Adult Med-Surg....Check.

Well, I finally made it. I passed my cardio unit exam with a (yes, you guessed it) a 76. Somehow I don’t seem to be able to get into that B range in this class. That put me needing 75 points to get a B in the class and only needing 25 to keep my C. Today’s final provided me with 51 points. At least I made an A in clinical. I have to admit that this has been the most difficult semester for me ever. That includes all of my “artistic” training years ago. No matter how much I tried, it just seemed that I could not learn all of the knowledge base I needed to know for the application portions of the exams.

I’ve got my course information for next semester (babies and mommies) and my books are on the way. I have a good nursing teacher friend who is able to provide me with free books for next semester…yea! Now if I could just figure out how to use them to benefit my grade. Any study tips from my readers are more than welcome. I’ll be able to get some of the reading done during the Christmas break.

I am looking forward to five weeks of R&R, Review, and Preparation for the next semester.

-DV

The End is Near

With this semester fast approaching, I look back and have to wonder where the time went. I completed the last of my clinical paperwork a week ago Friday (the day after Thanksgiving) and presented my paper to my clinical group on Thursday. Now that that is done all I have left is one more lecture in my cardiovascular unit followed by the unit exam on Wednesday. Then the biggie....a comprehensive final next Monday. There is still a chance for me to get a B in theory. I'm really hoping that the stars align for me and it works out. However, if not, I'm still in good shape for a C. Yes, it would suck just a little, but I'll be okay with that.

Tuesday is out last day in clinical and our instructor is allowing us to attend observation areas for the day. I have really enjoyed every area that I've been to except respiratory. I'm not too interested in doing that again. Also there will be opportunities for cath lab and wound care that day. Guess I'll have to wait and see where I end up.

I've been pretty stressed out lately with crazy family happenings (always during the holidays) and school, work and the like. I hope that all of this stress will go away after next weeks exams. I have been having some issues with my blood pressure lately. This summer I went to the dentist and they checked it (139/90). I figured it was just because I was in the dentist office for the first time in a while. I went again in October...still high. Then all last month I started checking my BP myself. It hasn't been below 130/90. During the last couple of weeks I've been having mild headaches daily along with fatigue and not sleeping well. I really don't want to have to deal with this type of problem, so I'll see how things go when the semester ends. Unfortunately, both of my parents have a history of hypertension and heart disease so it looks like I'm going to have to be really careful. I'm not even 40 yet and I exercise 3 times a week (typically). Now I could stand to lose a few pounds (15-20) but still, I'm not ready to be a patient. It's probably psychosomatic. Yes, that's it. It's all in my head. At least that's what I'll keep telling myself for another week and a half.

-DV

Recovery

I wasn’t too sure about going to the PACU today. I’ve heard reports from other students that the PACU is pretty boring mostly because of the delay in getting any patients. However, I actually had a very positive experience today. Admittedly, the first hour and a half was slow. The charge nurse told me that I was welcome to study until patients started coming in from surgery. Fortunately, I came prepared with my books and notes from class. After a while I was finally assigned to a nurse for when patients started coming in. I lucked out and got a really good staff nurse who immediately started showing me around and asking me if I had any questions. She was able to explain to me the processes for assigning patients to nurses in the PACU. She also made sure that I was able to have something to do when patients came through like getting them hooked up to the monitors. She was careful to explain all of her charting as well. Our first patient was a port placement, so that wasn’t very tough. He was pretty much fully conscious when he got to us. The story he told us about his brain tumor was very touching. Basically it all happened in the last year and he had to quit work as a highly educated professional. It must be very difficult going through an illness like this. After about thirty minutes we accompanied him to his room and came back to the PACU. A while later our next patient came. This is where things started to become very interesting. He was an open heart surgery patient who had a history of drug abuse. Basically, he came in yelling and continued to yell the entire time I was there. He was calling for his “momma” and yelling that “it hurts, I’m gonna die!” Mind you he was 39 years old and the morphine we were giving him I’m sure wasn’t nearly as effective as what he took out on the streets. Still, he was kind of being a big baby about it. I suppose “Be quiet and suck it up” would not be a very good example of therapeutic communication. I have to admit, I like patients like this. It makes for an interesting day. Maybe I’ll change my mind once I become a real nurse.

-DV

Pee, Pee, Pee

It’s the Tuesday before Thanksgiving. I am really looking forward to my day off. I came in this morning and got report on several patients and was able to pick out two that seemed like they would be good candidates for a student nurse. Patient number one – elderly woman admitted last evening for TIA’s. Patient number two – middle aged Hispanic man admitted last week for abdominal pain and is one day post-op for cholecystectomy. Patient number one had a ton of meds and I forgot my blank med sheets today. Great! Patient number two only had one IVP so I was saved. I was able to administer a couple of early meds to my first patients before she was wheeled off for testing, never to be seen or heard from again (until right before I finished my shift.) While she was away I was able to catch up on her meds for when she returned. That was a blessing; unfortunately, I was never able to administer them to her. I was ready though. My other patient was pretty easy to take care of. I was able to help him walk around the unit once and assisted him to pee three times. That was the extent of my day. While I am sure that helping patients pee is noble in and of itself, it does make for a rather long day when there isn’t much else going on.

