Oct. 25th, 2009 07:20 pm Last week of Med Surg Clinical!!!
So I am finally done!!! I get to sleep in on Monday and Tuesday now and no longer have to work with the CHF, renal failure, old guys that I have been stuck with! Don't get me wrong...I appreciated the expereince and got some good things out of it but boy I am glad to be done.
So this week I got to observe in the Emergency Department which was interesting given I am use to MB. I noticed that most of the patients that came in were their because of their chronic conditions which is alot different than the acute issues that bring in the kiddos. My first patient was a suicidal/homocidal individual that refused to have females care for him. Since there were no male nurses scheduled, my nurse and I completed the care but I did so from behind the curtain....the man's story was pretty heartbreaking. He just returned from his fifth tour in Iraq only to return home where his wife cleaned out the house, bank account, and took the kids. Can't blame the guy for going nutty. I guess the man showed up at the ED with a gun and threatened to shoot himself if they didn't admit him. Once in his room, he stated that he "wanted to go on a rampage" so security went to search his car, finding a number of rifles and ammunition. Scary scary! Saddest part was that Madigan refused to take him and suggested we medicate him and send him on his way. Mental Health Care needs to work....
The only other exciting thing I got to see in the ED was an intubation of this poor little 94yo man and a man came in under a code neuro although he was perfectly fine. One story that my nurse did tell me I found kind of interesting. I guess on the weekend, there was a 42yo patient who was in a rm on the unit next door to the ED. His pulse ox showed he was at 50-60% but the nurse assumed he was fiddling with it. Then his tele showed he was in asystole but the nurse assumed the guy pulled his lead off.....long story short, the nurse went to check on the patient an hour later only to find him dead in the bed.....She's likely going to lose her license and the family is suing.
Thank goodness clinical is OVER!!!
Oct. 13th, 2009 06:02 pm Senior Homecoming
This week was Homecoming week! I went to the game where PLU kicked butt. Most things I was pretty much out of the loop for but a gang of us (Angelica, Lucas, Zele, Kellie, Anne, and their dates) went to the Homecoming dance at the Tacoma Art Museum. It was hilarious because we all just danced like goofballs. Zele was my "date" and was such a gentleman, opening doors for me, getting chairs, etc. :) It was fun! Sunday morning, I missed the memo that church started an hour early so I missed most of it! I was super bummed cause Homecoming service is always my favorite but I guess I'll just have to come back next year.
Oct. 13th, 2009 05:30 pm Clinical week cinco!
This week I took on three patients all on my own!! It was not as crazy as I thought and I was proud that I managed everyone's care and had plenty of time to chart, eat, etc. Day one, I really knew very little about my patients history because I had to start out running....One was a little old lady that began refusing meds as she neared the end of her life. We transported her to hospice care today so hopefully she'll go peacefully. Another one of my patients was this gentleman that developed a random necrotic abscess on hi butt. He had surgery to remove the wound which left him with a open hole the size of a football, just not as deep! It was about 25cm-10cm and in one area went so deep, it penetrated the anal wall. It was crazy! The patient was not happy at all with his previous care but throughout the day I helped him warm up. When Prof Wolfer came in the room, he told her that she should be proud to have a student like me!! It was great to see that a little time and listening can change a persons day.
I really love St J. particularly when I get to work with Jane and Venita! They are so supportive and will step into help whenever I ask, yet give me the freedom to really provide my own care. I was charting, doing assessments, giving meds, educating pts, consoling family members, talking to docs, etc.
Day two this week was an interesting day. I took three patients again. One of my patients was this little old man that was in the hospital recovering from a recent leg amputation. It got me thinking. What does the O.R. do with the portion of the leg they cut off? Might you wander around a landfill and find a leg stick out of a pile? Can the patient keep it to bury it with them later? Do you cremate the thing and sprinkle it somewhere? Anyways, the old man was a firecracker and was definitely a nutter. When he was sitting in his wheelchair with PT, he looked at me and said "I'm in a wheelchair. See! Wheeeelchair. That should be a clue to change the sheets on my bed!" If he wasn't old and missing a leg I think I would have punched him.....
For the second day in a row I cared for the man with the big hole in his butt. Boy was he whining today. He wanted lots of attention and caught so frustrated when the schedule couldn't go his way. At the end of the shift, Venita and I were to clean his wound and repack it. We had the patient sitting on the toilet, as we shot water into the wound. Next thing we know the patient says, "I want to be honest with you. You are pretty girls and what you're doing feels nice. I am a man so I'm going to need a robe to cover up the front of me." I grabbed the robe but still a second too late....yes the man had a huge boner. Venita and I finished up the procedure asap and helped our patient back to bed were I had to stuff gauze into his butt. I fit an entire roll of Curlex!! The patient asked me to take a picture of his ass with his cell phone which I did despite how awkward I probably looked! Before I left the room, the patient offered me his phone number and suggested we go to the fair sometime.....I guess I should have been flattered but really I just wondered if the only men that would ever consider me datable are 40+ men with large chunks of flesh missing out of their ass?!
