2 weeks left of the quarter....
2 weeks left of the quarter and all is going fairly well. doing pretty good in my Fundamentals class (more theory than anything else), skating by on a wing & a prayer in my Pathophysiology class (it's a good thing all our exams & quizzes are online), and praying for a miracle in my Physical Assessment class. Phys Assess has an "unannounced" quiz every week that is more like a midterm, which is a real PITA when the instructor doesn't give us any guidelines for what to study other than reading the chapters. oh well... i'm adjusting to the fact that i'm a grad student now and will no longer be spoon-fed by the profs.
clinicals have been great... my instructor says I'm doing awesome and am "ahead of the curve" and "will do great" in my med-surg rotation next quarter. so far, i've learned how to properly give an enema, insert a nasogastric tube and a Foley catheter (for both guys & gals), dose meds, perform blood glucose readings, wound dressing changes, to be fearless when communicating in very broken Spanglish (it at least entertains the patient), how to sound intelligent in front of the rounding docs, how to spot a med student at 1000 paces, and that not all MDs are assholes (nor do they look like the guys on Greys Anatomy). but some of them are. LA County Hospital is interesting, to say the least. a brief run-down...
* a 5250 on contact isolation (14-day psych hold) - patient with a communicable skin condition that necessitates the donning of gloves, gown, & mask... in that order, which i forgot the first time i went in... whoops. was on 24-hr suicide watch (with a sitter) as she attempted to hang herself with a phone cord just after admit. hears voices & sees her dead relatives, who tell her to kill herself so she can join them. all she wanted were her meds and to be left alone to sleep. (fine by me, i adopted a 2nd patient that day)
* a very sweet gentleman who had half his cheek removed due to cancer that had metastasized to his salivary glands. i got to hold his face together to keep him from bleeding all over the place when he busted some stitches while moving & we waited for his doc to answer her pager.
* a patient with bladder cancer, a brain tumor the size of an orange, & renal failure who spoke no english and wasn't quite all together upstairs. we did a lot of pantomiming and i explained that my espanol was "mucho malo", which made her laugh.
* two roofers, both of whom fell off a roof. #1 stopped a 40' fall by impaling his calf on a fence post, and avoiding certain death by not landing directly on his cranium. #2 fell 20' and shattered his lower leg 2 yrs ago, had it rebuilt with pins & plates, had a skin graft when it got infected & wouldn't heal properly, re-broke it & tore up the skin graft when he tripped over a seat in church, and finally had muscle & skin grafts over the old graft and new plates & pins put in. Poor bugger's leg was all kinds of f**ked up, but he had a good attitude about the whole thing. (He also grossed out a classmate by pitching a tent when she helped him with a bed bath.)
* several more cancer patients who, again, spoke no english. only one I couldn't communicate with at all, as he spoken only Cantonese and we didn't have an interpreter. luckily, his daughter showed up toward the end of my shift so I could find out through her where & how bad his pain was (and get him some proper relief).
* former alcoholic with a heroin addiction who had epididymitis. his balls were the size of grapefruit (no joke). the look on his face was priceless when i told him i was going to ice his scrotum for 20 mins as his morphine push wasn't due yet. not that i was relishing in my patient's discomfort.
* My patient yesterday had end-stage kidney disease, so I got to witness her hemodialysis and talk to the renal nurse all morning. she was also a spanish speaker, so i was doing a lot of pantomiming and "como se dice ____?"-ing to try to communicate. luckily, the renal nurse spoke spanish, so he was a big help when i was trying to figure out where her pain was and what was going on with her eye (she had a pupil pointing in the wrong direction even when she was looking straight ahead... even my instructor couldn't figure out WTF was up with that). he complimented me on my level of spanish and said it was more than even his kids knew. not to shabby for a gringa!
