The Dog Ate My Care Plan…

Just a mom/wife/nursing student extraordinaire trying to make it in the big bad city…

Archive for the ‘Family’ Category

Peds Wrap-Up

Posted by isntshelovlei on December 5, 2010

Although there were no sudden flashes of perception or insight, I was not visited by any wise men (or wise women—maybe in the form of Florence Nightingale?), nor did I experience any other surreal epiphanies causing me to exclaim “Eureka!” in the middle of doing a straight cath, pediatrics was definitely one of my better clinical experiences thus far.

So just a few things I’ve come away from this rotation with…

I now (to my children’s dismay) calculate safe dose ranges before I give my kids any medicine, even Tylenol. I’ve also gotten into the habit of calling drugs by their generic names and forget that I do so until I get a dumbfounded look from my husband after asking him to pass me the acetaminophen.

The fact that I have three children ranging in ages up to eleven has also helped me appreciate some of the more theoristic (is that a word?) stuff that you learn in pediatrics—which to be honest, up to this point has for the most part gone in one ear and out of the other. Take Erikson for instance. My four-year-old is definitely in the midst of the whole initiative vs. guilt stage. She doesn’t need you to tie her shoes, she can and wants to do it herself…and I have to force myself to let her—even if it takes five, or ten, whole minutes—for-one-shoe (oy vey). Same thing with the zippers and the buttons on the sweaters and jackets. Though if she could tear her attention away from NickJr. for a couple of minutes that might speed the process up a bit…

Even Freud wasn’t as out there as I’d originally thought he was. That Oedipus-Electra complex stuff may actually have a ring of truth to it. I don’t know about the penis envy and all that but my daughter is definitely a daddy’s girl and I am her number one competition. She makes sure to let me know that my husband is her daddy; don’t touch her daddy, etc. And she’s always talking all this “Mommy’s in the red, Daddy’s in the green” nonsense—what’s that all about? LOL.

This rotation I also felt more like a nurse and less like a PCA (no offense to my PCAs, but that’s not what I’m paying $500/credit to learn to be). This semester I got to do a lot more “real” nursing stuff and not just vital signs, AM care, and changing sheets (though I can miter like nobody’s business). Since the patient population we were working with consisted of mostly spinal cord injuries and scoliosis (i.e. post-op spinal fusion, veptr, halo, etc.), there were plenty of straight caths to go around (and to think I used to be scared to do those…), plus lots of IV meds, and pin care. Dealing with children and adolescents I got to practice my art of persuasion (or I guess in nursing it’s called “therapeutic communication”) to encourage them to meet their goals, where it was to increase their fluids or work on becoming more independent with their ADLs.

So all in all I think my pediatric rotation went pretty well. I also not only made benchmark on the peds HESI, but it was my highest scoring HESI exam to-date. 🙂

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Some Nurse…

Posted by isntshelovlei on October 7, 2010

When (medical-ly) things go wrong in my own house, right under my own nose, it really makes me start to question how good a nurse I can/will be. If I don’t even notice when one of my own kids is in respiratory distress then how in the world am I supposed to be able to assess multiple patients?

One of my daughters—the “small girl” as she calls herself, not the much taller one from my strong therapy post—was admitted to the hospital this week (hence very few tweets and status updates from yours truly). I was at work, actually in the middle of taping another Insights in Nursing podcast episode over my lunch break, when I got a call from the daycare saying that she was breathing pretty hard. Of course I hightailed it over there, stopping by the house to grab her barely-used inhaler. Until this admission, the docs refused to label what she had as “asthma.” They said she was too young and her symptoms were just a bad reaction to a virus, so up to this point she had not been on any type of maintenance therapy. Nevertheless, I did still have that trusty rescue inhaler (which had probably not been used for close to a year). I get to the daycare and she looks absolutely horrible. I could see her working to breath through her hoodie. I gave her her “puffs” and put her in the car. By the time we got to the hospital she was tachypneic, with intercostal and suprasternal retractions. How could I have not noticed any of that this morning? Surely, she did not go that downhill that fast and without showing some preliminary signs/symptoms; she didn’t look like that when I dropped her off that morning.

Thinking back, there had been signs—just none that I had readily accepted. She’d been coughing recently. It started out as a dry cough; I now noticed that it had become junky. Just that morning, she complained that her throat hurt, and she looked tired as all hell. I sort of brushed it off thinking (or hoping) she was “just” coming down with a cold and even told her that she’d “be alright.” And of course she was tired. Our lives are hectic as a side effect of all of our various responsibilities; we get up at the crack of dawn after staying up late nights most of the time. I’m sure our entire household could benefit from a few more hours of sleep.

