She Shoots, She Scores

So I did my first straight cath (I told you I wasn’t going to be able to evade it two weekends in a row). It really wasn’t that bad. I just think that the whole sterile field thing, combined with the fact that we hadn’t done cathing in the lab (let alone on real human flesh) in over a year had me wigged out. You can study all the textbooks and watch all the skills videos you want, but in the end it’s nothing like doing the real thing. And I sure didn’t see the famous “wink” they talked about when they were teaching the skill in lab. But my clinical instructor is great. She’s really supportive and makes you feel comfortable even when you’re in there doing something for the first time and feel first-day-of-school-stupid. You realize that you know a lot more than you think you do and things just start to flow. Not so wet behind the ears after all…

Saved by the Belle

Today we travel to a land called Far Far Away (don’t mind me, I’m going through a Shrek thing right now). There I had a patient, little Felicia (but no sign of Fargus, Fargle, or Shrek—they must have been off doing whatever it is that ogres do). And just my luck, on my very first day in FFA I was supposed to do a straight cath. OY. VEY. I had been dreading that aspect of the rotation ever since I found out that most of the little ogres had SCIs (spinal cord injuries) and the likelihood of having to straight cath (and often) was very high. As a nurse, I wanted to help take the pain away—not add to it. It was somewhat “comforting” (to me) to know that most of the patients wouldn’t feel the procedure due to their impairment. But then of course my patient, little Felicia, had “patchy sensation…”

Stomach in knots, stress headache waiting in the wings, I gathered my supplies…12 french catheter, surgilube, sterile and clean gloves, blue chux, disposable washcloths (the ogres didn’t use betadine), urinal…

Deep breath…hand hygiene…

Knock, knock.

“Hi Felicia…”

Once I entered the room you would never know that inside I was a bundle of nerves. I’m good with kids—I’d have to be—I have three (four if you count my husband). Felicia and I small talked about how she ate her pizza with ketchup and mustard on top (ew) as my clinical instructor, the PCA, and I transferred Felicia from her wheelchair to her bed. The PCA (male) left so that we could get down to the nitty gritty…but to my surprise, Felicia then insisted that Princess Fiona cath her and that she wanted her to “stop making such a big deal out of it” (ouch).

Which of course was just fine with me. Talk about a sigh of relief.

But I am sure that next weekend my clinical instructor will make sure I don’t get away so easily…

Foleys, Injections, and Wound Care–Oh My!

We finally had the dreaded “math/drug calculation exam”—the one you need to get an A on or fail the course (though they do give you 3 tries before they cut you loose). I’ve always heard nursing students making such a big deal out of this exam, claiming to have lost sleep (and even hair) over it. It did take memorizing some of the lesser known conversions like 1 grain = 60 milligrams and 30 milliliters = 1 ounce, but it really wasn’t that bad. Aced it—100%. I think a lot of the stress nursing students experience comes from all of the melodrama and sensationalism they attach to everything. Chillax already—when one of us gets all worked up about something it is contagious—it spreads through the class faster than a fire in a grease pit. Not that I don’t have my own fair share of stress and worry, but the level of agitation among some of these students gives me flashbacks of my days working in inpatient psych—sheesh.

The other big kahuna (at least for a first semester nursing student) was skills testing. You basically rotate through several “stations” and demonstrate each skill. You have to get at least a 75 on each one or you have to return for remediation (*enter scary music*). So for the past six weeks we have been in the lab learning skills—vital signs, injections, catheter insertion, wound care…among other things. The lab was then available for “open lab” for those who wanted to practice before the actual testing. After one open lab it became evident that different groups were learning different techniques, some of them outrageously (and dangerously) as the Grinch would say—WRONG-O! I saw one student do a Z-track by making an actual Z with the needle as she withdrew it—what in the world?!? You’re supposed to withdraw the needle at the same angle it was inserted (straight out)…I wonder how many degrees a “Z” angle would be…

The actual testing went well. Got there early, but of course they were running behind schedule. Students were in the hallway trying to cram last-minute bits of information into their already encumbered semantic memories (“what’s systolic pressure again?”…). Finally it was my turn. First up was the Foley, which I was to insert into a female manikin (no live volunteers for this one, LOL). So the big issue with catheter insertion is not breaking the sterile field. But I was fine, took my time and talked my way through it. Next up was vital signs which were a no-brainer, then medication administration/injections. I had to select the appropriate needle and injection site (though she made me name all of them anyway). I was given an “order” to mix 10 units of regular insulin with 20 units of NPH. No problem, thanks to the mnemonic “Nancy Regan, RN.” So after all of the default stuff (5 rights, etc.), I draw up 30 units of air, inject 20 into the airspace of the NPH, then 10 units into the Regular, invert the vial, draw 10 units of Regular, then go back and draw 20 units of NPH—piece of cake right? I give my imaginary patient a 90° injection (instead of a 45° since my 85-yr-old “patient” is very thin) into her imaginary abdomen (which is actually a square pad of something nasty and gel-like, filled with the millions of injections it had received before mine). Meanwhile, the tester is firing questions at me, but at this point I’m like “Bam–ok, what else you got?” My last station was wound care—remove the dressing, measure the wound, irrigate, culture, and redress. It was a medical asepsis and not a sterile procedure so I didn’t have to worry about breaking any fields (just changing my gloves fifty times). Once you pass through all the stations the tester tallies up your grade, you sign off on it, and they send you on your merry (or unmerry for some) way.

After it was finally over and I emerged from the lab unscathed as opposed to running from the room crying and screaming with my hair on fire, there were about 5 students still anxiously waiting in the hall all staring at me with this look on their faces—“Well?!? Did you pass?” Of course I did, no sweat…