pantshead

Okay, I guess the semester isn't quite over, but all that's left is my Psych final on Monday. I know that I passed last week's A&P exams, and I don't expect Psych to be too difficult.

Due to HIPAA laws, I'm not really allowed to talk about patients. However, I figure if I don't give too many details I can probably still give you an idea of what kind of work we did and the patients we saw during clinical. ("Too many details" also includes gender....so sorry for some awkward sentences.)

I was assigned to an orthopedic floor in a regional trauma center teaching hospital. I had a patient who had been in a car accident, three patients who had fallen and broken legs (one with a broken arm, as well), a mangled limb with multiple skin and tissue grafts, and two spinal surgeries. Our floor also got medical/surgical overflow patients, so I also had a patient with dementia with a UTI (being treated with IV antibiotics), an elderly failure-to-thrive patient, and a patient in for observation of a growth. Others in my group had patients with voluntary joint replacements, other car and falling accidents, and other post-surgical patients (including some fairly complicated abdominal surgery--it's a little strange that they wound up on our floor!). Although none of our patients were in *terrible* shape, their condition didn't really matter because the regular RNs did all the complicated stuff (IVs, blood transfusions, etc...), and meanwhile every patient needs basic care.

We were mostly focused on basic care all semester, so with each patient we needed to take their morning vital signs, do a full assessment (or as much as we'd learned up to that point), help them wash up for breakfast if they were allowed to eat, then help bathe them, get them out of bed if ordered, change linens (whether they got out of bed or not), get them to Physical Therapy (on the same floor) if ordered, etc. In and amongst all that, we also helped patients get on/off bedpans, or changed briefs, or helped them to/from the commode or bathroom. Everything gets recorded--vitals; "nursing actions" like bathing, using compression stockings to prevent blood clots, turning the patient every 2 hours, putting an alarm on the bed if the patient might try to get out unassisted; volume of input and output (unless the patient is allowed to just use the bathroom). We also worked up to giving meds (only with our instructor's supervision, which meant we couldn't all do it every week) including subcutaneous shots (in the stomach--usually low-dose blood thinners. Insulin is also subcutaneous, but we won't learn about calculating the dose until next semester.)

It's amazing how long all of those things--even for one patient--can take. When a person is lying flat in bed and is in pain or doesn't feel good, it's really difficult to move them! We had done some practice in the lab on other students, but it's a healthy person pretending to have a hurt leg is simply not the same as an elderly person with a broken leg and an external fixator (one of those pin-and-rod contraptions that are used to hold the bones in place) that adds 15 pounds to their leg! And a patient with an ex-fix on a leg is not the same as a spine surgery patient (who must sit/stand very slowly and can't twist their back). And those are different from patients who've had abdominal surgery and may not be allowed to have their head elevated more than 30°. You get the idea...

I liked working with the patients, even if I wasn't doing anything very glamorous. We did occasionally get to do more specialized things--I mentioned that I got to give meds via an NG tube one week, and I got to remove a couple of catheters. Some students gave suppositories, but I didn't have any patients receiving them. (I was supposed to give an enema one week, but the patient really didn't want it right before PT and it was delayed until after the end of my shift. I can't say I blame him!) I didn't have to do anything *really* gross, although I'm sure those days will come! (Also, my concept of what would be gross in my own house and what's gross in the hospital is completely different. In the hospital if someone throws up (or whatever), you get them a new gown, change the linen, wash them up, and move on. It's not like it's on your couch, or your bed. Heck, you don't even have to do the laundry...it all goes into the linen bins & gets washed by the laundry department. I'm not sure I'd want their jobs...)

Some of my patients definitely presented food for thought--things I don't have any answers for, but I wonder whether the medical system has served them in the best way possible. One example would be a patient who was morbidly obese (defined as BMI > 40; the pt's was nearly 60)....the pt had already had both knees replaced, and also a gastric bypass (one of those stomach-shrinking surgeries to promote weight loss.) I admit I don't know how long ago the pt had the bypass, or which came first, the knees or the bypass. But it's probably safe to say that the pt's weight problem contributed to the damage in the knees. Aaaand the pt was hospitalized because a leg had just broken under the pt while the pt was walking around one day. Now, obviously, I'm not an orthopedic surgeon. But it really made me wonder whether replacing the knees was the best answer while the pt was still so overweight (and thus more likely do have problems in the future). Or would it have been better to have the pt lose a bunch of weight first? But if the knees were giving the pt too much pain to exercise (or, say, even walk around) then the pt probably wouldn't have been able to lose the weight without having the knees replaced.

Other patients just made my heart go out them and their families--my car accident victim was a young person with broken bones in all 4 limbs. I still wonder how the pt's recovery is going (I don't have a way to find out). Or my failure-to-thrive patient, whose family probably can no longer provide care, but couldn't get the words "nursing home" out of their mouths (they did want the pt to go to a "rehab facility," but still planned to bring the pt home after that). At least they were being realistic about their own abilities (I didn't fear for the patient's safety) but they were still at the point of viewing this as a temporary condition rather than a (likely) permanent change in their lives.

So, all in all, an interesting semester. I don't expect to write any more updates until the Spring semester starts after MLK Jr. day. I'll be taking the next level of nursing, the 2nd half of A&P, another Psych class, a nutrition class, and a "therapeutic communications" class. Sooo, more classes than this past semester, by 2! Meanwhile, happy holidays to everyone and thanks for reading about the process!