Archive for the ‘ The Clinicals ’ Category

It’s Cold In Here

Nope, the title isn’t a reference to the temperature outside. It is actually a patient quote.
Let me explain.

This is a flashback to the PACU floor. At school the other day, we were having a conversation about our very first catheter insertion on a real live, breathing person.
Mine was in the PACU. My patient was super distended, in lots of pain, and asking if there was anything we could do to make him void since it was so uncomfortable.

“Sure!”, my instructor said. “What would you do in this situation?”

I assessed his stomach and found he was extremely distended. I gave him the urinal to try once more on his own and of course closed the curtain for privacy.

Straight cath was the next option. His MD happened to stroll in and checked him out. He reached the same conclusion and gave the go-ahead.

I was nervous, feeling ill prepared. I hadn’t expected to do any catheters here and hadn’t reviewed.

“Calm down,” Mrs. D said. We reviewed the steps. Easy.

So, I get to work. As I’m wiping with Betadine, my patient- still groggy from anesthesia- decides it is a good idea to start talking to me.

“Hey, just so you know, it’s really cold in here,” he said with eyes half-mast.

“Oh. Uh-huh,” I nervously reply with an awkward chuckle. I mean, what do you say to that?
I insert the catheter and am having trouble getting it past the prostate. My coassigned nurse comes over and teaches me how to “walk the catheter in” because it keeps popping back out the second I let go.

“Yeah, it’s just cold in here. Just so everyone knows,” my patient states again.
More nervous laughter.

My coassigned and I finally get the catheter in and he leaves me to drain it. It was slow going. 800ml slowly drained. (Note: never drain more than 1000ml at a time!)
And while it drained, my patient decides to triple check and make sure I knew the temperature of the room.
Hint: it was not warm.

Thanks male patient. Long story short, I successfully completed my first straight cath and it was incredibly awkward.
Any good stories from you guys?



Clinicals + Lasagna = Sleepy

That’s right. It was a short shift of not a whole lot. I just tried to fill the time.
We talked about policies and procedures for 30 minutes.
I wanted to curl up in the fetal position and just sleep.

Now I’m home. Ate some lasagna.

Now, I’m exhausted. Clinicals always makes me hungry and sleepy. I’ll probably go nap now.
So, this isn’t too exciting. Sorry for that.
I’ll post more this weekend.

Dress shopping with Britt
Birthday dinner for HK.

Happy Thursday to everyone!


Fundus Buddies?


My instructor wants to us to be fundus buddies on the postpartum (PP) floor. After today, I can confidently say that I do not find the fun in fundus (aka the top of the uterus that you can feel during pregnancy).
I’m so bored!

Granted, I think it’s awesome their are nurses who do PP, but tain’t for me.
It’s just a bunch of boobs, butts, and vahoohahs.
And when I feel like I’m not doing a whole lot, time slows. Today was slow. It took FOREVER. I thought I would never leave!
We arrived at 0700. Started the morning off by going through floor orientation and then started the unit tour. Then a classmate from another rotation came in.
“Howdy T! What are you doing here?”
“Oh well, I’m meeting so-and-so for my community rotation,” T replied.
“Oh okay, cool.”
“Yeah,” he continued. “Have you seen so-and-so? I was supposed to meet her at 0830.”

My head exploded. What?! It’s not even 0830 yet? Are you kidding me? I thought it was almost lunch time!
I checked my watch in a slight panic, pushing up my jacket sleeve.
If it were a movie, there would be horror music as it zoomed in to the bright digital numbers that screamed 08:18.

My day went on in that fashion until 1530. I thought the day was done, it was 1000. I thought I had graduated school, it was only lunchtime. I thought I had already had babies of my own, it was only time for a lactation consultant meeting that dragged for TWO HOURS.

Now, this is nothing against the unit. Some students liked it. I just like a faster pace.

Here’s how to remember your focused assessment: Bubble He.

B- breasts [engorgement, cracked nipples, no clogged milk ducts]
U- uterus [firmness, fundus, is it at the umbilicus?]
B- bowel movement [have they had one, stool softener after 2-3 days]
B- bladder [emptying it?]
L- lochia [bloody, mucousy, discharge…what color is it?]
E- episiotomy [check sutures, bruising, tearing, hemorrhoids]
H- Homan’s sign [dorsiflex to check calves for blood clots]
E- emotional [PP depression, appropriateness]

And that’s it. Ugh. Not my cup of tea.
I’m team lead tomorrow aka charge nurse. Which is fine, I like charging.

Oh, and it’s a short day. Due to floor/curriculum changes, we got split into shifts for this rotation. Either 0700-1100 or 1100-1500. Luckily, we all got the shifts we wanted and I am happily on the 1100-1500 shift. I’m not trying to be up super early.
Only three more days (one tomorrow and two shifts next week) and then I can move on to Labor and Delivery. Until tomorrow…


Break Me Off A Piece Of That…


Okay, that’s definitely not how the song goes.
[Note: There’s an episode of The Office where Andy can’t remember what is the last word of the song. He spent the entire episode trying different things including applesauce, Chrysler car, and football cream.]

Anyways, I go back to clinical tomorrow. This semester is going to be insane with us rotating locations every two weeks. First up for me? Postpartum.

I haven’t been to clinical since the end of the November meaning I need to pack my pockets.

Teal stethoscope
Alcohol wipes
Multi-color pen
Bandage scissors
iphone (complete with calculator and apps)
pocket notebook
clipboard (super handy through one of the clubs that has references and values all over it)

Am I missing anything? What is an absolute must when you go to clinicals??

