Saturday, October 31, 2009

Some cool developments!

Well, nursing school is going along fairly well. I had a skills check, which is essentially a 45 minute period of time in which me, my instructor, and a dummy are in a room and I have to practice my "skills" on them. These are the skills I was expected to have mastered.
  1. Assessing heart sounds
  2. Assessing lung sounds
  3. Assessing bowel sounds
  4. Assessing vascular abdominal sounds
  5. Administering a bolus or continuous feeding (open and closed systems)
  6. Administering any medication (other than IV or obviously IV push)

It was nerve racking. I've never had such horrible test anxiety in my life. Not to mention my instructor threw some curve balls at me. Assessing the lungs, heart, abdominal vascular sounds, and bowel sounds were fairly simple but she threw some landmark questions at me that were pretty specific. We are required to know exact landmarks, so if she asked me where I might expect to hear the S2 heart sound loudest, unfortunately, "Right there!" is not an appropriate answer: it would of course be at the fifth intercostal space, midclavicular line.

The tube feeding was fairly easy;I just remember that on skills check I have to check the pH of stomach acid each time before administration, but in all honesty, I don't think I've ever actually seen this done on the job.

The tough ones were the meds; they threw some tricky ones at me to catch. Doctor orders for enteric-coated pills to be crushed and given through patient's NG tube, antihypertensives that required me to take an apical pulse for 1 minute and ended up being contraindicated, drugs given in larger-than-therapeutic doses, and sublingual nitroglycerin pills for an NPO patient (which I remembered that the benefit of nitro, as long as it's sublingual, outweighs the risk in an NPO patient).

I made it through though and am happy to be continuing my clinicals in a larger, more-renowned hospital with much sicker patients than the last hospital I did my clinicals at.

Oh, even more good news! If you read my last blog post, you know I was waiting for a grade for an exam. I got an 87%... that's freakin' awesome! That brings my theory grade to 83%. I'm sitting pretty on that for right now. I expect I'll be completing this class successfully, unlike last year.

Yesterday, I also got a free H1N1 vaccine because of being a nursing student. This is wonderful news because if I brought this home to my kids, I would be devastated. Secondly, if I caught H1N1, the resulting isolation and week of recovery time would likely destroy any chance of completing nursing school.

I also have attended an interdisciplinary workshop on elderly assessment. I got some great tips from physical therapy on determining fall risk, a great screening tool for geriatric depression, a "brown bag review" program, and some other really helpful stuff.

All-in-all, it's been a pretty positive nursing experience for the last two weeks. Things are looking up and I really think I'm going to be successful this year!

Friday, October 23, 2009

Sickest Patient Yet!

After complaining that my patient's keep getting discharged my instructor this clinical gave me my sickest patient ever!

My patient was a 94 year-old, tube-fed, dementia, and Alzeimer's patient with a C.Dif infection and a UTI. She also had stage

The only three words she could say was "Ouch", "Damn it", and "No". What I found quite interesting was that the nurse charted the patient moaning when she was turned but she said "No!" when asked if she was experiencing pain.

Anyhow, the clinical experience was pretty bland overall. I got to administer her PO meds through her NG tube and I did all the tube care (hanging feedings, flushing, etc.), which is pretty cool. I'm a little eager to do a few IM injections too, ever since I learned how!

I'm pretty much freaking out because I have a major test grade coming soon... Already took the test, but I wanna see the grade!!!

Saturday, October 17, 2009

Drug Calculations Suck!

Good news and bad news.

Bad news first. I failed my first drug calculation math test. How did I fail you ask? Because I wrote the answer to the hundredths place and not to the tenths place. 6.25mL, the correct answer, should have been written as 6.3mL, and this cost me the test.

The penalty for such an error? Minus two points off my entire lab grade. What does this make my score, as of right now, look like? Much like this:

Lab Quiz #1: 97%
Lab Quiz #2: 76%
Lab Quiz #3: (Not Done)
Lab Quiz #4: (Not Done)
Average Grade: 86.5%>87%
Drug Calculation Deduction: -2%
Clinical Notice Deduction: -1% (remember I brought a vitals cart into an isolation room.. ooops!)

Current Lab Grade: 84%

So it looks like I need to really focus on my lab grade right now. I'm simply not allowed to fail any lab test. If I get a two more 75 scores I will be ok. It is so friggin' unfair that I had a two-point deduction for that stupid math test. Would that so-called "error" have killed anyone? Would I have made that error if the drug calculation quiz didn't present drug orders to the thousandths place? Unlikely.

If my lab grade falls below my now required 78%, I'm definitely going to fight it!

And now on to the good news... my clinical teacher says that she has absolutely no clinical concerns for me. She would like me to improve my reporting off skills, but other than that, I'm doing just great! Of course my tests are exactly setting the academic world on fire, but to me 'C' means 'Continue'. And continue is exactly what I am shooting for!

Friday, October 9, 2009

Clinicals! Clinicals!

Nursing school is becoming pretty insane pretty quick.

I'm passing my tests (well two out of three taken I've gotten grades back on), yet I'm hardly setting the nursing world of academia on fire with my scores. However, I'll take the grades I'm getting since they are passing grades! I have a 97%, a 78%, and an as-of-yet undetermined score.

Clinicals have been interesting. I got a write-up for bringing a vitals machine into an isolation room, but I blame my current job for that because we don't use dedicated equipment, we just disinfect the machine after use. Other than that, I've been doing pretty good. I think I've got prioritizing my nursing diagnoses down to an art after my awesome clinical instructor told me the simplest rule of thumb in prioritization, "What's going to kill your client first? Not what's going to be the most painful or most chronic, but whatever will kill them first is usually the top priority!" Very simple; even I can understand it!

Yesterday I had a really good experience because after I discharged my patient, I was assigned a new one and my instructor wanted me to assess a new one and give her my top two nursing diagnoses before the end of the day. I assessed, and within five minutes provided my two nursing diagnoses: Ineffective Airway Clearance and Ineffective Thermoregulation. I thought she was going to high five me!

Another girl had a dementia patient and we were cleaning her up and she almost got sick because she had to clean up BM; I'm so glad I got my CNA license first so I could get those initial gags out of the way.

I now get to write vitals and physical assessment on official hospital documentation which is pretty cool since there seems to be some sort of confidence from the facility and my instructor in my abilities.

Next week I'm administering the meds, so if next week's blog post is "Death of My Patient", you'll know something has gone terribly wrong!