Oh what a day at clinical....it was a goodie but thank goodness I only have two days left!
Oct. 6th, 2009 08:47 pm MB Catch-up
A few weeks ago I was working at the ED. About 2 minutes after I clocked on, the triage nurse came rushing back carrying a little girl who was shaking. She had a large purple rash of half of her face and was shaking as though she was having a seizure. Her family followed us into the trauma room however they couldn't speak english so we really didn't know what was going on. The girl's O2 sats were low so I began trying to stabilize her while the RNs tried to get IV access. It was a crazy mess since we had no warning of the trauma arriving so we were on our own, without respiratory therapy, CT, trauma docs, etc. Next thing that happened was the little girl vomited. I tried flipping her on her side but since her jaw was clenched due to the seizure, she started choking. I was scared she was aspirating and her O2 stats were dropping on me. I don't know how I did it (the adrenaline was pumping) but I popped her jaw, thrust it forward and got suction in her mouth to clear the airway. It took a while of switching back and forth from air and suction, but I eventually got her vitals in the normal ranges when her O2 had been in the 40s. Ends up that the purple rash was a weird birth mark and the situation wasn't as critical as we initially thought but I was happy we helped that little girl out. She was a cutie.
Only other exciting thing that happened was I got to sit in and watch a teenager who was on his way to juvennile detention after beating up his mom. I never really heard the whole story but there was an officer outside the room and we had to keep the door open at all times. The kid had a good 3 inch lac on his forearm that needed to be stitched up. I was a shocked at how the Dr. talked to the kid. He really talked down to him and was much more demanding than he usually would have been with the other kids. This kid may have made bad choices but he doesn't need to be treated rudely. We are not there to judge or provide punishment. There's a whole other system for that. I guess I just felt bad, so I started talking to the boy like I would anyone else. I asked him about school and his hobbies. I bet him he'd need 12 stitched (ends up it was 13....) and I won over his respect. He just wanted to be treated fairly. I don't think that was asking much despite what he did wrong to get in trouble.
Oct. 6th, 2009 08:32 pm Med Surg Week 4
This week clinical was kind of boring but hey, they can't all be exciting right?!
When I got to the floor, I was shocked to see that Mr. H was still on the floor. Ends up that his health was deteriorating and he was experiencing unexplained amnesia. He kept shaking and was super restless. He would only answer certain questions and couldn't recognize people at times. It was so sad to see that he had made a complete 180 from the cute old man I was joking with just a week ago. I said my prayers and gave him the best care that I could. I had to provide most of my care to his family because his daughters were very upset at their dad's condition. I think they were relief to have me care for him since I had seen him prior to the change and I was a familiar face. When trying to move Mr. H from the bed to his chair, he all of a sudden stopped, let go of my hand, and placed his hand on my shoulder to steady himself. His wife said we looked like we were dancing, and he got a big grin and started ricking back and forth. We had a good laugh despite his dilirium.
In addition to Mr. H, I cared for this little Hispanic woman that couldn't speak a lick of english. I felt bad because the language barrier really reduced the number of times I went to speak with her and I feel like she didn't get that great of care. It'd be hard sitting in a hospital bed with people jabbering around you and not being able to easily ask about your health, etc.
So my second day this week, I was in the ICU rather than up on the Med-Surg floor. I actually found the ICU to be dull. All you do is vital, assess, medicate, and start all over again.....I worked with two patients. The first was a 29yo girl that suffered from cerebral palsy. She was physically and mentally limited, and to top it off, she was diagnosed with stage 4 ovarian cancer. The cancer is terminal however her family refuses to believe that she will not bounce back. They refused hospice and palliative care. It's hard cause you wanted to smack the parents but at the same time, how can you criticize anyone having to make those choices? The other patient I took care of was this huge guy that is suspected to have suffered a stroke. He was sedated the whole time so just laid in the bed like a brick.....
At the end of the day, I ran down to our end of the day conference. Remey, who had been on *** in replace of me, informed me that Mr. H was much improved and back to being alert and oriented!!!! I was so happy that I had to run up stairs and say hi! When I got there, he had about 10 people in that room having a party. It was awesome to see how many people love him! I told Mr. H that he had given me a scare and he couldn't do that again! He laughed and stated he didn't remember a thing, not even the dancing. :) When I went to leave, his daughters thanked me for all that I had done and handed me a little bag of candies with a picture of a hunched over old man on the front!!! It was hiliarious! I will hold their words and gift close to my heart for a long time.
