Nursing School week 2/#10

This week we continued learning about coronary artery disease and heart attacks (myocardial infarctions) in our theory class.  We had the first of 3 simulations in our Lab class--these aren't graded, but they give us a chance to "problem-solve" issues that could come up with a real patient.  We have different roles in the simulations--charge RN (a person who does the most interfacing with other people--doctors, physical therapy, etc...), a primary RN, a secondary RN, a family member (who has a bit of a script to follow), and an observer (who critiques the process).  The structure of the simulation is supposed to be like the start of your shift on a hospital floor, which begins with getting report from the night nurse.  According to the night nurse, our pt was 1-day post op from an abdominal surgery with a large midline incision covered by a dry and intact dressing.  The surgeon had not performed the first dressing change yet.  The patient had been using his PCA intermittently throughout the night, receiving 1 unit of Morphine each time.  The patient's urine output had been 750mL overnight, clear and yellow.  He was NPO (nothing by mouth) with an NG tube on suction that drained 100mL overnight.  His oxygen saturation had been around 95-98 while receiving 2L of oxygen via nasal cannula.  He had an IV of 5% dextrose with 0.45% normal saline (D5 1/2NS) running at 80 mL/hour.  Sooo, according to report, this patient had a pretty good night and should probably be in good shape.

When the nurses entered the room, however, the patient was complaining of nausea and stomach pain, and also dizziness.  The patient was lying down flat in the bed (which should never be the case with an NG tube).  They raised the head of his bed.  The nurses checked the PCA and discovered it was programmed wrong--instead of getting 1 unit, he had been receiving 4 units of morphine.  Morphine can lower blood pressure and heart rate, and also cause nausea (and the patient did not have an antiemetic ordered).  So, the nurses reported the error to the charge RN (so she could contact the doctor, and also to ask for an antiemetic order).  Then they took the blood pressure and found it to be very low.  They checked his catheter output bag and found dark orange (concentrated) urine--low blood pressure means less blood entering the kidneys, and thus less urine (this can cause kidney failure).  Eventually, it was discovered that the patient's NG tube also was not correctly hooked up to the suction (contributing to his nausea).  So, it was an interesting simulation--of a series of events that would hopefully never happen with a real patient!

In clinical this week I had my Operating Room observation day and then a day of observing an endoscopy/colonoscopy lab.  The OR was at an outpatient orthopedic surgery center--I saw a hand surgery, and ankle tendon surgery, and a shoulder surgery.  All of them were interesting.  The experience is as much about watching the procedure as it is about watching how the staff interact and do their jobs.  Next week I will be back to normal clinical.

That's about all the news!  I have a bunch of assignments to work on this weekend, which is clearly why I'm not doing any of them right now!