The Dog Ate My Care Plan…

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

Posts Tagged ‘lab’

Finally—Patients With A Pulse!

Posted by isntshelovlei on October 16, 2009

thumbnailSo we are finally out of the lab and in the hospital—woohoo for making it through all the exams, math tests, and lab practicum that made it possible. For a minute there I was becoming a little unraveled and thought I wasn’t going to make it. Our first day we had hospital orientation—which of course was boring as all hell. Videos upon videos we watched—fire safety, restraints, Accu-Cheks—ancient VHS tapes (do they still make those?) that they’ve probably been using for decades. And since watching TV has become such a rarity in my life these days, having to sit there and actually watch those videos for hours was just pure torture. Afterward we took a tour of our unit and the staff rolled their eyes at us with this “OH GAWD–we’re being invaded by nursing students” look on their faces. But whatever—never mind them. On my way home I stopped at Barnes and Noble to pick up a care plan book—Ackley’s Nursing Diagnosis Handbook—I LOVE that thing and highly recommend it. That along with my Medical-Surgical Nursing textbook (which at 2016 pages is more like a nursing bible) helps me crank out care plans with no problem.

Day 2 of clinical we were actually assigned a patient. The nurses were still less than enthusiastic at our presence, but none of them were downright nasty—though there were a couple that were a little more snappish than I would usually tolerate. But since this wasn’t my turf I had to fall back. I was assigned a sweet, older woman who basically had surgery but was discharged from the hospital too soon (imagine that—damn insurance pressure). So she had a fall, which landed her right back where she didn’t want to be. Acute pain, impaired mobility, and risk for peripheral neurovascular dysfunction were my nursing diagnoses for her. Probably should throw risk for impaired skin integrity in there as well. But basically all I did all day was vitals, hygiene/toileting, and meals. I didn’t get to give meds even though my patient was on plenty of them. I must admit I was bored out of my mind. The downtime at least gave me a chance to get a head start on my care plan. But even that was difficult given how cumbersome the nursing station had become with all the extra bodies—the only place left to sit was probably the bathroom!

And last but not least, we took our Fundamentals midterm last night (NCLEX-style questions of course)—I didn’t think it was so bad. You can usually narrow each question down to just two possible answers anyway. Both might even be right answers, but you have to determine which one is more right. Ah, the joys of nursing school…

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Foleys, Injections, and Wound Care–Oh My!

Posted by isntshelovlei on October 8, 2009

needlesWe 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…

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