Tuesday, March 31, 2009
My first code. Of sorts. (part I)
Okay, I'm sorry about that teaser from yesterday. I was so beat when I got home that I was incapable of much more than becoming a bump on the couch. I pretty much vegged out with some Intervention and Project Runway Canada. And then I went to bed at 21:00. So here's a synopsis of my mind-numbing day:
We arrived on the unit for 0700 report and I was again assigned 2 patients, both of which I've been assigned to before. You may remember my friend Mr. Willie (as in Groundskeeper Willie), of "Ach! Stop pulling me family crest!" fame. There was also Mrs. S who was about the sweetest old lady on the planet. She had arrived on the unit about 8 weeks prior, all skin and bones due to severe malnutrition. She was quite the success story as she worked her 78 year old ass off in order to get out of incontinent products and to self-transfer to the commode and wheelchair so she could get off the unit. She did a great job of building her strength up and she was going to be discharged off the unit into the nearby rehabilitation hospital. She still looked like a skeleton but you could see that she was gaining some weight. Seriously - any people with body image issues reading today? Starvation is NOT attractive. Go eat something while you still can!
So my first task was to go in and get vitals from Mr. Willie, who was sound asleep so I tried to be quick and non-annoying about it. Unfortunately he wasn't in an especially chipper mood so I attempted to be jokesy yet subdued and hooked him up to the vitals machine. I put the cuff on his arm and he yelled "Godammit woman, didja put your hands in the icebox this morning??"
Yikes. Apologies ensued. I didn't think my hands were particularly cold!
So I hooked him up and pressed 'Go' and waited for the vitals machine to do its magic. Unfortunately it couldn't find the BP so it kept inflating/deflating the cuff. Finally I just killed it and attempted a manual. Shit! Mr. Willie has Parkinson's disease complete with hand tremors. I was trying to palpate his radial pulse but I couldn't tell whether it was a pulse I was feeling or if it was just his wrist flexing. Yarg. By now I've spent 20 minutes trying to get a noninvasive set of vitals and he is thoroughly awake and not in the best mood. Finally I just estimate and inflate the cuff to 160. As it's coming back down, past 120, past 110, past 100, I'm thinking - crap. I can't get his BP manually either. Nurse FAIL.
Then I hear it and see the mercury jump around 97. Hooray! As I was charting it I realized that he has chronically low BP. I PROBABLY should have checked his baseline first! lol!
So I let my instructor know that I couldn't get Mr. Willie's pulse because of his Parkinson's tremors. She suggested I go for it and find an apical pulse for the first time. I went back into his room, ready to attempt it, and There. He. Was.
Nurse McDreamy.
Approximately 700 feet tall with sparkling eyes, dimples, and a great smile. Then he said hello in a rich Aussie accent. I felt MY apical pulse flutter. Swoon.
I introduced myself and said I was going to attempt to find Mr. Willie's apical pulse. Nurse McDreamy had Mr. W's G-tube out and was going to aspirate it and started explaining everything he was doing to me. In that luscious accent. Double swoon. Did I mention Aussies are third on my list of automatically-doable-men? That's my list of, regardless how ugly they may be, men that I would go out with if their accents were svelte enough. Irishmen are first. I really don't know what it is about them. Maybe I'll just blame Colin Farrell on that one. So after Nurse McDreamy was done his G-tube assessment, he started helping me find Mr. Willie's apical pulse. Poor Mr. Willie, being my guinea pig all morning. Lest you think I was neglecting him in the testosterone-laden presence of McDreamy, RN, actually the opposite was true. I actually made more of an effort to involve Mr. W because I felt so embarrassed from swooning over a fellow nurse at the bedside! I started with the 5th intercostal space and I couldn't hear anything. Just Mr. W talking. I jovially told him to zip it and kept listening. He continued making small noises and I realized it was his Parkinson's, so that was really distracting. Then McDreamy started pointing to different areas to listen to. Still nothing. Nothing, nothing, and nothing. I could hear him breathing but no heart sounds. McDreamy took my scope and tried. He couldn't hear anything either. Later he showed me the chart where it said that Mr. W had some kind of cardiac pathophysiology where his S3 and S4 sounds were muffled. If the cardiac specialist couldn't hear his heart sounds either, then I felt justified.
Mr. W is not one to beat around the bush, as it were. So he was washing his face and axillae, and suddenly said - "I believe that I peed."
Okay, said I, no problem. We'll get that cleaned up as part of your bath.
"Well, good thing, because now I have to shit!"
Blink, blink.
