The Dog Ate My Care Plan…

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

Posts Tagged ‘clinicals’

Semester Roundup

Posted by isntshelovlei on July 26, 2011

Here I am back at my poor neglected blog with its splattering of unfinished posts. I just haven’t had the time or the energy this semester…

So here’s my summer semester roundup!

This summer I took Public Health Nursing (also known as “Public HELLth” if you follow me on twitter) and the Art of Listening—I know, WTF right? But I needed one last elective that had to be an art (already had credit), language (only offered the same night as Public Health), literature (too much reading/writing), history (same), or music. So Art of Listening it was. And it was offered online which saved me another night of trekking to campus.

I actually thought I might enjoy a slight break from nursing topics. How bad could it be with no meds, no care plans, and no NCLEX practice questions? Bad enough apparently. Besides the fact that the class was all over the place the topic just didn’t hold my interest—I developed some serious ADHD trying to get all my reading and forum posts done by all of the crazy deadlines.

And then there was Public HELLth. O. M. G. To her credit I will say the professor tried to keep it interesting: breaking up the lectures with videos, tossing frisbees with communicable diseases taped on them around the classroom, and other theatrical stunts—it just didn’t work. She did give out candy at the beginning of class which was nice—especially if there were pink Starbursts (my fave). But eventually, I just stopped going if there wasn’t an exam/quiz or if we didn’t have something due that day. I found her lectures distracting and understood things a lot better when I just read and studied on my own. I’m not trying to corrupt anyone else, that’s just what happened to work for me, for this particular semester. On the other hand, the instructor I have this upcoming fall I’ve had before and I wouldn’t dare miss one of her classes—her lectures are like GOLD.

I also managed to squeeze in a second peds clinical rotation this semester (we usually only have one) and worked as an Asthma Educator in a peds clinic. And man was there some educating to do! From parents giving their kids their maintenance inhaler when they should have been using their rescue inhaler (and wondering why it wasn’t working) to the parents who just didn’t see the point of giving the maintenance inhaler every day when their kid wasn’t currently having any difficulty breathing—and so they didn’t (le sigh). No wonder there are so many uncontrolled pediatric asthmatics and asthma is the #1 admitting diagnosis in our local children’s hospital. Sheesh.

But that’s all over. Now I get a month off to rest my fragile mind (and get some sand between my toes) before heading back into the flames for the grand finale. That’s right—final semester coming up! I can hardly contain my excitement. Until then…

Peace, love, and coffee…

~IsntSheLovlei

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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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She Shoots, She Scores

Posted by isntshelovlei on November 15, 2010

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…

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Saved by the Belle

Posted by isntshelovlei on November 2, 2010

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…

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Pretty Please

Posted by isntshelovlei on October 28, 2010

Although peds and psych lectures both started back in August, the clinicals were broken up so that we did one at a time (I had psych clinical first). New rotations are usually preceded by a “clinical immersion” (think one-day clinical crash course); we just had one for peds this past Sunday.  But this weekend is the real deal—we’ll be starting another round of 12-hour shifts at our assigned hospitals, 630am to 630pm. Oy vey.

Most people know that I plan to specialize in pediatric nursing in one way shape or form after it’s all said and done—whether it’s pediatric intensive care, oncology, or maybe even palliative care. So since I began this journey over a year ago (wow, has it really been that long?), I have been looking forward to peds—I absolutely couldn’t wait to get here. This will be my sixth clinical rotation. I have fought my way through fundamentals, health assessment, maternity/OB, med-surg, and mental health to get to this point. After all of the running out the door at the butt crack of dawn with one eye open and mix-matched socks on, the Nurse Nastys and the Cindy Lou Whos, the stress and the hair loss I’ve had to endure to get this far, and even though I’ve been less than pleased with lecture portion of peds (and that exam last night was KIL-LER), I am praying that my peds clinical experience is all that I’ve hoped it would be.

So with that said…

I’m goin in, I’m goin in, I’m goin in, I’m goin in… (in my Lil Wayne voice)…

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Quicksand…

Posted by isntshelovlei on September 21, 2010

I just wanted to do a quick post to let everyone know I am not dead and have not abandoned my blog. I have just been completely swamped with trying to get a handle on this semester.

I started my psych clinical this past weekend and all I’m going to say about that is that I’m trying to keep an open mind… Let’s just leave it at that—for now anyway.

In other news, I was awarded another scholarship!! I was selected as a 2010-2011 recipient of the Charlotte W. Newcombe Foundation Scholarship for Mature Women Students. In these tough economic times, I am always grateful for any additional assistance and support as I fight the lions, tigers, and bears of nursing school…

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When In Doubt, Wear Gloves

Posted by isntshelovlei on June 19, 2010

Just when should you wear gloves? Usually the rule of thumb is to always wear gloves when there is a risk of coming into contact with blood, body fluids, or mucous membranes, and if either you or the patient has areas of broken skin.