But this was bad. She’d had a similar “episode” (since we weren’t calling it asthma) sometime in 2009, but it wasn’t like this. It took her a lot longer to come around this time. The albuterol and prednisone weren’t even touching her wheeze (which sounded more like an expiratory snore). I felt horrible. I am under such tremendous pressure and stress—between home, work, studying and keeping my grades up in school, trying to stay “involved,” community service, networking…all on very little sleep. But at what cost? I already know I’m stretching myself thin. But everyone keeps telling me that it’ll all be worth it in the end… 

I think my overpacked schedule and subsequent need to have things proceed in an orderly, organized fashion (such as not having kids get sick when I already feel like I’m being pulled in a million different directions) has led me to develop “hyper“chondriasis (sort of the “opposite” of hypochondriasis). Yep, that’s what this was—a case of hyperchondriasis by proxy. My kid was really sick, but I was in some type of manic denial.

Through it all, I did learn something new…retractions seem to work their way UP. As in the patient usually has subcostal retractions first, then intracostal, then supraclavicular or suprasternal ones. My daughter’d had retractions before, but never up at her collarbone area.

In any event, she’s home now, doing much better, and back to jumping off the walls and eating us out of house and home. 🙂

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My Strong Therapy

Posted by isntshelovlei on September 28, 2010

You know you’re into the meat of your nursing program when the concepts start to creep into your everyday life. You assess friends and familys’ vital signs…you are now a germaphobe and engage in scrupulous handwashing (and encourage others to do the same)…you might even use medical terminology in every day conversations (I’ve been known to say things like, “Well I do XYZ prn…” or complain that my son is “noncompliant” with some rule). One could imagine it would only be a matter of time (especially now that I am taking mental health/psych) before the therapeutic communication would begin to kick into auto-pilot.

I have three kids. It was the weekend and I was trying to study (of course) so I let them go outside so that I could have a smidgen of peace. My daughter comes back in the house huffing and puffing, eyebrows knitted. I sighed and put my books down. The conversation went a little like this…

ME: “What is the problem now?” (giving broad openings/open-ended question)

HER: “He thinks he’s the boss of me!!”

ME: “He thinks he’s the boss of you?” (reflecting/restating)

She nods.

ME: “He is only 11. Do you think he’s old enough to be anyone’s boss?” (voicing doubt)

She thinks it over for a minute (silence), then makes a face.

ME: “Well? Go on…” (general leads) 

HER: “No…but he still acts like he is…” she grumbles.

ME: “I know, sometimes big brothers are just difficult like that. But if you ignore him when he acts like that he won’t do it as much (supportive confrontation). Please stop fighting with your brother. If the two of you can’t get along, you will have to come back in the house (limit setting)…

Sufficiently unruffled, she goes back outside and all is well with the world.

Until next weekend…

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I Don’t Know It All

Posted by isntshelovlei on September 6, 2010

Do you ever feel like you are treated a little differently because you’re a nursing student, nurse, or other health care professional? For example, are you provided with less patient education because people know that you work in health care and “assume” that you already know certain things? Or is patient education just not occuring as much as it should in general and we just notice it more because of our background?

For instance, one of my kids had a physical last week. Towards the end of the visit her doc mentioned that they had the flu vaccine (already?!?—it’s still like 100 degrees outside!) and that she should get it today. It was less of a question—she basically assumed that I would want my child to get the vaccine. And my silence I suppose, was implied consent. Why wouldn’t I you/she might ask? That is a post for another day…

Anyway, the physical is completed and the doc says as she leaves that the medical assistant will be in to give the vaccine. No “do you have any questions?” No “is she allergic to eggs?” Now I know that an egg allergy wasn’t documented in my kids’ EMR, but still it’s just a computer program—there are glitches and cooties and sometimes computers are just blatantly stupid. And there’s really no way that out of the hundreds of patients that she has she remembers my one little daughters’ allergies. I thought you were always supposed to (or maybe it’s just best/better practice) (re)confirm things like allergies at every encounter, especially when administering medications/vaccinations.  And don’t some people develop allergies over the years?—you’re not always born with them. I’m just saying… But I didn’t stop her from leaving since I did happen to be comfortable with my level of education regarding flu vaccines. Besides—sometimes I just like to sit back and watch these things play out. Personally, I know how to ask questions when I want to. I am more than capable of making my needs known—just ask any of the early intervention agencies in my areas (poor things). My point though, is that some parents/patients DON’T.  And that’s why we still have people that believe that vaccines cause autism. Information, good information, is power.

