Just wanted to post some bragging rights here... :) we had our test on shock, code management, acute resp failure & ards this week and oh yeah.. got a 98!! i was flying high on that grade, especially after doing so bad on the previous test. Sure did make me feel great!
Final exam is next week... I just cannot believe that it is almost over, still. Planning on taking a little vacation over the next 2 weeks. Grades are due by May 10, so am hopefully expecting my ATT sometime in the week of May 15. I am scared to death of scheduling for the nclex, taking the nclex, failing the nclex. All i can do is prepare, prepare, prepare. Do my best. Pray to god for a passing score. All I can do.
I had meant to share more of my clinical stories this semester and some more of my work stories, but between taking 3 classes this semester and working, it was all i could do just to manage that, let alone the kids and their extracurricular activities. Hopefully, one of these days I will be able to put more of these stories together. Well, off on a studying/reviewing journey I go.
27 April 2007
17 April 2007
58 down, 2 to go
I can't believe that there are only 2 more weeks left of my nursing classes and I AM DONE. Finished. Of course, this is assuming that I am going to pass the class :) After the horrid test we took today, I am so very, very thankful I had a great average with some cushion. Just need to rock the next test and the final exam and I will a-ok.
I hope that the college sends the transcripts soon to the board of nursing. I am really hoping to schedule my test in the beginning of june. I am scared to death of taking the nclex. completely. totally. scared. I guess this is normal to have this anxiety about it. I mean after all the work and time and life-changing events/priorities, I would just die if I don't pass. I honestly don't know what to think or do.
On another note, I interviewed at another local hospital last week for a position in ob and er. I felt that the interview went well, but truth be told, I really wanted a position in the icu, for which I am interviewing for this coming wednesday. the problem is that this hospital does not pay as well as the one I currently work, so it just makes the decision even harder. I guess I have to actually be offered the position first - duh - but in case that happens, i want to be prepared of what I am actually planning on doing. I do hate not knowing what I am planning on doing. I have just been too indecisive on this. Guess I will just see how things go and then make a decision from there. Gotta get my pros/cons list out right away though and formulate some questions to ask in the interview.
guess i really need to catch some zzzzz's. first tuesday in awhile that i don't have to get up before dawn and go to clinicals *grin*
I hope that the college sends the transcripts soon to the board of nursing. I am really hoping to schedule my test in the beginning of june. I am scared to death of taking the nclex. completely. totally. scared. I guess this is normal to have this anxiety about it. I mean after all the work and time and life-changing events/priorities, I would just die if I don't pass. I honestly don't know what to think or do.
On another note, I interviewed at another local hospital last week for a position in ob and er. I felt that the interview went well, but truth be told, I really wanted a position in the icu, for which I am interviewing for this coming wednesday. the problem is that this hospital does not pay as well as the one I currently work, so it just makes the decision even harder. I guess I have to actually be offered the position first - duh - but in case that happens, i want to be prepared of what I am actually planning on doing. I do hate not knowing what I am planning on doing. I have just been too indecisive on this. Guess I will just see how things go and then make a decision from there. Gotta get my pros/cons list out right away though and formulate some questions to ask in the interview.
guess i really need to catch some zzzzz's. first tuesday in awhile that i don't have to get up before dawn and go to clinicals *grin*
02 April 2007
One step closer
tomorrow and wednesday will my LAST clinicals forever :) unless of course i continue on to pursue my BSN, which I am planning on doing soon in the future. but i am just so excited to be that much closer to finishing. Finally got the monster of a community assessment finished and turned in.. phew. hated that project with a passion! put in an application at another hospital.. want to keep my options open. not to mention that will be a greater opportunity for learning experiences at this other hospital if i can get the job :) keeping fingers crossed. the downside is that it will require some commuting, so they will have to offer a comparable package to the one in which i have already been offered.
i can't wait to have a normal life again. i have felt bound to textbooks and interventions and rationale for the past 2 years and now i just want some free time, me time, and most of all, put some real order back into this house, which has books and books and books all over, wherever i plan on working that night lol.
ok, enough rambling for now. i must go get some sleep. alarm comes early in the morning.
i can't wait to have a normal life again. i have felt bound to textbooks and interventions and rationale for the past 2 years and now i just want some free time, me time, and most of all, put some real order back into this house, which has books and books and books all over, wherever i plan on working that night lol.
ok, enough rambling for now. i must go get some sleep. alarm comes early in the morning.