Oct. 6th, 2009 08:19 pm Med Surg Week 3
I am a little late but week 3 of clinical has come and gone. This week was a crazy one! I took on two patients instead of just one! I wish I could say that it went well but my 2nd patient kicked me off her care during the middle of the shift!! :( She was a grumpy woman but I still felt bad that I couldn't make her happy. She was 29yo and had just had a emergency hysterectomy and her hospital experience was pretty bad prior to my care. She really had no patience left and wanted nothing to do with me!!
My other patient though was amazing!!! Mr. R.H. I had him for two whole days and I must say he was quite the old gentleman! He was in the hospital for ascites and a pleural effusion. He had a ton of chronic conditions including CHF, renal failure, diabetes, and more. sHe knew he would have constant fluid build up for the rest of his life but he was a fighter and wanted to keep on chugging. I met his daughter who were so nice. They had lots of questions about their dad's various diseases and wanted to talk about his code status. It was a difficult conversation to suggest that a DNR might be the most realistic option, however it was an interesting and beneficial interaction. Saying by the Mr. H was hard because he was just to sweet and dished me attitude right back but I am happy he's going to get to go enjoy his recliner at home!
The last patient that I helped with was a recovering heroin user. He was found outside and rushed to the ED. They discovered he had bilateral pneumonia along with his drug dependency. I got to watch a bronchoscopy which was a terrible thing to see! The patient gags and tries to cough while a tube gets shoved down their nose, into their lung. The patient doesn't remember a thing thanks to drugs but it really looked like he was going to die throughout the procedure. Prior to the procedure I got to talk to you gentleman and learned that he had become a father at age 14 and now had numerous children, all he seemed to care very much about. He stated that not even his wife knew he was in the hospital because he didn't want to worry her! (It'd been there almost 3 wks....) I held the patients hand throughout the procedure, and when he woke up and I was going to leave, he held on. He told me that I had something special and that I was going to go far. Mind you he was still pretty doped up but I took it as a compliment. He told me that I was beautiful and that if I didn't believe it I should look in the mirror cause I was quite the catch! :) I guess I'll just have to wait and see how things turn out.
Sep. 24th, 2009 02:57 pm Med Surg Week 2
I had a great time in clinical this week. I LOVED my patient and was sad to have to say goodbye. My patient's name was B.Y. and he was in the hospital for pneumonia although he had lots of other things going wrong, including osteoradionecrosis, pulled out his PEG tube, and suffered a stroke that messed up his speech. He was the nicest old man and we shared stories all day. I got to meet his wife and hear about his kids and grandbabies. When I was trying to get the air out of the big 60cc syringe I was using for his meds, I shot water straight up in the air and it landed on the floor. Barry just smiled and let me fiddle with the devices.... :) He even told Professor Wolfer how I was amazing and would make a great nurse! When I said goodbye, Barry held my hand and we both talked about how we might run into each other one day driving around. Boy do I sure hope so!!
While wheeling Mr. Y up from xray, we encountered a woman in the elevator that was obviously upset. She was talking on the phone and through overhearing, I figured out the gist of the conversation was that a young man had been in a car accident, lost 80% of his blood volume, and now required a blood transfusion if he had any hope of surviving. However the boy's mother refused to sign the documentation because they are Jehovah Witnesses. It's hard to imagine that a woman had to make the call between sticking to her faith or saving her son.
I saw my first sex change patient. Male to female. I am not going to lie, "she" looked pretty good below the belt. The skin definitely looked a little funny given it was scrotal tissue but over all I thought the vagina looked pretty legit! Supposedly it's full functional too so she'll experience sensation.
So that's that for clinical. In leadership class today, we all shouted out names of leaders we could think of off hand. We got the biggies like MLK, Mandela, Obama, Hitler, etc. which got me thinking. 100 years from now when they ask that generation about famous and impactful leaders, who will be on the list? Will there be someone I know right now? Will I be on the list? Would I want to be on that list and have that kind of recognition? I don't have the answers and really don't want to think about them however it was an interesting thought.
Sep. 17th, 2009 06:06 pm Med-Surg Clinical
So I finished my first full week of Med-Surg clinical. I can't say it was too eventful.....I did however take on a patient and completed all of his nursing care with minimal help from the RN. My patient was just a nice old man suffering from a small bowel obstruction, asthma, and COPD.
Strangest thing happened. I walked into another patient's room to check on his call light only to realize it was a person I had cared for before! I couldn't remember if it was W. State or at the P. County Jail.....I just remember him and his history with IV drug abuse. Sadly he was in the hospital because he fingers needed to amputated and he still struggles with drugs.
The nicest nurse watched over me at St. J. Her name is Edit, pronounced E-deet. I think I got on her nerves at time but I felt alot more competent than prior to working as a nurse tech.
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