"Uh, okay, Mr. W. Would you like me to draw the curtain for you? We'll give you some privacy." He nodded and I went to draw the curtain closed. Suddenly, McDreamy stopped me and rhetorically questioned what kind of rational human being would want to have a bowel movement in bed. Only, the language he used was slightly more crass.
So he started getting Mr. W up from the bed! Let me remind you that a few short weeks ago, Mr. W was entirely bed bound. Yes, he is technically CAPABLE of walking, but not very far, and not to the toilet, and definitely NOT while trying to maintain bowel control, you know?
I should have said something.
I SHOULD have said that Mr. W was better off just using his incontinent product in the bed because I didn't think he would be strong enough to make it to the bathroom, much less in a hurry, much less while squeezing his sphincter shut. And that sacral ulcer would make it very uncomfortable if not downright damaging to use a bedpan.
McDreamy RN was becoming a whole lot more like McAsshole RN while he insisted that Mr. W stand up and walk to the bathroom. His patient care went right out the window. His manner was short, somewhat condescending, and I was mortified for poor Mr. W who was just doing what he was told. That accent of his wasn't doing anything for me now except make me even more pissed off.
Except, he was not. With a splatter I saw that exactly what I expected had come to pass. My first Code Brown, ladies and gentlemen, and for a man on G-tube feed - well, you can imagine the scene.
Mr. Willie's Parkinsons tremors had gotten worse and worse to the point that I was afraid he was going to keel over. The nurse had him over by the bathroom so I let them go the rest of the way while I started cleaning up. He was sooo agitated, and so I was I. How awful. What a terrible loss of dignity. McA RN finally got him on the toilet and we got to work cleaning it up. He was cursing under his breath and rolling his eyes at the whole scene. I could have smoked him in the nose. Bahhh, I was so angry! Luckily one of my clinical buddies seemed to pick up on my agitation via peer ESP and came into the room bearing deodorizers. She sprayed it everywhere and that seemed to help. Unfortunately there was BM on my scrubs, on my shoes, on my arm (eww.) and just about everywhere.
So that's the first part of my, ahem, shitty day. There's more to the story but I am heading home from work now. I shall continue the story at a future time.
We arrived on the unit for 0700 report and I was again assigned 2 patients, both of which I've been assigned to before. You may remember my friend Mr. Willie (as in Groundskeeper Willie), of "Ach! Stop pulling me family crest!" fame. There was also Mrs. S who was about the sweetest old lady on the planet. She had arrived on the unit about 8 weeks prior, all skin and bones due to severe malnutrition. She was quite the success story as she worked her 78 year old ass off in order to get out of incontinent products and to self-transfer to the commode and wheelchair so she could get off the unit. She did a great job of building her strength up and she was going to be discharged off the unit into the nearby rehabilitation hospital. She still looked like a skeleton but you could see that she was gaining some weight. Seriously - any people with body image issues reading today? Starvation is NOT attractive. Go eat something while you still can!
So my first task was to go in and get vitals from Mr. Willie, who was sound asleep so I tried to be quick and non-annoying about it. Unfortunately he wasn't in an especially chipper mood so I attempted to be jokesy yet subdued and hooked him up to the vitals machine. I put the cuff on his arm and he yelled "Godammit woman, didja put your hands in the icebox this morning??"
Yikes. Apologies ensued. I didn't think my hands were particularly cold!
So I hooked him up and pressed 'Go' and waited for the vitals machine to do its magic. Unfortunately it couldn't find the BP so it kept inflating/deflating the cuff. Finally I just killed it and attempted a manual. Shit! Mr. Willie has Parkinson's disease complete with hand tremors. I was trying to palpate his radial pulse but I couldn't tell whether it was a pulse I was feeling or if it was just his wrist flexing. Yarg. By now I've spent 20 minutes trying to get a noninvasive set of vitals and he is thoroughly awake and not in the best mood. Finally I just estimate and inflate the cuff to 160. As it's coming back down, past 120, past 110, past 100, I'm thinking - crap. I can't get his BP manually either. Nurse FAIL.
Then I hear it and see the mercury jump around 97. Hooray! As I was charting it I realized that he has chronically low BP. I PROBABLY should have checked his baseline first! lol!
So I let my instructor know that I couldn't get Mr. Willie's pulse because of his Parkinson's tremors. She suggested I go for it and find an apical pulse for the first time. I went back into his room, ready to attempt it, and There. He. Was.
Nurse McDreamy.
