Difficult day or Chicken Little?

I headed back to Medical this weekend. I prepped on Friday on a patient recommended to me, who had a lot of care issues. After prepping for many hours, I decided I better watch procedure videos and pull out the E.P.P. chapters on management of a tracheostomy and PEG tube feedings because we've some theory on tracheostomy care, however, no real practice.

The PEG management seemed relatively easy once I had my routine settled on pulling back residuals, flushing the line and making sure that the valve was open for each administered medication and closed between. That wasn't an issue at all and I felt comfortable for the most part, doing my full head to toe assessments and dressing changes on the stoma in the GI and evaluating the trach site in the neck. I valued this experience because it was about as close as I was going to get to the ICU, without actually being there just yet. Since Critical Care is coming up, I jumped at the chance of learning some new skills. The first day went fairly well. My patient seemed comfortable. I was able to render full care, manage pain, complete all the charting, manage the nutritional aspects of the PEG line and spend valuable bedside time with my patient. After reporting off, the care nurse thanked me for all my help and I went home feeling like it was a decent shift.

Today was a different story though. I was ready for report and took some notes on hand-off about what a great job the care nurse did during the day shift. However, when I went in to assess her, her room looked like a disaster struck. She was down in the bed, the room was in disarray and nothing looked like the day before. I went over to arouse my patient and she immediately whispered to me that she had to go to the bathroom, and she was very uncomfortable. I repositioned her in bed so that she could sit on the bedpan and while she was voiding, I did my neuro assessment. She was A & O X3 and clearly stated something was wrong. After I did the toileting and assessed pedal pulses, femoral pulses and her back & abdominal assessment, I listened to her lungs and heart and noted the diminished lung sounds and long rhonchi and crackles...Her lungs were very congested and she had visible mucous in her mouth. I suctioned her several times and tried to get her comfortable, but she kept complaining that something wasn't right. When I went to give her meds, I told the care team that I did my assessment and thought respiratory therapy needed to be contacted and asked if we could call the pulmonary specialist too. I got that "But, it's Sunday..look." Ok, and what does that mean if we have an on-call physician or a back up hospitalist? Another blank stare that basically asked me if I was daft, without saying it outright.

They didn't seem too alarmed because she was still SPO2ing above 90, but I thought her breathing was labored. The other care nurse disagreed and didn't think she was in distress. I decided to stay in her room for the duration of the shift and it appeared she was getting worse. Nursing has a term called "snowing" a patient. This is to relax a patient who is experiencing anxiety. In some cases, it helps. I think in this case, while it was perfectly appropriate to help manage a patient's pain and anxiety with a tracheostomy, I was worried that something else was going wrong because she appeared to be breathing through her mouth and not her trach. All the secretions were coming into the mouth and should have been coming through the trach. I periodically mentioned that I thought she needed the trach assessed or removed and could we please call the on-call physician. The care nurse still didn't believe it was a problem and one told me to stop talking to her because she was transcribing orders and wanted to finish. She also happens to be an instructor at another school and I could tell she did not want to discuss the issue because it wasn't her patient. She also thought the patient wasn't in distress. I even asked her if I was overreacting. She thought I was and that I should accept that the drugs were doing their job and her saturations were acceptable.

Three or four times I asked two care nurses why we couldn't call the on-call pulmonary physician. I asked them to call RPT again and this time a therapist came up and agreed with what I was seeing, her sat were gradually going down even though we were titrating her O2 higher and higher. In this case, the R. Therapist could not even administer medications through the airway because it wasn't a patent airway. Bagging her failed as well. It appeared the trach was loose and blocking the airway. After being told several times to "stop being so intense" and this is not a problem, I was finally getting some answers. The RPT got her supervisor and we were able to open the stoma and see all this old gauze and secretions blocking the airway which we were able to clear, place the trach and cuff back in place and slightly inflate it to seal it a little better and she was back up to 99-100% SPO2 status after sitting at 88-90 on 65% oxygen. She had a blocked airway.

