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Nursing School week 2/#11
Apr. 15th, 2012 11:59 pmSorry to get behind again...
In week 11, we had another exam in our Theory class (just 2 weeks after the last one!) and had one lecture on upper GI diseases (like GERD, ulcers, etc...) The exam was ALL about heart attacks and CAD--I feared I hadn't done very well on it, but my grade was actually fine! I wasn't scheduled for simulation this week, so I had a couple of extra hours to myself on Friday morning.
Clinical presented a couple of interesting situations this week. I had a dementia patient (ie: it's already difficult to discern level of consciousness/mental state) who became severely hypoglycemic. I've heard before that "everyone's diabetic when they're in the hospital," and this patient was apparently one of those--the patient was admitted for severe pneumonia, and was given (among other things) corticosteroids to reduce the swelling in the airways. Steroids can raise blood sugar, however, which can tax the kidneys and raise blood pressure (which is basically bad for the whole body, since it damages blood vessels and makes the heart work harder). So, the patient was receiving daily insulin injections (one at each meal, and one long-acting injection that provides a basal dose throughout the day). In the morning, the pt's blood sugar was fine, but at lunch it was 39! (70-99 is normal; 39 could be coma-inducingly low). The hospital has a protocol of what do do and we used that to guide our treatment--I had my instructor and the patient's RN working with me.
As it happened, that patient was actually discharged later that day, so the second day I was assigned a new patient (I also had another patient both days). This new patient was awake, alert, and oriented, but in pretty bad shape. The doctor and a palliative-care NP came in to see the pt and presented the information: basically, the condition was not treatable. They asked the pt if s/he wanted to pursue treatment or just to be made comfortable, and the patient was very clear: Comfort only. This wasn't the hard part...the hard part was when s/he asked the doctor "so, am I going to die?" The doctor was very gentle, but said that yes, it looked that way. This was really hard for me to witness--I've had several patients already that I knew probably wouldn't live very long, but they've always had dementia, or been so sick that they hardly ever woke up. A patient who is able to understand what's happening is a very different case.
Now that I've let myself get behind, I can't remember what else happened 2 weeks ago! Oh, we had an exam in A&P. I think that was about it...
In week 11, we had another exam in our Theory class (just 2 weeks after the last one!) and had one lecture on upper GI diseases (like GERD, ulcers, etc...) The exam was ALL about heart attacks and CAD--I feared I hadn't done very well on it, but my grade was actually fine! I wasn't scheduled for simulation this week, so I had a couple of extra hours to myself on Friday morning.
Clinical presented a couple of interesting situations this week. I had a dementia patient (ie: it's already difficult to discern level of consciousness/mental state) who became severely hypoglycemic. I've heard before that "everyone's diabetic when they're in the hospital," and this patient was apparently one of those--the patient was admitted for severe pneumonia, and was given (among other things) corticosteroids to reduce the swelling in the airways. Steroids can raise blood sugar, however, which can tax the kidneys and raise blood pressure (which is basically bad for the whole body, since it damages blood vessels and makes the heart work harder). So, the patient was receiving daily insulin injections (one at each meal, and one long-acting injection that provides a basal dose throughout the day). In the morning, the pt's blood sugar was fine, but at lunch it was 39! (70-99 is normal; 39 could be coma-inducingly low). The hospital has a protocol of what do do and we used that to guide our treatment--I had my instructor and the patient's RN working with me.
As it happened, that patient was actually discharged later that day, so the second day I was assigned a new patient (I also had another patient both days). This new patient was awake, alert, and oriented, but in pretty bad shape. The doctor and a palliative-care NP came in to see the pt and presented the information: basically, the condition was not treatable. They asked the pt if s/he wanted to pursue treatment or just to be made comfortable, and the patient was very clear: Comfort only. This wasn't the hard part...the hard part was when s/he asked the doctor "so, am I going to die?" The doctor was very gentle, but said that yes, it looked that way. This was really hard for me to witness--I've had several patients already that I knew probably wouldn't live very long, but they've always had dementia, or been so sick that they hardly ever woke up. A patient who is able to understand what's happening is a very different case.
Now that I've let myself get behind, I can't remember what else happened 2 weeks ago! Oh, we had an exam in A&P. I think that was about it...
