Lots of Fluid

I started the day today on a different floor. It was pretty easy to find my way around. I was surprised to find out that there was only one nurse on my wing. When I was on the other floor, there were two nurses on each wing. It does look, however, that there may be fewer rooms per wing on this floor. The nurse I was with today had five patients and was very busy. She did not seem all that interested in showing me the ropes or teaching me about the things she was working on so I was pretty much on my own. At this point in the semester I am not too worried about that, but it is always nice to have someone who knows and cares that you are here to learn. Having been a teacher in a past life, I am sure that I will naturally be able to grab a nursing student and have them learn from me in the future. (At least I hope so.)

My patient today went to radiology to have a paracentesis performed to remove fluid from his abdomen. He had had the procedure performed a few days earlier and the physician removed 4L. I was thinking that there was no way they would remove that much today, but sure enough, they drained another 4L. I cannot imagine carrying around that much extra fluid. That is two 2-liters of soda. I am pretty sure there was more to get as well, but the doctor only ordered 3-4 L of drainage. I was very fortunate that my patient is very nice and easy to talk to. Someday, I am sure that this will not be the case. He has pretty much let himself go during the last 20 or so years. He has not seen a doctor and has ignored major medical problems such as the skin ulcers on his calves. Either he has been very healthy up to this point in his life or he is just waiting for his problems to go away. I have seen many people who ignore health problems. Now that I am entering a healthcare profession I can really see what kinds of problems this causes in the future. Fortunately, my family is coming around to asking me about their health problems. I do not always have answers, but I can tell them that thy need to seek out professional advice. I can usually convince them that following up on health issues will prevent complications later on by telling them about some of the issues I have learned about in my training.

On the lighter side of things, our clinical paperwork has been reduced and I can rejoice. A little extra time studying theory class would certainly be helpful. I still have to prepare for patient care, but the extra work later in the week makes life not quit so daunting. This makes the fact that the end of the semester is not quit in sight yet not as bad.

-DV

Watch Out for Air Bubbles

Today was a very long day. However, it was also very productive. Coming off of the second theory exam the last thing I wanted to do was get up early and go to the hospital. I would have much rather stayed in bed all day. I am sure that I will feel that way many times when I become a fulltime RN. My patient today was a very nice elderly woman in the hospital for a bowel perforation and hiatal hernia. She had had her surgery the night before and was just waking up when the staff nurse and I went in for our assessments. She was having some abdominal pain and we started checking out the PCA. The staff nurse said, “Oh, I like to set up the tubing a little different. Everybody does things differently and I just like things to be a certain way.” After a couple minutes of unhooking and re-hooking the patient up to her TPN, NS, and Morphine we left the room. As soon as we left the room the staff nurse told me what was going on. The lines were full of air and were going directly into the patients veins like that. The staff nurse was obviously upset about what she had just had to do, but she was extremely calm and professional while in the room with the patient. She reported the problem to the nurse manager and documented what she had done. Despite the obvious danger that the patient was in, I am very glad to have witnessed the staff nurse in this situation. It taught me how important it is to assess the lines at the beginning of the shift. It taught me things to watch for when I set up tubing, and it taught me how to act in perilous situations that present themselves while the patient is watching or listening. It is so good to be able to see a really good nurse in action. So many of the nurses I have seen during my clinical times have been mediocre at best and some have been just plain awful. I really hope that when I get a job and a preceptor, that the person training me is like the staff nurse I worked with today.

On a technical note, today I was able to hang my first IVPB. Not a huge deal, but it is one of those things that is kind of fun when you finally get to do it for real. I am beginning to find out (after many years) that I am a kinesthetic learner. I have tried for a very long time to figure out how I learn the best, and now I am pretty sure that actually performing skills is a much better way for me to learn than listening or watching. Once I have done something once or twice, I pretty much have it.

I really hope that my next clinical day goes as well as today. Despite the fact that I was really tired today, I was able to learn a lot while at the same time enjoying what I was doing. Days like today are a good prescription for recovery from days like yesterday.


-DV

Nursing School Tests

For the life of me, I don't know that I'll ever understand test questions in nursing school. "Which one of these four wrong answers is the least wrong?" God help me!

My first test this semester I made a 78%. I had studied my butt off to no avail. I have simply come to the conclusion that the amount of time spent studying for nursing school tests is not directly proportional to the grade that you will receive. So after the last test I decided that I was not going to study nearly as much for the next test because I would probably do just as well. My next test is in about one and a half hours. I studied about 3 times as much for this test. I just couldn't not study. I can only imagine what would happen to my test grade without studying. I'm sure it would end up somewhere in the pits of the negative scale. So here's hoping that the extra time I spent this time around will be worth the effort.