Today was the only patient experience that unnerved me because he actually had a good chance of coding while i was with him ("not on my watch" i told the attending MD). assaulted and suffered blunt head trauma that seems to have turned his brains pretty close to mush. unresponsive to his name or shaking, and only partially responded to a brisk sternal rub. (make a fist & rub the knuckles across your breastbone... hurts like a bitch, but this guy barely moved) his jaw was wired shut from a fracture, but the docs hadn't given him a tracheotomy, so he was breathing VERY hard and very rapidly, and using his neck, chest & abdominal muscles to boot. oh yeah, and because his jaw was wired shut and there were NO wire-cutters on the floor, he could have very well vomited, aspirated & coded... Not On My Watch. (the CNA and I made sure the RN procured said cutters & taped them to the wall right next to his bed, should the worst happen. I was fully prepared to have to jump on his bed & start performing compression if the need did arise. it didn't, for which I'm thankful.)
plus he had pneumonia (think: going for a jog while breathing through a coffee-stirring straw). he was on restraints to keep him from removing his IVs & gastrostomy tube, which apparently he tried to do even while in the semi-comatose state. I got to admin his meds through the G-tube, which was kind of cool (cuz I'm the only one who got to today), but nearly had a heart attack when the doctor shoved a tube the diameter of a kindergartener's pencil (and just as long) up his nose to help him breath better. With no lube! i wanted to question the doc, but feeling like "hey, i'm just a student", i didn't say anything. so much for that "patient advocate" role, i thought to myself as tears rolled down my patient's cheeks. next time, I'll step up and ask. nicely, of course, so as not to step upon any MD crocs.
overall, i'm surprised how much i've enjoyed my clinicals at County. when i first found out we were going to be there this quarter, i was like "eewwww... County Hospital???". but now, i've really come to like being there, mostly because of the population that it mainly serves... the underinsured, the uninsured, the homeless, and the down-n-out. Most of the nurses are great and have been willing to help us learn & answer our newbie-style questions with patience & understanding that they were once in our scrubs, too. And I wonder how different my clinicals will be next quarter at Huntington Hospital in Pasadena, with a full quarter of "real" nursing under my belt and feeling a bit less green than I did at the start of this quarter. I'll cast aside my "I'm just a student" attitude and try to be the patient advocate I want to be, because damnit, I'm part of a great cohort of really freakin' smart nursing students. That means I'm freakin' smart, too, right?
only 2 weeks left of the quarter and i am SO ready for it to be over. 4 more days (2 weekends) at the hospital, then a much-needed 3-week break. a wise former ELMN student told our class... buckle down and be a hermit while you're in school, and party like a rock star on your breaks.
I intend to do just that.
clinicals have been great... my instructor says I'm doing awesome and am "ahead of the curve" and "will do great" in my med-surg rotation next quarter. so far, i've learned how to properly give an enema, insert a nasogastric tube and a Foley catheter (for both guys & gals), dose meds, perform blood glucose readings, wound dressing changes, to be fearless when communicating in very broken Spanglish (it at least entertains the patient), how to sound intelligent in front of the rounding docs, how to spot a med student at 1000 paces, and that not all MDs are assholes (nor do they look like the guys on Greys Anatomy). but some of them are. LA County Hospital is interesting, to say the least. a brief run-down...
* a 5250 on contact isolation (14-day psych hold) - patient with a communicable skin condition that necessitates the donning of gloves, gown, & mask... in that order, which i forgot the first time i went in... whoops. was on 24-hr suicide watch (with a sitter) as she attempted to hang herself with a phone cord just after admit. hears voices & sees her dead relatives, who tell her to kill herself so she can join them. all she wanted were her meds and to be left alone to sleep. (fine by me, i adopted a 2nd patient that day)
* a very sweet gentleman who had half his cheek removed due to cancer that had metastasized to his salivary glands. i got to hold his face together to keep him from bleeding all over the place when he busted some stitches while moving & we waited for his doc to answer her pager.
* a patient with bladder cancer, a brain tumor the size of an orange, & renal failure who spoke no english and wasn't quite all together upstairs. we did a lot of pantomiming and i explained that my espanol was "mucho malo", which made her laugh.
