Welcome!
It is so great to be together again! I'm sure you have grown tremoundously since that very first class. For this blogging site, we will share all clinical experiences! Refer to the syllabus for the guidelines and posting dates.
I can't wait to hear all about clinicals!!
Karen
ok, i'm in :)
ReplyDeleteMe too!
ReplyDeleteI like this : )
ReplyDeleteIn like flynn
ReplyDeleteHi everyone! This is way cool! Can't wait to read what everyone has to say.
ReplyDeleteHi everybody.
ReplyDeleteSo today was very interesting, to say the least. I had my first experience with vomit and i handeled it quite well. Thank you to all of my group mates who gave a helping hand. Nursing is all about teamwork.
ReplyDeletemy day started out slowly with a pt recovering from bladder surgery having trouble with his foley. .... skipping here b/c i already posted and lost this information....
ReplyDeletethe day ended with the surgeon coming and telling the pt, and his family, he has bladder cancer. CIS (carcinoma in situ). following resolution of the situation currently, he's to be seen in the doc office one week after d/c to start BCG (bacillus calmette-guerin) treatment. "It is not clear how Bacillus Calmette-Guerin (BCG) works to treat bladder cancer. It may stimulate an immune response or cause inflammation of the bladder wall that destroys cancer cells within the bladder. BCG has been used to treat stage 0 and I cancer but is used most commonly to prevent the return (recurrence) of noninvasive bladder cancer. It is most often used after cancer has been removed from the bladder using transurethral resection (TUR)surgery"- webmd.
the pt, naturally, didn't hear most of this because as soon as the doc said "cancer" his response was "shit, oh shit". fortunately, his wife was taking notes, so there is hope someone will have information to discuss with the pt later when he will be more receptive. he didn't really hear the doc tell him this was curable with better than 65% 5 year survival rate. he heard 50% failure rate within 2 years (if you don't do this treatment then removal of the bladder if there's a recurrence).
le sigh.
so how was YOUR day???
hey joi!!!
ReplyDeletei think bonnie will agree with you!!!!!!!!
glad you made it through girlie :)
Hey guys!
ReplyDeleteToday was really exciting! I got to see a thoracentesis procedure. Thoracentesis is a sterile procedure performed by a doctor. The doctor first numbed the site then inserted a needle in between the ribs into the pleural space. The needle was close to 6 inches long and once it was inserted they took a CT to verify the location of the needle to make sure it was located in the fluid. Attached to the needle there was a tube that advanced inside the patient exactly like a catheter (only much larger). The doctor then attached an empty syringe and withdrew 875 ml of fluid from the pleural space. I found a good picture to show what it looked like and attached the link below. It was so interesting to see! :)
http://www.nhlbi.nih.gov/health/dci/images/thoracentesis.jpg
My patient was currently admitted with multiple diagnoses, but his most severe diagnose was annkle fracture. He was on IM morphine every 3 hours for his pain. Inaddtion to IM morphine, he also had the IV bolus that he could click for pain med whenever he felt pain. He had a medical history of coronary artery disease. His heart sound was irregular regular, and wheezing antior and posterior. MI was ruled out because his lab test for tryphonin was negative. Though out the day, his heart rate was fluctuated between 104-108/minutes with pulse. He was taking amiodarone for his dysrhythmia, and had telemetry attached to him.
ReplyDeleteHi Everybody!
ReplyDeleteWell yesterday I had a very good example of a cardiac patient. He was an 85-year-old man admitted for syncope. His admitting ECG results showed a first degree heart block. The results also specified more stating there was a wide QRS wave and bifasicular block. A bifasicular block is a combination of a right bundle branch block and left anterior or left posterior fasicular block. He had a permanent pacemaker put in on Monday. By Tuesday morning he was in normal sinus rhythm with a heart rate in the 80 BPM range.
Good Girl Joi! I am proud of you! You probably handled it far better than I would have:)
ReplyDeleteWell, Tuesday had its plusses and minuses. On the plus side, I learned some things about Venturi masks and how they work (they increase the amount of O2 the patient is receiving, as compared to nasal canuli; the percentage of O2 is set by the valves, which are colored according to the percentage of O2 the patient receives). Also on the plus side, I got to teach the patient's family about why he was on the mask instead of a cannula). The down side was Desire and my other patient, who was actively dying and had several forms of cancer (it was not clear if it was one form that had metastasized or if they were separate cancers). She was being visited by a hospice represenative during my shift and was taken off all meds (she had about 40 listed as being active at the beginning of the day) except for pain meds and some liquids. During the day she stopped eating/drinking and just wanted to be left alone. We did turn her once, but then the family requested that she not be bothered at all except for VS once a day. The daughter also kept shutting the door to keep us out. I did talk with the son for a bit, but the daughter was not communicating and obviously was grieving. I understood that part; the frustration was that, as a nurse, I had to simply step aside and do nothing for much of the day. Even just checking to see if she still was breathing regularly was difficult. It's a very weird feeling and one that I'm sure everyone will experience at some point.
ReplyDeleteHello everyone!!!
ReplyDeleteYesterday, I had a very pleasant patient with cellulitis on her left ear. I didn't get to spend much time with her because she was discharged before lunch, but I did enjoy administering her medicines, which included several ear drops.
Although I enjoyed my patient, I must say that the best part of my day was observing and being around nurses that have a true passion for nursing. It is obvious that they really enjoy their jobs, which both inspires and reminds me of why I want to become a nurse.
Hi Everyone it is Laura Key! Hope everyone had a great week! Love Love love Hillcrest and our floor. The nurses were great. Anyways I started out 0725 leaving the floor for a EEG and MRI. Very interesting. My patient was a 41 year old female found on 4/18 at work unresponsive on the floor. No on witnessed the fall. EMS was called and she arrived at the ER department. She has no recollection of the situation and it took her several hours to figure out what was going on. Throughout the evening I guess she was fine and then would almost slip into a state of staring. She was ok throughout her test. Very chatty during the EEG and MRI she began to hypervenitlate but ended up resolving her anxiety issues. She fell asleep in the wheelchair before transport arrived to take her back upstairs. Arriving back on the floor she was "arroused" (LOL) by our Primary RN Angie. Crying, anxious and confused about where she was again, how she arrived her and what happened. Parents called and I was handed the phone by patient to speak with both her father and mother (who seemed not calm about what was going). Simply stated the facts and hung. Finally calming down she complained of her head hurting and dizziness. We administered tylenol for the headached. I gave her graham crackers and ginger ale for the dizziness and nausea. After about an hour she felt much better. Visitors arrived prior to lunch and after lunch. Suprisingly she was fine during this time. Psych and Neuro came to speak with her and perform an eval. Their conclusion is she did the same thing yesterday and unsure about any illness that happens in the morning and completely subsides in the afternoon. Reccommendation was seek community services/out patient help due to lack of insurance coverage. Our Primary RN was going to speak to her regarding home life after all visitors went home. She felt there may be fear or anxiety about home. Patient has 2 children (10 & 12 year old girls, one with autism). An ex-husband who visited, a boyfriend and possible husband. Could be the same person, not sure because during episode she had mentioned both a boyfriend and husband to call. Hmmmm, well that was my day. Hope all is well! Cheers!