As I completed my charting, I saw that the last two shifts charted dressing changes on the trach site that clearly hadn't been done. I also saw that the PICC line was noted to be in the right arm when it was actually in the left. My charting always looks different in some way and I wonder if apathy at some point will kick in because I clearly am coming behind apathetic attention to detail and this isn't the first time. One oncology nurse took me aside last month and rechecked all my assessments because they were 'different' from the previous chart notes. She agreed with mine and signed below my name.

The care nurses tonight went behind closed doors to bag on me and one went to my instructor to say I was "too instense". The care nurse responsible for my patient told one of my classmates the same thing. The RPT went to my instructor and supported me in my assessment and said the patient had a risk for ARDS and coding without having a patent airway, and it was correct for me to want to get an order for the physician to reassess or remove the trach altogether. Since she is going to have a procedure in the AM everyone thought it could wait. I wasn't comfortable with it..neither was my patient. Difficult day or Chicken Little? Who cares? Another one of my classmates brought up a good point which actually made me feel a lot better about being such a pill tonight: If that was my mother, I'd be in the hallway naked screaming for someone to do SOMETHING! This is probably the first time since I started school, that I wondered if I wanted to work in an environment where your own colleagues refused to back you up.

I got in the car and felt close to tears but I knew I couldn't sleep tonight if I left the hospital with this patient snowed in with a closed/partially trapped airway. If that makes me Chicken Little, well then, the sky is falling...pick it up.

Going to the O.R.

Fabulous day last Monday, donning the blue scrubs, hat, booties and donning gloves for my trip into OR 6 and OR 2 for several procedures, including a thorocotomy, total neck dissection and finally, a ventricularostomy. The circulating nurse manages the team and the charting while the patient is in the O.R. We would go and make sure that all the consents and forms were executed in the file, fetch the patient, reassure their family, take the patient to the operating room, transfer them to the OR table, insert their catheters, hook up their monitors, round up any last minute supplies, coordinate any final preferences from the surgeon, the anesthesiologist, tie up the gowns of the sterile crew (tech/doc/etc) and call for the final time out before the operation begins. As the procedure opens and closes, every little thing gets counted, down to the sponges, laps and needles...because the last thing you want to do when you staple someone shut, is leave something inside.

The patients were all women...ages 78 to 34. The last patient had Hep C and a ruptured brain aneurysm. As I peered into her skull, the surgeon said "OK Sam Adams (my nickname) how come I didn't use the bipolar on her?"....thinking of my best Trivial Pursuit answer (which would be France..by the way)...I tried to equate it's equivalent answer in medical terminology and answered, "ugh...doc, that would be due to increased risk of infection?" Ding Ding Ding...what did she win Bob? Nothing.

I was amazed and humbled at how fast, clean, and closed everyone looked after they had been sauteed, fileted and drilled.

Going to the O.R. was a blast. It would be fun to work as a circulating nurse or nurse anesthetist.

Clinical Week V - MCA II - Props to Trudy!

Wow, how quickly 5 weeks comes and goes. We are officially second semester nursing students! Tonight, Trudy had a pancreatic patient that she did an awesome job with. She was able to insert her first NG tube & I was able to function in the capacity as her first assistant, which essentially means, I hold stuff, prop the patient's head forward and get him to sip water while she runs the line down to his stomach. The placement was so quick, the patient hardly gagged. It went smooth as silk. I was very impressed with Trudy. Gold star moment, red letter day. Yeah, I had to explain red letter to her. LOL!

Tonight was my night for sub-cutaneous (SQ) injections. Heparin and Insulin. I also learned the nuances of using a Lantus pen. The clown who invented the Lantus pen, is obviously not a nurse. It's one of the most difficult things to maneuver when you have to administer a SQ injection. The pen itself is too long and the distance between your fingers and thumb makes it difficult to manuever with one hand. You need someone to hold the patient's skin/tissue, while you work with this dial up pen/needle system. Hate it. Very glad to have the practice with the different syringes on real people, instead of lemons and oranges. No one hollered and one patient thanked me.

