Two weeks down

This week ends the 2nd week of my 5th quarter. I started my clinical rotation on the Med-Surg floor. I think I will have good opportunities on the floor, especially now that I am starting on IV med-pushes, and I can give blood transfusions, among other interesting tasks I can perform. This part scares me a bit because it is a med given straight into the vein, going to the heart. If given too fast the patient can literally drop dead, depending on the drug. I think after a few IV med-pushes and knowing the rate I'll be okay. My clinical instructor said she was going to drill us each day on our patients meds and after a few weeks, she'll back off when she knows that we know our stuff. I was a bit scared of my instructor, and I still am a bit, but I think it will be a great quarter.



I took my first test on Friday, and amazingly, I got 90%!!!!! Whohoo! I couldn't believe I did so well. There were so many students that didn't pass and got below the pass rate of 78%. I feel very fortunate and blessed to have understood the material so well. Lets hope the next one is just as good.

Clinical assignment

I just about cried when I found out where I was placed in clinicals this quarter. I was told that I needed to do my clinicals at two different hospitals, and because of my distance I drive they would "work" with me. Last quarter I was in Bellingham - 1 1/2 hours away. I was certain they would place me in Mount Vernon, for two reasons. 1) I already went to Bellingham, 2) because of the bad winter weather, they said they would place me closer to home (still an hour away).

I found out I will be doing my clinicals in Anacortes. I asked to switch to a closer one, but I was denied. That still does me no good because it is an hour to Mount Vernon and another 25-30 minutes to Anacortes. Not only that, but I have day shift that starts at 6:30am. On top of that, I have to go the day before and pick my patients and get pertinent information for my shift for the next two days. Unfortunately, I get out of class at 3pm, then travel to the hospital. Get my pts & their information, then leave around 5pm, and get home between 6:30-7pm and wake up at 4:30 to go right back up to Anacortes for my clinical that day? There is no way!

Jeff is the ultimate Husband & Father-of-the-Year. He is so sweet & supportive. He is so awesome in that he will take care of the kids 2 nights a week, so I can stay the night at a friends house and not waste time & gas. Unfortunately, I miss out on the time I can spend with my family. I know this is all for a reason, but I already miss my family just thinking about it. Thankfully it is only 14 clinical days - but this will be a really long quarter, and only 10 weeks left this quarter. I just hope I am successful as I have been in the past quarters.

Then end of another quarter

I am happy to announce that I have sucessfully passes my 4th quarter of nursing school. I have worked so hard, had sleepless nights and tried so hard to pass this class. I got exactly what I neede for my final grade to pass the class. Afterward, they tossed out 2 questions, which raised my grade. I want to thank all the prayers on my behalf. I have such supportive family and friends. Not to mention my husband who is so supportive to me. He does whatever it takes for me to be successful. What a prize he is!

Now, I can "relax" this winter break until I go back in January. Unfortunately, I need to memorize about 30 IV meds and all the components that each med has (class, indications, rate, side effects, compatibility...etc). So my break won't be as much of a break as I'd like, but at least I can take a few days off until I'm at it again.

My favorite rotation - THE ED

The ED you ask? Well, that's short for the Emergency department. I spent Thursday evening there and loved every minute of it. Here are a few of the things I did and observed.

1. I had the opportunity to perform two IV starts. The first patient I started her IV the first try and was successful. The second patient I started the IV on didn’t take the first time. The RN had difficulty getting it started too. She tried two times until she was successful.

2. I assisted the RN in prepping an analscope for a rectal exam. After we prepped everything, the physician entered the room and stated, "Well, I just figured out how to do this procedure, I saw a how-to video on You-Tube." I busted up laughing, but the patient sure didn't, I think she was in too much pain. He ended up having to do a digital rectal exam on her...still not the most pleasant thing, but I guess thats what happens when you state you have rectal bleeding upon admitting to the ED.

3. I performed an assessment on a dementia patient that was admitted for eating a sponge with paint on it. Yes, she ate a sponge with paint on it. She checked out okay. When I asked her to open her mouth to assess her airway, she opened and smiled. All I saw was red stains in between her teeth. It was actually quite funny.

4. I observed a trauma case in which the patient fell 14 feet and crushed his ankle. The patient was put under conscious sedation and the physician re-aligned, and re-set his ankle. I could hear the bones cracking as he re-set it. It was so cool!

5. Another patient came in with a femoral artery stent with an aneurysm. She was yelling out in pain. The surgeon was there applying pressure for almost an hour, waiting for the OR to be prepped.

6. Another patient admitted claiming to be 4-5 months pregnant with numbness and tingling on her left lower extremities. The physician performed an assessment and urine culture. He later determined her to not be pregnant, and with his experience, knew she did in fact have feeling in her lower left extremities and she has mental issues. His exact words were, “c-r-a-z-y, with a capital C.” She also had a journal open on the counter. I read a few excerpts from it and after reading it, I can honestly say, she definitely was CRAZY.

I really enjoyed my ED experience. I liked the pace, the physicians that were always around, paper charting, helping the patients in their urgent state. Most of all, I like the fact that everyone in the ED helps each other out when the work load is too much for one or someone needs to take a break. I think this is definitely a field of nursing I am interested in.

ICU rotation

This past week, I had a rotation in the ICU. I was assigned to a primary RN and assisted her with one of her patients. The patient I had was a post-op patient who's vitals rapidly decreased and was tranferred to the ICU. He was a contact isolation patient, meaning I had to gown and glove each time upon entering his room. In the ICU, he was diagnosed with sepsis, with respiratory acidosis as a complication. During the shift, he had 6 liters of NS 0.9% infused with only 200ml of urine output. He also had 5 other IV’s with other medications infusing with the NS. The physician inserted a CVP line to monitor his venous pressure. It was so interesting being in the ICU. I couldn't believe how much work and time one patient took. I love the fact that nurses only do paper charting, as compared to computer charting on other floors. I loved every minute of it. This is definitely an area that I am interested in and maybe the ICU might be in my future.

