Sunday, June 24, 2007

My patient patient

So...hooray! I ended up getting a 100% on both skills they selected for me to perform on the practical. I ended up having to do an insulin injection and medication via nasogastric tube. All my fussing over forgetting to open my biohazard bag was for nothing. But for the record, I DID remember to provide Mr. InjectiPad with adequate privacy, assisted him to a comfortable position, and only exposed the area I was working on (even though he was a naked, lifeless blob of liquid).

Big thanks are in order to Jane, my very patient patient. For both this class and for Health Assessment, she was a very willing victim for me to practice my skills on. The poor thing had "wounds" all over her body that I did dressing changes on, and during Health Assessment lab, she sat through nightly "Head to Toe" assessments, as I peered, poked, prodded, and listened (clinical terms being inspected, palpated, percussed, and auscultated) all over while she calmly reviewed our practice sheet to make sure I wasn't forgetting something (I kept forgetting to do the ears). Overall jane is in good health, although her tonsils get a grade "0." They like to "grade" things a lot in health assessment. Like pulse (0 is absent, 1 is weak and thready, 2 is normal, up to 4 which is bounding). With tonsils, 0 means they are not present, 1 means they are present but not swollen, 3 means they are toughing the uvula, and 4 would be when they are so swollen they are actually touching each other in the middle of your throat. Apparently with tonsils, less is more.

Act I Scene 1: Hospital Room

This will be short as it is after midnight, and I still have to finish studying to tomorrow's big exam. Today in lab we had a lecture about the wonderful world of ostomy bags. Actually it was more like a whirlwind drive-by lecture so they could give us more time reviewing the skills for the practical. Tomorrow, when performing a wound dressing change, I will remember to open up my sterile biohazard bag BEFORE I remove the bandage. Doing these practicals is tricky. It's like...I know how to perform all the actual skills (preparing and administering the injection, administering meds via nasogastric tube) but in addition to performing them, we need to verbalize certain things in a certain order that we would do in real life with real patients, but can't do in lab with the dummys. Things like "assists patient back to comfortable position". It's hard to remember to do that when the "patient's" leg comes off when you move it into the correct position for the injection. So it's a lot like learning a script for a play set in a hospital.

Fortunately, it is pass/fail tomorrow, and we only need to get a 75 on each skill to pass. But if you mess up on something major like breaking sterile field, or administering the wrong dose, you loss an automatic 25 points. So then if you mess on on something minor (like forgetting to SAY "I would be sure to provide adequate pricacy for the patient") you would fail. But towards the end all the instructors kept telling me "You know you are going to do fine tomorrow, right?" as I asked them to observe my technique for the 32nd time. So I guess I should feel good about that.

Okay, I said this was going to be short...but I lied. Back to my nasogastric tubes...

Saturday, June 23, 2007

Tired baby

So I was planning to write about the beautiful quinnipiac campus so y'all could see where I spend most of my waking hours, but fatigue has gotten the better of me, so I will postpone that until another day. Lab today was chaotic and stressful due to the looming practical exam on Sunday. Yes, we have an exam on Sunday. And we have lab from 1-6PM all afternoon tomorrow (Saturday). And then the final exam for the course is Monday AM followed immediately by our first clinical. I do not expect to sleep much between now and then. Except for right now. I think I need to sleep right now. And a brownie. I need a brownie now. Chocolate therapy.

Thursday, June 21, 2007


Today was "fun with injections" day! We learned all about giving every sort of injection under the sun. Intradermal (like the TB test where they inject a small amount of fluid in bubble under your skin (called a bleb FYI)), intramuscular, & subQ (like for insulin or heparin). Scary, scary scary. At first the syringe felt like a foreign object in my hands which suddenly felt large and amazingly clumsy. But within no time, we got the hang of it and were drawing fluids out of vials like experts. Okay, maybe not experts, but not bad for our first day. And surprisingly, no one in my section managed to stick themselves with the needle. At the beginning of lab, our instructor told us that if anyone did stick themselves that they would receive "a stern look from the teacher" and then the shame of having to wear a Mickey Mouse bandaid for the rest of class (which she displayed proudly to show she wasn't joking.) She rocks. So, yes, I escaped unscathed, however I did manage to spill a large quantity of reconstituted 'demi-dose' down my lab coat. But I didn't feel so bad, cuz several other students did them same, and the teacher said that the vials had most likely lost their suction.

