Nursing Chronicles

I am LONG overdue for a post. To add to Caitlyn's post about our apartment falling apart, there have been further occurrences involving a shower curtain rod falling on my head and the back door knob falling off. I think we may need to do a seance or some kind of offering to the Washtenaw ghosts.

Now time to bring you all up to date on my life since starting nursing school. I don't really have much of a life outside of classes and clinicals. I made it through the summer successfully, actually finishing with pretty decent grades but without really having much experience outside of mannequin and fake arms--for blood draws, starting IVs and practicing giving meds. This week begins week 5 of the fall semester and I am SO busy! I am taking obstetrics, pediatrics and medical/surgical 1 and 2, with theory classes on Mon and Fri and clinicals on Tue, Wed, Thur. Tue is the longest day med/surg 7am-7pm, Wed--OB 7am-2pm, Thur--Peds 2pm-9pm. Each site offers something different but by far my favorites have been labor and delivery, postpartum and the pediatric intensive care unit (PICU)--in that order. I've had the opportunity to see a baby be born, draw blood, administer medications (IV, oral and injection), catheterize and provide wound care (changing dressings) to name a few of the more exciting things.

In med/surg we usually stay on one floor but we get the chance to go to the rehab floor (PT/OT), the OR (I'm SOOOOO excited, I may get to watch an open heart or transplant!!) and oncology. I've had a variety of patients but for the most part I don't really enjoy med/surg--maybe it's just the floor I work on but it's so depressing, especially when the patients are getting terminal diagnoses. The one patient that really bummed me out was a 21 yr old guy who was transferrred from Guatamala for complications from a gall bladder removal. He looked like a Holocaust survivor--he hadn't been able to eat and weighed 81lbs. He was also in lots of pain but his Nurse Practioner wouldn't prescribe him IV morphine because she didn't want him to get used to IV meds since they wouldn't have them in Guatamala. She prescribed oral meds but he refused them because he wasn't able to eat anything and they cause upset stomach. It was upsetting/frustrating. But the worst part was that before he'd had his gall bladder removed he had NO medical history, awful. I knew from the get-go it wasn't a place I was going to want to work but it has been a good/interesting experience so far--but 12 hr shifts are so LONG!

With OB we go to the neonatal intensive care unit (NICU), labor and delivery, triage, postpartum, outpatient clinic and mammograms. This week will be my first week in the NICU and I'm excited! L&D was an amazing experience (nurses only have 1 patient), the patient I was assigned to was supposed to deliver vaginally but ended requesting a c-section. I think I was more excited about the baby than the mom, it was just so cool that a second before there was nothing and then there was a whole new life in the room. I was also able to hold the baby for nearly an hr and I will point out that the baby was a honkin 10lb 12oz!!!!!! My arms were sore the next day.

In postpartum I did my first blood draw and I got it on the first try! It was really nice, I liked the pace. It has been the once place where I felt like I could handle having more than one patient at a time. The nurses tend to have 4-5 patients. It was kind of a relaxing floor, letting the patients rest and bond with their babies. I was really nervous to do a postpartum assessment and newborn assessment but they went over just fine and my patient was very understanding. It was also really exciting that when she asked me questions I actually KNEW the answers!!! And fortunately nobody hemorrhaged while I was on the floor--some of the other girls both had patients that started massively hemorrhaging their first day on the floor.

In mammograms I observed several different procedures and the radiologist on call that day was amazing. He explained all the procedures to me (even though I didn't understand half of what he said), made sure I could see and let me ask questions. It's always nice to have people willing to teach you things. The day I was in triage was fortunately a busy day. I walked patients back to their rooms and asked them why they were there. You'd think they'd all be coming in in labor--not so. One woman came in pregnant with twins at 36 wks for a fetal stress test, another woman came in because she'd been side-swiped and they wanted to monitor the baby, one woman came in because she was very sick with a cold and they wanted to monitor the baby, the other women that came in were either in active labor or the early stages of labor. We sent one woman home because she was not progressing which was unfortunate for her because she lived in Rockford--a good 2 hr drive.

Another woman who came in in labor was just truly unpleasant--We asked what brought her in and she snapped "Are you kidding me?!" We weren't. We then proceeded to get her into her room, asked some questions and left for a bit. When we returned the nurse flipped on the light and the patient barked "you could've warned me!" We had to start her IV because she needed penicillin as she was positive for a bacteria that can be very dangerous to babies as they're born and a blood draw. The needle my nurse used was HUGE and she blew the vein on attempt number one, which caused an instant goose egg. So she had to stick the woman again and as we walked out the nurse said "well that's not how that was supposed to go, I didn't use lidocaine because she was being such a snot." Ouch. Another patient knew NOTHING about her pregnancy--not her due date, her doctor, how much weight she'd gain (which I'd know down to the ounce). The only thing she knew was that she was high risk because the doctors suspected a heart defect--she was the one we sent home because despite contractions she hadn't progressed after an hr of walking around.