ReplyDeleteI was stopped by a security guard during the fire drill to answer a bunch of questions. I had to tell him where the nearest pull station was, where was a fire extinguisher and how to use one (PASS), point to the 2 closest exits, know where to go to turn off the oxygen for the floor (ours was across from the nursing station, and usually it's the fire department that will cut off the oxygen), tell where the evacuation map/plan are posted.
ReplyDeleteMy patient on another note was very independent, there for observation due to chest pain. He had chosen to take himself off of his medicine for 3 days due to feeling lethargic. Dr. ordered a nuclear stress test which I got to observe. Results were not in the chart when I left.
The first day of clinicals at Hillcrest was great. We started to wait for our patients reports outside their doors, when I quickly noticed by the look of the primary nurse that my patient was the one sitting in a chair tied up in a vest restraint,a posey, next to the nurses station. So I greeted the patient with smiles and immediately she started to tell me there was some guy in front of her with a sweater. Nurses note: there was no guy with a sweater anywhere. This 81 year old female was admitted to the hospital with altered mental state, and typically she was all smiles. The patient was confused (A&Ox1), loss of orientation, poor regulation of emotions and behavior (this is why she was in a vest restraint, posey), and loss of memory. I asked her simple questions of her past/present and she responded with a squint of her nose, nodding her head no, and no coherent response. One interesting fact about the patient, which was not in the SBAR, was that couple years ago my patient had a shunt implanted in her brain. A shunt is a plastic or rubber tube that is implanted to help drain fluids in the body. That is why my patient was not allowed to go for an MRI, instead the night prior she had to have a CT scan. Surprising to my attention, since I am used to having the patient on soo many medications, she was only on a saline IV to keep her hydrated. One instance with the patient gave me a new outlook on how to handle input/output. Thanks to the assitance of Lauren, I was able to handle her. Just before Lauren helped, I assisted her to the bed commode and waited for her to urinate and have a bowel movement. After she looked at me and was trying to get up out of the commode, I thought she was finished. Little did I know, a person in an altered state can do things I did not know could happen. As I helped her up to put her in bed, I noticed that her bowel movement was on the floor! She did not know that she was walking and having a bowel movement, and neither did I. It was an interesting day filled with smiles, clean ups, learning, assessments, and great teamwork from our group. :) The nurses are also very helpful, which was a sigh of relief.
ReplyDeleteboy, everyone had such an interesting day! i think we are going to see some different style cases from marymount- for instance, there was no respiratory going in and out of every room on our floor- most patients were not on oxygen either. BIG difference from MMH.
ReplyDeletethanks guys for giving me laughs (eliza) and introspection (kevin).
To Erin's Post:
ReplyDeleteI never thought of cellulitis on the ear, but I googled it and lots of things popped up. I would think it would be a short hospital stay once they decide that is what the person had.
I agree that it was nice to observe the happenings of the floor. I feel like I saw a lot of positive behavior. I did not observe negatives or bad practices. We had lots of doctors around and they really spent time with the patients and most of them were very informative with the nurses. It will be fun to explore all the different hospitals and units throughout our program. I am excited to go back on Tuesday.
Hey guys!!! Sounds like everyone had an interesting first day at Hillcrest! I would have to agree with Laura that I love Hillcrest and our floor. The RNs and LPNs are extremely helpful!! As for my day, as we were arriving on the floor my patient was being transported down to the Digestive Health Center for a colonoscopy. He was a 44 year old man that was admitted for chest pain found later to be pneumonia. After doing some tests they found that he was loosing blood. They were unsure of the site that he was loosing the blood from therefore they did an upper endoscopy the day before and the colonoscopy yesterday to check the digestive tract. The procedure was very interesting to observe as the patient was under conscious sedation and was talking to us during the procedure. As the doctor was doing the procedure he stated that my patient was "full of crap". Literally meaning what he said :) Even though he was able to complete the colonoscopy he felt that he did not see everything that he could have so my patient had to have another one today. His colonoscopy was unsuccessful due to poor preparation. This is probably because he was ordered clear liquids the day before until midnight when he became NPO. My patient was somewhat noncompliant when he ordered a pizza from a local pizza place and proceeded to eat the Hershey's chocolate bar that he had hidden in his dresser the day before his prep haha!! Hopefully he had better preparation for the test today as the LPN and I explained to him several times what he needed to do and what not to do along with clearing the room of chocolate :)
ReplyDeleteRegarding Gretchen's comments (but the question might be more for Bonnie or Karen):
ReplyDeleteHow do you handle a patient who obviously is not complying with dietary requirements? I know employees at the nursing station were talking about how he ordered the pizza and had it delivered to his room, and that he had hidden the chocolate bar. You can't take those things away from him, right? Is there a point at which you can do something about it, other than documentation? Can you "officially" question why that person is even in the hospital, if he is not going to comply and you wind up wasting money on tests (like the colonoscopy) that are inconclusive? (Part of this question stems from my aforementioned frustration with my own patient.)
For Gretchen: Was the patient totally alert and capable of understanding the NPO orders? If he understood them, did he give a reason for disregarding them? Just wondering ...
P.S.: I totally agree with all of the comments that the nursing staff there is very helpful! I worked with two nurses and both were great ... one even went into teaching mode with me about the meds he was administering. Also, it was nice to meet and talk to a male nurse!
ReplyDeleteHi everyone! Okay, so on Tuesday I had the opportunity to insert an NG tube! One of the nurses on our floor had approached Stephanie asking if anyone wanted to do it, and she saw that I wasn't very busy with my patient, so I got to do it, with lots of her help of course! I was pretty frightened at first because we hadn't done it before and I didn't want to cause the patient too much discomfort, but it was actually a lot easier than I anticipated. Stephanie guided me through the whole process and held onto the tube for a little while with me, to show me how to guide it in the nose and how much force and speed to use while inserting it all the way down. We only needed one try and it was in! The patient did ask for a quick pause in the middle of it all, to recollect, but he didn't cough or gag really at all. I liked Stephanie's style though... in order to ensure that you are on the way to the stomach and not in the lungs, you have the patient talk to you the whole time... so she had him say "peanut butter and jelly" over and over again... very cute :) Great experience!!
ReplyDeletehi joi, so i have been dreading the whole vomit thing too. i haven't encountered any yet. i hope that i do as well as you did when it is my turn with the vomit.