I am still kinda afraid of having to reconstitute fluids. You do that when the actual medicine is too unstable in liquid to be pre-mixed. So then based on the concentration conversions listed on the vial and the dosage prescribed by the MD, you need to add solvent (usually sterile water or saline) to the med, and then figure out how many mL you need to administer the correct dose. Again with the scary. And just think....I will have to do this to a real live patient on Tuesday when our clinicals start. Hold me!

We did not have to inject ourselves (or our lab partners) with the syringes. Instead we had "Mr. InjectiPad" (Mr. IP for short) which was a small tan rectangular cushion filled with some unknown substance meant to imitate skin and the underlying dermis and subQ fat. Poor Mr. InjectiPad had a rough day.

Wednesday, June 20, 2007

On the bandwagon

I have finally jumped on the Crocs bandwagon. I never knew what all the fuss was about until I got my own pair, and let me tell you, they are frickin comfy. Jane bought me a pair yesterday because 1) she is awesome and loves me; & 2) because I kept stealing her Reef slip-on sandals. She would go to look for them and inevitably find them downstairs in my study, buried underneath a massive pile of nursing textbooks, med calculation worksheets, empty water bottles, and cat hair.

Speaking of cat hair, I think Didi is interested in pursuing a nursing career as well. I will be downstairs and she will want absolutely nothing to do with me until the MOMENT I open a textbook, at which point she will not leave the desk. I think she likes the pictures. Gogo and Niknup are also doing well, but have not confided any career changes to me.

Today in Lab...

I knew my theater training would come in handy someday. Today in lab I got to play the part of "fainting patient" so the instructor could teach us how to lower someone to the floor if they pass out. We also learned lots about administering meds safely, which is good cuz I don't want to accidentally injure someone by giving them the wrong dosage. Or giving meds to the wrong patient. Apparently these things happen fairly frequently. So if you are ever in the hospital and they give you meds, make sure they confirm your name AND your wrist band!

Yesterday in lab, we learned how to change the bed sheets WITH A PATIENT STILL IN THE BED. Pretty tricky, I know.

Tuesday, June 19, 2007

What I am learning

We learn a lot of very valuable information in lecture and lab. Following are some of the more interesting/odd things I have learned in the past few days:

1) the term "cheesy smegma" was in one of my nursing textbooks
2) a fancy way of saying that someone is overweight: imbalanced nutrition related to excessive intake relative to metabolic needs
3) potassium imbalances can mess your body up in a major way, so for god's sake, STOP READING THIS AND GO EAT A BANANA! (seriously we should all be taking multivitamins...)

Exam Anxiety

We take a lot of exams. And they are all multiple choice questions to prepare us for the NCLEX. I am not particularly good at multiple choice, mainly because I tend to overanalyze the question, read too much into the details, rather than simply choosing the best answer. But now that I am taking at least 2 a week, I am getting better.

Yesterday, which seems like 7 weeks ago due to the long hours of our work day, we had the second exam for our Fundamentals of Nursing class. (Based on the name, you would think this would be the first class we took this semester, but actually it is the third, following Community Nursing and Health Assessment. Health Assessment was fun. We learned to take vital signs, play with fancy equipment like pulsox machines, ophthalmoscopes & otoscopes. I have seen the inner workings of my lab partner's ears. But I digress. Back to the exam.

Being an accelerated program, most of the students are academic overachievers, much like myself. An A- is not good enough. So yesterday we had an exam. And it was VERY difficult. I usually leave an exam sure that I passed, confident I at least got a B, and hopeful that I got an A. Not so much after yesterday's exam. My feelings were shared by everyone else in the class. Our post exam break is usually filled with laughter, joking, and some obsessive answer checking: "What did you put for #34? Was it A) skin turgor or B) mucous membranes?" (Q: what is the best way to assess dehydration of an inhouse patient?) And a lot is at stake for us. If you don't pass a class, you are out of the program. End of story.

But after yesterday's exam, we were all strangely quiet. No one wanted to review the questions, because that would just confirm the number of questions answered incorrectly. But my favorite coping strategy came from this student: "I am taking a poll of everyone in the class. What are you going to be now that you are no longer going to be a nurse?"

It brought a much needed smile to my face.

And it turns out that I got an 88 on the exam. Not an A, but considering I left the exam not sure if I passes, I am relatively happy. Oh, that the best way to assess dehydration in your patient? C) their weight.

Episode 1

Hello all,

As many of you know, I recently returned to school full time to pursue an acclerated BSN. Many people ask how its going, and lots of funny things happen that I would like to be able to share with people, so this seemed like a logical solution. Here we go!