23 March 2007
Indecisions
I have been officially offered a job where I work. Not in the ICU like I had hoped, mostly because there aren't any open positions in there at the moment. The job is on the medical/telemetry floor, full time nights. My indecision comes from a potential desire to work somewhere else. I am just not sure if I am making the right decision, although it is possible that I am. At the other hospital where we do our clinicals, there are openings in the ICU, and I really enjoyed my experience in that unit as well as the way that hospital handles things a bit differently. I wonder do all students go through the same indecision as I am about where to work when they are finished, or do they know exactly where they want to work and there is really no other option for them.
We have 5 weeks left of school. 5 long weeks. But only 2 more weeks of clincal left :) I am so excited to be thisclose to being finished. Although the next 5 weeks is going to be full of tests, ATI tests mostly. I think we have at least 7 of them to take. I have mailed my application for licensure to the board of nursing and paid my nclex examination fee. Now just waiting for classes to be done, transcripts to be sent, and receiving my att so that I can schedule my exam. My nerves are shot... shot to hell. I have to finish writing up my part of this huge community assessment that we have had to do this semester (hate all aspects of this project, btw). Have to finish my portfolio for leadership, and study, study, study. In the meanwhile, my oldest son is on the JV baseball team at school, youth league baseball has started and I am only one person able to be in one place at one time. I can't feel more pulled in different directions than I do right now. Will it ever end? I know it will, but what will I do when it does?
I am sure that I will want to catch up on a couple years of lost sleep lol.
We have 5 weeks left of school. 5 long weeks. But only 2 more weeks of clincal left :) I am so excited to be thisclose to being finished. Although the next 5 weeks is going to be full of tests, ATI tests mostly. I think we have at least 7 of them to take. I have mailed my application for licensure to the board of nursing and paid my nclex examination fee. Now just waiting for classes to be done, transcripts to be sent, and receiving my att so that I can schedule my exam. My nerves are shot... shot to hell. I have to finish writing up my part of this huge community assessment that we have had to do this semester (hate all aspects of this project, btw). Have to finish my portfolio for leadership, and study, study, study. In the meanwhile, my oldest son is on the JV baseball team at school, youth league baseball has started and I am only one person able to be in one place at one time. I can't feel more pulled in different directions than I do right now. Will it ever end? I know it will, but what will I do when it does?
I am sure that I will want to catch up on a couple years of lost sleep lol.
03 March 2007
We are the Champions!
All-Star basketball tournament was today for the 11-12 year old league. And our team came out victorious! Wooooot!! Nothing like some good old competitive basketball. Some of the kids took some hardknocks on our team (including my own son!) But we fought hard and was undefeated in the tourney. I am so proud of our team for keeping their heads up, hearts strong, and finishing out a great season. Congrats!
Now that basketball is over, it won't be long until baseball starts full blast. Team drafts are next weekend and practices will start soon after that. My oldest son, who is in the 8th grade, made the high school JV baseball team and their games start next week too. I tell you, it will take some time management skills to be able to balance all of this running around, seriously. Good thing I am learning a lot of that here in my last semester of school. Truthfully, I can't wait for baseball to start. I love baseball. And I love the Cardinals... here is hoping for another championship season for my Redbirds :)
Now that basketball is over, it won't be long until baseball starts full blast. Team drafts are next weekend and practices will start soon after that. My oldest son, who is in the 8th grade, made the high school JV baseball team and their games start next week too. I tell you, it will take some time management skills to be able to balance all of this running around, seriously. Good thing I am learning a lot of that here in my last semester of school. Truthfully, I can't wait for baseball to start. I love baseball. And I love the Cardinals... here is hoping for another championship season for my Redbirds :)
23 February 2007
it's just a little different now...
well the nurse manager where i work has decided to fill the open positions in the ICU, so it seems as though I will most likely be starting out on the tele/med-surg unit. Actually, it is quite ok with me. I love working in the ICU, but I am not stupid to think that I shouldn't get good floor experience before moving into a specialized area. It is a bit of a relief because now I don't have to rush to take ACLS or anything like that before moving into there. :)
We got the papers to fill out our official application to sit for the nclex exam after graduation. Just having the papers and the book makes me nervous lol. Just thinking about filling it out makes me nervous. What if I make a mistake? I guess I will really have to review it before filling it out to make sure it is all right when I hand it in. Nervous.