Peds we also get to have off-floor experiences in the PICU, NICU and pediatric ER. I've been to the PICU and I'll be going to either the NICU or Peds ER this week. I absolutely loved the PICU, the nurses only have 1-2 patients at a time (in med/surg they tend to have 5-6) and there is always something to do. The nurse I was paired with was very helpful and taught me a lot. She also let me do a straight catheterization--it doesn't stay in--on one of her patients. A 6 yr old boy who had come in after his mom had hit a parked construction truck--she was high. When the paramedics arrived he had no heartbeat but they resuscitated him and brought him to the PICU where he proceeded to code/crash on and off for 12 hrs. He was in the front seat of the car and suffered such severe whiplash that his spine was almost completely separated. He was trached and on a ventilator with minimal brain function. It was very hard to see the hardest part was that he moved in response to touch, despite being completely paralyzed. They were spinal reflexes but try explaining that to the grandmother who sees that and thinks he may be coming back. Despite that sad story and the 5 yr old patient who died last week I still liked it.

My second week on the floor I had a patient that didn't arrive until 5pm--we go off the floor at 7pm. So I wandered around and helped people where they needed it. Including helping a nurse do a blood draw on the strongest 2 yr old I've ever met; AND he was in almost a full body cast. Ridiculous. The following week as I went to flush my 3 yr old patient's IV line with water her started screaming, so I stopped. Then my instructor tried and stopped when he started screaming again. The nurse came in and told us to go ahead, sometimes they just get startled because the water is cold under their skin. It was not the case. When I pushed the 3mL water in--to more screams--all of a sudden both my instructor and the nurse called out 'stop stop!' I'd already put it all in but then I saw the bubble in his arm. His IV was infiltrated--the line had slipped out of his vein and all the water went into his skin, which is very painful. I felt horrible, though I know what it looks like and sounds like for the future. I got back on my patient's good side with chocolate milk and mac-n-cheese.

Last week I was just on the floor and I had the most difficult patient on the floor. He had come in with pressure ulcers--having been born with down's. He had a stroke that ended with a massive brain bleed and left him unresponsive. He ended up getting surgery for his sores but while I was caring for him they suspected he had developed blood clots in both legs. I gave him a feed through a tube that goes straight into his stomach. He was also trached and required suctioning--which I got to do, as well as trach care (cleaning the part that sits in the neck, replacing the ties that keep the plastic plate in place) While I was doing that with my instructor, and being observed by 4-5 other classmates, his grandmother walked in and looked mad. Unfortunately it took a long time to get the new ties in place because his body was very stiff from having not moved in so long. When we finally finished 2 girls stuck around with me so we could change his sheet. But it was not meant to be a smooth process. The sheet was stuck to his surgical wound/staples, so we were spraying the sheet and wound with a special product that was supposed to help loosen the sheet. But it wasn't working so I told the other girls to stop and went to get the nurse--who sent in the tech. When I got back in the sheet had unstuck so we got the old one out from under him--slowly and gently because we didn't want to make anything worse. Then the grandmother got more mad and called out "this is taking too long, where's the nurse?" None of use answered because we were focused, so she left the room and got the nurse. Upon re-entering with the nurse she shouted at her "this is taking too long, there are too many people in the room, they don't know what they're doing and we said we didn't want any students with him." So we repositioned the kid and I got out of there as quickly as possible. It was a frustrating and upsetting experience. Not because the grandmother didn't want students--that's fine, I completely understand--but because she said I didn't know what I was doing, when I was doing everything I could to keep him from getting hurt and because my nurse didn't come to help when I asked. And it wasn't the first time that day.

It seems like I have a lot of horrible experiences but every week has its ups and downs, and I'm still trying to get comfortable doing everything. I have been enjoying myself despite some of the bad days. The hardest thing at the moment is finding the time to do all the paperwork I have for clinicals, sleep, eat and study for exams. It will be wonderful when I'm done with all this paper writing business. I just volunteered to work a health fair on the south side of Chicago giving flu shots, BMI, BP, wellness screenings, that kind of thing. Should be interesting to say the least. Sorry this is SOOOOOOOOOOOOOOOO long but I had a lot to catch you up on.