Approximately 700 feet tall with sparkling eyes, dimples, and a great smile. Then he said hello in a rich Aussie accent. I felt MY apical pulse flutter. Swoon.
I introduced myself and said I was going to attempt to find Mr. Willie's apical pulse. Nurse McDreamy had Mr. W's G-tube out and was going to aspirate it and started explaining everything he was doing to me. In that luscious accent. Double swoon. Did I mention Aussies are third on my list of automatically-doable-men? That's my list of, regardless how ugly they may be, men that I would go out with if their accents were svelte enough. Irishmen are first. I really don't know what it is about them. Maybe I'll just blame Colin Farrell on that one. So after Nurse McDreamy was done his G-tube assessment, he started helping me find Mr. Willie's apical pulse. Poor Mr. Willie, being my guinea pig all morning. Lest you think I was neglecting him in the testosterone-laden presence of McDreamy, RN, actually the opposite was true. I actually made more of an effort to involve Mr. W because I felt so embarrassed from swooning over a fellow nurse at the bedside! I started with the 5th intercostal space and I couldn't hear anything. Just Mr. W talking. I jovially told him to zip it and kept listening. He continued making small noises and I realized it was his Parkinson's, so that was really distracting. Then McDreamy started pointing to different areas to listen to. Still nothing. Nothing, nothing, and nothing. I could hear him breathing but no heart sounds. McDreamy took my scope and tried. He couldn't hear anything either. Later he showed me the chart where it said that Mr. W had some kind of cardiac pathophysiology where his S3 and S4 sounds were muffled. If the cardiac specialist couldn't hear his heart sounds either, then I felt justified.
Once complete with Mr. Willie, I scampered off to giggle with my clinical group for a few minutes over McDreamy. Another RN overheard us and, sadly, informed us about Mrs. McDreamy. Bummer! Anyway, totally unbecoming nonprofessional behavior aside, I went back to Mr. W to see if he needed repositioning or anything (he has a sacral ulcer) before I went to see my other patient Mrs. S. Mr. W, still not in the best mood, insisted that I get his bed bath going ASAP as he was expecting a visit from a physician and wanted to be clean before that. So I agreed and got his basin all ready, got all the towels primed, and who shows up again but McDreamy RN. Hooray, thought I, someone to help me roll Mr. W around this big bed.
My impression of this McDreamy fellow was about to do a complete 180.
Mr. W is not one to beat around the bush, as it were. So he was washing his face and axillae, and suddenly said - "I believe that I peed."
Okay, said I, no problem. We'll get that cleaned up as part of your bath.
"Well, good thing, because now I have to shit!"
Blink, blink.
"Uh, okay, Mr. W. Would you like me to draw the curtain for you? We'll give you some privacy." He nodded and I went to draw the curtain closed. Suddenly, McDreamy stopped me and rhetorically questioned what kind of rational human being would want to have a bowel movement in bed. Only, the language he used was slightly more crass.
So he started getting Mr. W up from the bed! Let me remind you that a few short weeks ago, Mr. W was entirely bed bound. Yes, he is technically CAPABLE of walking, but not very far, and not to the toilet, and definitely NOT while trying to maintain bowel control, you know?
I should have said something.
I SHOULD have said that Mr. W was better off just using his incontinent product in the bed because I didn't think he would be strong enough to make it to the bathroom, much less in a hurry, much less while squeezing his sphincter shut. And that sacral ulcer would make it very uncomfortable if not downright damaging to use a bedpan.
McDreamy RN was becoming a whole lot more like McAsshole RN while he insisted that Mr. W stand up and walk to the bathroom. His patient care went right out the window. His manner was short, somewhat condescending, and I was mortified for poor Mr. W who was just doing what he was told. That accent of his wasn't doing anything for me now except make me even more pissed off.
Unfortunately, and I'm going to chalk this one up to plain old newbie-ness, I didn't stand up for Mr. W. I thought that McAsshole the registered nurse would know better than a first year student. I hadn't worked with Mr. W for a few weeks and, who knows, perhaps he really was able to walk to the bathroom....
Except, he was not. With a splatter I saw that exactly what I expected had come to pass. My first Code Brown, ladies and gentlemen, and for a man on G-tube feed - well, you can imagine the scene.