I did try to help the guy that was blind and deaf. That’s a sitcom waiting to happen. During report the staff nurse and I were told that he could write on your hand to communicate and that if needed an interpreter could be called. I heard his IV alarm going off and went in to check on it. It looked like he was trying to ask for some help so I let him know I was there by touching his arm. He took my hand and proceeded to write “PRXHG===HATYlQ” (at least that’s what I was able to make out). It is quite possible that I could use some training in tactile spelling. I called the tech in and she was able to make out that he wanted a bath even though he had had one the evening before (so she said).

Later that morning, one of the other staff nurses on my wing said that she had some IV changes later and that I was welcome to do them with her if I wanted. I of course said yes, but ultimately they were done after I had to leave. Also, the “flu shot lady” came around giving vaccines to staff that needed them. The nurse I was with today needed one. I promptly asked if I could give it to her and she promptly declined. She said it wasn’t anything personal, but I’m pretty sure it was.

-DV

OR Rotation

I was really looking forward to spending time in the OR today. Previously, I had observed a laparoscopic PEG tube placement, and that was pretty interesting. Today I observed a chemotherapy port placement and 1 ½ laparoscopic cholecystectomies. (I had to leave for post conference before the second was complete.) I was pretty disappointed during the port placement. Because of the x-ray use I had to be out of the room for much of the procedure. Also, it was a very tight fit for the necessary personnel who needed to be close to the patient, so I was kind of out of luck on this one. Next came the gallbladder removal. I had some idea of what was going to happen due to my previous OR observation. Indeed, the gallbladder is not a bright green color like it is in all of the text books. Having had this same procedure done myself a couple of years ago I was very curious as to how everything really happened. I am always amazed at how “simplistic” surgeries are when I see them. Everyone always thinks that operations are so complex, but really, surgeons are just “fancy people plumbers.” If you look through some basic home repair books and an anatomy textbook, you could probably have a pretty good idea as to what to do, where to go, and what to take out. Seeing as how there were two cholecystectomies today, I thought about asking if I could do the next one…. “See one, do one, teach one” right? Okay, maybe I am being a little simplistic here, but still, it seems pretty basic. Maybe good surgeons just make it look easy.

As far as my observation of the circulating nurse, I am pretty sure that position is not for me. I really like to be a bit more hands on. All of the charting that has to be done just does not sound like fun to me. I would much rather be assisting the physician or doing my own procedures. However, when my assigned RN went to lunch, she was replaced by another RN who said that she had always wanted to be an OR nurse. She started as a scrub tech and went directly into an RN program. She had never worked on med-surg and started after she graduated in the OR. It takes all kinds. I am really glad there are people like her who enjoy that aspect of nursing. As of right now, I am still pretty unsure of where I would like to end up some day.

All in all, today’s observation was a good experience. However, I am hoping for a little more blood on Thursday. Does that make me weird?

-DV

Man Down...

Only 2 hours (lecture) into my cardiovascular section and I'm already behind. It's going to be a long four weeks.

-DV

I failed, but then I didn’t.

This last test over respiratory was a big kick in the seat of my pants. On my previous tests, you may remember that I scored 78% on both. My efforts to make that grade were very substantial. For the second test I studied really, really, really hard; harder than for the first test. For my respiratory test, I decided that maybe I was trying too hard. My grade did not improve and I had no extra time to do anything. My respiratory lectures were going well and I felt like I really understood the information. It was time for a new strategy. I decided to take it a little easier and not try so hard. That didn’t work. Initially, I ended up with a 68%. I was pretty average with the rest of the class from what I understand. I heard several students coming out of the testing center stating that this was the hardest test so far. Many had made 70%. By the time I got home I had decided to go back to studying like I had been and just hope for the best. About an hour after I got home, grades were posted to our online accounts. 74% WooHoo!!! I passed. My decreased efforts only cost me 4 points. Two of the questions were thrown out and two answers were accepted on another question.

I was pretty determined to start studying for cardiovascular ASAP. After looking at the reading assignments and all of the study materials I need to get through before the next test I realized that it will not be possible to make it through every word in the text. After some deliberation I’ve decided on another method of studying that I think will make more sense. It’s really about knowing what to do as a nurse if any of these diseases or medications makes it onto your floor. That will be my focus for the next three weeks. Reading just for readings sake just isn’t cutting it for me. Let’s hope for the best on the next test.

-DV