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pantshead: (Transformers)
You guys!  It's our final semester!....That was pretty much the mood when we all got back to school this week.

Of course, we've all heard a lot of scary things about this semester, so there was a fair amount of anxiety as well!

We did not have clinical this week, and we've been assured that we'll only have 1 patient next week to start out.  However, we are expected to be able to step up our care and our assessments...by the end of the semester, after all, we need to be able to make decisions on our own about patient care. 

Instead of clinical, we had a lot of classroom theory work.  We started by learning about Total Parenteral Nutrition, which is a feeding solution that is given through the vein.  Basically, it's the major nutrients (carbohydrates, amino acids, and fats) in the state they would be after they've been absorbed from the gut.  Medicines, vitamins, and minerals can also be added.  Each bag of the solution is custom mixed each day by the pharmacy, and they're wicked expensive!  (>$1500 each).  It's used for patients who cannot tolerate any absorption through the gut (like metastatic stomach cancer, or obstructed bowel), and also for patients with extreme healing needs (like burn patients, who need a lot of calories to fuel the rebuilding of tissue).

Then we had a review of some concepts about diabetes, and a math class (review of the calculations we already know how to do, and also learning a 'new' calculation--some medications are given in micrograms/kilogram/minute by an IV.  These might be things like blood pressure medicines for unstable patients.

Then we had a 'skill validation,' which we were all expecting to be really intense.  We had prepared several skills, and were told to come to the lab to do them.  Normally, this means an instructor watches you like a hawk and you have to do every last thing perfectly.  However, in this case we just talked through the skills as a group with an instructor, and reviewed the kinds of assessments we'd make for each skill.

Thursday in class we started learning about liver diseases--the viral forms of hepatitis.  We'll learn about cirrhosis on Tuesday.  On Friday (today) we learned about traumatic chest injuries--blunt force trauma, punctures, etc...and the basic mechanisms of internal damage and treatments.  Usually, this involves a chest tube, which is put into the space around the lung to remove air or fluid from this area (where it otherwise prevents the lung from expanding and will cause the lung to collapse).

That was pretty much our week!  Next week, we start clinical!
pantshead: (Transformers)
Well, this is a little delayed, but better late than never, I guess...

On Tuesday and Wednesday of Week 15, I took my final exam in OB, then the computerized exam (which was harder than I expected) and also the computerized exam in Mental Health (which was also harder than I expected!).  I had my evaluations with both clinical instructors, which went well.  I assume our grades have been posted by now, but our online registration site has been defunct since the middle of the semester so I can't check.  (This made registration for Spring of 2013 really easy, lemme tell ya!)

So, that officially marked the end of the semester.  3 out of 4 complete! 

Thursday and Friday I did...something...which probably related to getting Christmas presents ready to mail?  I really don't remember, and it was only 2 weeks ago.  Maybe I slept a lot...  My vertigo continued to slowly go away, and by Saturday the 15th I wasn't very aware of it any more except when trying to keep my balance or moving with my eyes closed. 

Saturday I started a Clinical Elective, where we get to spend 5 days on a floor with an instructor and just hone our skills.  I'm really glad I did this!  It brought back to mind all kinds of management and organization issues I need to keep working on, and gave me a chance to practice some skills I haven't used in a while.  I got to give my first intramuscular injection, too.  (It's flu/pneumonia vaccine season!).

The Elective met on Saturday, Tuesday, Wednesday, Thursday, and Friday.  On Monday, I mailed all the Christmas presents, having spent Sunday making fudge and bread to go in the boxes.  I can't say I really did a lot on Tuesday-Friday after Clinical--it's pretty exhausting, and I had to be there at 6:30 in the morning.  I definitely think that evenings will be my preferred shift (if I get a choice!). 

My brother arrived from the midwest on Saturday the 22nd, and we had a really nice week with him.  We went out to Rochester to visit a family friend on the 24th, and then had Christmas at our house.  On the 27th we did a lot of shoveling, but it wasn't too bad since the only pressing engagement we had was for PoC to go to work each evening.  (I so wish we were in a position where he didn't need to work nights, but it's a paycheck...)  My brother left on Saturday the 29th, and we left a few hours later for a very short trip to VT to see PoC's family.  The drive took about an hour and a half longer than usual, but we made it safely and returned home safely on the 31st.  Two days there is really about enough, anyway!  Now I'm enjoying relaxing at home for a few days until I really start to feel like I must study for next semester (the syllabus comes out next week; classes start on the 15th).  Maybe I'll write our Christmas letter! 

Behind the cut, for length, a recap of some of my clinical work this semester (Pediatrics, OB, Mental Health; I already talked about the Community-based nursing stuff).  As usual, excuse the fact that I can't indicate age or gender!

Clinical recap )
pantshead: (Transformers)
Almost done!  This was our last full week of classes and Clinical for the semester.  We didn't even have any exams this week!  (With these 8-week long classes, each of which have 4 exams, it's a rare thing.)

Tuesday wound up being my final day of Mental Health clinicial.  I was supposed to go on Wednesday as well, but Tuesday I woke up with moderate vertigo and by Wednesday I decided it wasn't worth driving down to the hospital again.  We can take one 'sick' day per semester pretty easily; any more than that involves all sorts of paperwork.  So, Wednesday I just slept and tried not to move around too much.  The vertigo is crazy and disorienting.  I'm calling it 'moderate' because I can still walk and drive (carefully, and only when I know the roads...), but I'm never free of the sensation that the room is moving.  Even closing my eyes doesn't help.  My gait has changed perceptibly--I usually walk very quickly, and I'd say I'm usually pretty confident about where my feet will fall.  Not now!  Now I have a bit of a stagger, and it's hard to walk in a confined space (like, say, the house) because doing so involves so many quick changes in direction.  Anyway...it's gotten a little better since Tuesday, but it isn't gone.  My doctor attributes it to the cold a couple of weeks ago--inflammation of the ear canals.