My patient this weekend is status post total abdominal hysterectomy. She is doing well and will probably go home tomorrow. I was able to work with my 84 year old patient that I had last weekend. He was talking up a storm and telling me about his big plans for going to the gym after discharge. He was the one that said thanks for the injection. After one week, I am fully convinced that Halidol should be outlawed for the elderly. What a cop out to give something so strong to someone so weak.

Another patient I worked with tonight was having a bad night and was calling out for his wife. It touches my heart to see the aging process, the ups and downs. One of the older gents on oncology was up on a chair, drinking a special cocktail I made for him with 7-up and apple juice and reading vogue magazine like it was the NY Times. He was another patient I could have adopted. Maybe, I am being called to geriatric nursing. It just feels so natural to me. On the other hand, I haven't had my ICU or peds/maternity rotations yet. I really like the older folks. Always have.

Trudy took our practice NG tube to post conference. After one of our classmates gathered all her stuff up for her and brought it to the front lobby, he remarked, "hey, here's your coffee...and your straw!" What a great shift.

Weekend III - Clinical MCA I Final

Brief little ditty about last weekend: Busy day on MT for two days ~ but we had some personality difficulties that resulted in our self exile out of MT for the rest of the semester. Actually, I think our instructor had enough of some of the mean girl antics and once we transferred to Oncology, we heard that they had a reputation for that and that most people refused to float to that specific unit.

Big deal...who has time for that? I had some decent patient interventions for my post appendectomy patient. He was ready to be discharged anyway and was happy with the care he had for the two days I took care of him. The last day of clinical found me on Oncology working with 84 year old man who had acute renal failure and an altered level of consciousness. When I prepped on him, I decided that my goal for the single day I would be caring for him would include a discontinuation of his soft restraints, close observation and weaning him from the anti-psychotic medications he was getting since he was admitted to the ER, so that we could properly assess his LOC. What a difference a day makes. Taking the time as a student to really be with your patient makes all the difference in the world.

We were able to see vast improvements in his communication with his family, he was able to eat after we completed a swallow evaluation and I was actually sorry to lose the follow-up time with him. After a long weekend on two different units, I studied for the MCA I final exam, finished research on a group project and completed my write ups for my care plans for midterm evaluations.

We had two long days of lecture/theory and new assignments that need some tweaking for Healthy Aging. I've pretty much decided that anyone who decides to prescribe Ativan and Haloperidol to the elderly doesn't care too much, because all the drug research I did in the last week stated that they don't metabolize these drugs like their younger counterparts. My patient was also in renal failure, so it was even worse for him to receive these because his kidneys weren't working.

I saw the massive effects the combination of these drugs had on my Dad a couple years ago, and I saw it in one of my patients this weekend. Frankly, it makes me angry to think some physicians think this is perfectly ok (chemical restraints/physical restraints/tying people up) sometime, I'd like to stick these docs in poseys and give them a taste of their own medicine, ah but I digress.)

To be able to discontinue the restraints and these anti-psychotic drugs only reinforced my belief in this regard about the efficacy of protecting your patient, at all costs. I had a completely different patient once these awful things were D/C'd. He was slow to respond up front at first, but perfectly aware at a measurable point in time, and I was able to get him calm and comfortable. He slept for the first time in 30 hours. Believe it or not, I was able to reassess the 84 year old the following weekend (tonight) and will include the update on him in my next post tomorrow night. There is way more to report in this current week IV. Trudy & I get to work together this weekend. It should be fun!

Weekend II - Clinical - Surgery Floor - Difficult People

Going from the medical side of nursing to the surgery side of nursing was interesting for me because I never differentiated much between the two, but they differ. Keep in mind that I am basing my opinions on two separate weekends of 14 hour days. AM staff is way more grouchy than PMs. Faulty conclusion. Maybe.

In order to give you a five week picture of what we are doing at the hospital I guess I should explain the weekend cycles.

The agency where I am rotating has several units that we are rotating through this cycle. 1) Medical Tower which is basically a step-down telemetry unit from the ICU. There are complex cases and some hospice. Next, 2) is Medical which is the melting pot for a plethora of health problems 3) Surgery, the floor they take you to after you've had it 4) Oncology, the floor where our friends with cancer are admitted, and finally 5) the O.R. where people actually have surgery. Our clinical group is rotating through all these areas. Week one, I started in the medical area, and last weekend I was on the surgery floor.

