Nursing School week 2/#7

[pantshead]

One more week until spring break!  The last week of clinical went well, but I'm looking forward to moving to a new unit in a couple of weeks.  I can mention a bit about the old unit, though:  The hospital I was at has a floor dedicated to patients who have tested positive for MRSA--methicillin resistant Staph. aureus.  The purpose of this floor is to keep these patients away from the rest of the hospital population.  The patient doesn't necessarily have an active infection--they just have to have a positive test (swabs of the inside of the nose, the groin, and any wounds that they might have).  Once a person is registered as "positive," this hospital considers them to always be positive, and tries to always place them on this floor.  Out of my 10? patients this rotation, only one had an active MRSA infection (in a surgical wound).  Not every patient is screened coming in--patients with infected wounds are screened; patients from nursing homes, group homes, or prisons are screened.  Our instructors have told us, though, that MRSA is a pretty common skin bacteria that many people have on their skin.  Sooo, this isolation policy probably helps keep the spread of MRSA down in the hospital, but I'm not convinced it works 100%, since there are probably unidentified patients in the rest of the hospital with the bacteria.

Anyway, MRSA is spread by direct contact, so on a normal hospital floor, a patient with a positive MRSA test is confined to their room.  They may have a roommate with the same status, or they'll be in a private room.  Any health-care-worker who enters the room wears a disposable gown and gloves [we don't normally wear gloves to simply touch a person--just if we might encounter fluids].  Family members are not required to wear gowns, which is a weird inconsistency because they might later go to the cafeteria or other public areas.  On the MRSA-isolation floor, patients may get up and leave their rooms (assuming that level of mobility is appropriate for them).  There's even a small lounge for patients and families.  Because the patients on this floor are cohorted by this one identifying factor, there was a big variety of patients.  My patients ranged in age from 33 to 98.  About half were nursing-home residents; half were living in the community.  Two were involved in outpatient substance-abuse recovery.  One was probably addicted to painkillers.  One had HIV and Hepatitis C.  I had a patient recovering from abdominal surgery, a couple of patients with pneumonia, a patient with an exacerbation of vasculitis (an auto-immune swelling of the blood vessels), a patient with diabetic leg ulcers, a patient with an exacerbation of COPD and also acute kidney failure, etc...  Generally, the level of acuity of these patients was higher than what I saw last semester on the orthopedic floor.  It is likely that two of the patients (at least) are no longer alive at this time.  (At one point, my instructor said to me "I assigned you patient X because I thought, based on X's condition last week, that we'd be doing end-of-life care with X.")  As it turned out, X actually went back home (nursing home), but the COPD/kidney failure patient and one of the pneumonia patients definitely seemed to be near the end of life.

It was an interesting unit, and our instructor really challenged us to look at the interconnections of the disease processes and identify how the whole health status of the patient was affected (that's where the Nursing Diagnoses from last semester come in--it gives us a framework to identify interacting problems/factors).  However, it was sometimes an aggravating unit--lots of repeat patients, and sometimes the staff seemed a little more jaded than I think I'd like to be.  Our level of responsibility increased a lot from the first week to the last--the first week we could give oral meds, topical meds, inhaled meds, and subcutaneous injections; we could provide bathing/repositioning/toileting/feeding assistance, we could perform a head-to-toe assessment and do some basic documentation of our findings.  By the 6th week, we could do all of those things, plus hang IV fluids and medications, change out IV tubing (not the IV itself, though), give insulin, and document our findings more clearly.  We advanced from having 1 patient each the first couple of weeks to having 2--and if a patient was discharged after the first day, then we got a new one.

What else did we do last week?  We learned how to give intramuscular injections--I hope to validate on this on Monday.  (I passed my Trach suctioning validation.)  We had 2 Theory classes on heart failure.  I did poorly on a lab exam in A&P because I spent too long trying to write-up my Anecdotal Reflections from clinical (a series of 8 to 12 prompt questions that we have to write up every week.  I loathe them, but this week they were in the form of our self-evaluation, so I needed to do it well.  I should have just stopped and studied more for the A&P exam, but oh well...)  We had a unit on age 2-5 in Growth & Development (the Psych class).  There was a job fair at school where I got to learn some information about summer work (which I should really get working on...)

I'm looking forward to my Dad's visit in 10 days, and I haven't been as diligent about studying this weekend as I probably should be, since I have a little more time this coming week (no clinical) and our next nursing exam isn't until after the break. 

Comments

[nadyezhda.livejournal.com]

I'm continuing to be in awe of what you're doing. Keep up your hard work :)