So I had a patient this weekend—I nicknamed him Mr. Independent. He had a BKA (amongst a host of other things), and didn’t want anyone helping him do anything because he was damn well capable of doing it himself (a nice change from what one of my instructors describes as the patients with the “alligator arms”). So his primary nurse asked him to at least call one of us when he planned to transfer. He of course informed us (once more) that he had already been trained to transfer and had been doing so successfully (by himself) for over six months now. But he agreed to call. So when he did, I came in and of course I didn’t think that going from point A to point B would involve coming into contact with any body fluids. But one too swift move from Mr. Independent and all I saw was red. Blood running down his arm..in the spokes of his wheelchair…on the floor. He had pulled out his frickin’ IV. I silently panicked because I immediately thought “I’m not wearing gloves!!” but I kept it pretty calm, cool, and collected on the outside. I think I automatically switched into Mom-mode. I remember once my daughter decided to jump off the top bunk bed and my son screaming “MOOOOOOMMMM! She’s BLEEEE-DING!!!!” So I’ve seen my fair share of bumps, bruises, and blood. I calmly told Mr. Independent, “I need you to STAY right there and I will be right back.” I knew gloves were right outside the room, so I popped out, grabbed a pair, just so happened to spot his nurse in the hall, waved her in, and popped back in (now gloved) to put pressure on his IV site all in about 15 seconds. Move over Carl Lewis…

So while I don’t plan to wear gloves 24/7 when I’m in the hospital, I now definitely keep a pair in my pocket—along with all of those other what-every-nurse-should-carry-in-their-pockets items…like alcohol pads!

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There Are No Words…

Posted by isntshelovlei on June 6, 2010

*RANT ALERT*

I’m sorry but I had to do it. Nothing pisses me off bothers me more than so-called health care “professionals” leaving patients to lay in their own piss and shit urine and feces. I came in today and one of my patients was literally laying in just that—liquid shit feces at that. I’ll give them that she was admitted to the unit sometime during the night. But you cannot tell me that no one noticed the odor that was not only limited to the patient’s room, but was now starting to creep down the hallway. Just how many people had been in and out of that room in the last few hours and just left her that way?—the night shift RN, the day shift RN, the PCAs (don’t even get me started on them), the phlebotomist (who we all know is notorious for waking up the patients at the ass crack of dawn to draw blood)… So don’t tell me that no one noticed this poor woman laying there, writhing in a sea of body fluids. I felt absolutely horrible for her. To make matters worse, she didn’t speak  any English, only Korean. AND HER CALL BELL WAS ACROSS THE ROOM!! How the hell was she supposed to call for help?—especially since she was neatly tucked in a far corner away from the nursing station. She was using the only method of communicating she had available—moaning—and still people continued to walk on by.

So I grabbed one of my fellow Supa Dupa SN’s and we went to work on getting her cleaned up. I should’ve grabbed one of the lazy ass PCAs (who see nursing students and believe that we’re here solely to do all of their work), but I wanted it done right—and without the attitude. Just yesterday, one of the PCAs came into a patient’s room to change his linens but he was on the phone. He asked her if she could wait a few minutes until he finished his call. Her response was: “Okay, but I ain’t guaranteeing that I’m coming back!” Now what type of shit is that to say to a patient?!? These people are sick. They have end-stage kidney and liver disease, multiple transplant rejections, terminal cancer… The least you can do is keep them clean and comfortable. It’s not like you’re doing anything since I’M doing YOUR vitals, YOUR accu-cheks, YOUR a.m. care, and whatever else needs to be done while YOUR ass is hiding in the clean linen closet on your cell phone.

But that’s a story for another day.

So we got my patient cleaned up, put a fresh gown on her, and changed her linens. We talked soothingly (and apologetically) to her as we worked, even though we knew she wasn’t able to understand what we were saying. I just hoped that maybe our tone of voice, facial expressions, something, would convey to her that we cared. Guess it’s just the NURSE in me…

What are you supposed to do in these types of situations? I know this happens often enough—but it shouldn’t. The majority of students (and clinical instructors as well) are scared hesitant to make waves since we’re technically “guests” at these hospitals. But shouldn’t ensuring a certain standard of patient care supercede all of the damn politics? Am I being oversensitive/overreacting? 

What if it was YOUR mother/father/loved one?