ReplyDeleteso i tried posting before and i am really stupid and it didn't go. oh well. here i go again. my lady was 94 years old and so cute. she was so tiny. she was in for a PE and was on a heprin drip. but she was having bowel movement issues. she wasn't actually having movements, she was just having black liquid come out like every 15 minutes. i did a fecal hemoccult blood test and it was positive. her HH levels were also low. no one really seemed to care that much. i told the primary RN and i also told the doctor when he came but they still discharged her. so hopefully she is okay and doesn't have a GI bleed. she is also legally blind and can't hear very well even with her hearing aids in. i found myself becoming very protective of her and i would rush into the room whenever someone would go in. people would just talk to her and then she wouldn't hear them understand but would just nod her head and smile. so i wanted to make sure that she knew what was going on. she didn't even know how to use her call bell when i got there in the morning because she couldn't see it. after i made it so that she knew which button to press she was crazy about knowing where it was. she wanted her finger right on it at all times. i think because she didn't call for them before that they assumed that she was okay but when i got there she asked me to clean her up and there was a lot of stool and it was really sticky and caked on so i don't know how long it was there for. now i find myself just thinking and worrying about her. i think that that is going to be really hard for me as a nurse. just being able to care for my patients while i have them and then being able to just let go and not worry about them after.
ReplyDeleteI had my first encounter with role strain during my first day. My patient was in the bathroom changing into his street clothes because he was being discharged, and his girlfriend was providing assistance to him; because that is who he was most comfortable with assisting him. Despite, the bathroom door being closed I could hear his girlfriend crying, and stating: "she did not mind helping him, but she could not take it anymore." The couple was crying together. I acted like I did not hear the them because I felt they were entitled to grieve without my interference, or fear of judgment.
ReplyDeletewow tina, did you know all of the things that the fire department asked you? because reading your post i was thinking to my unit and i don't know those answers. i'll have to check when i go on tuesday. it is awesome for you that you had a good experience with the doctors. i didn't really. my patient's doctor came in to tell her that she was going to be discharged back to the Manor and that was it. he was there for literally about 35 seconds when i stopped starting to leave. with my talking to him it probably added another 45 seconds to his visit. i was disappointed. i hope that my next encounter with a doctor is better. so glad that you had a great day. i'm with you though, i can't wait to go back on tuesday!!
ReplyDeleteIn response to Kevin's April 21st Post:
ReplyDeleteI think that if a patient is completely non compliant the staff can op to stop working with that patient as long as they find the patient another provider, and provides continuity of care for the patient during the transition to the new providers.I do not know if this option applies to just the doctors, or the nursing staff as well.
i'm wondering about that patient non compliance thing as well. i think perhaps this patient of kevin's didn't have proper teaching to explain to him a) the importance of the procedure and b) the need for a VERY clean bowel, therefore no sneaking of food. however, i also think it's up to the patient (they have rights remember) to eat what he wants, even if it mucks up the procedure and it has to be redone. which, of course, is a pain in the arse- for staff to set things up a second time, for the doc to redo the procedure and for the patient to have to go through the whole bowel cleanse a second time. HOWEVER, also a good learning lesson for him that if he HAD been compliant the first time, this second procedure would not have been necessary.
ReplyDeletenot sure nicole though if this is something that would be a medical handoff (ala what we discussed in bioethics).
RE: Cindy's comments re: pizza dude
ReplyDeleteI don't doubt that it is his right to not comply with the NPO order ... but if he does not comply with it, it should not be up to the hospital/staff to deal with the consequences. My guess is that his insurance will not pay for a second colonoscopy, and I don't think the hospital should have to pay for it, either. If he wasn't taught about the NPO order, that's a different case; if he WAS taught about it and the teaching was recorded in the nursing notes, it makes me wonder if he really is in the hospital for the right reasons. (P.S.: it was Gretchen's patient, not mine, although the same question might apply to the patient Desire and I had ... if you won't let us help you, why are you here?)
Kevin: My patient was alert and fully capable of understanding the NPO as well as clear liquid diet only. He just constantly kept stating how he just wanted them to figure out what was wrong as well as how hungry he was. When we took the chocolate away he really didn't say anything about it. I should do some more research on what occurred when the pizza arrived the evening prior. He has been at Hillcrest since the 8th and has made it very clear that he is frustrated and not wanting to be there. Maybe his noncompliance was a way for him to show his anger and frustration even though he isn't doing much but making his stay longer by not following the directions.
ReplyDeletesorry gretchen, YOUR patient!!!
ReplyDeleteGood point, Gretchen, that it could be a way for him to express his frustration!
ReplyDeleteGood evening everyone,
ReplyDeleteMy patient on Tuesday was very interesting...
An 83 yr old male had experienced a right hip fracture and dislocation. The really COOL this about his situation was that he had what they call a "5lb Buck's Traction" on his right leg.
The only simple way to describe it was that his right foot was in an air pressure boot and attached to it was a sling that was attached to a 5 lb weight that held it in place.
below is a website that shows it:http://health.stateuniversity.com/pages/1549/Traction.html
very cool to see to say the least! ( and painful im sure!)
Regards to Erin: I had no idea you could get cellulitis on your ear! I thought i was only the lower extremities... Love learning new things : )
ReplyDeleteRegards to Mariam: So proud of your NG tube experience! only hope my first experience will go over that smooth! ... and i love the "peanut butter jelly" tip too!!
ReplyDeleteIn response to nicole:
ReplyDeleteThat must have been difficult to see and not know how to respond. I completely understand your response to the situation. I don't think its our position to say anything to them so I think you did the right thing. I think with experience we will learn how to handle situations like that better!
In response to Harriet:
ReplyDeleteWas he placed in this position before or after surgery? Also was there anything different you had to do as a nurse because of the situation? He sounds like a very cool and different patient to have!
Hi everyone! What great discussion! Congrats Miriam on an NG insertion! How exciting.....NG's are very intimidating to look at and think about but not really all that bad once you've done it.
ReplyDeleteThere is alot of buzz about Gretchen's noncompliant patient. Kevin raises some really great ethical questions. This type of situation becomes very difficult for nursing because obviously we cannot refuse this patient of fair, nonbiased care...but the frustration of caring for a patient that won't listen is often insurmountable. This patient, I got the feeling, did not really want to know the results of a test that was not inconclusive. Inconclusivity carries an element of hope albeit misconstrued. On the other hand, Kevin is correct....who will pay for this? Ultimately, what will probably happen is the physician will tell the patient that without his compliance, there is nothing more that can be done and discharge him. The nurse's role is best executed by setting aside some time to get to the true root of the noncompliance. Is it a lack of understanding? Is it fear? Is it a lack of will power? Sometimes a patient will get really angry when asked simply, "Is there a reason that you are not complying with the doctor's orders?" but often times with this anger will come your answer.
To Eliza's Post:
ReplyDeleteSince your patient was talking about the "man in the sweater" it was clear that she was able to communicate to some extent. When you spoke with her, was she just not wanting to carry on a conversation and that is why she was nodding and squinting her nose or did she become not coherent as the time went on? I worked with a patient at Marymount that had a tough time that would go on and on about things but when it came to answering questions she really didn't respond either. It becomes difficult to communicate with these people sometimes.