So, after sleeping for most of Wednesday, I spent the rest of the time looking up information on designer drugs (like synthetic marijuana and bath salts) for a presentation we needed to give on Thursday in Mental Health.  The presentation was only worth 5% of our grade, so I don't think anyone in our group really cared.  We never even rehearsed it as a group!  However, we did okay and now it's over.  Other group topics--which I thought were more interesting, but my group was really into the designer drugs thing--included PTSD/veteran suicides and historic treatments for mental illnesses--such as strapping the patient into a spinning chair to stir up the blood, and infecting schizophrenic patients with malaria.  [Maybe I was just especially sympathetic on the spinning-chair-thing this week...]

In OB/Maternity, we learned about postpartum complications and spent a short time talking about perinatal losses--which includes everything from a loss of fertility to a stillbirth or neonatal death.  This is a side of OB that we didn't really see during our Clinical--our instructors tried to give us healthy patients with healthy babies so that we could learn what 'normal' looked like.  One student apparently did see a birth during which the baby had to be resuscitated, but as of our class time, the baby was doing okay.  Our last day in OB we learned about women's health promotion...or at least touched on the topic.  Obviously, it could be a whole class or field of practice!

On Friday we had our computer-exam in Mental Health, which means that class is officially done except for my Clinical evalutation with the instructor next week.  Next Tuesday we have our 3rd exam in OB, and then the computer exam in OB on Wednesday.  And then I've signed up to do a Clinical elective like I did over the summer--5 days on a Clinical floor, with no paperwork to do!  I think it will be good for me--we don't get to use a lot of our hands-on skills during the 4 classes I just finished, and I know we're going to need them when we start our final semester.  By the end of that, it will be the 21st and almost Christmas...good grief!
pantshead: (Transformers)
[Thanksgiving Week doesn't get a number in this accounting of weeks, in case you were curious.  Though as I mentioned a while ago, the inconsistent numbering of weeks has made our online learning site a little confusing.]

We had a really nice Thanksgiving!  PoC's mother, sister, brother-in-law, and niece were here from Wednesday through Sunday.  The weather was beautiful on Thursday, but did get progressively wetter and colder by Sunday.  We mostly ate food and played games, as predicted.  It was nice to host them--they haven't been out here since 2008 when we first bought the house--and generally pretty stress-free!  I didn't even try to get any homework done!  I did do a lot of dishes (much as we love PoC's mother, she's terrible at doing dishes.  The easiest way around this was for me to just say that I would be doing all of them). 

The only downside to Thanksgiving week was that I had no voice for Sunday - Tuesday, and it was pretty rough on Wednesday, even.  The sinus infection tried really hard to take root, but ultimately failed, and the bronchitis attempt also finally petered out.  Now I just have the lingering quasi-asthmatic-wheeze that drags on me for weeks after I have any type of cold.  So, it was indeed fortunate that we had no classes all week long (and especially not Clinical, which I would have had to miss).

After the family left on Sunday morning, I did a lot of laundry and cleaned the house, and then finally ran out of ways to procrastinate and got back to doing homework.  I was back in OB clinical this week on Tuesday and Wednesday (more on this in a week or two), and we have our last big write-up and assessment packet due now.  Theoretically it was due this morning (Friday) but our instructor knew we all had an exam in Mental Health on Thursday and an exam--followed by more lecture for the rest of the class period--in OB on Friday.  Sooo, because she's super-nice (and possibly more sympathetic than she really should be!) we don't have to turn all of that in until Monday morning.  I'm really grateful for this, because I've been wiped out all well--probably the residual cold combined with recovery from the holiday flurry.  So, I just focused on studying for the exams (which both went well) and I'll get all the rest of it done this weekend.

We also had to register for the Spring semester this week--if all goes well, this will be the final semester for everyone in my class!  Our numbers have been cut almost exactly in half from when we started school in August of 2011... 
pantshead: (Default)
Woohoo for Thanksgiving Break!  And not a moment too soon, apparently, because the seemingly minor headcold I was getting on Monday/Tuesday is now trying really hard to turn into a sinus infection.  Or maybe it'll just keep moving down my trachea and turn into bronchitis.  I would prefer neither of these options.

Anyway, this week I was back in Mental Health clinical, but only for one day.  She gave us the other day "off" in exchange for the support groups that we're visiting.  Our first week of MH we were really just supposed to focus on getting comfortable on the floor talking to patients.  We were supposed to practice things like the Mental Status Exam (which consists of our observations of the patient's affect and thought process, and the patient's answers to 2 questions:  "How are you feeling right now?" and "Are you having any thoughts of hurting yourself or anyone else?") and work through the 'therapeutic relationship' conversation.  We learned about that last year--it's a specific conversation in which the patient identifies a cause of concern, then identifies their thoughts and then feelings about that concern, and then comes up with ideas of how they could solve or reduce the problem.  It's kind of like cognitive-behavioral therapy, I guess.  This week we were supposed to use all of those skills (the MSE and the therapeutic relationship) to talk more in-depth with a patient and then create a big write-up and care-plan targeting one of the patient's issues.  So, we did all that and turned them in on Friday, and then also wrote up our lengthy self-assessments.

Thursday and Friday were lectures as usual (with no exams!).  In Mental Health we learned about schizophrenia--the disease one day, and the medications and treatment the next day.  In Maternity/OB, we learned about complications in the 2nd and 3rd trimesters of pregnancy (such as placenta previa--when the placenta grows over the outlet of the cervix, causes bleeding, and usually necessitates a C-section birth), then moved on to learning about the specific adaptations the newborn goes through in the first few moments and then hours of life.  These are really pretty cool--it's stuff like "the ribs/thorax are compressed by the birth canal, which not only squeezes out a lot of the amniotic fluid, but then causes them to recoil open when the baby's torso is born.  This recoil creates vacuum pressure in the lungs and in the blood vessels surrounding them, so all of a sudden blood starts flowing to the lungs from the heart because now it's suddenly the path of least resistance (which it never was during the pregnancy; most of the blood bypassed the fetal lungs and circulated to the body).  The vacuum pressure also draws in air via the nose, so then oxygen can begin to be exchanged in the lung tissue."  Also, the withdrawal of certain maternal hormones causes other changes to happen, and in relatively short order, a baby which has never survived in the outside world before is ready to do so.

