My Last Clinical

My last clinical for the semester was on Thursday. It was a great night, I had a fantastic patient and I got to practice a lot of my skills.

As you may remember, I've been working on the surgical floor in my hospital, and while most of my patients have been recovering from bariatric surgery (I'm at a bariatric center of excellence), some have been patients with abdominal tumors, pancreatic disease, etc.

My patient this week was a 65 year old man who had an acute MI that caused a bilateral pneumothorax followed by the onset of pneumonia. He had a chest tube in on the right reinflate the lungs and was on high dose corticosteroids and antibiotics to treat the pneumonia before he could head to the cardiac cath lab to treat his underlying heart problems.

My head to toe assessment on him was quite revealing. He was the first patient that I've had with crackles--When we were in lab our instructors used a simulator to play the lung sounds while we listened with our stethoscopes. Let me tell you, there's nothing quite like hearing the real thing for the first time on a patient. I will never forget what crackles sound like after hearing that.

It was also interesting to listen to his heart--he had all sorts of problems going on, spontaneous a-fib, tachycardia, right BBB, right ventricular hypertrophy, etc. And while we haven't learned to read EKGs yet (that's in two semesters when we have acute), I could tell that they were all over the place, depending on the day in which they were taken. His EKG from the ER was insane!

Anyway, he was also a type II diabetic, which I found unusual as he was 5' 8" and 110 pounds...I looked at him, saw diabetes in his chart, and assumed he was type I, but I was wrong.

Apparently he had some serious cachexia going, probably because he also had sarcoidosis (which would explain the weight loss) and was undergoing stem cell transplants over the last 3 years. See and to me, sarcoidosis is something you only ever see on House, so it was exciting (morbid, yes, I know) to see it in a real patient.

I got to practice my subQ injections again by giving my patient 21 units of Lantus and 7 units of Novalog (2 separate injections = extra practice) in addition to all his PO meds for hight blood pressure and high cholesterol as well as various expectorants.

All in all, it was a really great way to end my semester in the hospital. My patient was wonderful and he certainly had problems that don't normally appear on the floor we were working.

Now all I have to do is make it through all my exams and finals that are coming up in the next few weeks and then it's smooth sailing to the Caribbean for a very much needed, month-long vacation. But it gets exciting when I get back, as I'll be starting my psych and maternity clinicals!

We're Rapidly Approaching the Light at the End of the Tunnel!

The semester is readily winding down and things are starting to get even more stressful than they have been throughout the semester. To be honest, I didn't really know that was even possible. Luckily, I don't have any exams this week (just waiting to see my grade from last Friday's disastrous pharmacology exam). I have my fourth pathophysiology exam next Tuesday and then we're off until after Thanksgiving. This can either be a blessing or a curse. As soon as we're back, I have a 15-page paper due in Health Assessment, an exam in Adult I (med-surg), my Adult I final practicum, and a Pharmacology quiz. It's a real blast!

So that obviously means that Thanksgiving is going to definitely be a working holiday. Then there's one more week of classes and then it's on to FINALS!

I honestly can't wait for the semester to be over and to be able to say I have one semester of nursing school under my belt. I register for Spring 2010 classes tomorrow (ahh!) and I'm really excited because I'll be taking Maternity, Psych, gerontology, culture & health, and dying with dignity. Both maternity and psych have associated clinicals, so I'll be in the hospital two days a week, rather than just one. I think this will give me more of an idea what it will be like once I've graduated and I'm out there working as a nurse. Additionally, I won't be taking both pharm and patho simultaneously, so I think there will be slightly less stress to manage. We shall see, I suppose...

ATI Testing

So today was my first ATI test. I'm not sure how many of you out there are required to take ATI tests as part of your nursing education, but almost all of my nursing classes require a passing grade on proctored ATI tests in order to pass their classes. I think the idea behind the ATI is that if you can pass these exams in each subject, you should be pretty well positioned to pass the NCLEX when the time comes.

Today's ATI exam was for my Introduction to Professional Nursing class. There were two parts, a critical thinking assessment and a test of essential academic skills, or TEAS. The first test was pretty tedious, asking various questions meant to test your interpretation, analysis, explanation, inference, evaluation and self-regulation skills. The questions varied, and in my opinion, some of the questions were slightly ridiculous, but I suppose that's the point.

The second test, the TEAS exam felt more like a "normal" standardized test. It tested reading, science, math and English skills. On this exam, I was even able to get a perfect score in some categories! Although it did require me to remember basic math skills, including long division and geometry. Man, I haven't done math without a calculator in ages! It kind of felt good to be doing it with paper and pencil again.

Anyway, so I've survived my first of many ATI exams this semester. This one didn't require a minimum score to pass, but my ATI's for Adult I and Pharmacology do, so I hope they appear to be more on topic than today's was.

I just completed my Pathophysiology take home exam that's due tomorrow and I've been studying for Wednesday's quiz in Adult 1 on diabetes mellitus, nutrition, sleep patterns and home care. Then it's off to studying for Pharmacology. Did I mention that Friday's Pharm exam covers 15 chapters of material?? I think I'm screwed!!