To Tina's Post:
ReplyDeleteWhen I saw that security guard come up to you to ask questions, I definitely bolted in the opposite direction... so proud of you for answering his questions, I would never have known the answers! It's a really good point though, and I understand why they do those checks... everyone on the floor SHOULD know all of those things, and while we all know "PASS" now, we were never shown where everything would be located on our individual floors. I can understand why we as student nurses weren't shown, as we have so many other things to learn in such a short amount of time, but it was interesting to watch Stephanie while you were answering the questions. I know she was guiding you with her eyes lol, but she had never been there either, so I guess from experience, she is just more attuned to where these things would be located...
off topic a bit, but i had my massage last night and my therapist and i got into a bit of a theological conversation (easter today and all). turns out she's a former jehovah's witness, which allowed me to ask her the question that came up in class last week about blood donations. here's the answer:
ReplyDeleteeven if the blood is auto donated, it is NOT allowed to be transfused. has to do with the sacredness of blood leaving the body, and not being allowed back in. i then asked what about dialysis, to which she said she didn't know the answer to that, but would find out. she also said that newer witnesses are adapting to different medical information than the older ones, so some "might" be more amenable to an autologous transfusion, but DEFINITELY none of them will use an anonymous transfusion.
In response to Audrey's post from April 19th:
ReplyDeleteAudrey, what an amazing procedure you were able to experience!!! Thank you for posting the website that illustrates a thoracentesis. In class, we talk quite a bit about pleural effusion, but it never connected in my mind that a doctor would need to remove that fluid and test it. Did the patient feel any discomfort during this procedure?
In response to Nicole K's post on April 21: This is an interesting experience to gain insight into what the right reaction of the nurse or nurse to be would do. In my opinion I believe you did just what needed to be done, and allow both individuals to cope with each other first. If the patient or spouse/girlfriend/family/friend decided to take the initiative and ask questions on how to handle that type of role strain regarding that illness, then what would be the ethical and therapeutic way of handling it? The nurse has multiple roles, and the challenge is that we will encounter a variety of situations. Great decision Nicole!
ReplyDeleteTo Gretchen's post:
ReplyDeleteIt was a tricky situation understanding the extent of her altered mental state. At times, with different situations, such as transferring her to the bed commode, she was coherent enough to understand the command and respond by getting up into a sitted position so that she could relieve her urge to urinate or have a bowel movement and concur to me that she did in fact need to go to the bathroom with nodding her head. After two hours into taking care of her, I tried to engage in a open conversation, but that squint of the nose came back, she looked confused, and then immediately started to laugh. From then on, I kept the questions closed so she could answer with one or two words. I even tried to ask her simple questions such as "How many children did you have?" or "What was your profession throughout your adulthood?" with her daughter present, and she would answer by nodding her head "No" and not answering the direct question, she would respond with something completely unrelated. When her daughter got involved with the questioning, she even denied having children, with her 42 year old daughter next to her. Her daughter understood her mother's difficulty comprehending information, they said she was going to be tested for dementia. Dealing with an altered mental state patient, was a learning experience dealing with what questions are pertinent to ask, how to have the patient answer them (especially if the answer can only be answered by the patient, such as pain), and decipher what they are trying to say. As the day went on, her mental state did not change, she was not coherent to answer simple questions, and she laughed/smiled alot. It was cute, but when I need to know if she is in pain it took ten minutes with simple words and facial expressions to have her understand my question. It is a puzzle trying to communicate simple questions so you can help them.
In response to Kevin's post:
ReplyDeleteThank you Kevin for sharing your great experience about the actively dying patient. It would be hard to be in the situation that family members didn't want the nurse to come into the room. If I'm in that case, I think I'll probably try to talk to her son with my best knowledge about nearing death awaring, and maybe just stay outside the patient's room incase the family members need to talk. I wish I can do what the nurses in the FINAL GIFT do, such as talking to the family members and helping them regconize the dying person's message.
Okay I hope this works!...
ReplyDeleteMy patient last week was a very sweet and cute 96 y.o. female. She was A&O to person only, and it was hard to tell how much she could understand. It seemed like she went in and out of it.
Near the end of the day my patient's son and his wife came in for a visit, so i decided to give them some privacy and was putting my final info in the computer down the hall. About 15 minutes later, one of the stna's found me to ask if I had put my patient on the bed pan. I had not, and her primary nurse had not, however my patient was basically laying in a dirty bed pan, very confused. Apparently whoever placed her on the pan did it incorrectly and when the stna removed it there was poop all underneath her. It was an unfortunate scene and I felt really bad that that had happened to her. I think that her son probably thought he was helping out and placed her on it, but boy what a mess it caused!!! If I learned anything that day it was family may think they are being helpful, but they should really leave it to the nursing staff to help :/
In response to Eliza:
ReplyDeleteYou did such a GREAT job with your patient. She was definitely a little difficult and you were so sweet with her, and although she was pretty out of it, you humored her and got her laughing a lot (especially while she was pooping on you hahaha I will never forget the look on your face). But in all seriousness it takes a special kind of person to have that kind of patience. I was impressed :)
In response to Tina: Good job on the fire alarm stuff! I don't think I could've immediately explained where everthing on my floor is. Should probably find that out on Tuesday!!
To Erin (about Audrey's Post)
ReplyDeleteThe most discomfort the pt felt was when she was numbed up. They used numbing agent, which burned, and the initial poke of the numbing needle did hurt. But during the actual procedure she did not feel anything.
Once the fluid was removed she coughed quite a bit, but that coughing was what was re-inflating her once compressed lung.
My first experience was with a fairly easy pt. She was admitted when she bumped her leg which already had cellulitis, and became an ulcer.
ReplyDeleteMy experience with her was that she did not speak much English. She was fluent in Italian. At times it was difficult to get information from her regarding her pain, explaining her medication, informing her of what procedure I was doing (giving IV medications, taking vitals, etc). It was helpful when her daughter-in-law stopped in to help her order lunch, and was able to communicate exactly what kind of pain, and where her pain was.
I am loving all these posts!
ReplyDeleteOMG!!! I just typed out a WHOLE page to post and accidentally lost it! I wanted to apologize for my delay in responding to what has been posted. I was taking care of my own patient (my mom) who fell last week, is on Coumadin, and was seen in an ER/Urgent Care 3x within the week. I explained the WHOLE situation, with lab work an all!!! UGH!!!
ReplyDeleteOkay, here goes again: This was my patient for the week: 79 year old female, who fell 2 weeks ago tomorrow. She hit her head and her right hip. She didn't pass out and fall, but tripped and fell. Within 8 hours of the fall, she was bruised from mid-back, across entire sacrum and buttocks, and down her right leg to the knee. Had head CT scan done. By Sunday ( 1 week later), she was looking more and more pale. Finally convinced her to let me take her to the ER. Initial VS: HR-84, BP 112/60, pulse ox 88% on RA, temp-37.4 (oral). Her labs: H/H= 8.8/27. No O2 placed on patient (she refused), no IV fluids, and CT of the pelvis was negative. Admitted overnight. Two days later at home, calls because her BP is 90/50 and she took her Lopressor. Had her increase her fluids, and drink juice with 3 teaspoons of salt (why salt???). We will talk more about this case in class on Thursday.