This weekend, as I mentioned last week, friends visited and found themselves an apartment.  We've now pretty much gotten the house ready for PoC's family to visit starting on Wednesday--just one more bed to make up and a last round of cleaning to take care of.  And, I guess, a bunch of food to start making!  So, I'm going to try to be good and drink a whole bunch of fluids and get some homework done in the next two days! 
pantshead: (Default)
This week wore me out, for no particular reason.  I guess we've just reached that point in the semester.  I was back in Maternity/OB for clinical this week.  We spent our last day on the Labor & Delivery floor, and then spent a day in the newborn nursery.  In the nursery, our focus was on learning to do a full assessment of a newborn.  The physician also checks all of the babies before discharge, but it's an RN who checks the baby at birth unless a) It is known in advance that the baby is likely to have some problems adjusting to life outside the womb--such as known deformities, or maternal conditions like diabetes that cause the baby to become hypoglycemic at birth or b) The baby needs to be resuscitated at birth.  In both of those cases, the baby goes to the NICU (neonatal intensive care) immediately after birth.

Among the things we're learning to look for (in an approximately head-to-toe fashion):  The skull--the fontanels (soft spots) should be soft and flat; the bones of the skull might be overriding on each other after a vaginal birth but will straighten out over the next few days; the bones should not be fused together yet.  The features--eyes should open, the tops of the ears should be level with the eyes, the nostrils should both be patent (allow air through them), the lip and palates should be intact, the baby should be able to suck on a finger.  The baby's neck should be able to turn.  The baby's clavicles should not be broken (not uncommon, apparently).  Overall, the baby's position should be 'flexed'--ie: huddled in a little ball.  Babies who splay all their limbs out, or are fairly limp, are probably not getting enough oxygen or are not fully mature.  Fingers and toes should be the correct number.  The sound of the breath should be clear, and you should be able to hear some bowel sounds.  The umbilical cord should have the right number of arteries and veins.  The spine should be intact (no gaps when you run your finger down it).  The genitals should be fully developed (underdevelopment is common in premature babies, but they do catch up later).  Reflexes like grabbing with fingers and toes, splaying the toes when the foot is stroked, sneezing, sucking, turning in the direction of a stroked cheek, and flailing when startled should all be present.  The lack of any of these gets noted--some things can be signs of anomalies (spina bifida = non-intact spinal column; low-set ears is common in people with Down syndrome); some are signs of maturity (creases on the palms & soles of feet develop as the baby matures, so preemies have smooth palms); some are signs of adaptation (extended/splayed posture, blue hands and feet = lack of oxygen). 

We haven't really seen any babies who were not 'normal' nearly-full term babies.  For some of us in the group who don't have children, it was as much about simply getting comfortable with the babies as anything else!  There are 3 mothers in our group, so of course they were a little more experienced in this regard. 

In lecture for OB, we learned about the Stages of labor, which my group has already done in Clinical.  We learned more about what happens in each stage (the movements the baby's head goes through, etc...) and also types of pain management in each stage.  We also learned about fetal heart monitoring, and how to interpret signs of distress vs. normal reactions. 

In Mental Health we had our 2nd exam, and then on Friday we learned about personality disorders.  One of our Clinical requirements is that we go to 2 community-based support groups and write about our experience.  So, this morning I went to a nearby (open) AA meeting.  (Many meetings are closed--they are for alcoholics only.  This area has meetings at just about every hour of the day, though, so it's not hart to find an open meeting somewhere.)  I'm not sure what type of meeting I will go to next.

I'm going to try to be good and get my homework all done early this weekend so that I can start getting the house ready for Thanksgiving week.  We don't have any more exams until after break--hooray!
pantshead: (Default)
Onward!  This was my first week on the Mental Health unit, which is a locked floor of a nearby hospital.  The unit can be entered by anyone with a badge, but can only be exited with a key through a double set of locked doors.  This is for the protection of the patients as much as anything else.  I'd say (unscientifically) that about half of the patients we saw had been admitted involuntarily (which means that they said they were thinking of hurting themselves or others--or actually tried to do so; or were unable to care for themselves because of a mental illness).  In NYS, an involuntary admission must be reevaluated after 72 hours.  Many patients also chose to "convert" their admission status to a formal, voluntary status, which means they wrote a petition for more treatment.  The remaining half had been admitted voluntarily to begin with.  Generally, we saw patients with anxiety disorders, depression, and personality disorders.  We saw a couple of patients who were biploar, but none of them were in a manic state (which is really a form of psychosis--the person is completely unaware of the consequences of their actions).  Treatment on this unit focuses on helping the patients get back on their medications, and also on learning and practicing coping skills within the safe setting of the unit.  So, a patient who has angry outbursts can work on finding new ways to respond when provoked...rather than having an outburst at work and losing his job.  Nurses and other staff on the unit (counselors, social workers) give them feedback and support.

Mental Health is interesting--and needed for all nurses, since mental illness affects up to 50% of the population--but I don't think I want to work in the mental health field.  Most of the work we do is simply talking with the patients.  While I recognize that it's important, it's just not something I feel very excited about doing day-in and day-out.  The primary paperwork that we have to turn in for this unit is our Self Reflections, in which we need to write in great detail about how we met each of the school's 8 objectives in this area.  I loathe writing these...and we all heard that this instructor was really harsh on last week's group.  We'll see...

After clinical, I had class as usual on Thursday and Friday.  In the Maternity/OB class, we had our first exam (which went very well), and we've begun learning about the actual process of labor.  Those of us who were already on the labor and delivery floor last week are already a little bit familiar with this, but it wasn't possible to synchronize the lecture content to our clinical days.  In Mental Health we learned about mood disorders and suicide. 

This weekend a friend visited, and we learned he'll be moving to the area.  So, that was a nice surprise!  That's all the news...
pantshead: (Default)
Our first week of clinical for the new rotation!  I started in Labor and Delivery (I go to Mental Health next week).  It was an unusually quiet week on the L&D floor, but some of us did get to attend births.  (More on this at the end of the semester when it won't be date-stamped.)  This hospital has an L&D floor with private rooms where the families can go through labor and then deliver the baby.  There's a separate high-risk wing (I haven't been down there yet) and 3 operating suites for C-sections (haven't been there yet either).  A few hours after the delivery, the mothers & babies move to a different floor where they spend a day or 2 in the hospital before going home.  We'll go to that floor 1 of the days next week, but I haven't seen it yet, either.  It seems to me like it would be a little awkward to change floors, but I guess this hospital is usually so busy with deliveries that they really can't afford to have some of the rooms taken up by postpartum families.  Also, I think it allows the nurses to be more specialized--the nurses on the L&D floor help with the birth and assessment of the baby, and of course with the labor, but they don't really do a lot of baby care or post-partum care. 

