Posts Tagged ‘ clinicals ’

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.
YUM.

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.

Tonight:
Dress shopping with Britt
Birthday dinner for HK.

Happy Thursday to everyone!

Love,
Laney

Fundus Buddies?

NO!

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…

Love,
Laney

Break Me Off A Piece Of That…

…stethoscope!

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.
Love,
Laney

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.

HOO-RAH!
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.

Simulation Lab

Well, today I’m at clinical in the simulation lab at school. I have to be honest, the Sim. Lab frightens me to know end.
Why? At the end of last semester, we had a simulation lab without ever being told what one was or what to expect. We actually didnt even know we were going to a skills lab that was any different. In this kind of lab though….anything can happen. Patients can throw up, scream, seize, die, need multiple IVs, suctioning, catheters, Hemovac drains, angry families….all at once!!! Last semester, I was in the first group to go and was trying to give meds while the patient (which had a voice box) was screaming and throwing up. Scarred for life.
The horror stories of simulation lab are pretty amazing. The first group to go this semester had multiple students crying in front of their patients apparently. And because they cried in front of their patients (which are dummies but are supposed to be treated like real patients in a real clinical setting) they got marked down. Some groups got sent home for “not coming in with any brain density” and being totally unprepared. I’m in the second group which is this week and next.
The first half went pretty well though- no tears yet!!
We have scenarios with three patients in each one. We switch roles for each patient. For the first patient, I was the silent observer which was great. For the second one, I was charge nurse overseeing all the other roles, guiding, and documenting along with talking with the doctors. I did a good job and got excellent feedback which I am very excited about!
Hoo-rah!!

In the last scenario I was the IV/treatment nurse and did a dressing change, trach care, and suctioning. I started off not remembering some stuff but after I got over my nerves it was a piece of cake.
Overall, a great clinical day :)

PACU.

It’s official. I am in love with the PACU. Post anesthesia care unit, that is.

Basically, this unit a is fast paced, on your toes, better know your P’s and Q’s kind of place. That’s where I went today with two other classmates. It was amazing.

Here’s how it works. There are 12 beds open. Today, they were short a nurse so we were working 8 beds. Patients roll in from the Operating Room to the PACU because that is the recovery room. Each nurse gets two beds. The first patient goes to bed 1, second patient goes to bed 3, then 5, and 7. After each nurse gets their first patient, it goes around again on the even numbers.
PACU patients are ideally there for an hour or so before being transferred out, although they are often in the unit longer for various reasons.
Patients that go home same day may go the ambulatory care area to meet with family and finish getting things settled before leaving. Patients going to the floor may have to wait in PACU until they get a bed. The other reason for the longer wait time is if the patient is unstable.
Vital signs are checked every 15 minutes and your assessments better be spot on. You also have to maintain fluids going in and make sure the dressings from surgery are dry and intact. If there is too much oozing or bleeding, you’ve got to notify the right people and potentially roll them back. Depending on what kind of surgery they had, your assessment focus changes. For example, a patient with back surgery, you want to make sure they can move their legs and still have sensation while a heart patient, you’re monitoring their rhythm strips. Those are some basic examples.

The neat thing about PACU is that it starts off slow where you’re doing nothing. Well, that bit is the only dull bit. As soon as the first surgery rolls in, you hit the ground running. The patient rolls in and you jump in. Someone is charting while someone else is hooking up their leads to the monitor while someone else is hooking up the oxygen. The level of teamwork is amazing.
The PACU nurses are unbelievable. They’ll be taking report from the CRNA (certified registered nurse anesthetist) and listening to the various people calling out data and charting it all at the same time. They can listen to the breath sounds to see if they’re clear or wheezing, crackling, etc while counting how many breaths they take in a minute at the same time. A task a lot easier than it sounds.

“Pt X came in a for an inguinal hernia repair this morning and is under general anesthesia. There-”
“36.4 is temp!”
“- estimated blood loss is 5ml and-”
“12 respirations, clear and equal!”
“they’re on 8L of oxygen non-rebreather mask. They”
“BP 134/83 and there’s an 18 gauge needle in the left hand!”
” have a history of smoking and asthma. Their pre-op BP was 145/95 and they”
“Dressings dry and intact.”
“were given Ancef 1gm at 0850″

That’s just an example of a report from CRNA and call-outs from the ones assessing all happening at the same time. And it all happens in about five minutes. Then you follow it up with a more in-depth look and then reassess every 15 minutes. Plus, you could have another patient to tend to at the same time.

The other thing is that when you wheel a patient out, you could come back to another one rolling in. So fast paced! I adore the fast paced environment. And everyone is so knowledgeable there. You’re always learning and seeing new surgeries or new doctors who do the surgeries in different ways. Truly fascinating.

What else is fascinating? The way people respond to anesthesia. HILARIOUS. That’s a post for another day though.

Today was busy and I got to do more today clinically than ever before. We’re taking it to a new level and today, I finally started feeling like more of a nurse and less of a NA (nursing assisstant).
I did a straight catheter for the first time on a male (human, not a dummy), an Accucheck to test glucose, prime the tubing on a drip (medication that flows through an IV), change the tubing on a drip already hung, and learned how to/successfully put on EKG leads. And then, of course, all the normal assessment things.
I also saw some neat drains that you only see straight out of surgery. There’s one drain that pulls blood out and once it’s full, you flip it and retransfuse it back into them. So awesome.