So the MA comes in with the vaccine, squirts it up my kids’ nose (it was LAIV/Flumist), gives me the information sheet (after the fact), gives my kid a sticker and goes on her merry way. Meanwhile, I’m wondering, who does the education around here? Shouldn’t they really give you those information sheets BEFORE they shoot your kid up with something? What if I look over the info sheet and suddenly realize “oh sh!t” my kid is pregnant (don’t act like that couldn’t happen in these days and times)…she shouldn’t get it?!? What if I couldn’t READ the damn thing at all (but then again I’m a nursing student I guess I should be able to read)? What if English wasn’t my first language? Maybe I’m over-reacting, my critical thinking (and often fastidious) student nurse wheels a’grinding… But then again, maybe I’m not.

Now I know that the person that administered my daughter’s flu vaccine was not a nurse but a medical assistant. And I know that patient education cannot be delegated to a UAP (unlicensed assistive personnel for those not fluent in healthcare/medicalese). But shouldn’t someone be doing the education? I just think that regardless of your background things like patient education should be part of every health care encounter even if it’s redundant (unless declined). I had a nursing professor that would say “well i’m not a cardiac nurse so I’m not familiar with xyz…” And she was a CRNP! But it wasn’t her specialty, so her knowledge base wasn’t as wide in that area. People shouldn’t assume that just because you’re a health care professional that you know (or even more importantly, understand) every nook and cranny.

So honestly I really don’t know for sure if my being a nursing student really was the reason why we received so little (if any) patient education. But it wouldn’t have been the first time. During a brief hospital visit of my own, it was frequently implied that they didn’t need to explain things to me because I was a nursing student. Key word in that sentence—”student.” But even when I become a full-fledged RN I will not know everything. Not to sound cliche but, “you never stop learning.”

If the nation is really going to try to shift from “sick care” to “health care” and focus on prevention, patient education will have to be a large part of that. Might as well start practicing now…

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Slow and Steady Wins The Race!

Posted by isntshelovlei on December 18, 2009

So it’s a wrap! At times I wasn’t sure that I would be able to do it (or that I even wanted to anymore), but I made it through my first semester of nursing school! I also got my first B in about eight years—damn philosophy/ethics! It was a high B at that—like an 88.5—so close and yet not close enough. But I’m actually okay with it. My primary focus was on nursing and I did extremely well. Finals were not as bad as I expected them to be; neither was the dreaded HESI. For anyone planning/needing to take it, what I found to be really helpful were the case studies and practice quizzes/tests on Evolve. I also liked that they gave you the rationales for the correct and incorrect answers—it really helps you learn to critically think through the scenarios. I’m not saying the HESI was a breeze because it wasn’t, but it was manageable. Some of my classmates may not agree with me seeing as though the class average on the exam was a 613. But I got a 1033—not too shabby. So I’m feeling pretty good—and it was comforting to know that all of the stress, the meltdowns, and the hair loss were actually turning out to be worth it.

But now when I get home from work I find myself totally stupefied. No chapters to read, no care plans or concept maps to develop, no exams to study for—what in the world am I supposed to do with myself for an entire month? And has cable always been this crappy?—there isn’t anything good to watch that I haven’t seen enough times to be able to recite the script on my own. I will get to spend more quality time with my family though. It gets so hectic during the semester that sometimes I feel like I’m just a family member visiting from out of town. Even my son has said a couple times—“it seems like I haven’t seen you for three days!” Between getting up at the butt crack of dawn to go to work, not getting home from class until after they’re asleep, and then tiptoeing out to clinical like a thief in the night on the weekends—sadly, sometimes that’s almost true. In order to pull this off everyone is making a few sacrifices—not just me.

During the break I’ll also have a little time to work on a few scholarship applications (times is hard, lol)—I know for one the deadline for the FNSNA scholarship is coming up in mid-January. Join me for a little friendly competition?  

But before I know it I’ll be bored out of my mind and ready to go back to school (and back to bedlam). Spring semester I’ll be taking Health Assessment and Maternity—maybe I’ll get to catch a baby or something 🙂

Happy Holidays and New Year to all—I’ll see you in 2010!

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