In lectures this week, we continued learning about antepartal discomforts and just started learning about complications.  We'll do more on that next week--everything from preeclampsia (hypertension during pregnancy) to diabetes (whether it develops during the pregnancy or the mother already had it) to blood incompatibilities (an Rh - mother carrying an Rh+ baby needs to get treated so her blood won't become sensitized to the '+' in the baby's blood)....and also things like drug/alcohol use during pregnancy.

In Mental Health, we had our first exam on Thursday and then learned about anxiety and obsessive-compulsive disorders on Friday.  It was a beautifully warm day here, and she let us out early!  (Today, Saturday, is gray again.  But I don't think we're going to get much of the Frankenstorm, so I can't complain.)
pantshead: (Default)
Our new rotations have begun!  No clinical this week, but lots of orientation and lectures. 

Tuesday was our orientation day for Maternal/Neonatal care.  We had lecture in the morning, and then met with our clinical instructors and toured the labor and delivery floor of the hospital.  My group will be starting in L&D and then move to the post-partum floor (where mothers and their babies stay for a day or two before discharge).  We start on this floor next week--the hope is that we'll all get to see at least one birth.  Unfortunately by next week we won't have actually covered labor and delivery in lecture, which means we have some extra reading to do this weekend.

Wednesday was our orientation day for Mental Health.  This was a shorter day, because we didn't go tour the clinical unit.  We started learning about some of the statistics regarding mental health (as many as 50% of people will experience some form of mental illness in their lifetime) and also some of the barriers to receiving care (lack of insurance coverage and stigma being two big problems).  We will do clinical for this class, too (I start the week after next).  The clinical takes place on a locked floor of a nearby hospital.  Mostly, we'll just be talking with the patients....and writing about it a lot.  The floor is a locked floor mostly for the protection of the patients (not the protection of 'society').

Thursday and Friday we had lecture in both classes.  Unlike Community health (last rotation), these are both 3 or 3.5-credit classes.  This means 2.33 hours of Maternity lecture each day, and 1.8 hours of Mental Health.  By Friday, the Mental Health lecture seemed sort of interminable...  we were all just tired out!  Unlike last rotation, we don't have quizzes everyday!  And there's only one group project, due at the very end of the semester and not worth very much of our grade!  We do have plenty of other work--including our first exam coming up next week already--and more-detailed write-ups to do from our clinicals.  

In other news, we were excited to hear that PoC's family is hoping to come out here for Thanksgiving.  Still hashing out details, but it would be nice to have them! 
pantshead: (Default)
This was a shorter week than last week!  I had my 3rd exam in Pediatrics on Tuesday (it went fine), and then 2 exams on Wednesday.  The school uses a testing company as a part of the curriculum.  The testing company publishes its own books, which the school gives us.  When you take their tests, it gives you feed back on what areas you should review.  The tests are scored with a raw mathematical score and also a percentile score and a "proficiency level" (3 is best, 1 is not good, < 1 is very bad).  The percentile is based on all takers of that particular test who are in similar degree programs (ie: Associate Degree in Nursing programs, for us).  The school takes the percentile rank (not the mathematical score), and turns that into a score that's worth 5% of our course grade.  I'm a little skeptical of this whole process, but I can't complain--I've gotten a proficiency level of 3 on all of them so far.  However, my raw mathematical score has been in the low 80's...so I'm sort of thinking "what does it say about the test--or about nursing students--if a score of 82% puts me in the 98th percentile?!"  Anyway, we took those two exams, and had our clinical evaluations with our instructors, and then we were done!

Thursday I mostly loafed around, went back up to the hospital to get my free flu shot, and worked in the garden a bit.  Friday I did start doing some of the reading for the 2nd rotation, but I definitely should work more on that today!  (Oh, the siren call of the internet...).  On Sunday I'll be playing in the handbell choir at church for the first time in (I think) about 7 years.  I used to sub for them pretty regularly, but my schedule at the Stage was always pretty wonky and I dropped off of the list.  It is definitely an amateur group, but everyone (other than me) who's in it either sings in the choir or plays & teaches music.  I haven't done anything musical since last playing with them (except for singing hymns with the congregation).  My sight-reading was really rusty at the first rehearsal (2 weeks ago), but I did better this week. 
pantshead: (Default)
This was only a "kinda" week--I only had classes on Thursday and Friday.  I was mostly good over the weekend (through Wednesday) and did my reading for class, etc.  I also had some time to work in the garden (taking out tomato plants, largely) and get some of the Fall clothes out of the attic.  Super exciting, right?  I also spent most of one afternoon figuring out my homework for the 2nd half of the semester.  The school uses Moodle (an on-line learning/management environment) to give us most of our course information.  I'm not really crazy about Moodle to begin with, but I think my issues have as much to do with the way the instructors use it as with the program itself.  Basically, for each course our assignments are posted under the week number.  The syllabus had a schedule --- "In Week 2, we're covering assessment of the newborn:  Topic 6 and 7."  So then I have to open up the Topic Objectives for each of Topics 6 and 7 to find out what the reading assignment is, and whether anything else is due.  Sometimes the week numbers don't line up between courses--one course doesn't assign a number to Thanksgiving week, and the other one does.  Sometimes the Topic numbers don't align with the actual content listed in the Syllabus.  So, anyway, it took a few hours to go through the Maternal/Newborn and Mental Health courses to figure all of this out, get it into my calendar, and get all the dates and times onto our calendar in the kitchen.

On Thursday we learned about blood disorders (hemophilia, anemia, thalessemia) and neoplastic disorders (ie: cancer).  On Friday we learned about infectious diseases and vaccinations, including a class debate about whether vaccines should be mandated by the government or not.  (The general consensus in our class: no the government shouldn't mandate them, but everyone who can get vaccinated should get vaccinated, and educating patients/families is the best way to help this happen.)

