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Nursing School week 2/#5
Feb. 17th, 2012 11:52 pmI passed two validations this week--giving insulin, and the locked-IV skill I described last week. Of course, both of my patients in clinical this week were receiving insulin, so I got to jump right into that. We use a certain brand of needles that retract after you've depressed the plunger all the way--this way there's no "sharp" for anyone to get stuck by (but the used needles still go into the sharps bin). This is great...except it makes them more prone to getting an air bubble at the top of the barrel that's really hard to get out because the retracting mechanism is in the way! It's even more difficult when you're trying to draw up a very tiny amount of something...and insulin often comes in very tiny amounts (like, 0.02 mL). So, I spent a lot of time in the med room flicking at bubbles in syringes. (Because insulin goes into the fatty tissue, a tiny air bubble wouldn't really hurt a patient other than maybe giving them a bruise... But you also wouldn't know exactly how much liquid was in the syringe with the bubble in the way, and when you're already dealing with hundredths of a mL, any little bit is significant.)
I also got to perform a sterile dressing change this week--a skill we learned last semester but I hadn't had an opportunity to try.
In lab class this week we learned about PCAs, which are patient-controlled-analgesia machines. It's like an IV pump, but you load a cartridge of painkiller into it and then lock it shut (so it can't be tampered with/stolen). They can be programmed to deliver a continuous dose, allow the patient to receive "on-demand" doses by hitting a button, or do both functions together. Because they almost always have narcotics in them, we learned about signing for every mL of medicine--if you discard a cartridge that still has a little left in it, another RN has to witness you waste it--which means pouring it down the drain, not putting it in the trash. [Could this practice possibly be why we have pharmaceutical pollution in our groundwater??]
In Theory this week we learned about pre-operative and post-operative teaching and management--telling the patient what to expect before a surgery, monitoring their condition when they come back, and then (in general) working towards the goal of getting them up and walking as soon as possible. Here is an interesting fact: If a patient has a low fever within a day or two of surgery, it is NOT an infection. It's due to partial lung congestion or collapse of the alveoli (called atelectasis)--not uncommon after your whole body has been anesthetized. Breathing deeply and coughing is the best initial treatment.
My brain is rapidly turning to mush tonight, so I will leave you with one final musing on abbreviations: There are some formal abbreviations that we are not supposed to use because it's too easy to mistake them for something else. For example you're not supposed to use cc (the unit) because 20cc could be misread as 2000. Another example is bid, tid, qid (which mean twice a day, three times a day, and four times a day). You're supposed to write out the words, because patients might not know what the abbreviation means. The reality, though, is that there are lots of abbreviations for which there are no rules, and interpreting them requires context and (sometimes) assumption. As an example, I had a patient who had a history of drug use and PCP. It took me a couple of readings in the chart to realize that PCP was pneumocystic pneumonia...not phencyclidine (the drug). Of course, PCP could also mean Primary Care Physician. Or, according to Wikipedia, "post-coital pill," or "primary care paramedic." A case that I encountered last semester involved a patient who had come to the hospital in an ambulance. The EMT's assessment included the notation "0 LOC." Normally, "LOC" = Level of Consciousness...so at first I interpreted this to mean that the patient had been unconscious (a level of 0, right?) at the time of transport. Reading more carefully, I realized that "LOC" in this case meant "LOSS of Consciousness." In other words: The patient had NOT lost consciousness.
I also got to perform a sterile dressing change this week--a skill we learned last semester but I hadn't had an opportunity to try.
In lab class this week we learned about PCAs, which are patient-controlled-analgesia machines. It's like an IV pump, but you load a cartridge of painkiller into it and then lock it shut (so it can't be tampered with/stolen). They can be programmed to deliver a continuous dose, allow the patient to receive "on-demand" doses by hitting a button, or do both functions together. Because they almost always have narcotics in them, we learned about signing for every mL of medicine--if you discard a cartridge that still has a little left in it, another RN has to witness you waste it--which means pouring it down the drain, not putting it in the trash. [Could this practice possibly be why we have pharmaceutical pollution in our groundwater??]
In Theory this week we learned about pre-operative and post-operative teaching and management--telling the patient what to expect before a surgery, monitoring their condition when they come back, and then (in general) working towards the goal of getting them up and walking as soon as possible. Here is an interesting fact: If a patient has a low fever within a day or two of surgery, it is NOT an infection. It's due to partial lung congestion or collapse of the alveoli (called atelectasis)--not uncommon after your whole body has been anesthetized. Breathing deeply and coughing is the best initial treatment.
My brain is rapidly turning to mush tonight, so I will leave you with one final musing on abbreviations: There are some formal abbreviations that we are not supposed to use because it's too easy to mistake them for something else. For example you're not supposed to use cc (the unit) because 20cc could be misread as 2000. Another example is bid, tid, qid (which mean twice a day, three times a day, and four times a day). You're supposed to write out the words, because patients might not know what the abbreviation means. The reality, though, is that there are lots of abbreviations for which there are no rules, and interpreting them requires context and (sometimes) assumption. As an example, I had a patient who had a history of drug use and PCP. It took me a couple of readings in the chart to realize that PCP was pneumocystic pneumonia...not phencyclidine (the drug). Of course, PCP could also mean Primary Care Physician. Or, according to Wikipedia, "post-coital pill," or "primary care paramedic." A case that I encountered last semester involved a patient who had come to the hospital in an ambulance. The EMT's assessment included the notation "0 LOC." Normally, "LOC" = Level of Consciousness...so at first I interpreted this to mean that the patient had been unconscious (a level of 0, right?) at the time of transport. Reading more carefully, I realized that "LOC" in this case meant "LOSS of Consciousness." In other words: The patient had NOT lost consciousness.