Ahh well, am sure things will work out in the end as they are supposed to be. I won't spend a lot of time worrying about the little stuff because I have too many other things to do and other things to worry about, such as my test coming up on Monday and my other classes as well.
Ok off I go to review a bit before getting ready for work.
We got the papers to fill out our official application to sit for the nclex exam after graduation. Just having the papers and the book makes me nervous lol. Just thinking about filling it out makes me nervous. What if I make a mistake? I guess I will really have to review it before filling it out to make sure it is all right when I hand it in. Nervous.
Ahh well, am sure things will work out in the end as they are supposed to be. I won't spend a lot of time worrying about the little stuff because I have too many other things to do and other things to worry about, such as my test coming up on Monday and my other classes as well.
Ok off I go to review a bit before getting ready for work.
01 February 2007
weight a minute
Last week, I had a really great learning experience. This week, my assigned patient (Yes, we were supposed to have 2 this week. Unfortunately, census was down so we only had 1.) Anyhow, my assigned patient was admitted over the weekend with a change in mental status. Try writing that up for clinical prep – shoot there are so dang many things that contribute to a change in mental status. It is difficult to know which direction to effectively write up without knowing any further history. But I got it done. Arrive at the clinical hospital 0630, ready to go. Get report on my patient, learn some things important, like there was a right subclavian portacath. (immediately knew that she was most likely a cancer patient, since they tend to have these for chemo medications). She was s/p breast ca and a left radical mastectomy. She became seriously confused, was admitted, and had a raging UTI.
It’s no secret that a UTI will cause a confused presentation in the elderly. Much documentation has been done on that subject alone. Heck, Pope John Paul the III died from a UTI that progressed to sepsis. But this woman was only 50. Hmm.. ok, I thought. Also learn that she has a positive history for diabetes and hypertension. Pretty common these days, especially together. But I was not prepared for her. Not by any means. You see, I walk in to greet her, and find out she was the size of the hospital bed itself. Literally. They had ordered the special bed for her, but it had yet to come in. So in the meantime, she is packed into the regular bed on an air mattress. She couldn’t turn or move because there was no room. None. She is 530 lbs. And full of fluid.
She has widespread anasarca, which is now weeping and causing skin breakdown. Everywhere. Straie were puffy and full of fluid, looking like they would bust at any moment. Left lower leg is dusky and her toes are almost black. Her skin is literally sloughing off from the fluid overload. But that wasn’t even her main problem. Nope.
Although that in itself is pretty horrible to see, it must be even more horrible to experience.
Her main problem, however, was pancytopenia from the chemo. Her WBC count… normally 5-10, were 0.9. Hgb was 7.9 after a unit of prbc’s and procrit. Most seriously though… her platelets were 6, when normally 150-450. There was petechiae everywhere and purpura over her left leg as well. DIC was a formidable risk, and ever present in the mind. Sure she had open sores where her skin was tearing to let the excess fluid out. DIC, on the other hand, could be a potentially fatal complication. Yes, she had received some irradiated platelets, but still her numbers only went up to 12. She was on vitamin k. Her bleeding times were well out of whack.. as to be expected.
She was really a nice woman struck by cancer and now all of these complications. She was concerned that she was dying, and chose to ask me instead of her primary physician about her prognosis. (of course, I told her what I knew, that her blood counts were really low and her circulation was disrupted from her edema, but it was not my place for talking about a prognosis). Luckily, the second day, she had received her special bed and we were able to move her around in the bed to the best of our ability. Most of all, I felt sad for her situation. There was nothing as a nurse that I could do to really help her other than continue to try to keep her as comfortable as possible and monitor for any acute bleeding and pain. Couldn’t even dress the wounds properly as her skin was just too moist to have anything adhere to it. She was a completely different patient than I had last week, but still, extremely sick nonetheless. I guess that next week I will get my walkie-talkie :)
It’s no secret that a UTI will cause a confused presentation in the elderly. Much documentation has been done on that subject alone. Heck, Pope John Paul the III died from a UTI that progressed to sepsis. But this woman was only 50. Hmm.. ok, I thought. Also learn that she has a positive history for diabetes and hypertension. Pretty common these days, especially together. But I was not prepared for her. Not by any means. You see, I walk in to greet her, and find out she was the size of the hospital bed itself. Literally. They had ordered the special bed for her, but it had yet to come in. So in the meantime, she is packed into the regular bed on an air mattress. She couldn’t turn or move because there was no room. None. She is 530 lbs. And full of fluid.