In our Community Health class on Thursday the remaining groups presented their community assessment projects.  I know I was wicked stressed out about this project several weeks ago--I'm so glad we already presented ours and didn't have it hanging over our heads until the end of the semester!  And we got our grades for the project--we scored very near 100%, which was awesome (and relieves my beginning-of-semester fears about failing a 1-credit required class because I was having so much trouble with the quizzes). 

So, that was my week!  It looks cold and drizzly for the weekend here, so I'm glad we got some garden take-out done last weekend.  I have 3 exams next week, so now I'll try to be good and study for them. 
pantshead: (Default)
This quarter is rapidly drawing to a close.  I had my last 2 days of pediatrics clinical this week--I got to take care of a 1-month old!  I'd asked my instructor if I could be assigned an infant, since I have so little experience with them.  Some of the assessment skills that we do are different for infants--such as taking the blood pressure just by feeling it (it's usually too faint to hear with a stethoscope), and taking the temperature under the arm (we do this for toddlers too; it's considered more accurate than those in-the-ear tympannic membrane thermometers). 

Our lecture on Thursday in pediatrics was about neurological disorders--seizures, epilepsy, Reye Syndrome, meningitis.  On Friday, we had a lecture/discussion about some of the issues involved in caring for terminally ill children.  Certainly a challenging, emotionally-laden topic for the group!  I will say, as a PSA to anyone who has continued reading so far, please, PLEASE consider making a Living Will with the assistance of your doctor or another knowledgeable person.  I feel like I've already read too many cases of a) the family didn't know the patient's wishes and felt unable to order cessation of life support, or b) the patient at one point may have said "I'm never going to quit fighting this illness," which led to enduring a terrible, prolonged death--intubated, unable to talk, feeding tube, unable to feed/bathe/dress, hooked up to machines and monitors, as the family tried to support the patient's wishes long past the time when any cure was possible.  A Living Will allows you to specify what treatments you want and don't want, and how long they should be used!  Okay, PSA over.

Our lecture in Community health was actually presented by the head of the school, who (among other things) is trained in disaster management.  She just gave us a quick overview of the role of a nurse in preparing for disasters (identifying at-risk populations, identifying what type of disaster is most likely, coordinating organizations that will work together to respond to the disaster), responding to the disaster (assessing, triaging, treating), and recovery from a disaster (including mental health support, re-assessment and evaluation, and bringing a community back to full health and functionality.  One thing I learned about triage is that it's very different at a disaster scene than in the Emergency Department.  In the ED, the assumption is that every patient can be saved if given sufficient treatment.  In a true disaster (ie: the needs are larger than the resources available), patients most likely to survive are treated first.  Patients unlikely to survive even with extensive treatment are labeled as "expectant," and (ideally) are given comfort care.  I understand why it doesn't make sense to use valuable resources on a patient who probably won't survive anyway, and I understand it must be harrowing for the person who has to make this decision.  But what I kept wondering was...who came up with the term 'expectant?'  It sounds so hopeful, and yet it means that death is expected soon...

Now I don't have school again until next Thursday!  Since I had 2 Community clinicals last week, I'm all done!  I'm hoping it doesn't rain the whole time--it's getting time to start putting the gardens to bed.  I hauled all of the fans up to the attic this afternoon and brought down our Fall coats.  We won't be wearing them quite yet, but we're definitely headed that direction.
pantshead: (Default)
A slightly less exhausting week, but I'm looking forward to sleeping in this weekend!

I had Community/Non-Acute Clinical this week.  As I think I mentioned, we do three of these total.  I had thought we'd have one for each of the 3 weeks of Community clinical on the calender, but as it turned out, some of us have 2 one week (Tuesday and Wednesday) and then a week off some other time.  I had 2 this week--one at an inpatient substance-abuse rehab, and one at an assisted-living agency.

The substance-abuse rehab was interesting, though my preceptor didn't do a very good job of actually teaching me what the nurses do there.  She just sent me off to the sessions that the patients were doing.  Patients usually spend 2-4 weeks there.  They can do detox there (not true for every rehab--some of them you have to already be detoxed before you get there), and then they can start their rehab there.  This facility has a 12-step-based program for alcohol and drugs (and people who are addicted to both).  They treat people age 16 and above--I'd bet that the oldest people I saw were in their 60s or 70s.  It feels, in a way, like the worst summer camp ever--all the staff are really nice and supportive, but at the same time there's a strict dress code, you can't wear too much makeup, you'll get written up if you horse around or don't keep your room clean, you can't bring any means of contact with the outside world, and men and women are not allowed to interact outside of official group sessions.  They eat in the dining room together, but at separate tables on separate sides of the room--staff also eat in the dining room to keep an eye on them.  So, imagine being an adult, for goodness sake, and not only do you know you're in trouble because you've hit rock-bottom with a drug or alcohol addiction, but now you're voluntarily allowing a bunch of other people to tell you how to spend every minute of your day.  I understand that this method is believed to be effective, and I guess it probably is--I heard a lot of stories about patients who felt really out-of-control in their lives (which led to the substance abuse, which then became a self-replicating problem)--maybe it's a relief just to hand over the reins to someone else for a while.  Every moment of the day is scheduled for them, from 6am to lights- out at 10pm.  I attended group lectures/educations sessions, and small-group therapy sessions.  The nurses seem to spend most of their time taking vital signs, assessing withdrawal symptoms, and handing out nicotine lozenges (it's a smoke-free campus). 

The assisted-living organization was also interesting.  It's actually a managed-care organization, which meas that patients receive all of their services (except emergency room visits) through them.  They have their own fleet of doctors, home-care nurses, aides, podiatrists, dentists, optometrists, etc...  If they don't offer a service, then they're required to pay the cost of the service to the provider--so it's in their best interest to offer as many services as possible.  Their goal is to help older people live independently for as long as possible (though "independent" can include 'living in a group home with 24-hour aide service but it isn't technically a nursing home.')  I spend the morning with a home-care nurse, and then the afternoon in their health clinic which is attached to their day center.

On Thursday, my group in the Community class presented our project.  The purpose of these projects was to have us perform an assessment of a part of town (treating that community as the "patient"), and then identify strengths and weaknesses, and use these to come up with a nursing diagnosis.  We then needed to come up with a plan and interventions to address this diagnosis--fortunately, it's a paper project, so we don't need to actually do the plan!  We won't have our grades on the project until the last week of the term...but at least it's turned in and finished! 