LOVED, LOVED, LOVED all the postings and the responses. It was great that Kevin and Nicole addressed the emotional side of their patient, and how they dealt with each situation.
I am impressed that Tina could answer the questions about the firedrill (not sure I could have), and loved the procedure posts and vomit too!
Kevin, to answer your question about the non-compliance issue, remember the goal of any treatment needs to be the goal of the patient, and not just the nurse. It was driving me crazy that my mom was refusing to wear her O2!!! We can encourage, teach and even bribe.....
I also worked a 319 clinical for the trad. program on Wednesday. I felt sorry for the student who offered to go through her meds with me since her instructor was busy. What should have taken 5 minutes, took 25 minutes when I asked the questions about CHF, HTN, CRF and how they all fit with the meds (surely a rookie mistake to volunteer!).
Keep the comments/feedback coming!
Tuesday I had an intersting patient. a 62 year old white female. Admitted for Multiple Myeloma. An initial Assessment revealed: patient not alert, oriented only to person but disoriented to place and time. BP:105/62, HR:106, Pulse ox 100 on room air, RR:22. Head and neck: conjuctive pink, and moist. Mouth moist, no JVD. Lung: no crackles, vesicular breath sound audible bilaterally. Heart: HR 106, regular with S1 and S2 audible, no murmurs. Abdomen no visible mass, Bowel sound audible, no palpable mass, no tendernes.
ReplyDeletePalpable bilateral lower extremity edema 4+.
Wound dressing on left hip.
All things considered, these are the nursing interventions of a patient diagnosed with multiple myeloma.
Careful ambulation to decrease hypercalcemia and improve pulmonary status
*Adequate hydration, to prevent calcium from precipitating in the kidney, careful monitor hydration status.
* comfort measure and analgesic for pain(per physician order).
* Safety to prevent pathological fractures.
*Do not lift anything weighing more than 10 pounds.
* use proper body mechanic.
* A brace may be necessary to support the spine.
*Monitor a patient for signs and symptoms of stroke.
*DVT prevention
Hi Audrey, your clinical experience stroke my frontal lobe. Could you please tell us more about your patient who underwent thoracentesis. His age, some risks factor such as smoking ,TB or HIV/AIDS, and other exposures(Abestosis). Also could you describe the fluid that was draining out of the lung? I mean was the fluid a fresh blood, a serosanguino(blood mixing with water), did the fluid look yellow in color?
ReplyDeleteTo Miriam's:
ReplyDeleteYou got to put an NG Tube in??? O wow, Gretchen is going to be jealous, lol! Anyways, great idea about talking to you know you are in the stomach! How cool. So it was easier than you thought! Glad you did well.
Lauren - That is such a shame. Family does think they are helping and it ends up not being a help at all. I hope she is doing better. They should of stepped out of the room and asked the staff to help her.
ReplyDeleteCindy - Interesting about the Jehovah's Witnessess and changing their views a bit with the modern healthcare times. Thanks for the info!
ReplyDeleteTo Naomi:
ReplyDeleteI knew most of the answers. The one that Stephanie was helping me with her eye movements was the oxygen turn off station...still wasn't sure where she was directing me, but by pointing in the direction of in front of the nursing station, I was fine. Thanks Miriam for bolting, you could have come helped ;) lol
I've been involved in many fire drills, so I lucked out!
Just a comment about putting in an NG tube in a real patient....it is much easier than working on a plastic mannikin. Although, they don't cough or talk or gag....It's still so much to keep together when you actually get to perform the skill!
ReplyDeletehi guys, i forgot to type this before and i think that it might help someone in the future. so since my pt was blind i was putting her finger on the nurse call button each time so that she could feel the brail bumps on it. once while i was doing it a different nurse from mine was helping the lady in the bed next to me and heard so she came over and showed me that putting an ecg sticker on the call button would make it even easier for her to feel it. it was a great tip.
ReplyDeleteHey guys-
ReplyDeleteI'm a little late but figured I would post my entries anyway!
In response to TINA- thank you so much for posting that thing about the security guard asking you all those safety questions. I'm going to look for all of that stuff tomorrow when I get to the hospital because as of right now I have no clue. And these are clearly things I should know!
And just to post an entry about my patient from last week...
ReplyDeleteI had a 66 year old female patient who was receiving IV fluids when I noticed her IV site was red and inflamed. I asked her primary nurse about it and she said that we needed to start a new IV on her.
So.. I had the opportunity to start an IV on her! I used a 20 gauge needle and attempted to insert the IV on the anterior right forearm. She had very good "juicy" veins and I inserted the needle until I saw blood return. My mistake (as Jessica informed me) was that I kept inserting the needle after I saw the first bit of blood return. So I ended up blowing the vein. I feel like I learned a lot though just from trying it out on a real human. I got the feel for it a little and will be much more confident next time!
oh wow marsie! great learning experience!!!
ReplyDeletehi guys, yesterday wasn't too exciting. my pt. was an 84 year old man. he came in for change in mental status. he was totally fine yesterday though. it turned out that he had had a uti.
ReplyDeletewhen we came in to give him his meds he started crying. he was upset b/c his wife had died recently in hillcrest. a few other friends of his had also died recently. bonnie was talking to him. he felt like a big baby crying and was apologizing about it. then bonnie told him that she was once told that tears are like vomit for the soul. no one wants to do either but you normally feel better after you do. so true. i liked that.
Naomi: that similie from Bonnie is pretty amusing, considering how she feels about vomit!
ReplyDeleteMy patient yesterday was a 92-year-old man who, due to complete heart block, had a pacemaker implanted on Monday. He was very alert and with it; a former dentist, he was very interested in all of his medications and how I was administering them, especially the Ancef piggyback, which I told him he was getting as a post-surgical precaution. He seemed to be recovering well from the surgery. The device was implanted through an incision near his left clavicle, and the incision was “glued” back together, so there was no need for a dressing change. He had a little pain, but not as much as I would expect after his surgery; most of the time he said he had no pain at all, at other times it was a 2 or 3, and at most it was a 5 out of 10. He was able to ambulate with some help (he just held my arm) when getting into the bed so transport could take him to radiology. We also talked about listening for crackles, and he understood the importance of that. The other surprising thing about him was his age; he did not look 92, but more like late 70s or early 80s. He had one big issue when I arrived: he wanted to know where his cane was! Apparently, he took it with him to surgery and it didn’t come back up with him. He asked everyone from the cleaning staff to the transport person to everyone he saw in radiology to people we passed in the hallway on the way to radiology. He was very persistent. The nurses had tried to track it down but, as we know, things got way too busy on the floor for any of them to spend any time looking for it. A helpful transport person found security had it and asked them to return it, so security brought it up and made the patient sign for it. (The story reminded me of one of the ATI questions, about what to do with jewelry taken from a patient going into the OR.) Anyhow, he was thrilled to get the cane back and much happier to try to move around. He actually spent much of the afternoon sitting in his chair, instead of on the bed, since he finally had his cane back and felt he could move around more. It’s surprising how big a difference a small thing like that could make in his confidence and ability to heal. It also was neat to see his ECG printout and to talk to the staff from the surgeon’s office, who came up to check how his pacemaker was working (they can run his tests remotely since he’s “wireless”), and for Bonnie to show me the pacemaker spikes, showing how the pacemaker is controlling his heartbeat.