Surgery is different from medical because the patient populations there are diverse. I had no idea what to expect.

AM Day one, I went over to the nurses station to introduce myself. Huge mistake. The float nurse taking a new admission looked at me like I was piece of rotting meat underneath her shoe. I asked one of the regular, less threatening looking nurses if she could recommend a patient for me to prep on and she recommended the patient the floater was admitting. Of course and great! When people are being admitted, there is little, if any information about them available because the chart is literally being assembled during the admission process. The only thing I could gather from looking upside down at the Kardex the float was writing on, was that the new patient was a 74 year old female and she was being admitted for ORIF Tibia fracture (basically it is an open reduction internal fixation procedure with a scope and meniscus repair.) The float looked up at me and said, "I wouldn't prep on this patient. She's not going to like you because you are a student!" Well...well...well... thus begins my first challenge on the shift and it didn't come from the patient. 'Thanks for the advice, but I'm going to prep on her anyway." The float scowled at me walked away with the chart so I couldn't copy down any more information. Fun. At this point, I made a mental note (Note to self: "Don't bring the box of Truffles for the nursing station until AFTER report).

I walked down the hall, poked my head in the door, foamed in and saw a delightful 74 y/o woman sitting in bed with her knees up like Gidget and her husband sitting on the couch next to her. Humor always works for me so I just dove right in- "Hi, I'm student nurse...I'm going to be taking care of you tonight after your surgery...I can see you had a little trouble on the slopes recently!" Now keep in mind, no one could have prepared me for the response I got.

"Yeah, we were coming off the lift at Mammoth and the wind just kicked my legs out from underneath me...just a stroke of bad luck I guess." Gidget was skiing. Holy cow. I fell in love with her immediately. She was in better shape at her age than I was at 27. To say I was convicted to go back to the gym is an understatement. Her labs told the rest of her story. She was as healthy and fit as anyone 50 years younger than her. She just broke her leg skiing. After getting a good history, I went back to look up her three prophylactic drugs and I prepped.

Well, I knew I was in for a triple care plan weekend because when she got back from the O.R., she didn't even return with a foley. Now that's huzpah. She was discharged before I got in the next day for my AM coffee. I was able to do a few things for her before she went to sleep for the night, like change her and her bed and frequent vitals. She asked me all kinds of questions about my family and refused all her pain meds. "They make me sick" she said... In my mind I thought to myself, 'yeah, kinda like mean old float nurses.'

My second patient I met on AM Day two. Since Gidget went home before the cock crowed, I got dirt bike guy with the ruptured appendix and peritonitis. The charge nurse told me he wasn't going anywhere for the rest of the weekend so I decided to prep on him. He was just back from an early surgery to clean out his gut and he actually looked pretty good. I was able to meet his wife and kids and talk with him a bit before I prepped, so we established some rapport.

Day one with dirt bike man was relatively uneventful. The anesthetic was wearing off and he was walking around the hospital. Day two, the pain set in and I could barely get him out of bed. He went from no drugs to IV morphine. I did a head - toe on him and talked to his wife about limiting his activities. Peritonitis can be very serious. I didn't get to spike his bag because I can't do IVs yet, but I watched/monitored him & kept him comfortable, did his assessments and monitored his drains for signs of infection. I let him listen to his bowel sounds.

As I took primary care of Gidget and Dirt Bike Guy, I also took of the other patients my staff Rn was responsible for. I did the fingersticks and charting, ran a host of errands and completed patient teaching on several clients with family present. I had a little run-in with the staff CNA who didn't particularly care for student nurses. She wrestled the Dynamaps from us and took issue with me taking vitals on one of her patients who was decompensating. The CNA also had a penchant for recording respirations without actually assessing them, (which I took issue with). The only reason I know that she did this was because she did it while I was assessing dirt bike guy. My respiration count was 12. She wrote 20 on her clipboard. She also got mad at me for taking an axillary temp on a patient who was in acute distress with pneumonia. I noticed the patient had oral vitals all morning (she was stroke patient who had no control of her tongue). When I took her axillary temp it was 3 degrees higher than the oral probe. They weren't valid vitals.