On Thursday in pediatrics, we learned about musculoskeletal disorders in children (ranging from fractures to muscular dystrophy).  On Friday, we had our 2nd exam.  I did fine, though not as well as last time! 

Now, weekend!  I'm feeling the urge to clean the house.  I wonder if it will go away if I stall long enough?  Perhaps I should just get on with it...
pantshead: (Default)
It's a little hard to believe this was only the fourth week.  I'm exhausted!  I did get to take a bit of a break from studying and help a friend move this weekend--actually a nice change of pace!

This week I had pediatrics clinical again, which I thought went pretty well.  We got our Pediatrics exam scores back, and I did very well--it's a nice way to start the semester.  We presented our group project in Pediatrics--that's one off the list!  I think it went okay--we don't have the grades yet.  This project is only worth 5% of our grade, which is not too intimidating.  We also learned about caring for children with cognitive & developmental delays (we focused on Down Syndrome and Autism, and also learned about ADD which is NOT a cognitive delay), lead poisoning, and children who have been abused.

I finished the paper for our Community class, which is much more stressful because the paper is worth 20% of our grade and then the presentation (due this coming week) is worth 30%.  Bleargh!  I volunteered to write the paper because the thought of us trying to write a paper as a group was enough to make me pull my hair out!  But now, of course, if we get a low grade on it (ie: anything below an A, in my book) I'll feel really responsible.  I was so stressed out by it that I started getting migraines and nausea for about 3 days.  Needless to day, I'm glad it's turned in now!  I don't actually have to do much preparation for the presentation--since I wrote the paper, the rest of the group is doing that.

In news that is slightly related to school, I've agreed to start driving a lady with dementia to and from church each week.  She recently lost her license (having been pulled over for driving erratically), and her family does not live nearby.  This isn't a job--I go to the same church--but I think it might actually be some good experience.  She's not someone I know very well, and actually I hadn't realized how sick she was.  I though she was just a batty (and sometimes irritating) old lady.  So, not to get too sappy about it, but it actually felt like a little bit of a Call (in the religious sense) to do something to help her maintain a normal part of her life. 

That's the news for this week!

pantshead: (Default)
As I mentioned earlier (I think) every other week we have Pediatrics clinical OR Community clinical.  This was my first week of Community clinical.  This is only a 1-credit class, so we actually only have clinical a total of 3 days.  We are assigned to the sites we visit--they range from in-patient and out-patient substance abuse treatment centers, to the poison control center, to assisted living and visiting nurse organizations, to the outpatient pediatric surgery center, and also the Urgent Care at the local hospital (one of them).  I was assigned to Urgent Care, which turned out to be a fast-paced, very busy day!  Urgent Care is supposed to see patients who have minor colds & fevers, insect bites, maybe sprains and strains (they have a radiology lab for X-rays).  It's a good place to go to get some antibiotics for your kid who has strep and also get a doctor's note explaining why you missed work.  This Urgent Care is actually affiliated with the hospital Emergency Department, which means they can easily transfer a patient who comes in with more severe symptoms.  

What I actually saw at UC was a mix of "what's supposed to happen" and "reality."  There were a lot of kids with fevers, sore throats, nausea, etc...  The structure of the place allows a "family unit" to be examined together in one room, which seems very smart!  These kids got strep tests, antibiotics if needed, and recommendations for fluids and tylenol.  There were a good number of "my foot/knee/arm hurts, I twisted/banged/don't know what I did to it."  These folks got braces/ace bandages, X-rays, referrals to follow up with an orthopedist, and prescriptions for Ibuprofen and (usually) something stronger as well.  There were women (and probably men, but I didn't see any) who came in for STD testing, pelvic exams, and pregnancy tests.  Sometimes they came in with another complaint--"my shoulder hurts, but I also have this weird discharge, could you test me?"  There were a few folks who came in who really didn't belong at UC--kidney stones, which require fairly intensive pain management and also a lot of IV fluids.  Interestingly, one of these was actually treated at UC because the patient's overall condition was more stable.  One was transferred to the ED because the pain was extreme and the patient had a lot of other complicating conditions.  I would imagine this patient was actually admitted to the hospital for a day or two, but I'm not sure.  I didn't see anyone who came in with chest pain, partial paralysis, or anything like that (ie: heart attack or stroke symptoms) but I'm sure it happens!  The patients seemed to be a mix of "I don't have a regular doctor," and "My doctor's office can't see me until next week, but I'm sick now!"  Most patients seemed to have some kind of health insurance (from what I gathered) but NYS has free or very-low-cost insurance for low-income kids, so you'd hope they actually had it! 

It was an interesting place to observe/work (I was actually able to help out) because the RNs have a lot more autonomy there than on the floor of the hospital, it seems.  The place is staffed by RNs, a radiologist, and EMT who does EKGs (heart rhythms) and blood testing, and Nurse Practitioners/Physicians Assistants who are the 'providers' (ie: the people who actually diagnose the medical condition).  The RNs usually see the patient first, and they can follow a series of standing orders to initiate care--such as drawing blood, ordering a urine culture, starting IV fluids, etc....based on the patient's initial complaint and symptoms.  Then the patient is seen by an NP or PA, and is then discharged by an RN with their prescriptions and instructions.  Everything gets documented in the computer, because often the RN who takes in a patient is not the same person who discharges the patient.  Their goal is 90-minute (or less) service, though the day I was there they were very busy and I don't think they always met this goal.

Aside from UC, we learned about genito-urinary diseases and defects in children, and then on Friday we took our first exam.  I think it went pretty well.  We got to go and check our answers against the key right afterwards (having already turned in our ScanTrons) and I don't think I missed many questions!  Woohoo!  We have another exam 2 weeks from now, I think.  It's hard to pack everything into an 8-week quarter! 

My plan for today is to do the rest of my homework for the week so that I can then write the paper for our Community project.  Our homework topics this week are lead-poisoning and Child Abuse.  Nurses are mandated-reporters in NYS (ie: if we suspect abuse of a minor by a person who's supposed to be responsible for that minor, we're required to report it). 
pantshead: (Default)
The dreadful cold that PoC has been fighting seems to have caught me within the last 18 hours.  Good thing it's the weekend, right?