* two roofers, both of whom fell off a roof. #1 stopped a 40' fall by impaling his calf on a fence post, and avoiding certain death by not landing directly on his cranium. #2 fell 20' and shattered his lower leg 2 yrs ago, had it rebuilt with pins & plates, had a skin graft when it got infected & wouldn't heal properly, re-broke it & tore up the skin graft when he tripped over a seat in church, and finally had muscle & skin grafts over the old graft and new plates & pins put in. Poor bugger's leg was all kinds of f**ked up, but he had a good attitude about the whole thing. (He also grossed out a classmate by pitching a tent when she helped him with a bed bath.)
* several more cancer patients who, again, spoke no english. only one I couldn't communicate with at all, as he spoken only Cantonese and we didn't have an interpreter. luckily, his daughter showed up toward the end of my shift so I could find out through her where & how bad his pain was (and get him some proper relief).
* former alcoholic with a heroin addiction who had epididymitis. his balls were the size of grapefruit (no joke). the look on his face was priceless when i told him i was going to ice his scrotum for 20 mins as his morphine push wasn't due yet. not that i was relishing in my patient's discomfort.
* My patient yesterday had end-stage kidney disease, so I got to witness her hemodialysis and talk to the renal nurse all morning. she was also a spanish speaker, so i was doing a lot of pantomiming and "como se dice ____?"-ing to try to communicate. luckily, the renal nurse spoke spanish, so he was a big help when i was trying to figure out where her pain was and what was going on with her eye (she had a pupil pointing in the wrong direction even when she was looking straight ahead... even my instructor couldn't figure out WTF was up with that). he complimented me on my level of spanish and said it was more than even his kids knew. not to shabby for a gringa!
Today was the only patient experience that unnerved me because he actually had a good chance of coding while i was with him ("not on my watch" i told the attending MD). assaulted and suffered blunt head trauma that seems to have turned his brains pretty close to mush. unresponsive to his name or shaking, and only partially responded to a brisk sternal rub. (make a fist & rub the knuckles across your breastbone... hurts like a bitch, but this guy barely moved) his jaw was wired shut from a fracture, but the docs hadn't given him a tracheotomy, so he was breathing VERY hard and very rapidly, and using his neck, chest & abdominal muscles to boot. oh yeah, and because his jaw was wired shut and there were NO wire-cutters on the floor, he could have very well vomited, aspirated & coded... Not On My Watch. (the CNA and I made sure the RN procured said cutters & taped them to the wall right next to his bed, should the worst happen. I was fully prepared to have to jump on his bed & start performing compression if the need did arise. it didn't, for which I'm thankful.)
plus he had pneumonia (think: going for a jog while breathing through a coffee-stirring straw). he was on restraints to keep him from removing his IVs & gastrostomy tube, which apparently he tried to do even while in the semi-comatose state. I got to admin his meds through the G-tube, which was kind of cool (cuz I'm the only one who got to today), but nearly had a heart attack when the doctor shoved a tube the diameter of a kindergartener's pencil (and just as long) up his nose to help him breath better. With no lube! i wanted to question the doc, but feeling like "hey, i'm just a student", i didn't say anything. so much for that "patient advocate" role, i thought to myself as tears rolled down my patient's cheeks. next time, I'll step up and ask. nicely, of course, so as not to step upon any MD crocs.
overall, i'm surprised how much i've enjoyed my clinicals at County. when i first found out we were going to be there this quarter, i was like "eewwww... County Hospital???". but now, i've really come to like being there, mostly because of the population that it mainly serves... the underinsured, the uninsured, the homeless, and the down-n-out. Most of the nurses are great and have been willing to help us learn & answer our newbie-style questions with patience & understanding that they were once in our scrubs, too. And I wonder how different my clinicals will be next quarter at Huntington Hospital in Pasadena, with a full quarter of "real" nursing under my belt and feeling a bit less green than I did at the start of this quarter. I'll cast aside my "I'm just a student" attitude and try to be the patient advocate I want to be, because damnit, I'm part of a great cohort of really freakin' smart nursing students. That means I'm freakin' smart, too, right?
only 2 weeks left of the quarter and i am SO ready for it to be over. 4 more days (2 weekends) at the hospital, then a much-needed 3-week break. a wise former ELMN student told our class... buckle down and be a hermit while you're in school, and party like a rock star on your breaks.
I intend to do just that.