It’s About Time Someone Posted Around Here

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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How To Alienate Friends and Online Strangers

Yeah, that’s me.  Wanted to see how long I can keep up this ridiculous charade of promising to post.

Had a lot more work to prepare for tomorrow’s Lab than I thought I did.  Sooooooooooo, apologies abounding from yours truly.

More to come … umm, sometime?

I have Lab tomorrow from 2-10, then first day on the Cardiac floor on Thursday from 2-10.  More to come probably on Friday!

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Back From the Dead?

Seriously, how long’s it been since I’ve been here?  A week?  And here I was doin’ so well.  Oh well, I guess I’ll go through these little lulls every now and then.

So yes.  How’ve ya been?  I’ve been pretty decent …

Finals were over on Tuesday the 15th.  We took all 3 of them at once.  In actuality, it wasn’t all that bad, since these were not cumulative exams, covering all the material from the midterms on.  However, it was still a lot of information, with the added stress of taking all 3 exams at once.

Let’s see, what else has happened recently?

• Spent about 8 hours celebrating after the final exam(s) with classmates.  That was a ton of fun.  Started off at a local restaurant/pub, then the party moved on to my apartment, and then moved off to another local favorite.  I think I might have slept 14 hours the following day.
• Most of my grades are posted, and I’m very happy with them.  As I said before, I kind of pushed my online graduate course to the back burner for most of the semester, and it showed in my grade.  While still happy with the grade, it was my lowest one.
• Class schedule has been posted for next semester, and it looks great!  January through the end of February looks like Monday-Tuesday 9-5 in class, then I have clinical rotation Wednesday/Thursday 2PM-10PM again.
• For the first 7 weeks of the semester, I’ll be in telemetry rotation.  For the last 7 weeks of the rotation, I’ll be in OB rotation.
• They’ve split up the 130 or so students into 2 sections this semester, so some of my close friends I won’t be seeing.  I’m not sure whether this means we’ll be in classes with them still, but just not potentially in rotations.  Not really sure yet.
• My clinical group is great for telemetry!  All good people, and I’m excited to get to know them better.  Looks like 7 of us.

And oh yeah, we just got 23 inches of snow on Saturday!  SO great when you don’t have to shovel any of it.  W, E2, and L2 met up with me at school, where we didn’t even try to make a snowman, because the snow was too fluffy.  Decided to just go eat instead, and ended up at a favorite place of ours, where W’s classmate, A4, met up with us.  From there we just walked around in the blizzard, attempting to see straight, stay warm, and keep away from W’s shenanigans with the snow.

Poor A4 was totally set up and had her face and neck filled with snow, courtesy of W.  Good times.

So what does this extended break hold in store for me?  Lots of things, I suppose — here’s my Winter Break Bucket List:

1. Lots of sleepy.
2. Fix up my bicycle all nice and purty.
3. Experimenting with making my uncle’s delicious bread (he taught me last week!).
4. Working.
5. Lots of Slurpees.
6. Re-learn how to play the piano.
7. Study for the HESI.
8. Watch at least 2 seasons of ER on Netflix.
9. Find new glasses.
10. Call Comcast to get me new cables and get rid of the humming in my TV.
11. Get back into the gym.

Ok, I didn’t say it would be an exciting Bucket List.

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One Other Thing

Yeah, forgot to mention something about Simulation Day.  After our group went first, we had a lot of time to sit back, observe the other students, and just enjoy the day.  About 2/3 of the way through the simulations, I heard my name being called from near the front of the room.  It was the Director of the Simulation Labs and the Director of Clinical Rotations, and they were pointing at me, asking me to come with them.

“Uh oh,” I thought.  “I must be in trouble.”

Alas, I was not in trouble.  They simply wanted to use me for my freakish limbs.  That’s right, I was, once again, The Guy With the Long Arms.

As part of the simulation, they needed to pretend I had to get into the chair from my bed, and 3 students were in charge of moving me.  I was instructed, “Act as weak as humanly possible.  You just came out of surgery, and you have absolutely zero strength.”

Awesome.  I can do that!

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The Last Week — Stream of Consciousness

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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How’ve Y’all Been?

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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Off to See the Wizard — F’real This Time

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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I’m baaaaaaaack!