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Silence Is Not Always Golden

Posted by isntshelovlei on May 3, 2010

Our last OB clinical was yesterday—there really was a light at the end of that long, dark tunnel. I really didn’t think I could take another day on the postpartum floor so I was glad when my instructor said I could go to the NICU. But it’s never a good sign when you get there and the charge nurse presents you to the nurse she’s assigning you to and tells her, “I’m sorry, I have to give you a student today.” WTF?!? And like I wasn’t even standing right there! The nurse kept a straight face but you could tell she was less than pleased. So there I was, only there for about 60 seconds, and I was already turned off to the whole situation and ready to leave. You have TWO whole patients who sleep 98% of the day anyway, what is the big damn deal? Lord forbid I keep you from your sticky buns and trash mags…  

But I took a deep breath and kept it moving. It was the last day, and I was determined not to feed the trolls. I did the eternal scrub up to my elbows just to be able to enter the unit but was not allowed to touch anything—not  a chart, not an isolette, and certainly not a baby—for five-and-a-half painful hours. I should have brought a crossword puzzle or something. I’m really starting to rethink my desire to be a NICU nurse. Not because of the less than stellar experience I had (because the nurses in the NICU where I volunteer are great), but because I’m starting to think it’s just not enough excitement (patient care/interaction) for me. I know that some people like relaxed jobs where they sit around and don’t do much, but if that’s all I wanted to do I could have went to school for envelope stuffing or something. The most interesting thing that happened all day was two incidents where fentanyl (big time pain med—100 times more potent than morphine) syringes came up to the unit completely empty. But they weren’t just empty syringes. They were actually drawn up to the dose that was supposed to be in them but there was nothing in those chumpies but air. Gone unnoticed, that would have been one hell of an air bubble… Freak pharmacy thing or…you fill in the blank…

Though it’s no secret that maternity wasn’t my favorite rotation, our last moments in OB will forever leave a footprint on my heart. As we walked through L&D we could hear a woman in the actual pushing stage of labor. And she was a-hollering—totally to be expected when you’re pushing something the size of a watermelon out of a hole the size of a lemon. She had the nulliparous students in the hallway cringing at how much pain she apparently was in. So she’s in there screaming and you can hear the nurses encouraging her to push. There was a climax of activity/noise and then all of a sudden it was quiet. Since we were not actually in the room and able to see what was going on, at first when you hear the woman stop screaming you figure okay—the baby is out. But then you slowly start to realize that it’s too quiet. The critical thinking wheels start to turn and you ask yourself why isn’t the baby crying? Next thing I know they were calling for a neonatal crash cart… 

…dystocia…nuchal cord x 2…baby completely blue…umbilical cord separated from the placenta…blood everywhere…

When you work in health care you will sometimes see how even in a beautiful situation such as a new life being brought into the world, things do not always go as planned. Always count your blessings.

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Touchdown!

Posted by isntshelovlei on April 18, 2010

At first I thought it was going to be like our last few clinicals where I was bored to tears. For the first two hours or so, we watched the nurses eat their full-course breakfasts complete with omelettes, bacon, home fries (which everyone complained were too salty), bagels smushed with avocado (WTF?), and toast—with Smart Balance spread of course. We did not partake in their feast though one nurse offered me a Starburst. When they were done eating they proceeded to cackle about the Kardashians, the Gosselins, and just about every other celebrity as they perused their mile-high stack of trash mags. The conversation then shifted to Martha Stewart, how they liked their Bloody Mary’s spicy, and so on. One even remarked, “Oh, I remembered to bring my iPod today.” None of them wore stethoscopes (not much patient care going on anyway) and honestly you couldn’t tell the nurses from housekeeping as both wore varicolored scrubs.

But it got better.

When it was all said and done I got to see a vaginal birth, a C-section, an epidural placed, and a D&E (dilation and evacuation). Just for that stroke of luck, you can bet your sweet ass that I won’t see anything else the rest of this rotation. The vaginal birth was great—as the mother of three I had been wanting to be on “the other end” for once. The baby was big (8+ pounder) and mom was small which unfortunately landed her with a third-degree laceration (tear) in the end. The C-section was a lot faster than I’d thought it would be—if I had blinked I would have missed it. The patient came in actually wanting to try a VBAC, but the doc wasn’t having it. I think they did entertain the idea at first until her blood pressure went up and the baby starting having decels. Third patient had a history of a LEEP and was dilating slow as molasses (which I’m told often occurs with LEEP patients). She was only 2 cm dilated when they gave her the epidural (I thought you had to be at least 4 cm), but she just couldn’t take the pain anymore—the Nubain just wasn’t cutting it. They were also augmenting her labor with Pitocin (which in my experience creates the worse contractions), and she was now having contractions every 2-3 minutes. Hell I’d want my epidural too. It was the D&E that kinda bothered me. A D&E is a surgical/therapeutic abortion done in the second trimester. Basically the cervix is dilated and the contents of the uterus are removed by vacuum. They use an ultrasound to make sure they got all the tissue out. But it just seemed like there was blood everywhere—they were slinging it and tossing bloody gloves and instruments and whatnot. And right after that—we got to eat lunch! Sheesh…

That’s all for now folks—a nap is definitely in order!

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