Mr. Willie's Parkinsons tremors had gotten worse and worse to the point that I was afraid he was going to keel over. The nurse had him over by the bathroom so I let them go the rest of the way while I started cleaning up. He was sooo agitated, and so I was I. How awful. What a terrible loss of dignity. McA RN finally got him on the toilet and we got to work cleaning it up. He was cursing under his breath and rolling his eyes at the whole scene. I could have smoked him in the nose. Bahhh, I was so angry! Luckily one of my clinical buddies seemed to pick up on my agitation via peer ESP and came into the room bearing deodorizers. She sprayed it everywhere and that seemed to help. Unfortunately there was BM on my scrubs, on my shoes, on my arm (eww.) and just about everywhere.
So that's the first part of my, ahem, shitty day. There's more to the story but I am heading home from work now. I shall continue the story at a future time.
Have any of you ever been faced with this? Someone who should know better but doesn't, and who you should speak up to but are afraid to?
Monday, March 30, 2009
A difficult day
at clinical today...
Suffice it to say, for now, that it wasn't the patients - it was the nurses.
Thursday, March 26, 2009
Back'n'action
Well, in case you're wondering, my post from last week is still unresolved. But I am being open and honest with myself for the first time in probably a while and I can feel change in the air. To be honest I've been steering clear of blogging for a bit because I have been doing a whole lot of partying to get my mind off things. However, judging by my traffic counter, not many people are interested in my emoting, so it's back to your regularly scheduled program of UgRN!
P.S. Thanks to everyone who sent their well wishes. It was totally appreciated and I know I've got a whole lot of life left in me and a lot of experience to gain, so it helps a lot to get the experience and wisdom of other people :)
Anyway - clinical! OMG, there's only 2 weeks left of this semester. Two weeks proper, anyway. Then there's a gap while we celebrate Easter with the fam and then it's back to finals. Then after finals there's another mini semester in May. But I'm not thinking about that! I'm thinking about 2 weeks left in classes!
I'm soooo ready to be done this semester. I think I've said this before but I love nursing and nursing school. Really, I do. I just haaate the freakin' wringer they put me through! I'm sick of going to classes every day and learning a million new things, all the while thinking, 'shit, I've got to memorize all of this stuff for the final!'. It's really insane how much the human brain can store. Add to the mix my current life stressors and lack of sleep, and it makes for a pretty explosive college girl!
This week in clinical I had TWO patients! One was a stepdown from ICU (is that the right word? coming from ICU to a medical unit?) with a previous tracheotomy and a whole lot of tubing, and the other was just about the sweetest nonagenarian that I've ever met. My assignment wasn't supposed to be quite so crazy but my previous patient was discharged and replaced with the ICU patient. So I totally had my hands full. I did vitals for the first time on a real patient (with my Littmann Master Cardiology scope, which I heart!). My instructor, who seems to love me now that I wrote such a good reflection journal, watched and said that my technique was great so she wasn't even going to double check my results on a manual BP. I insisted that she did and she got the same BP as me! So that was very exciting for me.
The thing with vitals is that people are counting on you to come up with accurate numbers. It's not like a bed bath where you can just do it your way and no one complains. If the numbers are off, it could screw with someone's meds or tests, and ultimately life. So I took it as a pretty big deal. My biggest obstacle is actually finding the brachial pulse on someone. I didn't even KNOW there was a brachial pulse except on a baby arm. So a few of us spent hours on that just palpating each others arms. It's pretty funny, any nursing student can approach another nursing student and start poking their elbows for a brachial pulse, and we all instantly understand! We don't even need to ask permission any more. That's peer support for you.
So just to be sure, I checked my stepdown patient's vitals manually and then with a vitals machine, and I was totally thrilled to see they matched exactly for BP and pulse. SpO2 was at 95% on 5L (?) of oxygen which was good. The sneaky part about measuring someone's respirations is that they will change their respiratory rate when they know that's what you're counting for. So we are taught to palpate the radial pulse, count off 30 sec and take the reading x2, and then to keep our hands on their wrists for another 30 sec while we count off their respirations while ostensibly still checking the pulse. It was a lot of fun. I felt kind of sneaky in a good way. But then I got all over confident and forgot my HR count while I was counting off respirations. So clearly I have some work to do there, haha!
The sphygmomanometer that we have on the unit is really super ancient. I might have mentioned this already, but it's about 3 feet tall on casters, with for-real mercury in it, and you need to push it around the unit to get to a patient's room. Compare that to the portable cuffs we used in lab that is essentially just the cuff, a dial, and the pump part. Totally can fit in your pocket. The nurses on the unit laugh at us for taking BPs manually, but oh well! I'm so thrilled that I can do it at all! :)
Anyway, I just wanted to check in with you all. I haven't forgotten about you! <3
Meme: What does your stethoscope look like?
I've been tagged by Student RN Tiffany!