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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First Clinical Rotation (Reprise)

Well hello there again.  Today was the (real) first day of clinical rotations, and I did indeed get into the hospital and see a real, live patient.  Ok, so here’s the clinical day, in running diary format:

• 12:45PM:  Arrive at the computer training center.  Prepare to undergo 4 hours of training.
• 1:04PM:  Fight off first bouts of sleepiness due to instructor’s ridiculously exciting tone of voice.
• 1:09PM:  Two PowerPoint slides down, 183 to go.
• 2:15PM:  Woo-hoo, a break!
• 2:45PM:  Start the online portion of the training — several modules on how to enter data in the hospital’s charting system.
• 3:30PM:  Totally ready for bed.
• 5:00PM:  Finally done with the torturous afternoon.  Our instructor gives us until 5:45PM to eat dinner and meet as a group on our unit.
• 5:41PM:  Arrive on the floor.  I can smell poop somewhere.  Seriously.
• 5:45PM:  The real nurses seem annoyed that we’re there.  We’re totally in the way.
• 5:46PM:  Our instructor shows us the assignment sheet.  Each of us is assigned one patient to assess tonight.
• 5:47PM:  Check the assignment sheet — I am assigned an elderly woman who recently underwent major abdominal surgery, and has multiple concomitant medical problems.
• 6:00PM:  After checking the patient’s chart for past medical history, past surgical history, admission notes, nursing reports, etc, and asking our instructor a million questions about what to do next, we are all ready to see our first patients.
• 6:01PM:  Patient’s family member is asking the nurse to transfer the patient back into bed, because patient is exhausted.
• 6:02PM:  I offer to help transfer patient back into bed, and nurse readily agrees that I would be a big help.  (See?  Being a tall man is proving useful, 17 minutes into my first rotation.  Yeah!)  Nurse asks me to wait at nurse’s station until she gathers several people to help with the transfer.  I’m supposed to assess my patient, so I guess I’ll just wait until the patient is back in bed.
• 6:14PM:  Waiting …
• 6:38PM:  Hmm … I do believe there are 43 vertical lines on that one ceiling tile up there.
• 6:55PM:  I wonder if I should get a Slurpee on the way home later on … mmmmmmmm, Slurpee.
• 7:03PM:  Ah, we’re finally ready!  I put the alcohol rub on my hands, get them clean, enter the room, and see 4 other nurses preparing to transfer the patient from chair to bed.  She was totally going to transfer the patient without me.  I already feel left out.  Anyway, I put on gloves and kneel on the bed, grab the draw sheet (the sheet that sits under the patient to help move them around if the need arises), and the lead nurse says, “Ok, on my count … one, two, THREE!”  And lift we do, hefting her over the side and into the bed.  We spend several moments moving her around getting her into a comfortable position, and changing some of the sheets underneath her.  I notice this is done MUCH quicker (and admittedly a little rougher) than when we did it with the mannequins in Lab.
• 7:06PM:  I take off my gloves, throw them away, and leave the room to head back to the nurse’s station to grab my assessment sheets.  Unfortunately, the family member just left, so I can’t have her help with the history.
• 7:10PM:  I go back into the room to perform my assessment … and the patient is absolutely, 100% … asleep.  I can’t really rouse her, and when I have to, she is pretty confused and nonresponsive to my questions, so I decide to skip most of the hands-on and history questions.
• 7:13PM:  I start the portion of my assessment that I can still do with the patient nonresponsive:  I check her pulse and respirations; I check her ankles and feet for any swelling; I check to see whether she has a catheter and the quality and quantity of her urine output; I check the capillary return of her fingernails, seeing how long it takes for blood to return; I listen to her anterior lung sounds (is that some wheezing or crackles in there?), since I can’t turn her over or ask her to sit up to listen to lung sounds on her back; I check her ID bracelet and ensure she’s the correct patient; I check her IV medications and see what’s hanging on the pole.
• 7:25PM:  I’m done with the assessment (what I can finish) and am about to head back to the nurse’s station to complete my documentation, when the patient suddenly awakens and seems very agitated — she tells me she’s in a lot of pain.  When I ask her what level her pain is at, she responds that it’s a “10 out of 10” on a 0-10 pain scale (with 10 being the worst).  Also, she says she just had a bowel movement.
• 7:26PM:  I tell the nurse in charge about this recent development; she thanks me and says she’ll go and take care of the pain request.  And, presumably, the poopage.
• 7:30PM:  Sit down at nurse’s station and complete my documentation — Nursing Admission Form and Interdisciplinary Plan of Action (IPOC), which is a very involved form detailing the care this particular patient should expect to get, including any teachings the nurse can perform for the patient and/or her family.  I fill out what I can, and hand it to our instructor.
• 7:35PM:  Our group meets in the nurses’ lounge and has “Post-Conference,” where we sit around and talk about the day — today we didn’t really do this, but talked about the upcoming weeks.
• 8:00PM:  We are set loose to go home and recuperate.
• 8:03PM:  Get that Slurpee and walk home.