The lesson from clinical this weekend on the surgery floor was learning how to deal with difficult people. Luckily my partner and I had two incredible staff RNs mentor us and show us procedural things and organizational techniques that were great learning tools. The nuances of nursing school are learning how to navigate the difficulties because the difficult people are always going to be difficult. They aren't necessarily always going to be the patient though.

Holding steady...a great place to be

March 10 was two days ago and it occurred to that I am 9 months from pinning (which will be December 10 at the Crest Theater in Sacramento). Nursing school is kinda like being in a high risk pregnancy, except the labor lasts about 9 months. Some days/nights, I miss seeing the kids for entire days because they are already in bed by the time I get home. Some days I feel like an early Alheizmer's patient suffering from dehydration. Other days I feel like a meth addict spiked up on caffeine. But enough about clinical.

What do I do when I am not in clinical?

Now that things have ramped up quite a bit, I can't post to "training wheels" nearly as frequently as before. The clinical weekends are quite long- due to the prep and polish time for care-planning plus the pre & post conferencing we do with our group prior to and after we get off our assigned floors. Care planning keeps me up late but it is getting a little better (thanks for the tools Comrades X & Y)

We basically have (4) courses now.

MCA-I theory is like the prime rib of nursing theory. It's the foundation for everything we do, but we only get 3.5 hours per week of lecture on the material and that includes an NCLEX style exam. This is heavy only because the theory chapters are extensive. Week one included the nursing process, complete health assessment & physical, stress & pain management + comprehensive management of the respiratory system. Week 2 included a cargo ship on management of comprehensive cardiac disorders, reading EKGs and peripheral vascular/immunology problems. Week 3's menu featured an exam on fluid/electrolyte imbalances, arterial blood gases, hemotological disorders, wound care & the inflammatory process. This last week we are all about perioperative stuff (pre-op-post) including a comprehensive final exam on all of the above. We had a very nice guest lecturer from the med center (an OR nurse) come in and show us all her toys. I loved it.

Your main question probably is, how do you squeeze all that into 3.5 hours of lecture each week? Well you don't. You cram all the chapter key points into your head, memorize lab values and abnormals and all the classes of drugs that you used within those systems. You practice hundreds of NCLEX style questions within those body systems to get a feel for what to look for on the exam, and then you wing it, baby, wing it. Week 1 (77.5%), Week 2 (95.5%), Week 3 (80%)...so you can basically tell that I am a perfect bell curve for MCA I. I am learning to settle for C's and B's (especially with all the effort I am expending to stay above the water) and am grateful when the periodic 'A' shows up. (old faithful friend)

My second course is Health Assessment II: I am a little irritated with the amount of time we are investing in this course when we really need the MCA I time. I guess what I am looking for at this juncture is skills. The roadies already outlined the whole textbook and we are doing head-toe and focused assesssment on our hospital patients, so when I get lectures on learning theories and nutrition, I want to shriek because we already mastered these subjects prior to entering our accelerated program. I suppose that if I hear the word Piaget one more time, or if some instructor asks me how many kilocalories there are in ETOH, I am going to the nuthouse. We really need a certain level of skills training.

Clinical is my 3 days of darkness because the days start in the dark and end in the dark. I love it because it feels like nursing. The prep time makes the days run together though. This last weekend I prepped on (3) patients. I am doing accuchecks now and full assessments. More on that in the next post. The good news is that I can pass meds this weekend. The reasons are a conglomeration of love from family, friends and help from on high: 1) Comrade X plugged me into a web tutor, Trudy did some dimensional analysis with me 2) My parents prayed for me and I gave a shout out to St. Joe 3) and I figured out that mg and mcg are the difference between 1 and 1000 (rocket science I know). I am learning to weigh my patients in kilos and I know how to read medication labels. I went from abject failure to 100% on my medication exam - so thanks Mom & Dad & Comrade X -I book marked your website and gave props to God & St. Joseph since they helped out too. Thanks to all for the leg up.