If not I'm not studying for the next one.

-DV


Update: Dammit......78 again!

(Sigh....)

So nursing school has apparently been a little bad for me. I've gained about 15 pounds since starting last spring. Looks like I'm going to have to lay off the donuts for a while. Dammit!

I still run when I can. Lately it's 3 times a week before theory, but eating is a huge problem. Too much junk. Here's the challenge... Run at least 10 miles a week and work up to 100 push-ups in one set. The running is not much of a problem. That's pretty much what I do already. I can pump out about 35 push-ups if I'm fresh.

Ready-set-go!

-DV

Edit: Friday, Oct. 15, 2010. Today I ran 4 miles (that's a total of 10 miles for this week. I also did 95 push-ups in 5 sets) Now if I can just stay away from the Cheezy Poofs!

In One End, In the Other

Today I looked at people from one end to the other, quite literally. The endoscopy lab was pretty interesting. They were very busy when I got up to the floor and didn’t really have time to do anything with me until about 7:15 when the procedures started. Hindsight being what it is, I wish I had been more proactive in admitting patients with one of the RN’s. Not that there was very much to do with admitting patients to the endoscopy lab, but I would have at least observed a couple of lines started. The unit manager was pretty good about keeping me in a room all morning. He first led me to a colonoscopy. I was really surprised at how small the procedure room was. I had always thought that it would something like an operating room, but it was more like a large doctors’ office. I was able to watch the monitor very easily and observe the RN and the physician without any trouble. The doctors were happy to point out any anatomy that I was interested in seeing. Surprisingly I was able to identify most of what I saw. I guess all that studying in A&P paid off. I was also able to observe a couple of EGD’s and EUS’s. During the EUS the physician pointed out the anatomy on the sonogram for me. While I didn’t really “see” the organs he was pointing out, I can see how if you view the sonograms enough you would be able to point out landmarks and visualize the various organs. The thing I really wish would have happened more (in all of my on site training) is narrative of what was going on, what we are seeing, what we are looking for during these procedures. I hope that when I have a job as an RN and I have students around that I am able to teach while I work. I understand that the doctors and nurses are busy, but it doesn’t really take that much effort to take the reigns and help the students learn about what is going on. One of the doctors did this for me during one of the procedures today and it was really helpful. I know that I can ask questions, but sometimes I am not sure what to ask or I am not sure if it is a good time to ask questions. I suppose some people are natural teachers and some are not. As a student, you just have to hope for the best.

Overall, today was productive in that I was able to see many of the diagnostic procedures that I have studied in the texts. It is good to really know what happens now.

First Time in OR

Today I had just gone up to the floor to get report on my patient when I noticed that he was not in his room. I went to the nurses’ station where the two nurses were going over report and they said that he had just gone down to have a PEG tube place. Oh noooooooo. Fortunately, I was allowed to go into the OR and observe. I was given a set of scrubs and then I was taken to the OR where my patient would be having his procedure. The RN I was working with today was very helpful. She took me to the pre-op room where it was VERY busy. I would assume that the morning shift is usually that way. It was interesting to observe everything that was going on. My patient was missing a consent for anesthesia. The RN that was assigned to him during pre-op was busy with another patient and eventually came over to get the consent signed. After all of the consents were signed we took him to the OR where he was treated to a nice mixture of meds to make him very sleepy. It is always amazing to me how fast theses meds work. I no time at all he was being intubated. The procedure was really amazing to me. It always seems like surgery is such a complicated procedure, but really it’s all basic pluming or carpentry. You’re just using more expensive equipment and you’re working on a human. I was surprised at the roll of the RN during the procedure. Mostly, she was charting the whole time. She had to chart all of the pre-op procedures, the staff, the equipment used during the procedure, the meds used, etc. Occasionally she would adjust the CO2 or the lighting, but other than that, she charted. I understand that charting is very important, but I’m pretty sure I am not interested in spending my days charting what other people are doing. After the PEG tube was placed a muscle biopsy had to be performed. That looked like it was going to hurt tomorrow!

After observing the OR today, I have a much better appreciation for what the med-surge floor nurses need to be doing for their patients. I can see how infection would be a really bid deal and how it is important to assess your patient once he/she is back onto the floor. I also have a better appreciation for good shoes. Standing in place all day on a hard floor isn’t easy on the feet!

-DV