I L-O-V-E It!

It has been awhile since I last posted. It seemed to get to be the same old thing every Saturday of clinical and didn't have much exciting things to blog about. I just started Jr. Practicum. It is a short May-mester only lasting 2 weeks. We are required to get in 48 hours of clinical experience along with 6 hours in the simulation lab. I have been assigned to the Outpatient Infusion Center. I could not have a better experience! What the infusion center does is do all the IV or Central line access meds (as well as some injections) on an outpatient basis. Our patient load is mostly those undergoing chemo, needed blood products or those in sickle cell crisis. I have gained so much experience in the three shifts I have worked so far. I have started and discontinued an IV every day, performed one venipuncture (drawing blood for labs), given 3 injections, accessed and deaccessed ports, drawn up meds and lots of other things. The nurses are so incredibly supportive of each other!

Some interesting things that have taken place:

I gave a patient a $6000 injection of a drug called Neulasta. It promotes your body to increase its white blood cell production. Interesting side note - the patient was illegal and had no insurance. So for those that say they don't get healthcare because they don't have insurance - you're not correct.

I gave an elderly man an Arixtra shot - for prevention of deep vein thrombosis. It is a subcutaneous shot that you typically put in the stomach. He walked in, asked for his shot, dropped his pants and asked me to give it a little lower than I expected, pulled his pants up and was out the door. I turned to the nurse next to me and said "nothing like wam-bam, thank you mam!"

One of my patients receiving platelets to get him ready for his next round of chemo had lung cancer and his left lung had been removed. With no oxygen assistance his O2 saturation was 99%. That is better than my mother can get! Isn't it amazing how the body can compensate?

Did you know how horrible sickle cell anemia is? It puts people in debilitating pain. It also causes necrosis of the joints. I had a 21 year old patient in for IV fluids and pain meds due to sickle cell anemia. She had already had a left hip replacement due to the necrosis and was now having issues with her right.

That's all for now. I am so happy to find something I really love to do! I told my husband that being out of the house and working has been enlightening. I love being with my boys, but as I told my husband - "I've tasted freedom and it is yummy!"

A very sick patient

My patient Saturday was literally "falling apart." After a revised above the knee amputation, the patient had nothing below the pelvis on one side and the wound was left open. The vascular surgeon explained to me that the wound would never be closed, it was just too big. As the patient laid there coming in and out of consciousness, I attempted to assess the vital signs, breathing, bowel sounds and overall appearance. During the bed bath, open sores wept and oozed. I was humbled by the state of the patient. I prayed as I bathed, but wondered what to pray for.

My patient also had MRSA and C-Diff, so I had to gown up everytime I went into the room. That was an experience!

I have one more day of med-surg bedside nursing and then move to ortho. I'm looking forward to the change.

Also, I'll be attending an AORN (Association of Operating Room Nurses) seminar this week.

I, again, have a lot to reflect on.

One kidney or two?

My patient this weekend had his left kidney removed due to a mass. I really felt more of a connection with he and his wife after going through Steven's kidney failure. They were a great couple and he was EVER so patient as I took a ton of time changing his dressing. They had really taped him up in the OR and I wanted to cause as little pain as possible. I used the adhesive remover as I slowly pulled the three layers of tape off of his body. I also was able to dc his int (the IV catheter) so he was able to go home.

Bed bath number two was today. It was a 50 something aged woman that had just had a hysterectomy.

I've been struggling with the concept of bedside nursing. I think part of it is that we are not really doing the skills we have studied, we are doing more of the unskilled jobs. Not that I think I am above it at all - and as I mentioned in my first experience giving a bedbath, it can be rewarding - but I just haven't been satisfied with what I've seen. Nursing is definitely what I want to do and feel called to do - but it might not be bedside. We will see. I must stay open.

OR Experience - Hip nailing

Today’s experience brought about a whole new thought process for me. I truly feel like to be a nurse is a calling. I had thought that that sense of serving and compassion could only be achieved through bedside nursing. I struggled with the thoughts that I really did enjoy my OR experience and would seriously consider learning more about the OR environment. The struggle came because I wondered if I could serve the patient and show compassion in that position. I believe that the operation is certainly a service that the patient requires and I believe that an OR nurse can still advocate for the patient (i.e.: positioning of patient in OR, making sure they are comfortable). What interests me in the OR is the challenge it seems to present. I have always enjoyed watching the “surgery shows” on television and it was even better live! I certainly know that bedside nurses are intellectually challenged every day, but I can see that OR nurses are intellectually challenged in a different way. I have a lot of thinking to do, but I still have plenty of time. I might change my mind several times before graduation. I am going to keep myself open.
One option is to do critical care nursing. It seems like it might be a combination of the two roles of perioperative type thinking and bedside nursing. My husband went into renal failure August 20 of this year and was in the ICU for three days. Spending so much time there peeked my interest as well. I hope I will get the opportunity to shadow a ICU nurse to experience what they experience.