I am super excited to be back into the hands on care. I’ll be up bright and early at 0650. I’m definitely NOT a morning person.

A little less hand holding?!?!

That’s right. A little less hand holding.
This was a great last couple of weeks for clinicals.

Last week, I had an adorable client who reminded me of my great-grandmother. I really start to feel like a full-fledged nurse for the first time because I got to advocate for my patient. I set up consults to address stressors outside of the hospital and really built up a rapport over the two days. It was awesome to hear that she was disappointed I wouldn’t be back for a third day. I really accomplished a lot!

This week, the leash was loosened a bit. My instructor really likes for you to take the opportunity to spread your wings if you fell ready because Ortho is a floor where you can do that. You see a lot of the same things (oh, if I see another hip….) which may be boring to some people. I thought it would be boring at first. But then, I realized what an advantage it is to get used to a particular clientele. You really get to test yourself and work faster and add on responsibilities.
For this week, I got a patient on Day 1, did his care, and discharged him home on Day 2. It was awesome! I got to do so many skills by myself- very exciting. My instructor said I was at the level I’m supposed to be at and that I could go in on my own. We would talk it over first…for example the dressing change. She would make sure I was competent and then let me go do it. It was fine since I had already performed all of these skills before.
So, this week I took out a foley catheter, took out an IV, did a dressing change, and administered meds- all on my own! My coassigned nurse peeked her head in while I was doing the dressing change so that she could note it for her own assessment and told me that my dressing change was awesome.
My patient and his spouse both told me I did a great job and how I must have been a straight A student (I wish).
I talked with my instructor about adding on to my assignment- possibly having two patients?? Next week, I’m team lead which is like being Charge Nurse…so I won’t be able to do it then. But the week after is my last week of clinical and she said that would be fine.

She also said how she liked that I was really maximizing my clinical experience because some people in the group were not. And then there were some people in the group not ready to handle that patient load. But she thought that I was more than ready to handle it.

I’m floating on Cloud 9.

Guess Who’s Back? Back Again…

Hey! Basically, we’re getting down to the wire and my attention has been thrown full throttle into projects, papers, and tests.
The last test, I didn’t do so hot on…meaning more throttling at full force.

Also, clinicals is wiping me out. Now that the specialties are over, we are doing full patient care and charting for 8 hours a day every Wednesday and Thursday.

Here is a typical clinical day (for me on an orthopedic floor which is my current rotation):
0800: arrive on floor
0815: get assignment, greet patient, fill out CPS form with history and lab values, print off nursing rounds report, print off physician orders and write down what each order is for, have all of this done and ready for group report at 0930.
0845-0900: start patient assessment, assist with breakfast if necessary, mouth care, anything else they need
0930: group report.
1000: patient assessment/medication administration/vital signs/
1030: chart assessment, chart meds
1100: chart treatments (ADLs, safety, mobility, equipment, etc)
1130: get patient up and eating lunch/medicated before physical therapy. I also seem to answer family questions at this time since this is usually when they start showing up.
1200: IV assessment, chart said IV assessmet
1215: go to lunch
1245: return from lunch, check on patient. if they are out with PT then change linens and tidy up room.
1300: get patient back in bed. bed bath if needed and dressing change
1330-1345: chart treatments again (same as before but also including dressing change/wounds now)
1400: next set of vitals and chart those
1430: report off to nurse and leave floor for the day. go downstairs for post-clinical conference.
1500: go home!!

Of course, anything else needing to be done gets squeezed in. Last week, I had to advocate for my client and set up PT/OT consults (which hadn’t been set up yet even though my client was already a day postop and this could have delayed their discharge by a day!). I also had to set up a Social Work consult since there were reluctances about going home. I adored my patient last week. She said I was really sweet and seemed genuinely disappointed that I wouldn’t be coming back after my two days with her. It was awesome to have the same patient two days in a row. It was very different…I liked it!

Anyways, back to the grind tomorrow. Teal stethoscope and all.

Week 2 of Oncology

I had a patient that had everything but the kitchen sink wrong. From various psychological and psychosocial issues to an extremely advanced form of cancer to an advanced stage of an autoimmune disorder…I saw it all.

It was interesting to see the social stigma when it came to the autoimmune disorder. Some people refused to enter the room even though there was no bleeding or anything. We talked. The first day this patient was alone. So alone. Growing hypoxic and making no sense. Rambling.
Wasting away.
As a student, I couldn’t do much. The doctors were consulting with each other in the hallway.

So I sat. And we talked.
We talked about family and faith.

They told me how they were normally introverted but I was easy to talk to.

The next day, a complete 180 degree turn had occurred overnight. Where their skin had been dry and cool and blue the first day, it was now warm and pink. Up and eating breakfast with family that finally decided to come in after days of being in the hospital.

After the care had been given and the paperwork done- we sat. And we talked.

Sometimes, that’s all you can do I’ve come to realize.
Sometimes, that’s all that’s needed.

The spouse, one with a history of abuse, causing a ruckus in the hospital from being difficult to please, thanked me for the care I had given. The spouse went back to the bedside and watched the patient sleeping in a chair before opening a book.

The prognosis isn’t good. I don’t want to work in hospice or palliative care.
But I am so thankful there are people who do.
Some of the nurses on that floor are beyond amazing.

The prognosis won’t change.
Yet, I walked away still feeling like I made some sort of difference. Or I had some kind of effect.
I think that’s what counts.