![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
Nursing School week 2/#2
Jan. 28th, 2012 08:32 amThe first full week of classes! Mondays are a short day (I'm done at 1130) and Thursdays are really looong--I'm in class from 8 to 5 with one 30 minute break. Tuesday and Wednesday are clinical, and Friday is a medium-length day (9-3).
I'm relieved to say that our A&P teacher is a) not the same guy as last semester, b) has taught the class before, c) has a plan about how to teach the class, and d) actually knows the material she's teaching! Hallelujah! The psych class will be fine (same instructor as last semester; the topic now is Human Growth and Development). The online nutrition class is a new creature for me, but I managed to complete and turn in my first assignment with a minimum of fuss. I may take a couple of other online classes this summer, so this is a good test-run.
The nursing theory & lab classes are the biggest challenge right now. Fortunately, their content is closely linked at the moment (this wasn't always true last semester). We're learning about electrolyte balance in the body (basically, what happens when you lose more or retain more of certain electrolytes) and acid-base balance (which is kind of the same as electrolytes except that acids and bases aren't electrolytes). We need to be able to look at the gas values from an arterial blood draw, recognize that the blood pH is either normal or abnormal, and if it's abnormal, figure out why (the respiratory system and the kidneys/metabolism are the two main causes). If the pH is normal, the balance could still be abnormal because lungs and the kidneys can compensate for each other up to a point. And, more importantly as nurses, we need to recognize the signs and symptoms of various imbalances. (The nurse won't order a blood draw, though I think we could request one. So we need to understand what to look for when we assess a patient that might be a sign of an imbalance.)
In Lab, we're learning about IV devices and IV fluids. There are several kinds of IVs, [if you're squeamish about things in the skin, you might want to skip this paragraph!] but really just 2 main types that we're learning about so far. Peripheral IVs are short little catheters that go into a vein in the arm (usually). They're often used for just a couple of days. Central lines wind up just outside the right atrium (the "intake") of the heart....but they can get there in several different ways. They can start in the arm (usually near the biceps) and the catheter runs through the vein up and over the shoulder (which, confusingly, is called a Peripherally Inserted Central Catheter). They can start just above the collarbone or at the hip (commonly the choice in emergencies), or they can come up to the collarbone and then be tunneled beneath the skin to the middle of the chest, where they emerge and the skin tissue grows into a special collar that anchors them in place. They could be a port, which is a surgically-implanted receiving chamber is covered by skin and is just accessed with a special needle. (These are common for long-term chemotherapy, dialysis, HIV patients, and others; my mother had one for her chemo.) While in school, we will not learn to place IVs in the body, though I think we'll be allowed to remove them. However, we're going to use all types of them.
There are different reasons for different IVs--a central line is needed for certain kinds of drugs that are irritating to the veins; a central line can stay in place longer (but may require daily maintenance and/or anti-coagulants to keep it from getting occluded). The catheter itself may have multiple lumens (different tubes inside it, and 2 or 3 access ports on the outside of the body) which allows different medications to be given down the line at the same time. We're also learning about IV fluids--basically, some fluids have different osmotic characteristics [science class review of osmosis: If a fluid with a lot of solutes (hypertonic) is on the other side of a membrane from a fluid with very few solutes (hypotonic), water will cross the membrane to try to dilute the high-concentration fluid and make it equal to the low-concentration fluid (isotonic)]. There are times when a hypertonic treatment is given to draw water out of the rest of the body and back into the veins & arteries. There are times when the reverse is needed. Also, different fluids have different types of electrolytes in them, so the electrolyte needs to match (or not conflict with) the patient's need. AND, also, certain IV medications cannot be mixed with certain fluids! The common set-up is that a patient will have a bag of fluids for hydration (saline, or dextrose, or whatever) and then will receive a medication down the same line for 2-3 hours. When these two liquids mix, they have to be compatible. We don't have to memorize this, but we have to know where to find the information for each medication.