First patient interaction

Yesterday, I experienced my first patient interaction clinical. Wow was I crazy nervous and it didn't help things when during my assignment, my clinical instructor said, "oh, and I'm going to give you a patient that is best described as a little quirky." Not exactly what I was hoping to hear!

My patient was in the hospital due to many complications from diabetes. His medical diagnosis was amputation of his left toe and a popliteal/femoral graft. My rounds started at 6:30am and I was to enter the room at 7:00am to take vitals. Of course, I was totally uncomfortable waking someone to take their vitals. I've always secretly detested those perky morning nurses that come in and wake you. They have just had 8 uninterupted hours of sleep, while as a patient, you've been woken up every half hour for medicine, vitals, noises in the hall, etc. But there I was - THAT NURSE. I walked in a quietly said, "Good morning, Mr. ___." Nothing. Then I said it a tad louder, "Good morning, Mr. ___." Immediately he opened his eyes, looked at me and huffed - "you're late! your instructor told me yesterday you would arrive at 6:30am. " I responded with, "I was here at 6:30am, I've just spent the last 30 minutes hearing all the wonderful things about you!" "brownie points," he responded. Then he said, "what in the H$%ll did you do to your instructor for her to assign you to me?" "Lucky, I guess," was my response with a smile. From that point on, things went great. He was a hoot and we had some interesting conversations. Although it took me 4 attempts to use the Dynamap to take his temperature, he was very pleasant with me and we seemed to get along well. We've never been trained on the Dynamap (that is the thing that wheels around to the rooms with bp, temp, pulse ox, etc. We had to do everything manual however to keep our skills sharp.

One interesting experience was to give an elderly woman a bed bath. One of my nursing classmates was anxious about giving her patient a bed bath. I too have a fear of that. I have an issue with intimacy with people I really don't know. How much more intimate could one get than giving someone a bath! The patient was such a sweet lady. She was in her late 70s. She had just recently had her colon removed because of cancer. She actually reminded me a lot of my grandmother that just recently passed away. Same build, same temperament, same sweetness. As I began to work with my classmate, I realized how uncomfortable the patient was with exposing herself. I tried to make her comfortable talking about how I would make sure she stayed modest. As I cleaned her back and her feet - I was almost moved that this woman would entrust me with such a personal thing. She was so appreciative and kind. That is why I want to be a nurse!

The day ran long and my legs were tired, but I felt like a made a difference! A true difference. I prayed for those patients last night. I am blessed.

Next week is OR observation.

Almost to clinicals

The semester is starting to wind down. I have a few more clinical check offs left - including foley catheter this Thursday (any volunteers :-)). I will be registering for next semester tonight at midnight. There are only 7 spots on the clinical day I want, so I need to get it as soon as I can. I'm technically a senior, so I get to register first. I'm trying to get a Saturday clinical to save on the babysitting - but it does put a kink into me trying to pick up an extra job on the weekends at the hospital.

I found out this past week that I had earned a "big deal" scholarship. It is really answer to prayer as we continue to be jobless. Hopefully that will work its way out soon.

I had a dream a few nights ago and this was the just of it. Life is like a book. We can write our own chapters or trust in God, who already knows the end of the story, to write the chapters. Good concept, but hard to apply. Its amazing what can come out in your dreams!

Where would you like that?

Today was my "check off" for medicine administration. It included intramuscular/subq shots, IV push, IV bolus and oral meds. We had to pick, out of a hat, our one that would be tested. I "lucked up" on IV bolus. It isn't necessarily hard, it just has the most steps. I'm proud to say I efficiently gave my fake patient 2 ml of demerol in a very safe and professional manner. Nobody died! I love getting these check offs done; however I'm sure in real life it will be like doing it new all over again.

I have two more tests next Thursday - but I'm on the downhill of the semester. Exams will be December 11th and then I will be off until January. Then clinicals start. I hope to be working on Saturdays for my clinicals - it sure will help with babysitting. I heard yesterday that the preceptor for the clinical I want is incredible. That really made me happy!