I'm On It

19 Jul 2012
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interesting things as of late..part 1

In clinicals:

nothing this past week patient-wise, but I did have a nurse preceptor who was floating to the floor and had no idea what was going on. i felt the need to help her w/ all 5 patients instead of the 3 i was assigned because she didn’t ask any questions of the nurse giving her report even though she had a bunch of questions (the nurse was kind of grouchy because she had to wait30min and was ready to go home). after a while she caught on to things but she spent like 30-40min on the computer going through all the patients’ stuff..mind you…..meds were due, she hadn’t introduced herself to anyone…one guy (who i had been talking to for the past few wks and is super nice..jet ski accident) needed turning..so i just went and did what i could

she was a decent teacher though..good w/ constructive criticism. she had had students on her floor.

oh the jet ski accident man finally got to go to rehab =)

oh but a few things bothered me…one patient needed some kind of nasal antibiotics and she thought she had already had them but couldn’t remember just knew that ‘some1 had put something’ up her nose

the nurse told me to just mark it as ‘given’ i was like ‘but we don’t know what given..’ she was like ‘but there’s nothing else for her that goes up her nose so it must’ve been that

oh really now?

and then one patient had slightly elev blood glucose and according to the sliding scale we were to administer 1 unit of insulin but hte nurse said it was no big deal

ok so later the lady needed 5 units of insulin! and when i had to explain to my professor why it wasn’t given earlier and why it wasn’t given before meal time he went and changed the time it was given and the reason for the ‘slight’ delay. i was like ‘so…this is ok? this is waht we do? change times?’ he was like ‘its tricky…’

WHAT’S SO TRICKY?!

after all these lawsuit cases we hear about in our ethics class…i refuse to have my name on anything that looks tampered with

14 Jun 2012
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updates part 1: clinicals

this week in clinicals i had a guy whose neighbor had noticed some odd behavior and turned out he had a brain tumor. they removed part of it and was recovering. the sutures on his scalp were like right out of a Chuckie film. the strangest/scariest thing happened though.. in the morning he was all nice and friendly. coherant. compalined of a headache near his eye (on the side of the tumor). We (the nurse and i but really the nurse..i gave meds later) gave him some pain med and a laxative because he said he hadn’t gone poo in days. came back like 30 45 min later to check on him (w/o the nurse) and he was like totally OUT of it. very very drowsy. not so easily aroused. and he was droppin the F bomb like crazy lol. he was upset that we had ‘left him by himself for hours’ (which wasn’t true so i tried to see if he was oriented to time/place/person/situation) and he just kept saying ‘im fucked up.. i feel fucked up.. where the fuck were u i’ve been by myself for hours where have you been’ i was like…come again? and then the nurse came in (mind you i was ABOUT to go get her) and when she noticed what i noticed she started moving so quickly i was like oh shoot should i have gotten her sooner?? should i have checked his vitals? is this normal? but she seemed like she was concerned but not like freaking out. then the NP came. she seemed like it was ok. his BP was (relatively) normal and his sugar was fine. his strength had weakened a little but he could still obey simple commands and open both eyes with some effort.. he was back n forth with the f word idt the nurse noticed. the mood/behavior change freaked me out the most. also i tried to feed him and it just dribbled out. now i know that sounds stupid, but i didn’t like spoon him a spoonful of food it was a tiny piece of bread to see if maybe food would help (because i initially thought it was low blood sugar). he did try some of the OJ. im glad that he was ok. it was determined that the pain med was what was causing the effect and it was fine. he was pretty much out for the rest of the day though.. like OUT cold. he told me to leave him alone but i didnt because i told him i’d check on him frequently since he said we had left him by himself (private room). the techs fed him, shaved him, made him stand up to pee in a urinal thing..he looked asleep the whole time!

also the nurse tried to trick me w/ a med calculation ‘error’ but i caught it lol

then a real med error almost occurred (thank God for having to check 3 times!) the pharmacy had placed the wrong med in the wrong bin. i hope no1 else overlooked that mistake..

my 2nd patient wasn’t even there she had radiation and so i just made up her bed for her. i was concerned at the fact that her food from the previous meal (as in the day before) was still sitting there and gnats were crawling in it yet the custodians had been in multiple times!