Clinicals - Week 2

This week I took 2 patients. I wasn't going to be advantageous and take three when my instructor has not forced me yet. After all, I am free labor and I am paying to work at the hospital. It was nice though with two patients to have a little bit of time figuring out my evening routine, meds, charting, patient care and learning new skills. It's wonderful that there is always a learning opportunity, whether it be the patient and their current diagnosis and how to effectively treat it; or learning a new skill by working with IV pumps, and other skills.

Both days this week I had both the same patients. It is nice to have continuity of care and for the patient to see a familiar face. One patient was in for cellulitis on his lower left leg. It was pretty grody to look at, luckily he was all bandaged up. That was the extent of the complications of that patient, besides previous heart problems.

My other patient has had quite a history of events recently that unfortunately she now permanently is mentally impaired. She has history of bipolar and which she took Lithium (a mood stabilizer). It as effective for a long time, but unfortunately it has a small therapeutic range from 0.5-1.3. She collapsed last month and was unconscious for quite a while, leading to oxygen & blood loss to her brain. In the ER her Lithium level was 3.7 and potassium was elevated (which leads to cardiac arrhythmia's). She fractured her femur when she fell, but they were only able to stabilize her femur in traction for a week while she recovered in ICU. She went to surgery and was admitted to my floor. She was anxious, confused and talked incoherently. She called me Sharon. During my shift, she fell on the floor because she was anxious and moving around so much, eventually wiggling out of bed. I was with my other patient, so I didn't see it, nor was I responsible for it. She had wrist restraints placed and closely monitored. I had to feed her and change 2 loose BMs. Not my favorite thing to do, but I breathed out of my mouth to get through it.

I went over my patient with my instructor expressing my concern for her and her state of confusion. I wanted to help her and "fix" her. He taught me a good lesson, that sometimes we can't fix patients. We can only treat them and monitor them and hope they improve.

I was able to assist with a blood transfusion, set up the tubing, spike the blood bag and go through the numerous safety checks for delivering blood. I monitored the patient closely for signs of transfusion reactions. It went a-okay.

Stay tuned. Next week, I will be in the ICU & ER. I am sure I will have stories to tell about that.

One Flew Over the Coo Coo's Nest

Have you ever seen One Flew Over the Coo Coo's Nest? This week I was at the Hospital for 2 days for my mental health rotation. It was not quite as bad as the movie, but it was pretty darn close. I picked a patient to focus on, which I'm writing my research paper on. She has Schizoaffective Disorder, Bipolar Type. The voices in her head were "talking" to her. She has serious issues, just as every other patient in there.

Here are some of the interesting things that went on:

• An almost comatose, delusional patient wrote on a paper for me that she "is responsible for the E.Coli outbreak."
• A sweet lady with severe dementia was "missing". The entire staff was looking for her.I found her hiding in a bathroom. She was facing the wall and when I turned the corner she was right in front of me and scared me. :)
• A homeless man tried to interrogate me about being married, how many kids I had, and how "pretty I was". He was inappropriate to all the female staff.
• A young girl with severe depression got mad at me because I didn't wake her for breakfast. Well it didn't matter because she's bulimic and she threw it up anyway.

It was an easy rotation. I went to group meetings with numerous counselors. I learned how to increase my self esteem, how to effectively cope, and how to effectively break bad habits. I'm on my way to a better me!

First Day of Clinical

This week, I started my first day of clinicals. I am working 1 1/2 hours away at St. Joseph Hospital in Bellingham. It went as good as could be expected for having the entire summer off. I was a little rusty. I haven't worked evening shift so I had to figure out my evening and my tasks to be done at certain times. Also, I had to figure out the computer system to do all my charting.

I had the chance to start an IV on a new admit patient. I was able to get the IV in successfully the first time. It's a good thing I did, because I only had one chance to poke the patient. The IV catheter had two ports. The nurse told me to unscrew it to flush the IV. The IV had two ports. I was a bit confused and I unscrewed one of the ports and blood gushed out. Luckily the patient didn't see the blood and I was able to catch it all in my glove. I soon then realized she meant unscrew the cap off the saline and screw it into the IV port to flush. Well, I guess it can't go smoothly all the time...especially my first time on a patient.

Starting my first IV

Last week, my clinical group was required to start IV's. I was a little nervous going into it, just like when I gave my first shot. I graciously let other students go ahead of me. Some made it on their first try, others it took up to 3 tries.

I (reluctantly) volunteered to be someone's guinea pig. My instructor helped the student find a good vein to use. Fortunately for me in this situation, I don't have good veins and my instructor wouldn't let her poke me.

I finally got the nerve to do it, and my friend volunteered to be my guinea pig. With good coaching, good fine motor skills, and conficence (which I lacked a bit), I was able to start her IV on the first try. It is a little tricky, getting it into the vein, but it was easier than I thought, but she did have good veins. Next time it will be on a patient, so I will be more confidence and will have to hide any doubt in myself.

Another test down

My exam yesterday covered mental health, cardiac and pediatric respiratory. I put a lot of study hours and it paid off. The test was taken on a computer, a change from last year. They are preparing us for state boards, which are taken on a computer. I was nervous going into it, worried that taking the test on the computer might negatively impact my test scores. I set high standards for myself to get 90%. I did not attain that score, but 88% will do just fine. There was a problem on the test I did not answer correctly, which surprised me. Apparently the number one mental health disease in the US is not depression, schizophrenia, or psychosis, but substance abuse topped the list. What is wrong with people?

Two tests down, 4 more to go!