1) Post a picture of your stethoscope
Here are the rules:
2) Tell what you love about it
3) Tell what you hate about it
4) Tell me what your dream stethoscope would be
5) Does it have a name?
6) Tag all your nursing friends (Including the one that tagged you) and dont forget to leave a comment on their blog telling them that you tagged them!
4) Tell me what your dream stethoscope would be
5) Does it have a name?
6) Tag all your nursing friends (Including the one that tagged you) and dont forget to leave a comment on their blog telling them that you tagged them!
______
1) I already posted a picture of it :) I love my engravings. They're so me!
2) Mostly, I love the fact that it's got the horse engraving and my name/school/grad year. It keeps me connected to the idea that some day I will graduate from this chaos! I also love how loud it is as I can sometimes be a bit hard of hearing. Probably due to my extensive telephone work and the iPod usage that I enjoy whenever possible :) I also love how heavy it is. Shocking, I know, but when things feel flimsy in my hands I just don't feel as confident with them. This guy is NOT flimsy!
3) Bah, the only thing I hate is being the only person in my whole freakin school who doesn't have a bell AND a diaphragm. Everybody's like dude, wtf is wrong with your scope?
4) LOL, I don't have enough experience with them to know what I would change. I like mine. I would REALLY like one that could magically shrink down into my back pocket when I didn't need it!
5) Not yet, but I'm sure it will. We've only had them on the unit twice now! I've called it "My Little Pony" a couple of times. Maybe that will stick. Or how about, "Damn this thing in my pocket digging into my leg!"
6) Oooh I totally tag back Tiffany, little d, Lou, Somnambulant (if you're still blogging these days!), and Wardbunny. I'll comment on your blogs tomorrow to let you know. But for now... I am off to bed!
Tuesday, March 17, 2009
Dear Drofen
It's been a rough few days...
Thank you for posting that review of Fireproof. I decided to rent it on iTunes and it really struck a chord with me. Yes, it appears that men really are capable of being real men all on their own and shouldn't require careful prodding from a woman to do the right thing.
I started to realize that I'm a bit of a pushover and I shouldn't have to take the B.S. that I have been, but I keep taking it hoping that everything will be smoothed over in the end. I need to put a stop to that and start demanding the respect I deserve otherwise I may never get it. Well, I don't know if it will work out or not, but I have to trust that Someone has my best interests in mind.
"A real man needs to be a hero to his wife before he can be to anybody else"
You may have started something big in me. Thanks, I think ;)
Thank you for posting that review of Fireproof. I decided to rent it on iTunes and it really struck a chord with me. Yes, it appears that men really are capable of being real men all on their own and shouldn't require careful prodding from a woman to do the right thing.
I started to realize that I'm a bit of a pushover and I shouldn't have to take the B.S. that I have been, but I keep taking it hoping that everything will be smoothed over in the end. I need to put a stop to that and start demanding the respect I deserve otherwise I may never get it. Well, I don't know if it will work out or not, but I have to trust that Someone has my best interests in mind.
"A real man needs to be a hero to his wife before he can be to anybody else"
You may have started something big in me. Thanks, I think ;)
Saturday, March 14, 2009
Deflating
This week was mind numbing, to say the least... to the point that I can't believe it's already been a whole week since last weekend.
Monday we worked the PM shift on the unit from 1400 - 2200. It was probably the best one so far. We each had our own patient assignment and were responsible to handle all of their hygiene and repositioning. My clinical instructor winked at me when I was reading the assignment sheet, saying I'd 'have fun' with my new patient. I didn't know what to think!
So I sat down and read his chart, and he's basically an elderly Scottish guy who's got a case of old-age-itis and had a variety of problems catch up with him to land him on my unit. His chart was scary to me. Pressure ulcer on sacrum, fully dependent, NG tube, lived alone, no family. I had a picture in my mind of an angry, aging Groundskeeper Willie, who yelled at everyone who came to help with peri-care.
Monday we worked the PM shift on the unit from 1400 - 2200. It was probably the best one so far. We each had our own patient assignment and were responsible to handle all of their hygiene and repositioning. My clinical instructor winked at me when I was reading the assignment sheet, saying I'd 'have fun' with my new patient. I didn't know what to think!
So I sat down and read his chart, and he's basically an elderly Scottish guy who's got a case of old-age-itis and had a variety of problems catch up with him to land him on my unit. His chart was scary to me. Pressure ulcer on sacrum, fully dependent, NG tube, lived alone, no family. I had a picture in my mind of an angry, aging Groundskeeper Willie, who yelled at everyone who came to help with peri-care.