ew

7 Jun 2012
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ok i’m just going to start typing and there’s no time for gifs

here’s everything i’m behind on tell y’all about:

classes:

so i thought this summer there’s be 1 hard/core class and 2 easy classes but the 2 ‘easy’ classes require constant attention because there’s always something due or to be done which is annoying but yes, i know…big girl panties. gotta put em on

my first exam went alright. felt better during it than my score reflect but we got a few points added so that’s a plus. the test covered hematology and oncology

my policy class and ethics class are pretty interesting and eye-opening though =)

clinicals:

the neuro unit isn’t so bad. it’s actually pretty interesting, and, like i said before, i feel i have a lot more responsibility and independence. at the same time i feel a little more relaxed because our professor doesn’t care so much our care plans as he does the fact that we know our medications. also, he doesn’t yell at us when he sees us just chillin he asks ‘if everything is ok’ and if we say yes he keeps it moving

i’m getting better and documenting in the computer and i truly do feel responsible to do all of the health assessment head-to-toe and neuro checks on my patients because if something goes awry my name will not be a part of it! i’ll be the one saying “i tried to tell ya!”

sometimes my documentation conflicts with that of the nurse but w/e i observe what i observe and i document THAT. i’d rather be paranoid than overlook something

community clinicals:

i’ve enjoyed going to the women’s domestic abuse shelter. i bonded w/ 1 woman last time..we were going over her health history (very difficult for me because i had to write in all these side details because i didn’t want to leave anything out and some things she just didn’t know/remember which was expected. idk some of mine either!) and we got to talking and i just really felt her spirit and wanted to encourage her. she works really hard, she’s close in age to me and has a daughter but spends so much time working to make money she feels guilty. she left her abusive partner a couple months ago and has been celibate for a year. she wants to wait til marriage now and she wants to do something health-related. i was talking to her about all the diff things she could do and ways to get funded. she was surprised at some of the info and some of the occupations we discussed. i would not have known that which i did unless i worked in the hospital probably. i felt sad that i couldn’t come back the next week (out of town) and not knowing if she’d still be there after that i wrote her a nice long letter and i attached it to the health history form i had copied (more legibly this time) for her. maybe she’ll be there next week though.

one thing that did concern me was that she had had a pap smear recently w/ abnormal cells showing up and never went back for followup because she was scared. so i explained about the process and the potential increased risk as time went on and how it doesn’t mean something is terribly wrong but she should def go back and here’s what to expect blahblahblah and here’s what to expect if you don’t. i hope she goes back.

HIV counselor training:

this was part of the community clinicals but it was optional. it was all day but went by pretty quickly. i enjoyed it. the instructor was a RIOT. i love her. she gets things DONE in the community and plays no games. well in MULTIPLE communities i should say. the one hard part was the role-playing. trying to get someone to comply as you go through the paperwork beforehand if they’re in a rush, for example. maintaining control of the situation..inquiring about their perception of HIV and putting down any myths. educating on how it is contracted. not encouraging any negative stigmas. and then telling someone who figured there’s no way they’re positive that htey are. i literally almost cried even though it was fake and so did she. she then got up and walked out (that was part of the role and i wasn’t expecting it) and i literally almost pinned her to the wall. so i apologized for layin hands on her and then somehow convinced her to sit back down (maybe i encouraged the thought that the test was wrong and we should try again) but then asked about what she’d do if it wasn’t wrong (assessing for suicide risk..which warrants not administering the test) etc etc. it was very difficult. it’s life changing but doesn’t have to be life ending. if i were HIV positive… hmm idk

anyways i’m gettin tested again soon. me and my boobear

we then had to reverse roles and it was our assignment to hit on the ‘counselor’ and make them uncomfortable (most of it was girl on girl) so that we could see how to handle inapp situations

ok class endin g2 run!