We are one week out from finishing MCA I - our final exam is next Wed. We have case study projects too. I have to do nursing research on the subject of rhabdomyolysis and since I have had some experience with that, that's my piece of the presentation. In the midst of all the this, there are quizzes mashed in there somewhere, like pieces of garlic that bite you in the ass.

Did I mention that in addition to weekend clinicals, Health Assessment II and MCA I, I have a very interesting gerontology class called Healthy Aging? Trudy and I are doing face to face meetings with a couple in my neighborhood as part of our gerontology project. Considering I am 19 years from my own gerontology status upgrade, I don't feel too far from home. I actually love this course; kinda like dessert.

With 272 days, 9 hours and 38 minutes left, it is important to think positive, be positive and stay positive. So, as of March 12, 2009, we are holding steady and it is a great place to be.

First Clinical MCA I - it felt good

I want to take this opportunity to say thanks to the roadie who posted this weekend about her clinical experience. AKA IMDOINGIT...I refer to her as (Bee) though because she's busy busy! It's nice to read someone else for a change.

This weekend was an exercise in the virtual unknown. As I reflect tonight on what some of my classmates experienced in other facilities, I am even more grateful for the opportunities I had this weekend at my hospital. One of my classmates was prepping on a patient who did not fare so well and coded. This would not be a good first clinical experience and I felt sorry for my classmate. Another friend of mine who is in another BSN program in town told us about being on a floor where a hospital employee coded and how upsetting that experience was for her. To say I had some fear going into this, is an understatement, but at the same time I was excited too.

Going into the first three-day clinical rotation was filled with anxiety, only because we had no idea what to expect, how we would be received, who our staff and charge RNs would be, and how our patients would receive "us".

The great relief for me going into this practical side of nursing school, was knowing somehow that my clinical instructor was going to be someone whom I respect and admire because of her willingness to be a good guide, a collaborator, and a nursing student advocate. That took away 50% of the stress up front.

Day one was a rather extensive orientation to the hospital. As we went to our assigned stations, three things occurred to me 1) Holy Cow, I get to take care of people & 2) Holy Cow, this is why I am sitting on my butt all day at school!! 3) Holy Cow, the things I do today are important and it feels kinda like nursing.

Three of us rounded the corner at Medical 4-5 and at the first stop, the RN at the station said she had a patient who was an 84 y.o who had an altered level of consciousness (dementia) and host of other problems and I offered to take her. After reviewing her chart, I stopped in to introduce myself and basically stared into the face of what could have been my Florida grandmother. We held hands for a bit and talked about the next few days and then I went home to prep. This involved looking up all the medical problems, all the drugs the person is taking (and the importance of the pharmacology behind the drugs - pharmokinetics) and then we evaluated all the labs in light of our patient's medical problems. After putting the puzzle pieces together, I put together a plan over the course of the weekend as to what I would do for this person as their nurse.

Without making too many assumptions a couple things occurred to me. This person was dehydrated, nutritionally deprived and lacking sufficient oxygenation. Since she was a no code, (basically if she were to decline for any reason, no extraordinary measures would be taken to save her life- like CPR, ventilation etc), there would be limits as to what interventions nursing and medicine would do, if she were to get critically ill. I decided that I would work up a plan that involved basics. Basic care like feeding, hydration, bathing, toileting, fluid/electrolyte homeostasis and ADL interactions. I thought back to my own parents and what I would want a nurse to do for them and I wrote out some goals. First and foremost, I wanted to get my patient out of bed. Second, I wanted to get her cleaned up - peri care, hair and (especially her mouth and dentures) and bathing. I also wanted to assess her skin and respiratory status since she was on 2L of O2 NC. All day long, I was planning on working fluids into our interactions (she required thickeners because she had swallow precautions) and getting her to think about eating (she was very anorexic). Since her diet was mechanical soft, I knew we had to work on getting her food flavored up a bit, because like it or not, ground-up-anything looks like dog crap and tastes like nothing at all.