I’m back there tomorrow starting late!! The other nice thing about PACU, they are the latest starting clinicals. I don’t have to arrive until 7.30 so that I can change into my scrubs and be on the floor at 8. Hello, luxury.

Typical Week

I got asked what a typical week for a nursing student is. A couple of my friends and I both have to work- which we try to squeeze in on the weekends.
Being in second semester, I have class Mondays and Tuesdays and clinicals on Wednesdays and Thursdays. So here it is.

Monday: Attend class from 9-1 or 9-3. If I have a test, I get to go from 9-11 and go home. After class, there are sometimes optional review sessions to attend. If there is a specialty clinical later in the week (like OR, PACU, Oncology), we attend a pre-clinical conference from 1-4.
Then go home and read.
Tuesday: Finish up lectures from 9-3. Attend any study session after school. Finish up lecture assignments. Read. Work on pre-clinical paperwork (such as care plan tools, medication administration sheets, etc)and prep for the next day.
I also try to squeeze in a couple of games of Halo and an episode or two of Cops with Ishaq on lecture nights :)
Wednesday: Clinicals from anywhere between 6-4 depending on the location.
Go home and do the journals, blog, and care planning paperwork. Then prep for the next day.
Thursday: Clinicals again. Go home and finish blog, and care planning paperwork because it’s due by Friday at 11am.
Friday: Day off!!! But I work from 8a-8.30p
Saturday: Work from 8a-8.30p.
Afterwards is date night. Dinner in bed with a movie or TV show on Netflix.
Sunday: True day off!! Catch up on housecleaning, grocery shopping, and reading for the week.

Tips and tricks to surving:
Take books everywhere. I leave a book or two in my car. You never know when you can catch up on reading.
Do something other than school to break it up or you will go crazy.
If you have to work, take one day off a week where you don’t have work or school because you will burn out. It’s okay if you do some homework at home, but that one day will mean a lot.

No sweat? Sure!

My teacher walks into the patient’s room to this sight:
S.R on one side, myself on the other, L.O in the front…and our amputeed patient with one leg sprawled sitting on the floor with his shorts around his knee yelling “awww now. shoulda helped me!!”

Let me back up to the beginning.

S.R and I were sharing a patient. He had meds at 10 and 12 plus a high maintenance wife, so I guess he needed all hands on deck. He was also extreme high risk for falls and had a sitter at all times. His sitter was Naiya who happens to be one of the best NAs I have ever come across.
We come in to greet him only to find the curtain pulled and Naiya giving him a bath. So, after going back in the hall to finish up our pre-emptive paperwork, we come across an LPN who asked us who we had. After telling him it was JP, he said “Oh bless your soul. He will try to put you through the ringer. He’ll pretend he can’t do stuff when he really can. You just gotta keep pushing him. Good luck!!”

After a few minutes we go in and greet ourselves. We struggled getting through his assessment since he complained the whole way. Then the blood pressure machine wouldn’t work so S.R tried to take it manually. She couldn’t hear the bottom number however so I went to give it a go. Before I could get the cuff on his arm he complained loudly, “Awww now! How many nurses does it take to get a blood pressure??” It sounded like the opening line to a bad joke.

I got his blood pressure and continued along the assessment with many “Aww now”‘s along the way. Luckily, his wife had come in and was telling him to be nicer to us and lecturing him. She also told us about how she was taking him home this weekend regardless of the fact that doctors had told him he would be in long term care the rest of his life. It was concerning however b/c there were doubts about how well his care could be at home. I digress.

He had to go to the bathroom. So with Naiya in the back, myself on one side, SR on the other, and his wife in the front, we got him from his wheelchair to his potty chair so that he could have a bowel movement. Throughout the transfer, Naiya and his wife were telling him to stand on his leg and move. “Stand up! All the way up! Stand!”

Fast forward to noon. My patient had just come back from lunch and was sitting in the hall. I finished my paperwork and gave my first sub-q injection (insulin to the LUQ). It went without a hitch! Lunch is at one so I felt on my A-game. Another resident wheeled up and parked right in front of him and (bless his advanced dementia self) started singing at the top of his lungs. JP looked at me and said he wanted to go back to his room. I told him okay and went to look for my partner, SR, to help. I came back and he told me had to go to have another bowel movement…bad. He added the “bad” after taking a glance at the other singing patient. I told him that was fine but I was going to have to get more help. He kept yelling at me to hurry.

When we couldn’t find any NAs to help, my instructor suggested using some classmates. S.R on one side, myself on the other, L.O in the front, KR in the back. “1, 2, 3, go!” The patient lifted himself a quarter of the way up before sinking to floor yelling “HELP ME! HELP ME!” We were pushing and lifting but it was 199 lbs. of dead weight on us. KR was trapped behind the wheelchair saying “should I get help? What should I do??”

“STAND UP JP!” I panted struggling to keep him off the floor. “Come on, stand up! All the way up!” SR said, struggling.

He kept putting all his dead weight down, not standing at all. We tried pushing him over the edge of the potty chair but his butt kept hitting the rim and pushing the seat up.

Finally, I told KR to go get help. LO stated that we should just ease him to floor. “I’m..so sorry about this JP”, LO added.

That’s when my teacher walked in to see 3 sweating nursing students and a patient sprawled on the floor with his shorts a-dangling.

So clinicals last week was….interesting to say the least.

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