28 May 2012
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oh, one more thing (and a few more gifs)

one note about clinicals this semester: SO MUCH MORE INDEPENDENCE! i promise at one point i was checking out and administering meds w/o any supervision (shhh don’t tell)

and i was very attentive to my patient. i was scared that if i missed one thing it would just lead to a domino effect of bad things

not only that but my nurse said she wasn’t going to do a head-to-toe assessment because i was doing it so she’d just look in the computer at mine. i was like oh uhh ok..lemme go back and make sure i covered everything lol

the lady wasn’t a check check and check kind of assessment either. she had numbness in her legs, clubbing of the nails of her left foot, back pain, a UTI but no M/S changes (anymore at least), anxiety, meds that hadn’t been approved in the system yet that i had to keep following up on and reminding the doc about, etc etc. the numbness concerned me. like i dug my pinky nail (it’s kind of long despite our regulations. but no i don’t do crack) into her leg and she hardly felt it. i was like o_O

her bottom row of teeth had been broken from being intubated during a previous procedure. but she has no dentist. she’s not poor though. her hubby and sons are all in very high places. sadly though her hubby recently contracted an infection from a hospital and has since become very weakened. i met him. it has also changed his personality she said. he gets very snappy..and confused..and then later apologizes. that must be stressful to watch your husband (whom she described to once be ‘big and strapping’ begin to deteriorate physically and mentally from a preventable mistake). universal precautions are real people!!

anyways i felt good by the end of clinical. although with it starting so freakin early i really didn’t wake up until maybe 5 hours into it =) but thankfully neither did she.

for a while all of us were just kinda bored pretending to be busy but then right around the time we were PLANNING on grabbing lunch…everything required our attention and we almost didn’t get lunch at all. funny how that happens.

the pre/post paperwork really isn’t so bad either. probably because our professor doesn’t care too much about it as long as we are on the right track. his main concern is our knowledge of the medications. not my strongest pt but he guarantees it will be lol and i believe him!

one complaint: they wouldn’t let me start an IV.

everyone seemed to say but not say that they were not willing to be responsible for something going wrong. ok…i’ve started IVs before..sometimes successful sometimes not.. but ok. even the nurses don’t normally start IVs on that floor they call the LPN or IV nurse.. fine fine fine!

=/ things were diff at my last clinical site. the nurses themselves were like ‘you can practice on me if you’d like’

here, literally, they were like “i will NOT do that with you, go ask so-and-so” then my professor said “just drop it”

lol well ok then…

28 May 2012
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observations from last week (with gifs!)

before i get too far behind let me catch up

no ER stories because i haven’t been in to work. that changes tomorrow hopefully!

From community clinicals (domestic violence shelter):

we met w/ about 7 ladies or so. i made the STUPID mistake of asking their names..smh..

they all looked nervous but they were willing to give their first names. i felt like a total idiot lol but i just smiled and went with it

we pretty much just had open discussion w/ them. some diff issues came up that a lot of us could relate to. most had to do w/ stress, insomnia, diet and nutrition, developing lactose intolerance and how to deal w/ it even with a love for cheese, how to get a little brother to stop eating because he was over 250lbs and not very tall or very old (ironically this kid was considered to be healthy by a physician and doesn’t even eat junk food! only healthy food! he’s eating so much though because he’s scared his mom will go back to jail and he will not have any food…so he is trying to store it all now.. Lord..=’( )

we also brought a yummy and healthy treat that every1 loved (except for the diabetic who had to pass, but we gave her an alternative..which was fruit..which idk if that was a good idea or not but my professor was there and she didn’t object lol )

next time we will go and take their family health history so we can talk about preventative care. i wonder if hte same women will be there. we didn’t know what to expect but really only two or so looked anything close to banged up. well 1..it wasn’t really noticeable..but another literally looked like a wounded animal..it made me wonder what she had gone through before finding her way here. my goodness

hospital clinicals:

the neuro floor isn’t so bad. at least it wasn’t last week. considering that when i thought of ‘neuro’ i thought of a total care patient..my patient was so easy and low maintenance and independent

and so sweet! the only thing she needed help w/ was w/ a bed pan. and she barely peed. she had me talk to her daughter in law who is also a nurse so that i could remain encouraged. she said i’d make a great nurse. she was super sweet! my only freak out moment was after i found out that she had had C.Diff

and then she gave me a hug and touched my face…i was like

but in her records she was off of c.diff precautions (oh we have that? )

because it had not been active or w/e the word is (sorry) in 5 months..which is the limit..it had been exactly 5 months. i swamped my professor with questions because the last thing i want is c.diff. but then i realized how many times i had unknowingly come into contact with it in the ER (like w/ that first lady who passed away) and i fig i’d be ok.