Picture my surprise when I peek around the door and I see the tiniest little man lost in a huge air bed, peeking out from beneath 3 blankets.
"Hi, my name is UgRN, and I'll be you're student nurse today, Mr. M!"
He said something very quietly.
"Sorry, Mr. M, what was that?" I leaned in.
He chuckled a little and said "I sez, 'why, halloooo, lass'! They keep sendin' me the pretty young nurses. I haven't had so much attention from the ladies since I was in uniform! Or the men, either, for that matter."
So set the tone for the entire shift.
You may remember that I spent a memorable 6 months gallivanting around Scotland with my backpack, a few pounds in change, and a job working for a coastal horse trekking outfit. So my patient and I had plenty to reminisce about. He's an Edinburgh man and I didn't spend nearly enough time there but I did remember the long ardurous hike from High Street, down to Holyrood, and then over to Princes Street. I also remember how crazy packed the streets were (I kept hitting people with my overstuffed backpack) and how I couldn't afford anything :) But I did buy a tartan Christmas ball.
It was kind of funny, really, how we all seemed to congregate at Mr. M's bed when there was nothing else to do. He kept us in stitches all night. He was a total saint, too, when we were experimenting with proper peri-care for a fully dependent man with an indwelling catheter. It turned out that out of all of us, the one person who did not have a chance to practice peri-care was the only male in our clinical group. So we voted him to be the one to do it. There were 6 of us with nothing to do so we made ourselves "useful" by fetching pillows and offering, uh, "helpful" instructions to our poor classmate who didn't know if he was coming or going. We rolled Mr. M back and forth all over creation and he swiped good naturedly at us, saying "Hey! Don't pull on my FAMILY CREST! There's not much there as it is, you know! You lady nurses are always so rough with it but this man here is ever so gentle." OMG, I was in tears, I was laughing so hard.
A little later I was reflecting that I had a completely wrong impression of him from his chart. He wasn't a scary recluse at all! And how different it must be for him to come from living indepedently with hardly any social interaction at all, to coming into the unit totally bedfast and charming everyone to where his bed was the local muster point.
Anyway. It was a great shift. We also got to watch the nurses swab for MRSA/VRE and then put the swabs in the vacuum tube and shoot it over the the lab. Fricken SWEET!
Yesterday we learned (finally) how to do blood pressures. Man, I can't find a brachial pulse to save my life. I was poking my partner's arms all over the place until our lab instructor whizzed over, touched her lightly on the inner elbow, and said "Here".
We had the coolest stethoscope ever. It's a teaching stethoscope with one chest piece and two earpieces! So she found the brachial pulse and set it all up, and I could finally hear what I was listening for. So we did about 800 BPs on each other until our fingers were tingly from lack of perfusion. My BP was, like, really low. 90/60 or somesuch when the instructor was doing it. She asked me if I was fit - not really! But I guess that explains why I see stars all the time when I stand up.
Anyway, my bus is coming soon so I will complete this when I get home from work. Tsk, blogging at work!
Monday, March 9, 2009
My stethoscope is here!
Over a month after placing the order, I finally have my 'scope in my hot little hands. It's a burgundy Littmann Master Cardiology over which I hemmed and hawed for a couple of weeks. I read all over allnurses.com and the overwhelming majority of students seemed to prefer the Master Cardio over the other ones, and if you look after it you shouldn't have to buy another one. So I splurged on it (it was just under $300 CAD - $221.82 USD because I got it engraved).
I already detailed my experience with stethoscopes.com a few weeks ago. Would I deal with them again? I don't know. They were very timely about getting my scope shipped out, but it really does just sound like some guy reselling stethoscopes out of his basement. Also - the whole Magna Fortis thing. And $100USD to ship to Canada? LOL! We share a border! It wouldn't cost that much to ship to Russia! They did, however, engrave my scope just like I wanted, with a horse on the chestpiece and my name/school/grad year on the earpiece. So I got what I was after, anyway.
I listened to my heartbeat in various locations for like half an hour already. I don't know how to do anything else. But it sounds cool :)
Yesterday I was at the University library from 1300 to 2300, and I only got through one chapter. It was urinary physiology. Although I accomplished like 1/10th of what I wanted to, I'm glad I was able to work through the chapter because I started it not understanding anything and I methodically worked through GFRs, Na+ cotransport mechanisms, leak channels, aquaporins, medullary countercurrent multipliers, aldosterone and vasopressin, and now I kind of get it. So no, didn't accomplish much in terms of quantity, but I feel pretty good about the chapter that I *did* spend 10 hours on :)
Heading to clinical today at 1300. Probably not going to class tomorrow morning so I can study Micro instead - midterm tomorrow at 1400! Scary.
