley kit, ready to start her catheter, with a look on her face, like, “Why did you let the family in already?”

Oops.  Forgot about that part.

“Sorry, entire family, please go out to the waiting lounge again.  We’ll be with you shortly.”

My bad.

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So, I worked 3PM-11PM again today.  In fact, this is the 3rd day in a 6-day-straight stretch of working 3PM-11PM.  Which is good … gives me a sense of continuity that I think I crave in a strange way.

Around 2:45PM, charge nurse:  “Ken, you’re getting pulled over to another unit to work the floor there.”

I work 3PM-7PM over there … do my thing … meet some new people … get my work done.

Around 7PM, charge nurse:  “Ken, we have a patient in that room over there who needs a 1:1.”

Grrrr …

In fact, 1:1s aren’t all that bad.  You check the patient every 15 minutes, drink some coffee, read a good book, chat up any bystanders, watch the Phillies on TV.  Not all that bad indeed.  But you sorta start to lose your routine and you sorta start to lose your touch and you sorta start to lose your ability to stay awake.  Not to mention, you feel bad watching the other staff rush to and fro getting things done that normally you would be helping with.  Instead, they rush by you as you read that interesting paragraph on p. 43 of your book and sip at your piping hot coffee from Au Bon Pain downstairs that didn’t cost you anything because they were closing and just wanted to give it away!  Woooo free coffee!

Ahhh, did I mention that my 1:1 patient needed the 1:1 because he was 1) attempting to rip out his indwelling catheter, 2) rip out his IV access, 3) take off his sling after having a permanent pacemaker installed (which might result in undoing everything they just did in the OR), and 4) trying to change into his clothes so he could go home?  No, I failed to tell y’all that.

Reason just doesn’t work in that situation, eh?  However, I find that restraints do.  And then he exhausted himself from the restraints and fell asleep within the hour.

And then it was back to my book.

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Stuff that happened last night:

  • Helped out with my first ever hot water enema on a patient.  Boy, that was a real pleasure.
  • Did 1,684 EKGs and 2,391 AccuCheks on patients (could be a slight, but only slight, exaggeration).
  • Helped take care of my first Swan-Ganz catheter (way above my head at this point).
  • Patient who needs assistance to the bathroom + patient on Lasix = super busy NurseExternKenny.
  • Successfully terminated a 2-inch-long water beetle of some kind.
  • Got to eat dinner at 1:45 AM.  Will never, ever get used to that.

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  1. I am done with my telemetry rotation in the CCU.  I feel pretty good about this, and feel like I learned a lot about how to be a good nurse.
  2. After a few hundred hours in the hospital, I finally removed my first foley catheter in a patient tonight.  How did it take that long?
  3. Nurses who show me how to do things are awesome.  Nurses who instruct me how to do things are awesomer.
  4. I think a good name for a band is “Vasolex to the Max.”
  5. I am now an expert in making a bed with a human being in it.
  6. You may think Pepsi Slurpees are indistinguishable from Coke Slurpees … but you’d be wrong.
  7. The best way to tell you’re finally comfortable with a hospital floor is when you know just how to hold the styrofoam cup under the ice machine so the ice doesn’t spray all over the floor.
  8. Over the last 6 weeks, people have told me I look like Fred Savage, Tom Hanks, and the dude who plays Sheldon on The Big Bang Theory.
  9. There’s no real good way to ask a patient when his last bowel movement was … so ya just have to ask it.
  10. It feels ridiculously great, as a student nurse, when you can help teach a patient’s family something about their loved one’s disease.

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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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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 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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