Cold aside, this week seemed a little more manageable than last week, though my procrastination habits caught up to me between Thursday and Friday.  On Tuesday and Wednesday, I had Pediatrics clinical at the Children's Hospital.  As I mentioned before, we're on a surgery floor.  In general, it did seem (as I imagined) that most patients were otherwise-healthy children who needed to have surgery for a particular reason--broken bone, appendicitis, correction of birth defect, etc...  Some students in my group had patients who were chronically ill and/or had congenital conditions that contributed to their illness (ex:  A patient who had trouble swallowing correctly developed aspiration pneumonia--when material goes into the lungs--and needed to have a feeding tube placed in the stomach).  We saw a lot of patients who were there with their parents, but some parents simply can't stay in the hospital 24 hours a day--they have other children at home, or jobs, or both!  Dealing with parents was probably my biggest concern about pediatrics, and I can say I think I had a really great experience with one parent and a so-so experience with another set of parents this week.  The one parent was very supportive of the child, but also no-nonsense...didn't try to "bargain" to avoid a procedure that needed to be done that the child was frightened of, but just stayed with the child the whole time and offered reassurance.  The other set of parents were very wary of anything being done to their child that might possibly cause pain--which I understand, but it wasn't clear how they thought they would take the child home (the next morning) without pain since they wouldn't even let anyone take the child out of bed! 

We have less paperwork to do for Clinical in Pediatrics--just a 12-page packet each week on one of our patients (if we have more than one).  Completing the packet is supposed to help us take good look at all of the factors involved in that patient's health, and to evaluate whether the patient is at a "normal" stage of Growth and Development or is delayed.  We also need to show written medication calculations for each patient (and each med) demonstrating that the prescribed dose falls within the safe dosing range.  Children (at least these children) don't take nearly as many medications as adults, thank goodness!  (I had an adult patient last semester who was taking ~35 separate medications.)  We also must do an extended write-up one week called a Tanner's Model.  The Tanner's Model is intended to help us 'think out' our clinical decision-making process--we have to write about an incident that happened, and how we responded to it.  They aren't necessarily medical incidents--I did write one last semester on a hypoglycemic patient, but I also wrote one about talking with a patient who had been giving a life-limiting diagnosis.  This semester, they must generally be on a topic that deals with communicating with the patient (or family) or promoting health.  I wrote one this week--we'll see if my instructor accepts it!  (If they're borderline, we can usually revise them.  If not, we have to do a whole new one on a different topic.)

In our theory classes (Thursday and Friday) we learned about caring for children with GI and Cardiac conditions.  We also reviewed math, because every semester we have a math test that we must pass with 100% in order to pass the class.  It's always about medication adminstration--If Tylenol is supplied as 160 mg per 5 mL, how many mLs are needed for a 500 mg dose?  This semester, however, we first need to calculate whether this dose is a safe range for the child (SDR = 10-15 mg/kg/dose).  Then, if it's an IV medication, we'd calculate the rate of the infusion.  We've also learned to calculate minimum daily fluid requirements and the IV rates for them.  So, our math test was on Friday morning and covered all of that!  I passed!  (We get 3 chances, but I'd rather not need them...)

In our Community class, we learned about Transcultural nursing.  I did not fail this week's quiz, which makes me feel a little better, but I still think that class is going to take up a disproportionate amount of my brain until after the group project is over on the 20th.

And now it's Saturday!  Time to do next week's reading, homework assignments, and start studying for our first exam (Friday). 
pantshead: (Default)
The summer is officially over for me--classes started on the 20th.  I had finished my summer classes on the 8th, so I did have a brief break in-between classes.  The Microbiology instructor turned out to be awesome, which made that class fun and made me feel grateful I'd happened to pick his section (apparently the other two sections running this summer were awful).  The Pharmacology class turned out okay, but I was unimpressed with the level of actual instruction provided.  It was an online class, so I understood that we'd do all of our reading on our own, but the brief on-line lectures were often typo-ridden.  The discussion sections were interesting--they were all devoted to medication errors that have happened to patients--but I wish the instructor would have posted some follow-up (such as "if a patient receives an overdose of _____, then the antidote is _____ and the most important systems to monitor would be respiratory and cardiac."  That's basically the information we were supposed to come up with during the discussions, but since we're all students and this could be life-saving information, I would have preferred an "answer key" at the end of the discussion.  Oh well.  I think online classes might not really be my thing.  I also bought myself a $4 Sociology textbook, read it, and took the CLEP exam which will exempt me from needing to take Sociology this coming Spring.

Mid-summer, I did a Clinical Elective, which is just more time on a clinical floor.  As it happened, I was actually on the same floor I'd been on in the spring, which was nice!  The Electives are a mixed group of students--some had just finished their introductory class, and some were going into their final semester.  (During the year, all the students in our clinical groups are at the same level.)  The awesome thing about the Elective was that there was NO paperwork to turn in!  We still needed to know all of our information (such as medications) but we didn't need to write it up and turn it in.  Hooray!  I might try to do another one this winter break, but I think they'll be very much in demand by then.

So, now my third semester has started.  Since I've now completed my 'Liberal Arts' requirements (see above), I will only be taking Nursing classes this year.  Our third semester is generally referred to as "Specialties," and actually involves 4 separate classes.  We take 2 at a time--I am currently taking Pediatrics and Non-Acute/Community Health.  Pediatrics is a 3.5 credit class, and Community is a 1 credit class, but I feel like Community is going to involve more work.  Each pair of classes meets for 8 weeks and then we'll swap (to Maternity and Mental Health) in mid-October.  Because of the limited timeframe, the workload is a little different, too.  We now have daily homework assignments (which we didn't have last year), daily quizzes (also a new thing), a group project in each class (blech!), and, of course, exams.  The Community group project is 50% of our grade, and involves a presentation and a paper....produced by a group of 6 people.  We'll see how all of that goes!