When I arrived the following day, the family was there and we all talked. I wanted to include the patient in our conversations and involve her in some of the decisions about how the day would go. As we did this, I was able to start assessing her orientation and it didn't appear to me that she really had dementia. I think she actually had dysphagia , which definitely caused her to speak slowly, but she didn't appear as confused as her chart said she was. The night before she was in wrist restraints and these were removed when the family arrived. With the IV out and some of the more powerful drugs DC'd (discontinued), she seemed much more alert from the previous night.

We spent the day, focusing on sitting up in a chair, drinking and eating all her soft foods. I talked to her daughter and grand daughter about thinking about creative ways to get calories into her (like Jamba Juice) since this was a thick enough smoothie that she could eat with a spoon. She didn't have the sugar or fat restrictions that would preclude this, it would help her get her tastes buds stimulated a bit, because it was very apparent from looking at her intakes that she didn't like the texture or lack of flavor in her hospital "food." I also told them that they could also bring her soups she liked, provided they were thicker cream based (which would also up her calories a bit). The patient hadn't had a BM in a long time, so we got a stool softener into her and by the end of the shift the following day, she had two.

The "dementia" patient I had was AOX4 and talking up a storm with her nephew, discussing politics and asking me about that 7-up smoothie I made for her, wanting more. With 2000 mL of fluids - her urine turned clear and yellow and she perked up, making jokes about me being an old lady myself. She let me overhaul over dentures and I was able to to do a head to toe assessment on her.

After talking to the daughters some more about how simple little things can make a huge difference for their mother...I charted some noticeable changes on her chart (as her fluid balance was restored, her labs were improved from two days previous.)

I am not saying that this person doesn't have a long road ahead of them at the SNF (because she has some serious health probs) but I felt like her level of awareness was markedly improved by food, fluids, time, attention and TLC.

It felt like nursing and it felt good.

I Did It!

Last week was wild. We had our first exam in Managing the Care of Adults I, had out Medical Math Exam and started clinicals! My partner and I were assigned to a orthopedic post operative/medical-surgical floor. I was a bit unsure of what to expect - okay, very sure of what to expect. We made nice with the charge nurse and unit assistant, our nurses, and the CNAs right away. That, and God's blessings, really helped us to have an awesome three shifts! WE WERE RUNNING! We both selected patients who were fairly stable. There was a lot going on with them, but they had devoted spouses by their sides, so needed us less than many of the other patients who did not have family with them. My partner and I helped care for about 12 patients each over the course of our three evenings. I love working PMs.
I was able to help cheer a near-centurian who was very lonely and very depressed. The charge nurse commented on how surprised she was at the patient's response to me...apparently the poor dear had earned the title of "crotchety" and perhaps rightly so. One of the beauties of being a student nurse is that you get to provide the extra attention the nurses don't always have time to give...the smile, the pillow fluff, the ever-filled cup of water, the fresh gown and sheets, the tucking in and wishes of sweet dreams at night. So many of us are simply lonely and need a little TLC. It really goes a long way. I was truely honored to care for these dear ones. I loved it. I helped toilet, turn, adjust, dress, scoot, etc. a lot of people. I was not surprised at bottoms or other private areas, but was discretely checking them for edema and redness. I was not appalled at swollen and gnarled legs, ankles, feet and toes, but was providing comfort and freedom from tangled tubes - ensuring that indentations went away. I did not pass out when my nurse changed a dear one's abdominal dressing, but watched with interest and awe and prayed the dear one could endure the pain...the dear one did. I faced my fear of hurting someone by assisting a nurse in lifting the leg of a dear one who just had radical surgery as the leg was placed in a CPM (a device which moves the leg in a painful bicycle motion to prevent freezing up of the joint)...the dear one groaned in pain and I lifted higher (eliciting further groaning) to enable healing. I was concerned and praying, but lifting all the while. I practiced patient teaching to yet another dear one who was embaressed by this "young girl" explaining the procedure and use of a handheld urinal. I earned the respect and affection of my nurses, the charge nurse, and the assistant manager on my floor.
So, so, so much more happened, but that is enough for tonight. Coronary revascularization awaits me and I must tend to much more reading if I am to get a good grade on this exam.