My First Injection!

Thursday's clinical was a very exciting one! We started off with an hour-long lecture from a respiratory therapist discussing the various methods used for oxygen delivery in the hospital setting. I was already familiar with the non-rebreathers and the nasal cannulas, but learning about the various ways to deliver humidified oxygen was new. We learned about the different flow meters and how it's possible to deliver only a certain percentage of oxygen to the patient, depending on the order.

After this mini-lecture, we headed up to the floor and received our patient assignments for the night. I was assigned a 35 year old woman who has just had gastric banding surgery the previous day. To make it more interesting, she was tachycardic and would spontaneously go into atrial fibrillation, with her heart rate fluctuating around 130 for almost 24 hours. I was told they were planning to cardio-convert her if the heart rate did not slow.

I saw a cardio-conversion years ago when I was working in the emergency room, but didn't really know the physiology behind what was happening to the patient or why a cardio-conversion was necessary. I was really looking forward to seeing another one!

So we go in, introduce ourselves to our patients and take a round of vitals. My patient's BP is 164/106, her heart rate is 127, respiratory rate was 24, temp was 98.4 and her O2 sats were 87%. I quickly got her back on a cannula with 2L going and notified her nurse.

The nurse promptly notified the doctor who ordered 5 mg of Lopressor to see if the HR and BP would come down. It just so happened that she was due for her Lovenox as well, so I was asked if I wanted to administer that myself, subQ. This was my first opportunity to administer an injection, or medication of any kind actually, since passing my drug calculations test, so of course I jumped at the opportunity. The Lovenox was a pre-filled injection, with 40 mg/0.4 ml. I was instructed to inject into the patients left thigh. This being my first injection, I was a little nervous, but incredibly excited. It was my first real nurse-like thing that I got to do!!

So now apparently my patient was needle shy, which would have been a nice thing to know prior to going in there with my injection all ready to go, but after I picked my site, pinched, and went to inject, my patient jumped. Now, this of course got me upset because I was thinking that I botched my first injection, that I put the needle in with too much force or something, but I later learned when sticking my patient for the glucometer that it was a fear of needles, as she jumped before I even pricked her finger...

Anyway, all in all, I thought it was a good night. I didn't end up seeing a cardio-conversion that night, but I did get to inject, watch the mini-infuser of Lopressor go in, and watch the administration of Cardizem. Unfortunately, her BP and HR remained elevated and the cardiologist on call scheduled the cardio-conversion for first thing the next morning. So, I didn't actually get to see the procedure, which wasn't too upsetting because I've already seen one, but I did get to work with a great nurse and a very interesting patient.

All in all, it was a great night in the hospital!

Where Have all the Clinicals Gone?

So my midterm results are in--I got 3 A's and one C+. The C+ was the most disturbing part of the whole week. I'm really not enjoying the professor--she's quite eccentric. In the past, she's asked a fellow classmate to run up to her office to fetch her Prozac, hit a student on the back of the head for yawning in her class and demonstrated "brearing down" and Kegel exercises. Talk about inappropriate.

Anyway, last week's clinical was cancelled because one of the two clinical professors had a tragic death in her family. She cancelled her group's clinical this week as well, as I think there are still some funeral arrangements going on. My clinical professor gave me a call this afternoon as well to cancel our clinical. Apparently she had the H1N1 vaccine and is terribly ill--nausea, vomiting, high fever, chills, etc. This has been a common occurrence among people I know who have gotten the vaccine.

I'm kind of bummed about not getting in to the hospital--I haven't been there in almost a month! At this point, I feel like it's been ages since I've gotten to interact with real, actual patients. Let's keep our fingers crossed for next Thursday's clinical!

First Midterm Tomorrow

So my first midterm is tomorrow--both my health assessment lecture exam as well as my lab practicum exam. I don't know what it is about the material or if I'm just in some sort of rut, but I'm finding it really difficult to buckle down and just study for this. One of my classmates told me that she was at the library studying until 1 am yesterday and was up again at 4 am this morning to pick up where she left off. This just seems crazy to me. I just don't understand how there can be that much information that she needs to memorize for this exam. I mean, even if you haven't done any of the reading throughout the semester, I still feel like that is unnecessary. I suppose I shouldn't judge though--everyone has their own individual study habits. Alright, off to force myself to sit down and run through the physical assessment yet again!

Fall Break

So today is my second day off for what my school affectionately calls "Fall Break." It's nice having a little break, but I return to my Health Assessment midterm and practicum, both on Monday, my second Pathophysiology exam on Tuesday and my Adult I midterm on Wednesday. I was supposed to have a Pharmacology exam on Friday as well, but we didn't finish covering the necessary material, so that got pushed to the following week--thank GOD!

Anyway, so while this is supposed to be considered time off, a couple of days for us hard-working students to rest our over-studying brains, it is instead an incredibly stressful few days where we can all start to panic about how incredibly overwhelmed we all are.

The one nice thing though, is that I did go see Billy Elliot with my mother last night - nothing like a little theater to break up all the stress. It was really fabulous, and for anyone in the NYC area, I highly recommend it.

OK, off to continue the studying!