We have our first exam next week--covering all of these things, plus diabetes from last week. So, apart from paying some bills and tidying up the house a bit this morning, I hope to spend a lot of time studying this weekend!
I'm relieved to say that our A&P teacher is a) not the same guy as last semester, b) has taught the class before, c) has a plan about how to teach the class, and d) actually knows the material she's teaching! Hallelujah! The psych class will be fine (same instructor as last semester; the topic now is Human Growth and Development). The online nutrition class is a new creature for me, but I managed to complete and turn in my first assignment with a minimum of fuss. I may take a couple of other online classes this summer, so this is a good test-run.
The nursing theory & lab classes are the biggest challenge right now. Fortunately, their content is closely linked at the moment (this wasn't always true last semester). We're learning about electrolyte balance in the body (basically, what happens when you lose more or retain more of certain electrolytes) and acid-base balance (which is kind of the same as electrolytes except that acids and bases aren't electrolytes). We need to be able to look at the gas values from an arterial blood draw, recognize that the blood pH is either normal or abnormal, and if it's abnormal, figure out why (the respiratory system and the kidneys/metabolism are the two main causes). If the pH is normal, the balance could still be abnormal because lungs and the kidneys can compensate for each other up to a point. And, more importantly as nurses, we need to recognize the signs and symptoms of various imbalances. (The nurse won't order a blood draw, though I think we could request one. So we need to understand what to look for when we assess a patient that might be a sign of an imbalance.)
In Lab, we're learning about IV devices and IV fluids. There are several kinds of IVs, [if you're squeamish about things in the skin, you might want to skip this paragraph!] but really just 2 main types that we're learning about so far. Peripheral IVs are short little catheters that go into a vein in the arm (usually). They're often used for just a couple of days. Central lines wind up just outside the right atrium (the "intake") of the heart....but they can get there in several different ways. They can start in the arm (usually near the biceps) and the catheter runs through the vein up and over the shoulder (which, confusingly, is called a Peripherally Inserted Central Catheter). They can start just above the collarbone or at the hip (commonly the choice in emergencies), or they can come up to the collarbone and then be tunneled beneath the skin to the middle of the chest, where they emerge and the skin tissue grows into a special collar that anchors them in place. They could be a port, which is a surgically-implanted receiving chamber is covered by skin and is just accessed with a special needle. (These are common for long-term chemotherapy, dialysis, HIV patients, and others; my mother had one for her chemo.) While in school, we will not learn to place IVs in the body, though I think we'll be allowed to remove them. However, we're going to use all types of them.
There are different reasons for different IVs--a central line is needed for certain kinds of drugs that are irritating to the veins; a central line can stay in place longer (but may require daily maintenance and/or anti-coagulants to keep it from getting occluded). The catheter itself may have multiple lumens (different tubes inside it, and 2 or 3 access ports on the outside of the body) which allows different medications to be given down the line at the same time. We're also learning about IV fluids--basically, some fluids have different osmotic characteristics [science class review of osmosis: If a fluid with a lot of solutes (hypertonic) is on the other side of a membrane from a fluid with very few solutes (hypotonic), water will cross the membrane to try to dilute the high-concentration fluid and make it equal to the low-concentration fluid (isotonic)]. There are times when a hypertonic treatment is given to draw water out of the rest of the body and back into the veins & arteries. There are times when the reverse is needed. Also, different fluids have different types of electrolytes in them, so the electrolyte needs to match (or not conflict with) the patient's need. AND, also, certain IV medications cannot be mixed with certain fluids! The common set-up is that a patient will have a bag of fluids for hydration (saline, or dextrose, or whatever) and then will receive a medication down the same line for 2-3 hours. When these two liquids mix, they have to be compatible. We don't have to memorize this, but we have to know where to find the information for each medication.
We have our first exam next week--covering all of these things, plus diabetes from last week. So, apart from paying some bills and tidying up the house a bit this morning, I hope to spend a lot of time studying this weekend!