She has widespread anasarca, which is now weeping and causing skin breakdown. Everywhere. Straie were puffy and full of fluid, looking like they would bust at any moment. Left lower leg is dusky and her toes are almost black. Her skin is literally sloughing off from the fluid overload. But that wasn’t even her main problem. Nope.
Although that in itself is pretty horrible to see, it must be even more horrible to experience.
Her main problem, however, was pancytopenia from the chemo. Her WBC count… normally 5-10, were 0.9. Hgb was 7.9 after a unit of prbc’s and procrit. Most seriously though… her platelets were 6, when normally 150-450. There was petechiae everywhere and purpura over her left leg as well. DIC was a formidable risk, and ever present in the mind. Sure she had open sores where her skin was tearing to let the excess fluid out. DIC, on the other hand, could be a potentially fatal complication. Yes, she had received some irradiated platelets, but still her numbers only went up to 12. She was on vitamin k. Her bleeding times were well out of whack.. as to be expected.
She was really a nice woman struck by cancer and now all of these complications. She was concerned that she was dying, and chose to ask me instead of her primary physician about her prognosis. (of course, I told her what I knew, that her blood counts were really low and her circulation was disrupted from her edema, but it was not my place for talking about a prognosis). Luckily, the second day, she had received her special bed and we were able to move her around in the bed to the best of our ability. Most of all, I felt sad for her situation. There was nothing as a nurse that I could do to really help her other than continue to try to keep her as comfortable as possible and monitor for any acute bleeding and pain. Couldn’t even dress the wounds properly as her skin was just too moist to have anything adhere to it. She was a completely different patient than I had last week, but still, extremely sick nonetheless. I guess that next week I will get my walkie-talkie :)
Toot Toot from the trainwreck
Each week, we are required to fill out a self-evaluation of our progress in lecture and in the clinical setting. We all stress out, hoping that our performance was satisfactory in our instructor's eyes. Since I had a difficult patient last week that I had felt I did pretty good with.. I gave myself all S (satisfactory) in all of the categories. I didn't make any mistakes, and did the best that I could with a dying patient (who passed over last weekend). We give this "tool" as well as a myriad of other paperwork for our clinical prep to our instructor to review and comment upon.
Now to toot my own horn :) I got my self-evaluation back with not 1, not 2, but 3 E's (for excellent). Yeah, I think I just grew about 3 inches lol. No one has ever mentioned getting an excellent in clinicals before, so maybe they were just afraid to say anything, like me. Some students can be so touchy when others do better, sometimes it is just easier to play things off. But to know that I did excellent in critical thinking, prioritizing care, and discussing scientfic rationales for treatment and planned medical care made my damn week.
Oh and I was sure to thank my ICU cohorts for all of their assistance and teaching so that I was able to competently care for that patient. They deserve huge kudos for contributing to my educational efforts :)
Now to toot my own horn :) I got my self-evaluation back with not 1, not 2, but 3 E's (for excellent). Yeah, I think I just grew about 3 inches lol. No one has ever mentioned getting an excellent in clinicals before, so maybe they were just afraid to say anything, like me. Some students can be so touchy when others do better, sometimes it is just easier to play things off. But to know that I did excellent in critical thinking, prioritizing care, and discussing scientfic rationales for treatment and planned medical care made my damn week.
