Nursing School week 3/#3
Sep. 8th, 2012 09:55 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
pantsheadAs I mentioned earlier (I think) every other week we have Pediatrics clinical OR Community clinical. This was my first week of Community clinical. This is only a 1-credit class, so we actually only have clinical a total of 3 days. We are assigned to the sites we visit--they range from in-patient and out-patient substance abuse treatment centers, to the poison control center, to assisted living and visiting nurse organizations, to the outpatient pediatric surgery center, and also the Urgent Care at the local hospital (one of them). I was assigned to Urgent Care, which turned out to be a fast-paced, very busy day! Urgent Care is supposed to see patients who have minor colds & fevers, insect bites, maybe sprains and strains (they have a radiology lab for X-rays). It's a good place to go to get some antibiotics for your kid who has strep and also get a doctor's note explaining why you missed work. This Urgent Care is actually affiliated with the hospital Emergency Department, which means they can easily transfer a patient who comes in with more severe symptoms.
What I actually saw at UC was a mix of "what's supposed to happen" and "reality." There were a lot of kids with fevers, sore throats, nausea, etc... The structure of the place allows a "family unit" to be examined together in one room, which seems very smart! These kids got strep tests, antibiotics if needed, and recommendations for fluids and tylenol. There were a good number of "my foot/knee/arm hurts, I twisted/banged/don't know what I did to it." These folks got braces/ace bandages, X-rays, referrals to follow up with an orthopedist, and prescriptions for Ibuprofen and (usually) something stronger as well. There were women (and probably men, but I didn't see any) who came in for STD testing, pelvic exams, and pregnancy tests. Sometimes they came in with another complaint--"my shoulder hurts, but I also have this weird discharge, could you test me?" There were a few folks who came in who really didn't belong at UC--kidney stones, which require fairly intensive pain management and also a lot of IV fluids. Interestingly, one of these was actually treated at UC because the patient's overall condition was more stable. One was transferred to the ED because the pain was extreme and the patient had a lot of other complicating conditions. I would imagine this patient was actually admitted to the hospital for a day or two, but I'm not sure. I didn't see anyone who came in with chest pain, partial paralysis, or anything like that (ie: heart attack or stroke symptoms) but I'm sure it happens! The patients seemed to be a mix of "I don't have a regular doctor," and "My doctor's office can't see me until next week, but I'm sick now!" Most patients seemed to have some kind of health insurance (from what I gathered) but NYS has free or very-low-cost insurance for low-income kids, so you'd hope they actually had it!
It was an interesting place to observe/work (I was actually able to help out) because the RNs have a lot more autonomy there than on the floor of the hospital, it seems. The place is staffed by RNs, a radiologist, and EMT who does EKGs (heart rhythms) and blood testing, and Nurse Practitioners/Physicians Assistants who are the 'providers' (ie: the people who actually diagnose the medical condition). The RNs usually see the patient first, and they can follow a series of standing orders to initiate care--such as drawing blood, ordering a urine culture, starting IV fluids, etc....based on the patient's initial complaint and symptoms. Then the patient is seen by an NP or PA, and is then discharged by an RN with their prescriptions and instructions. Everything gets documented in the computer, because often the RN who takes in a patient is not the same person who discharges the patient. Their goal is 90-minute (or less) service, though the day I was there they were very busy and I don't think they always met this goal.
Aside from UC, we learned about genito-urinary diseases and defects in children, and then on Friday we took our first exam. I think it went pretty well. We got to go and check our answers against the key right afterwards (having already turned in our ScanTrons) and I don't think I missed many questions! Woohoo! We have another exam 2 weeks from now, I think. It's hard to pack everything into an 8-week quarter!
My plan for today is to do the rest of my homework for the week so that I can then write the paper for our Community project. Our homework topics this week are lead-poisoning and Child Abuse. Nurses are mandated-reporters in NYS (ie: if we suspect abuse of a minor by a person who's supposed to be responsible for that minor, we're required to report it).
What I actually saw at UC was a mix of "what's supposed to happen" and "reality." There were a lot of kids with fevers, sore throats, nausea, etc... The structure of the place allows a "family unit" to be examined together in one room, which seems very smart! These kids got strep tests, antibiotics if needed, and recommendations for fluids and tylenol. There were a good number of "my foot/knee/arm hurts, I twisted/banged/don't know what I did to it." These folks got braces/ace bandages, X-rays, referrals to follow up with an orthopedist, and prescriptions for Ibuprofen and (usually) something stronger as well. There were women (and probably men, but I didn't see any) who came in for STD testing, pelvic exams, and pregnancy tests. Sometimes they came in with another complaint--"my shoulder hurts, but I also have this weird discharge, could you test me?" There were a few folks who came in who really didn't belong at UC--kidney stones, which require fairly intensive pain management and also a lot of IV fluids. Interestingly, one of these was actually treated at UC because the patient's overall condition was more stable. One was transferred to the ED because the pain was extreme and the patient had a lot of other complicating conditions. I would imagine this patient was actually admitted to the hospital for a day or two, but I'm not sure. I didn't see anyone who came in with chest pain, partial paralysis, or anything like that (ie: heart attack or stroke symptoms) but I'm sure it happens! The patients seemed to be a mix of "I don't have a regular doctor," and "My doctor's office can't see me until next week, but I'm sick now!" Most patients seemed to have some kind of health insurance (from what I gathered) but NYS has free or very-low-cost insurance for low-income kids, so you'd hope they actually had it!
It was an interesting place to observe/work (I was actually able to help out) because the RNs have a lot more autonomy there than on the floor of the hospital, it seems. The place is staffed by RNs, a radiologist, and EMT who does EKGs (heart rhythms) and blood testing, and Nurse Practitioners/Physicians Assistants who are the 'providers' (ie: the people who actually diagnose the medical condition). The RNs usually see the patient first, and they can follow a series of standing orders to initiate care--such as drawing blood, ordering a urine culture, starting IV fluids, etc....based on the patient's initial complaint and symptoms. Then the patient is seen by an NP or PA, and is then discharged by an RN with their prescriptions and instructions. Everything gets documented in the computer, because often the RN who takes in a patient is not the same person who discharges the patient. Their goal is 90-minute (or less) service, though the day I was there they were very busy and I don't think they always met this goal.
Aside from UC, we learned about genito-urinary diseases and defects in children, and then on Friday we took our first exam. I think it went pretty well. We got to go and check our answers against the key right afterwards (having already turned in our ScanTrons) and I don't think I missed many questions! Woohoo! We have another exam 2 weeks from now, I think. It's hard to pack everything into an 8-week quarter!
My plan for today is to do the rest of my homework for the week so that I can then write the paper for our Community project. Our homework topics this week are lead-poisoning and Child Abuse. Nurses are mandated-reporters in NYS (ie: if we suspect abuse of a minor by a person who's supposed to be responsible for that minor, we're required to report it).