Hey friends, so yesterday I had another very textbook cardiac patient...maybe this will help with studying?! My pt was a 76-year-old male admitted for atrial fibrillation with rapid ventricular response and volume overload. He came to the ED the night before because he had palpitations, dizziness, short of breath, and swollen extremities.
ReplyDeleteOne week prior he had undergone mitral valve repair and full maze procedure. The mitral valve repair was performed due to severe mitral regurgitation. The maze procedure was performed for his atrial fib. In this procedure they used radiofrequency ablation or heat to create scar tissue in the atria to interfere with "stray" impulses that cause atrial fib.
With that said I wondered why his atrial fibrillation still occurred after surgery? I found that studies show in 30% of cases, atrial fib. will return temporarily right after surgery. In 90-95% of cases, pts. return to NSR about one year after the procedure. Hopefully results will soon show for him!
Yesterday I was unfortunate to have two fall risks patients 85 and 99 year olds. This experience put some pressure on me as well as my group partner, we should assess patients for fall risks, we should also do a Braden scale as our patients were bed riden, addressing their needs in a timely manner had also been and issue; one of our patient who appeared to be drowzy was very alert whenever his phone rang. I found him almost climbing out of his bed trying to answer the phone call. At the end i enjoyed my day working with these patients and learned that having 2 fall risk patients in the same room could minimize the potential risk of fall. There was always a someone to watch on these patients. Me, Gretchen, the primary nurse, and patients family members.
ReplyDeleteYesterday I had an 88 year old male patient with the diagnosis of failure to thrive. He had been in the hospital for 9 days already and they were still trying to figure things out. His main problem was that his sodium levels were too low. He was on a fluid restriction of 1000cc/day to try and help control the sodium. It was then determined that his output was not good, so they did a bladder scan to see how much he was retaining, if it was less than 300cc a straight cath would be done and if greater than 300 he would need a foley catheter….it showed 330 so he needed a catheter….and I GOT TO DO IT!!! The procedure went very well and it helped having an easy going patient (he was practically asleep when we were going to do it and he could care less, so it took away the fear of him not wanting it or afraid of the pain, at the end he said he only felt a little bit of it). I really like the nurses that I worked with, they all were eager to help and teach. They even did a teaching lesson of how to do the catheter in the clean utility room so I would not be as nervous when doing it with the patient and instructor!
ReplyDeleteYesterday I had a 62 year old patient with a dx of venous insufficiency re her exploratory laparotomy. Her hx is Crohn's disease and an ileostomy.
ReplyDeleteFor me it was a rather light day because she was a nurse at Hillcrest and was able to take care of herself 100%.
However, I learned a lot. Especially about the ileostomy because it is a topic that I just didn't really understand prior.
From my understanding, the ileostomy is a surgical opening of the skin where part of the intestine is brought to the surface. Here, intestinal waste passes out and into the ileostomy bag.
Something else I learned was the stoma has no nerve endings! So she couldn't feel if you were to put something hot or cold on over it!
RE Desire's post: At Marymount they used the picture of a "leaf" outside the doors of fall risk patients.... What do they use at Hillcrest?
ReplyDeleteRe: Harriet's post: That is cool that you learned the stoma had no nerve endings! I had a patient @ Marymount with a stoma and just never thought to really ask how it was affected by heat/cold but nice to know!
ReplyDeleteYesterday I had a 31 y/o male admitted for an L5 diskectomy. He was also an RN at the downtown CC campus and worked in the ICU. He ended up getting discharged around 10am; he was in pretty good shape. I did find it slightly intimidating having a nurse as a patient though! And he was very sympathetic when I told him I'd be asking him all kinds of questions for my careplan :)
And Tina- thats awesome you got to do a foley!!! I'm pretty nervous for one of those; nice the guy was basically asleep too!
ReplyDeleteIn response to harriet. At Hillcrest it will say "fall risk" outside of the patients door.
ReplyDeleteI dont know where my post from earlier went!!! So this is my third attempt. I had a 82 yaer old patient with had a femor repair. She was very alert and i felt like i was driving her crazy with the vital signs every four hours. Before i left she refused to have her blood pressure taken. Nothing very exciting Tuesday but i did gather all the info i needed for my careplan.
ReplyDeleteJust thought about this. On our floor we did have a patient who fell and hurt his leg......AFTER HE ATTEMPTED ROBBED A BANK. Needless to say, he wasnt there very long. the POLICE came to arrest him shortly before our lunh break!!!!!! FUNNY!!!!!!!!!!!
ReplyDeleteharriet- on my wing they have a sign that says falls risk but then other rooms having the falling leaves. and some pt.s had yellow wrist bands on that said falls risk. so it's not super organized.
ReplyDeletejoi- how funny about the bank robber. did you have to do anything for the guy? was he hand cuffed to the bed? this brings into play what sr. kathleen talked about with regard to treating some pt.s like if they are killers or criminals or something. interesting.
tina- so proud of you and your foley experience!! i'm really scared to do one. i feel like i need to do something hard like that to get me over the fear hump.
great job!!!!
hi all...
ReplyDeletekaren, i should be studying and instead i'm getting caught up on this.
my pt yesterday was a retired cop, age 73. he was a bit on the pissy side; i called him a curmudgeon and there was no disagreement! he was in for rt pleural effusion 2ndary to + pneumonia (and his thoracentesis was today, darn it!). the med count for him at 9 am was 15, plus about 2 more (not including insulin) by lunch time. he also had a-fib and that was part of his treatment plan.
he is on anti-neoplastic medication for a rbc problem he's had for years. i found this to be very interesting, as when i looked up the med prior to administration, all it had was information re leukemia and other blood cancers. so, instead of guessing, i asked him why he was taking it. however.......... with my hearing and his mumble, what i heard first was "for my pud", which about put me in hysterics! then he explained further, and i was quite grateful i'd kept my laughter inside (oops!!)
he needed an IVPB inserted prior to our leaving for lunch, but here's where his recalcitrance and obstinance came through loud and clear...THAT was the time he was being positioned out of bed, and he flat out refused to let me hook up the IVPB. pitched a fit! stephanie had to step in and tell him in no uncertain terms that SHE was in control and not him (i'm not ready to be that bossy with a pt yet it appears). needless to say, i didn't get to finish programming the pump directly (stephanie and i talked it through quite quickly), hooked him and boogied!
overall, he was quite cooperative and i did have some good conversation with him, but now have experience in some other areas i didn't before...hmph!
