Tuesday, September 29, 2009

First Clinical Over; Test Tomorrow

Well, I've been quite busy! I got a 97% on my first skills test and I'm friggin' excited about it!

My first clinical is complete. Most of it was useless departmental training that I'm going to have to be retrained on next rotation in another hospital. Quite disappointing; especially the two hours of glucometer training I already took for my job at the hospital. I feel like I know HI and LO controls intimately now.

I'm in a community hospital which is cool. I like that setting much more than long-term care. I love seeing different kinds of patients and more importantly I like helping people that are lucid enough to thought to know what is going on. I love learning about the different procedures they have had and the different disease processes that are occurring within them.

I definitely believe nursing is one of the most important jobs in the world. Human support from birth to death, nurses are there. Case in point, when I asked my elderly client the very generic question during my assessment, "What are some stresses in your life?" she responded, tearfully, about how she lost a baby due to "crib death" (now known as SIDS) in the 1960's. She said it was her fault and she should have known, she should have done... something.

This makes me think... How often did she talk about this? Apparently not much. How much assessment information is waiting just under the surface? I'm honored that on my first clinical day someone thought enough to share something so personal, just because I asked a simple, generic question. (BTW, an intervention for this stressor I chose was to find her some resources on SIDS so she would not continue thinking her baby's death was her fault.)

I've still been working two jobs and doing this school full time. Dealing my father's death, slight family issues at home, and all these responsibilities have made my blood pressure sky-rocket, which is something that has never happened to me.

I have to take Effexor anti-depressant medication and I have Klonopin for PRN anxiety. The Klonopin makes me feel totally unable to get anxious or nervous; truly a strange feeling indeed but my blood pressure and pulse rate is thanking me for taking it when I get worked up.

I have a major theory unit test today. I hope I nail it. I failed this one last year. I'm getting very nervous about this test (klonopin, here I come).

Friday, September 18, 2009

My NCLEX-style Tricks!

A few patterns I've noticed I feel obliged to share. My brain is physically unable to comprehend these NCLEX-style questions for some reason. I overthink, I underthink, or just regular think and don't critically think.

Here's what I figured out so far...

  1. When the question asks what should be done first, always prioritize physiologic needs over social or psychosocial needs. For example, you have eliminated two distractors and you're left with two options in a prioritization question. Feed a burn victim or bath an amputee whose is complaining his bath is running late. Feeding would be the priority since it is an important physiologic need.
  2. If you have a selection of physiologic needs, it's always prioritized by the ABCs, (Airway, circulation, breathing.) So if you have a burn victim and need to prioritize nursing diagnoses between acute pain, risk for infection, or risk for ineffective airway, the airway wins because it falls within ABC's and the others do not.
  3. If it's a therapeutic response question, never answer a client question that does not address their concern. Even if it sounds appropriate, it's wrong if it doesn't address their concern.

Hope these patterns I've noticed will help me on the tests to come...

My Life has Turned Upside Down

Nursing school just got a whole lot harder...

My orientation was on September 4th, however, I got a phone call that morning that my father had passed away. It was a devastating loss, and I still am having a difficult time with it. Apparently, his heart stopped while he was asleep due to his chronic CHF and COPD.

Relating this to my nursing school, it has caused all sorts of problems. I missed my scheduled physical which was planned more than a month ago which is required to attend physical. I missed my first day of orientation along with my first day of class. I'm now juggling two jobs, nursing school, and attempting to handle my father's affair.

My physical was late, late, late! I had to get it done ASAP at an immediate care clinic, run over to my job to pick up a negative PPD result from a few months ago, then to my family doc for a record of my shots and serum titers. Dropped off this morning; sitting at work as I blog! This nursing school thing is deadline after deadline and I always feel rushed, behind, and not on top of things, which is not the way I like to feel!

I've been in class for two weeks now just learning to total basics: S1 and S2 heart sounds, lung sounds, bowel sounds, vital signs, and assessments. Everything is going smooth so far, except for the fact that I always seem to be in school. I feel totally caught up despite the setback. We even had a quiz and I feel that I got every question correct; however, I've had this feeling before and done poorly so I'll report my score on Tuesday.

They covered nearly everything in my CNA class during a single five-hour lab session. Crazy considering that the class was almost six weeks long. Right now, we are focusing on assessment and I hope I get it down this time through nursing school. I didn't do terribly bad; in fact, I passed my clinicals mid-term assessment.

Wednesday is my first preassignment and next Thursday my first clinical experience. I'm looking forward to it. I think my CNA experience will help quite a bit, and I think I'm picking up more this time through. I think this will be my year... only time will tell though.

I'm very upset about my father's passing. He was so proud I made it into a very good and difficult-to-be-accepted-into program. I saddens my heart to think that he missed my first day of school and that he'll never get to see me become an RN. He's missing he grandson grow up... 63 is just too young to die.

In a way, he's even more my inspiration to become a good nurse. He was patched up and discharged at the local hospital. A doctor told him his heart was "pumping only at 20% efficiency" before he died; totally unacceptable behavior for a doctor because my father became very depressed after this, often looking at pictures of me, him, and his grandson and crying.

His home environment was not stable; he was unable to care for himself and my mother has developed epileptic problems and was unable to provide proper care for him. She is also in charge of his medications which has been a problem more than once with her neurological problems.

If a nurse in that local hospital took her job to the next level and did what she could have done and properly found resources to help my father and my mother, maybe he'd be around today. This is not my attempt at blaming a nurse or calling them a bad nurse; they probably did everything by-the-book, however, doing their job above and beyond what their employer expects and giving his/her patient what they really needed could have saved a life.

Between this family ordeal, my jobs, and my school, I'm starting to feel the effects of burnout and, even though I delegate as much as I can to family and close family friends, I feel that my problems will never end...