Our clinical days are Tuesdays and Wednesdays, and each week we do either Pediatrics or Community.  In Pediatrics, we'll be on a surgical floor, so generally we'll have otherwise-healthy kids who are in the hospital following a particular procedure.  We're told that we'll be spending most of our time focusing on Growth and Development--evaluating where each patient is, and helping to find ways to preserve/promote normal Growth and Development while they're in the hospital.  Although we'll provide patient-care, we can't give medications or do other procedures without the RN present (on an adult floor, the RN responsible for the patient is not with us when we give medications, but our instructor does check them).  We're also supposed to be evaluating family structures and seeing how we can help promote health for the family--giving respite to parents, teaching, etc...   Our Community clinicals are only 3 out of the possible 6 days, and we get sent to a different organization each time.  I'll be going to Urgent Care, a substance-abuse rehab, and an assisted-living facility.  These are mostly observational experiences.

Our first week started a little crazily--no Clinical, but 4-6 hours of lecture on Tuesday and Wednesday, followed by our normal lectures on Thursday and Friday.  I did really poorly on the Community quiz for the week, which was frustrating and of course led me to immediately think "I'm going to fail this class!"  which is (I hope!) a ridiculous over-reaction.  I'm looking forward to starting Clinical next week--I have Pediatrics first--but of course am a little nervous as well:  New instructor, new floor so I don't really know where anything is, etc...  One of the great things about having finished my Liberal Arts classes is that I don't have classes on Mondays this semester.  I have plenty of homework, though, and I'm glad of the extra time to do it!
pantshead: (Default)
We had some uncomfortably hot weather (90° at 9 in the morning) followed by a week of cool, gray, rainy days.  I was glad we put in the garden when we did--a week before Memorial Day, which is a bit chancy some years because we could still have frost that late, but this year it was a gloriously warm, sunny week.  All the seeds have sprouted at this point, and we've begun thinning some rows of seedlings.  PoC dug out a whole new bed out back, and we expanded the bed in front of the house as well (but can't plant much in it until we get a tree cut down--that will happen next week, most likely).  It's really gratifying to see the seeds come up--hopefully we'll get some good yields later in the season. 

It was really nice to have a few weeks of lazing around and getting the garden going.  I also updated my stamp collection (yes, I am that much of a dork) which involved learning that I might need to get a bigger magnifying glass.  Seriously.  We played some more games on our list of "games we own but haven't played"--most of which are older, out-of-print games.  We also had a lot of visitors--people passing through on their way to summer theatre gigs, or back in NY for the summer, etc...  We've felt a bit isolated during the school year because I'm so busy and PoC's schedule is so erratic, and it was nice to enjoy hosting some visitors!

I still don't have a job for the summer, which is mildly disappointing, but I'm really enjoying the relaxation.  However, I know it would be good for me to get some work, so I'll keep hunting.  Yesterday my summer classes started--Microbiology 2 days a week, and Pharmacology online.  There are a lot of students from my school in both classes, as well as some students from the community college that is actually teaching the classes, and probably some folks who are hoping to apply to nursing school within the next year or two.  The pharmacology class will be my 2nd online class, and (unlike nutrition last semester) it will involve a lot of discussion.  I gather this is pretty common for online classes--you have to log in and post (and reply) a minimum of 3 times to each topic, etc...  This sounds like it might get tedious, but I'm actually impressed with the depth of the discussion that has happened on one of our topics so far.  We'll see how it goes!

Finally, a bit of number-crunching from the first year of nursing school (but not about grades this time):  I wrote 6 pens completely out of ink.  I created a stack of hand-written, college-ruled notebook pages almost 2 inches thick (mostly single-sided).  Additionally, my stack of Clinical paperwork (also mostly handwritten, but some typed) is 2-3" tall!  Whew!
pantshead: (Default)
I have just taken my last exam of the semester!  Hooray!  My schedule last week was:  Monday--A&P lab practical, Tuesday--nursing final (cumulative) exam, Wednesday--therapeutic communication final (cumulative) exam, Thursday--Human Growth and Development final exam, Friday--Nutrition final (cumulative) exam.  Today was the last A&P unit exam. 

Other than the Nursing final, most of these exams were not too scary (and I had figured out that I would actually *pass* the nursing class even if I didn't take the final, but of course I wanted to do better than that!). 

We don't have any grand summer plans--classes for me (and maybe I'll get a job--had one interview but haven't heard back yet) and work for PoC.  We might work on some part of the house, but haven't decided which part. 
pantshead: (Default)
Overall, a pretty easy week!  I had my evaluation with my clinical instructor on Monday, and I did pass clinical--thank goodness!  The prospect of failing an entire semester because of one instructor's interpretation of your performance is just scary...and no, I don't have reliable numbers on how many people actually fail Clinical, or what the reason is.  Obviously, there are some quantifiable, objective ways you could fail--such as being written up for the same (or similar) infractions more than once.  (Example:  one student in my group gave an insulin injection without getting a second RN to check the order and dose.  The instructor had checked it, but insulin requires 2 RNs to check it.  When she and the instructor realized the mistake--which had not resulted in the patient receiving the wrong dose or anything like that--the instructor said "I'm really sorry, but I have to write you up for this."  Basically, the student just had to acknowledge that she understood what she had done wrong, and indicate how she would avoid making the same error again.)

But, at any rate, I passed!  Our final exam is next week, and I'm in the same position I was in last semester--my average in the class is high enough that I am pretty unlikely to do badly in the class, no matter how I score on the final.  That's a nice position to be in, and I know it's a luxury--there are plenty of students who are teetering on the edge of passing (anything below a 74.5% is a failing grade) and who are counting on this final to try to pull them over the line.

We did have a brief session this week with the instructors for the Fall semester.  The third semester is called the "Specialties" semester, and is structured in two 7-week halves.  In one half, we have lecture and clinical work in Pediatrics and Non-Acute care (doctor's offices, out-patient surgery centers that see, for example, orthopedic patients, health-promotion, etc...); the other half is Mental Health and Obstetrics.  For the second half, we switch.  The clinical work tends to be more observational than hands-on, because we only do 3 weeks of clinical in each area (we alternate weeks).  So, it will be a very different format, with a lot of different topics.  Obviously, I'll learn more once I get into it...

That's about it!  I'll probably post one more "update" next week after exams are nearly over, assuming my brain hasn't leaked out of my ears by then!  After exams, I have about 2 weeks until my summer classes (Microbiology and Pharmacology) start.  Time to get the garden planted, at least!