Yesterday I had a 94 years old patient, who failed and broke her right femur in her apartment bathroom two weeks ago. She had a stroke, but it was uncleared if her stroke occured during or after the surgery. She had aphasia due to the stroke.Even though she had difficulty to form words, she could still understand what other said. She recognized her name in writting, but speaking it was way off. Everytime she tried to say something, she looked very tired and anxious. I tried to help her out by paraphrased what she tried to say, and she would say "yeah" or smile to agree with what I said. It was heart broken to see her struggled with aphasia :(
ReplyDeleteIn clinicals I had a patient who was there recovering from a back surgery. During the process of changing the bandages on the incision site I observed she had developed a pressure ulcer on her left buttock. It was just getting past the point of stage 1. I charted the discovery, and reported it to the primary nurse. She had not discovered it yet. I was the first person to observe it. I felt like a real nurse when the primary nurse asked what do I recommend be done for the patient, and should ointment be applied to the wound? I told her that since it already had comprised skin integrity that I do not think that may be the best way to go. Then she asked me should the pressure ulcer be left exposed to the air. From there I recommended she observe the site herself, and make a decision based on what she observed. That was my clinical experince...someone asked my professional opinion.
ReplyDeletego nicole!!! good call and pick up! kevin and i found a pressure ulcer on our first patient at MMH; the primary was pleased we found it :)
ReplyDeleteResponse to Tina's post:
ReplyDeleteIt is interesting to learn that we can use foley on patient who retains more than 300cc of urine in the bladder. I used to think that we would only need to use foley on bedrest, post-op, incontinent patients and those who retain more than 900cc of urine in their bladder.
Since your patient's sodium level was very low, did he also have a very low blood pressure too? I wonder if we can do what Karen mentioned in class today by giving him two teaspoons of salt with water to increase his sodium level.
So Tuesday I got to spend a few hours in the lab drawing blood! It was a lot of fun, and I really feel like I got the hang of it! I only used butterflies though, where I could see the immediate flashback and know that I was in the vessel... not sure how I would do otherwise. It definitely feels way different on a real person than those dummies in the lab! And I kind of want to do more... it's a little addicting, like a game almost lol! Other than that, my patient was being discharged and didn't need much of anything, so it was a rather calm day.
ReplyDeleteTo Hmeris. They use the same symbols for fall risk patients. A leaf Picture.
ReplyDeleteTuesday was actually very laid back for me. My patient was capable of bathing herself and using the bathroom and needed very little help with ADLs. The only difficulty that I had with her was that she was clearly addicted to her pain meds. She first informed me that her percacet was no longer "working" for her. So she had ordered Toradol prn every 4 hours. After that was administered she asked if she could have her Dilaudid which her doctor also had ordered for prn every 6 hours. When I went to administer it through her IV she asked me why I was pushing it so slowly (clearly wanting the rush that comes from it). It was interesting to see and difficult to stay patient with her but was a good learning experience!
ReplyDeleteIn response to Jasmine,
ReplyDeleteThat is my main difficulty in nursing so far is not getting emotionally attached to patients, especially the cute elderly ones. I wish I could take them home and take care of them and it breaks my heart to see them struggle like they do. Im sure you did an excellent job taking care of her and brightened up her day :)
Hello everyone!!!
ReplyDeleteThis past Tuesday was pretty exciting for me because I observed my first procedure! My patient was in renal failure, so she had to have a permacath put in for dialysis. The whole procedure process was very interesting and more relaxed than I would have imagined. The placement of the permacath was also interesting because exteriorly, it looked like it entered her subclavian. However, the catheter was actually threaded under the skin into the jugular and down through the vena cava.
In response to Miriam's comment on April 28th at 3:30 PM:
ReplyDeleteMiriam, you are so lucky!!! I cannot believe that you had the opportunity to draw some blood. What are these butterfly things that you mentioned? When you entered the vessel, despite the flash of blood, could you feel it too?
I can never figure this blog out and how to sign in. Anyways - Tuesday was interesting. I had to do a lot of patient teaching. My patient was an 88 year old male, admitted on 4/25 for change in mental status. He has CHF, +4 pitting in his lower extremities. The primary and I had to spend a long time with him and his family discussing the need for him to weigh daily, be on a low sodium diet and fluid restriction. I found a lot of great pamphlets/handouts on ccf.org intranet. It was so helpful! The primary actually showed me where to find the information. I used a lot of the handouts to sit with the family and discuss the importance of each protocal. All in all another great day!
ReplyDeleteErin -
ReplyDelete1) That's so cool that you got to see that! How long did that procedure take? Did they explain it all to you as stuff was going on, or did you look it up before/after?
2) The butterfly is the type of needle (http://en.wikipedia.org/wiki/Winged_infusion_set). It's easier to use, but the blood does flow slower, and can clot easier, making it flow slower or even stop. That's the thing though, you don't really "feel" that you are in the vessel, so the flashback is what lets you know with the butterfly, so you immediately stop advancing the needle so you don't puncture the vessel or anything. It's especially helpful if you can't really see the vessel as you are putting it in (but you've obviously felt for it beforehand). The way I think I saw them using the other needles, they had the collection tube nearly inserted, so when they reached the vessel, they snapped it in and would see it begin to fill. I didn't see any of them "miss," which would have been helpful so I could see what to do from there...
In response to Laura:
ReplyDeleteGreat job teaching, I bet that was a learning experience for you too! I find pt teaching a hard aspect of nursing. Was your patient and his family responsive and ready to learn? Did he mention why he never knew or complied with lifestyle guidelines of CHF before? Is this a newer diagnosis?
To Miriam:
ReplyDeleteThats awesome you got to use the butterfly needles! I bet the flash thing is cool to see and helpful. I also found it hard to realize when I was IN the vein for the insertion of the IV. You would think that you'd be able to feel some kind of pressure or some indication that you're in the vein, but I found out its more just about looking for that blood return. I think I was so focused on looking at the vein and making sure I was putting the needle in right, that I forgot to look for the initial blood return and thats why I ended up putting the needle in too far. Ya live, ya learn!
I tried to submit before and I lost it :(
ReplyDeleteTuesday was an inventive day as a student nurse. It started out with the transferring nurse doing a report on my patient and not including his mental status by saying he is crazy. I started to do a systemic assessment on my 82 year old male patient who was admitted to the hospital due to a left hip fracture. While I was assessing him, I started to ask how he broke his left hip. A&Ox2, alert, clear spoken, and confused about place. According to my patient he broke his left hip due to an unstable rug, where it slipped underneath him and he fell on his left side, located in the Atrium of Hillcrest hospital while waiting to change his foley catheter. When I proceded to ask the nurse whether that was true or not, she replied with saying he was crazy and it was not true. So the investigative lawyer inside of me came out and I asked her if I was able to check his chart. With the primary nurse's permission, I started to look through the chart. Towards the end of the chart I noticed a statement made by the physician stating that the patient did in fact break his left hip in the Atrium at Hillcrest! As a student nurse you want to trust your primary nurse's assessment and not to second guess. In this particular situation, I acted as my patient's advocate by trusting what he said and doing everything in my knowledge to justify the reason. Another instance occurred where I given instructions by the primary nurse to remove his foley catheter. Before I was going to remove the catheter, I needed to know the history of the foley catheter. He answered by saing he has had it in for one year due to urinary retention. So I approached the nurse saying that I will be unable to remove the catheter until we speak to his primary physician. When I told the priamry nurse, she was very thankful and wanted to give me a raise ;) This experience taught me how important it is to be your patient's advocate, so you would be able help them reach their optimal level of health and develop a therapeutic relationship. Sometimes you have to listen and trust your patient, even though everyone else around you is saying something completely different.
holy wow! that's funny eliza! but good on you for thinking to get out the chart and read through. also good on you for being a good advocate for your patient- EXACTLY what we are being taught in our classes...