Oh and I was sure to thank my ICU cohorts for all of their assistance and teaching so that I was able to competently care for that patient. They deserve huge kudos for contributing to my educational efforts :)
29 January 2007
Oh that quivering heart
Unfortunately we only had 1, yes 1, critically ill patient this weekend. Words cannot describe the letdown of complete boredom when this said patient slept the entire shift, except for a few moments of waking and talking to her family. It was the longest 8 hours ever. Well, almost ever. At least I didn't have to squirt any saline into my eyes to keep them from shriveling up from dryness :)
90 y/o comes into the ER from the nursing home with bradycardia. Turns out the potassium is 8.2 and is also in acute renal failure. Rhythm is oh so regular after atropine... 3 nsr beats and then a nice long sinus arrest pause. And it stayed this way for awhile until turning to sinus brady, rate of 40-50. Wonderfully spiked T waves. Emergency dialysis was scheduled, and a catherter inserted into the femoral vein. 15 minutes into dialysis... those T waves came right on down and NSR emerged with a rate of 70s-80s. Amazing, really.
This was the night before. Now, as my night moved along at the speed of a snail... I continuted to watch the rhythm, if not for a lack of better things to do. Potassium was now 2.3 and some ST depression was evident on the ECG monitoring. Some PACs were thrown in now and again, coming at faster intervals as time moved along. About 6 am...the rhythm went to 2:1 flutter for about 30 seconds and right into AFib. Have to say, that was about as interesting as the night got. Can't say that I have ever seen someone convert to AFib, so got to see something new. I wonder though.. did it stay in AFib or was it just transient?
I don't know where this patient progressed from there... I left at 7 am and didn't have to return until next Friday night. Chances are that this patient will no longer be a resident in the ICU, but moved out to the floor or even back to the nursing home by that time. Perhaps next weekend will be more interesting. Although I have to say that after this last week of clinicals.. it was nice to have an easy night of work.
One last bit of information told to me by the charge nurse: If you have to ask if you should call the doctor, then you probably should.
have a terrific monday! :)
90 y/o comes into the ER from the nursing home with bradycardia. Turns out the potassium is 8.2 and is also in acute renal failure. Rhythm is oh so regular after atropine... 3 nsr beats and then a nice long sinus arrest pause. And it stayed this way for awhile until turning to sinus brady, rate of 40-50. Wonderfully spiked T waves. Emergency dialysis was scheduled, and a catherter inserted into the femoral vein. 15 minutes into dialysis... those T waves came right on down and NSR emerged with a rate of 70s-80s. Amazing, really.
This was the night before. Now, as my night moved along at the speed of a snail... I continuted to watch the rhythm, if not for a lack of better things to do. Potassium was now 2.3 and some ST depression was evident on the ECG monitoring. Some PACs were thrown in now and again, coming at faster intervals as time moved along. About 6 am...the rhythm went to 2:1 flutter for about 30 seconds and right into AFib. Have to say, that was about as interesting as the night got. Can't say that I have ever seen someone convert to AFib, so got to see something new. I wonder though.. did it stay in AFib or was it just transient?
I don't know where this patient progressed from there... I left at 7 am and didn't have to return until next Friday night. Chances are that this patient will no longer be a resident in the ICU, but moved out to the floor or even back to the nursing home by that time. Perhaps next weekend will be more interesting. Although I have to say that after this last week of clinicals.. it was nice to have an easy night of work.
One last bit of information told to me by the charge nurse: If you have to ask if you should call the doctor, then you probably should.
have a terrific monday! :)
27 January 2007
Does it change you forever?
I heard a line from a tv show preview... stating that once you see someone die, it changes you forever. The first person that I ever saw really die was my grandmother. I am not sure to this day that I ever really got over that, to tell the truth. I still miss her terribly. Now, I have seen people die in the hospital many times, but it has never really affected me as much as my grandmother's death. Of course, I knew and loved my grandmother, so I am sure that would be the difference there.
But, I think that being with someone when they pass, especially if they do not have any family there with them, is important. I wouldn't want to die alone, and I don't think that anyone should have to. I'd like to think that there is an unmeasurable amount of comfort for that person, knowing that they aren't alone; that is okay to let go.
Just had to ponder that for a moment... now I have to go study.
But, I think that being with someone when they pass, especially if they do not have any family there with them, is important. I wouldn't want to die alone, and I don't think that anyone should have to. I'd like to think that there is an unmeasurable amount of comfort for that person, knowing that they aren't alone; that is okay to let go.
Just had to ponder that for a moment... now I have to go study.
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