In thinking back about what I could have done differently, I really wish I had gone in immediately after receiving my patient, because I should have realized that, despite the nurse saying she was ready to move the patient (and needing my help), there still would have been a likely lag time in that getting done.  I could have gone in, started my assessment (especially because the family member was there and could have answered much of the medical history questioning), and had much of it done while the patient was still awake.  Even if they came in ready to transfer the patient, I could have just stopped my assessment and helped move her.  However, in my naivete, and wanting to just help the main nurse with the transfer, I stayed back and assumed I would be needed immediately.

But this is what nursing school is for … to come to understand these types of things.  All in all, a pretty good day, despite not getting my assessment done in the way I would have liked.

Some acronyms and shortcuts I’ve been running across on documents pretty frequently:

• POX:  pulse ox (oxygen saturation in the blood)
• AAO x 3:  awake, alert, and oriented times 3 (to person, place, and time)
• ROM:  range of motion
• JVD:  jugular vein distension
• PERRLA:  pupils equally round and reactive to light and accommodation
• HOH:  hard of hearing
• ADL:  activities of daily living
• Hx:  history

And now it’s time for bed.  Sweet, sweet glorious sleepy, here I come.  Full day planned tomorrow — lots of errands and lots of schoolwork.

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First Clinical Rotation

Today was the magic day — first clinical.  This is how it was supposed to go down:

• 12:45PM:  Meet as a group in lobby and head to computer/charting training.
• 1:00PM-5:30PM:  Go through training on how to chart/document in the hospital.
• 5:30PM-9:00PM:  Perhaps go to floor of hospital and orient ourselves and maybe see patients.

And this is how it actually went down:

• 12:45PM:  Meet as a group in lobby and head to computer/charting training.  (OK, so far so good.)
• 1:00PM:  Arrive at training room and see a room full of other students taking up every available computer.  (Uh-oh.)
• 1:03PM:  Stand around awkwardly as instructors gather to figure out what’s going on.
• 1:06PM:  Sit around the periphery as instructors decide that there’s some sort of scheduling snafu.  (Duh.)
• 1:10PM:  Leave computer room and head back to building where we met.  (Nice sunshine today.)
• 1:20PM-1:45PM:  Sit at a table and receive brief orientation to instructor’s expectations.
• 1:45PM-1:50PM:  Walk to hospital.
• 1:50PM-2:30PM:  Receive very brief tour of the unit we’ll be on.
• 2:30PM:  Go home.

So yeah, so much for a big 8 hours of clinical my first day.  All in all a fairly disappointing day … but stuff happens, right?  So gotta roll with the punches.  Tomorrow will be a busy day:  4 hours of computer training and then a few hours of seeing our first patients.

The patient-seeing will entail a few things:

1. Doing a “head-to-toe” assessment:  Basically a very thorough overall assessment of all body systems.  This is where I’ll take my vital signs and ask the patient a million questions and use my senses to assess the patient.
2. Completing a Nursing Admission Form:  This is where I’ll ask the patient another million questions on a super-thorough form.
3. Starting to learn how to document document document document document document document.  After that, we’ll document some more.  And then after that’s all said and done, it’ll be time to start documenting.

For the first month or so, I will get one patient to assess and follow.  After I get the hang of assessing my patient and charting everything, they’ll add in more tasks.  The instructor hopes to have us giving meds by the 4th week or so (we’re not allowed to give IV meds, I don’t think — only oral, intramuscular, and subcutaneously).  Also, each of us will have one week where we play the role of “charge nurse” in our little group, in that we’ll help schedule the tasks for our fellow students and basically oversee everything for that week.

I’m pretty nervous about tomorrow, because this will be the first time I’m actually talking to a live patient and performing nursing duties!  I’m ridiculously excited, however.  I know I’m not expected to do everything right at this point, but I’m still hoping I don’t mess up.

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