Saturday, March 7, 2009
Midterms, round 4
Once I'm done this set, I should be done with midterms until September. Good riddance! I actually prefer finals to midterms because even though there's more ground to cover, they usually aren't as gruesomely detailed as midterms are. And you don't have to fit studying around class time. This weekend I've got the table pulled up to the couch again, basking in my Koi scrub pants because they are just so freekin' comfy, spread end to end with Micro and Physiology.
You may remember that I bombed my first clinical reflective journal. I basically rehashed my post about my first day which I thought was adequately reflective. WRONG! I got 2/5, which is 3% off my final grade. I was so pissed about the whole thing that I wasn't open to learning what I did wrong. Actually, it ended up being a really good experience for me to get a bad mark like that. I don't usually bomb on assignments that I even put a partial effort into. Sometimes getting a slap in the face from reality is a good thing!
So I took it seriously on the second journal. The topic was to reflect on our use of therapeutic touch to provide comfort. I think the big problem I had (as did many of my classmates) was looking past the word "journal". It was not a journal so much as a researched paper that wasn't in APA. I referenced Potter & Perry many times and material from my lecture. I actually ended up putting in a couple of hours into it. Happily, the teacher marked it yesterday and I got 5/5! More so, she said it was "the perfect journal" and she wants to use it as an example for future clinical groups. I'm so thrilled. Like I said, I'm actually glad I did so badly because I was able to really focus on how to do it right the next time.
In case you're wondering, here's an excerpt of how my school wants a clinical reflective journal to look (because I couldn't find an example online when I wanted one!) P.S. Please don't plagiarize. That's just not classy.
In Potter and Perry, it was mentioned that students can find touch stressful, but they learn to cope with intimate contact by changing their perceptions. As we were getting Mrs. E into bed, she was so tense that she was lifting her head and shoulders right off the bed. As I started the bed bath for her, it was initially very task-oriented for me: now I dip the washcloth in the basin, now I wring it out, is it too wet, oh, now is it too cold? Now I make the mitt – how does that go again? Now I touch the skin, not too firmly, not too gently. As I started getting the hang of it I realized I had run out of limbs to clean and it was time to do her abdomen. Mrs. E didn’t bat an eye when I undid her gown and she had her most private self exposed to me, but I saw a body that at one time had probably been reserved only for her parents or husband to see. And now, just about anyone wearing a uniform and an ID tag could see it.
I knew then that my perception had changed. She was much, much more than the unlucky recipient of my first bed bath. She was a person all her own and I had the privilege of helping her with her most intimate necessities. After that moment I began cleansing her abdomen knowing I was washing a unique human being. The task of washing became more of an act of caring. No longer did I concentrate so hard on the procedure. My focus was on helping Mrs. E take care of her needs. From there, I was more comfortable handling her body and the washcloth. As I relaxed, so did she! By the end of the bath she was lying flat out, completely relaxed. I could see that my touch had probably helped provide both relief from feeling unclean and, when I relaxed, my touch eased her into finding a position of comfort.
Clinical, as I've said, has been just awesome. I've pretty much had the same patient all along - that is, my friend Mrs. E with that whole catheter thing. I gotta say, she's really grown on me since that first day. I've helped her with her bed bath, cath/peri care, bed changes, transfers, ambulation, and pretty much all of the tasks that I can currently do.
My big breakthrough, though, has been with her roommate who is a large German lady with mild dementia who yells a lot and is often in wrist restraints, with high anxiety and restless legs. I wasn't technically assigned to her but I found myself really drawn to her. I went to check her brief and she locked eyes with me, pleading in perfect English - "Please take these things off me. I hate them!", gesturing to her tied wrists. Of course I couldn't, as she had a tendency of removing her IV and whatever else, but I felt really awful that she was so coherent and tied up like that. Then I peeked in her room around suppertime and I saw that her food tray was on her table, right over her lap, and her arms were still in restraints so all she could do was smell her food. That got me kind of mad, actually. How inappropriate is that?? If she can't eat yet, don't park her freakin dinner right under her nose.