ReplyDeleteHello Everyone!!! I keep losing my posts as well :( :( On Tuesday I had both of the same patients that Desire had! I focused more of my attention on the 99 year old male. He was admitted at 2:30 in the morning on Tuesday because he fell. He was first taken to the new UH hospital but they were "too full" so he was brought to Hillcrest! Just by looking at this patient you would have NO idea that soon he will be turning 100! He was very alert and talkative as well as very appreciative of the help that everyone was giving him. Throughout the day the pain in his leg continued to worsen and I could see him declining. I went down with him and observed the X-rays that were done on his leg. The tech actually was unable to finish all of the x-rays due to the amount of pain that the patient was in. When we returned back to the room the primary nurse gave him Vicodin. Within about 30 minutes he was throwing up all over the place. Needless to say I got my experience with the dreaded vomit! Something that I found to be very interesting was during the X-ray. The tech that was doing the x-rays was very nice and talkative to the patient at first. As she noticed that he was in pain and starting to complain quite a bit she started to get very firm with him and lost her "very nice" touch. She was constantly rolling her eyes when she walked away from him and the caring attitude was disappearing. It was difficult for me to watch her act like this because she was not even asking him what was wrong or what was hurting she was just chalking it up to him being noncompliant.
ReplyDeletetest comment
ReplyDeleteBecky: That maze procedure sounds cool. I was interested since I had an A-fib patient at Marymount. Apparently, they are creating a path using scar tissue as the “walls” so that the electrical impulse has only one way to get through the “maze,” which is where the name comes from. I thought it was cool because, rather than simply starting the electrical impulse or getting it to run, they were trying to control its path and prevent it from running elsewhere, using scar tissue, which does not conduct electricity. That would be a cool procedure to watch!
ReplyDeleteHere’s a site with some artwork that explains it:
www.cts.usc.edu/mazeprocedure.html
This week was pretty cool for me because my patient reflected some of the information we were going over in class. My patient was a 77 y.o. man who fainted at home and had a contusion on his forhead and bruising on his face and other body parts. He was brought to the ER and upon doing an EKG they found that he had had an MI. This is probably the cause for his syncopal episode, even though he was completely surprised to learn he had a heart attack! He was sent to the cath lab and they inserted a stent in his CA.
ReplyDeleteIt was really cool to work with someone that was a great example of what we were going over. It definitely makes the information so much easier to grasp, and more "real" if you will.
One more thing! we also had a prisoner on our floor Tuesday!! We didn't actually get to see him, but it was pretty cool :)
ReplyDeleteJasmine: I don't think for most people they would need to cath them over 300cc in bladder, but they needed a specimen and for him, it was a sign that he was not having enough output and they really need to figure out his low sodium. Once they do figure out what be causing his sodium (they are thinking meds or kidneys) then they will give him what sounded like a sodium vitamin??
ReplyDeleteGretchen: Your day sounded difficult. It's frustrating when the staff are not caring and I find it scary that they act that way in front of a student...I wonder if that is them on their best behavior and if we were not there how much colder they might have been. Too bad he vomited with you and not just on the mean tech!
Along with Miriam (although I went in the am, she in the pm) I spent the day in the outpatient lab drawing blood. It took a while for them to trust me to do some draws, so I observed for most of the first hour. They are REALLY good at their jobs. Not one of them missed a single draw on the first try.
ReplyDeleteI learned a lot about the color coded vials, and the different tests they were drawing for.
We did have several OB pts doing 3 hour glucose tests. Those were not happy patients!
It was a great experience and I am now confident in my blood draw skills!
In response to Gretchen's Post:
ReplyDeleteThe way the hospital employee was reacting I wonder if that individual was burned out from the job. I just hope no one would ever have a callous attitude toward my loved ones. Furthermore, many people in the health care profession is judged by the action of their peers, and I would not want the health care profession to be seen in a negative light.
In response to Audrey's Post:
ReplyDeleteWhat was your patient diagnosed with that she was on so many pain medications? Did she have a surgery or something? Was she constantly on the medications or was there a time frame where you may have been able to tell she was going through withdrawal or getting aggitated without the medication?
In response to Nicole and Tina:
It does make me sad to think that someone would be burned out for the day or simply just taking frustrations out on a patient. I know that he was being difficult and was constantly asking when they would be done but he was in a lot of pain. Had the tech taken the time to explain what they were doing and why they were doing it, he may have cooperated better. Whenever she stepped out of the room I asked him lots of questions and was able to explain to him what I could and was trying to distract him from the x-rays as best as I could so that the time went faster for him :)
Gretchen,
ReplyDeleteSounds like you had a pretty eventful day. I had a similar experience with a nurse automatically assuming the patient is faking their pain when we were at marymount. I'm sure there are some people who do exaggerate or ask for pain meds when they don't really need them, but as we've learned, what the patient tells you regarding their pain is what you have to go with!!
To Gretchen's Post:
ReplyDeleteThe "dreaded vomit" seems to be contagious! I wonder if it is a daily occurence at the hospital, at least once a day you will experience the vomit. Did the nurse, who seemed to have her cookies in a bunch, realize what she was doing? It is a wonderful thing to hear of a person living sooo long and able to communicate effective with appreciation:) It is nurses with those kinds of attitudes that can effect somebody's will to fight an illness. What was the result of the X-ray? Was he able to perform ADL's? I am rooting for this amazing trooper to reach 110! Today my grandmother turned 93 and A&Ox3:) It seemed like he was just full of life and genuine. Shame on that nurse.
This post is in regards to 5/3/11. I can not view any posts from that day, hopefully this will post. I had an amazing 59 year old male who came into the emergency room with flank pain. This type of pain is a result of a kidney stone, his was about 5.5cm!! According to him and the primary nurse, renal calculi is one of the most excruciating types of pain. His was on the severe side since his was enormous! Because of the severity of the situation, he was required to undergo a Percutaneous nephrolithotomy (tunnel surgery) resulting in an insertion of a nephrostomy bag to facilitate urine. The urine will be cherry colored for a month, and he would also (just like we did throughout his stay at the hospital) strain his urine. I was excited to see that he responded to my teachings of drinking at least 1500ml of water. I even told him that it is necessary for him to continue drinking water, avoiding foods with high salt, and avoiding fruit drinks. He loves his orange juice! Since he has achieved to get a kidney stone, his chances of getting another in the future is high. So he has to be very strict about his intake to help avoid further kidney stones.
ReplyDelete