Later the shift, we helped with getting the patients ready for bed. That's where the little story in my reflective paper came from. I also helped get the German lady ready for bed. The change in her was remarkable when we took the time to reposition her onto her side - her legs stopped swinging back and forth across the bed. She was so relaxed and comfortable that my clinical instructor ok'd taking off her restraints. I helped her with her mouth care and brushed her hair and she practically melted under my touch. By the time we left the room both of the ladies were totally unconscious and resting really comfortably. I felt sooooo good being able to do that for them.
Last Monday I was assigned to that room again and continued trying to figure out the German lady. We were on from 0700 to 1500 so I popped in right after report to say hi. She didn't remember me (it had been a week so that's cool). This time they were both in restraints. My friend Mrs. E had pulled out her foley catheter the night before. After hearing her moan every time anyone touched it for the last few shifts, I couldn't BELIEVE that she had done that to herself. I mean, the size of that balloon?? Yeeowch! When Mrs. E woke up and found herself in wrist restraints she really started hollering. Poor woman with dementia waking up from a dead sleep to find herself tied up. She was in quite a panic.
The nurse assigned to my room was nice enough but had a really thick accent and, I think, wasn't able to or didn't want to speak in a soothing manner to either woman. She was, IMO, really patronizing, calling them Grandma or Mama. She watched me take down the covers and said "Careful, she may punch you". All of this in front of a perfectly competent person! The nurse had to do some blood draws and told her those five awful words - 'This Won't Hurt A Bit' which it did and that really set her off! She started calling the nurse a liar: "Everything that comes out of your mouth is a lie", and in general being very vocal and upset.
The physicians came in a little while later asking her for some information to which she remained silent. They looked at me questioningly, saying "Is she refusing to speak today?" I just shrugged at that. It was clear that this woman's biggest problem was people were treating her like a problem.
I was pulled from the room for a while but I returned after lunch. She was nodding off and I asked her if she was feeling good, if she had enjoyed lunch, if she was comfortable. She said something distantly and looked away. I suddenly put my hand on her arm and asked her if she would like me to take her tray away. For me to spontaneously touch people is a huge step! She locked eyes with me and said, "Yes, thank you..." and then I asked her if she'd like some more tea. "Yes, please... could I have a cookie too? That would help me feel so much more at home. You know, my husband lives just a few blocks from here. I so wish I could just get up out of this bed and walk home!"
My heart totally went out to her and I said of course you can have some more tea and a cookie. I'll be right back!
So I came back with the tea and 3 cookies and she was totally thrilled. She started talking and talking and it was clear to me that all she wanted was someone to talk to her like she was a person and not a noisy lump in bed 8-1! I crouched down by her bed as she kept talking and she paused, saying "Thank you - thank you for staying to hear my story - no one ever does."
Yep, my big breakthrough so far. The problem in 8-1 is, in fact, a really nice lady who is someone's wife and grandma, and who just wants to be treated like a human being with thoughts and feelings. I'm so sure that one day I'm going to read this post again, when I'm a burned out fulltime nurse somewhere, and I hope I remember what it felt like for me to make such a tiny, significant, difference in someone's life.
That's about my spiel for today. Pearl Harbor's on - is it bad for me to love to watch the Army nurses giddily traipse around Hawaii and then watch them handle the triage and trauma after the attack? I also love to see them in full nursing regalia - knee length skirts, heels, tights, and caps, of course.
I'm thinking about writing a letter to the dean of my program complaining about the biased language that the profs seem to be using in all the classes. Most of the profs are MN or PhD, and yet on the midterms or in examples, the nurses are always she and the physicians are he. Usually the patients are he's, too. I feel so bad for the male students - they must feel so excluded when they see that. The annoying part is that if we ever submitted a paper with biased language like that we'd be taken out for sure. They just don't seem to realize that biased language is perpetuated by everyone who uses it! So, we'll see how that goes.
I also took a picture with the nursing union president for my scholarship. There was soooo much authority in that room I just about crapped my pants. I hate taking pictures! But I'm $1k richer so I can't complain. That is going straight into my ING account and hopefully I can pay for next year out of pocket.
Unfortunately when I saw my pictures from the photo shoot I was like, holy shit, where did all that come from? I'm definitely packing some face fat which makes me look like a whole different person. Someone I'm not especially excited to be. So I joined Weight Watchers a few weeks ago along with the rest of my female family (they've been on it for a while and had really good success), and you can see my progress at the bottom of the page if you're interested. I like it so far. I'm not one to stick with regimented diets so the choices really appeal to me. I'm hoping to drop about 30 lbs and get back to my high school body - wish me luck :) Slow and steady is my plan. Cutting out all the extra noms that I love so much. As long as the scale is going down and not up, I'm happy.
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