GREAT day!!

I had a great day today! I’ve had some good mojo going when studying lately…and it paid off. I got a 98 on my concepts test!! There were about 6 questions that I wasn’t sure about when walking out of the test; I thought I’d made a high 80 (which I would have been ok with. It was a harder test than the first!). But I went with my critical reasoning/gut instinct, and obviously it was a good thing I did.

Also, I got an invitation to accept membership to Phi Kappa Phi – the largest and most selective honor society in the nation. To be invited means I am in the top 7.5% of my class. Whoop!!

That is all. 😀

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Nursing School Pet Peeve, #1

“Do we need to know this for the test?”

“No, so let’s not worry about it.”

I hear this more times than I can count. And yes, sometimes, I am unfortunately part of that conversation too…but I am trying hard not to be. You see, I feel like most of my class is just trying to skate by with knowing only enough to make a good (or even just passing) grade on a test – and then the information is dumped as soon as the test is over. We were reviewing some drugs in our medication administration skills lab a week ago, drugs that we had JUST LEARNED for our pharm test, and I felt like my classmates and I were grappling for the answers when just days before we’d known those drugs in and out!

Nursing school should not be about knowing “just what we need to know” for a test, neither should it be about just memorizing all of the information for a test and then dumping it for the next. Yes, that was done in pre-req classes and honestly it didn’t really matter. But these classes and information is knowledge I NEED to know for my profession – it’s knowledge that will make me a better nurse. I don’t want to get all A’s in nursing school if it means I did it only by studying for each individual test and not having the drive and curiosity to learn and know more, even if it’s not going to be tested over.

Just some thoughts. In my opinion, everything I’m learning in nursing school should be something I worry about knowing – because one day it could save a life.

 

A Reminder

I really didn’t want to go to Children’s Medical Center on Thursday morning to volunteer. I have a concepts test coming up on Tuesday, and I’ve barely studied for it – not to mention the fact that Thursdays are my only weekday “off” from school but I usually spend the morning at the hospital.

My usual shift is 4 hrs on Thursday mornings, and I was frustrated because I thought that I could really use that time to study for my test and get some assignments done. But I really didn’t want to call in since I’d done so two weeks prior due to a nasty head cold that I didn’t want to “share,” so I reluctantly got ready and arrived on time for my shift.

I’m really thankful I went. For four hours my mind wasn’t on school, it wasn’t on tests, it wasn’t on assignments. For four hours, my mind got a break from all of that and I was able to focus instead on playing with kids and holding babies. And not only that, but I was able to watch the nurses interact with their patients and was reminded again of why I want to be in this profession. Being there for my shift not only took my mind off of school and gave me a much needed break, but also realigned my attitude about school and life in general. I finished my shift much happier, much calmer, and much more focused on my goal for the next two years.

Basically, this is an important reminder that in nursing school, you need time away from the books and the stress to focus on something else – whether it be volunteering or a favorite hobby. You’ll only end up burning out if you do nothing but school all the time!

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I took this picture from the 5th level of the parking garage. Love this place!!

Assessment & Documentation

One of the hardest thing for me to learn, so far in nursing school, is assessing my patient and then documenting my subjective and objective data.

It’s not that it’s a hard concept for me. Assessing a patient basically means learning how to take a history of/examine a patient and look for normal/abnormal findings, subjective information is what the patient tells you, and objective information is what you gather from your own physical assessment of the patient. But the first problem for me is that it takes me positively FOREVER to complete a focused assessment on my “patient”; I have to reference my book every two minutes, I’m slow and clumsy, and I feel like I just don’t know what I’m doing. I definitely DON’T feel like a nurse; I feel like I’m a bumbling idiot, and it will take nearly an hour, maybe more, of the allotted lab time for me to complete my focused assessment. :-/ Then I feel bad because if I went first, my lab partner is rushed in order to finish on time when she’s doing her assessment on me.

The second problem is that it’s hard for me to document my data in a brief, efficient, concise, yet flowing way that my instructors (and eventually hospitals) want. I don’t think it’s a complicated task…yet somehow it will take me 1.5-2 hours to do when I get home and start my “charting” – and I really need to get it down to about 30 minutes tops (for head-to-toe assessments) and 15 minutes tops (for focused assessments). Eek!

Here is an example from about two weeks ago, when we were covering the lungs/thorax in lab. Remember that this is not a real patient – it’s all made up for learning purposes. After I charted this and submitted my charting, my instructor told me it was really good, but still too long. I need to be able to mince my thoughts yet still be efficient in getting my assessment findings across:

Subjective

A 20-year-old Caucasian female presents with c/o a cough. (T) Patient states cough began on February 4, 2013. “It just happened; I woke up that morning coughing out of nowhere.” Patient states that cough has been consistent since then, with coughing spells occurring briefly every half hour throughout day. (Q) Describes cough as wet/productive and congested in the morning but dry and hacking in the afternoon and evening. States the quantity of cough as mild to moderate intensity. (S) Severity of cough a 5/10 in morning and a 3/10 in afternoon/evening. (P) Patient states that no activity exacerbates cough. Patient took one Mucinex in the morning of February 6, 2013, however, “the Mucinex was a waste of money,” as it does not seem to be helping. Patient denies taking any other OTC medications. (R) Patient denies chest pain upon breathing or coughing, only general tightness in the region of the sternum. Patient rates tightness as a 2/10. (U) Patient states cough has not affected ADLs as she has been able to go to nursing school classes as she usually does. Patient believes she has a cold; “I just want to make sure I don’t have anything worse that could make someone else sick.”

Patient denies shortness of breath, no past history of lung diseases, denies tobacco use and exposure to environmental irritants at work. Last TB skin test November 2012 with negative results, flu vaccine November 2012 with no adverse reactions. Denies ever having a chest x-ray done.

Objective

Posterior Inspection: Transverse to AP diameter 2:1. Spinous processes straight, thorax and scapulae symmetric bilaterally. Appropriate development of neck and trapezius muscles for age; no use of accessory muscles. Position relaxed and upright with arms at sides. Breathing effort even and unlabored with 14 respirations per minute. Skin color light beige, even tone – consistent with genetic background. No lesions on skin noted.

Anterior Inspection: Ribs sloping downward with symmetric interspaces bilaterally. Costal angle within 90 degrees. Development of abdominal muscles appropriate for age; no use of accessory muscles. Facial expression eager, A&Ox3 and cooperative. Lips and nailbeds pink, free of pallor and cyanosis; approx. angle on nailbeds 160 degrees. Skin color light beige, even tone – consistent with genetic background. No lesions on skin noted.

Posterior Palpation: Symmetric chest expansion bilaterally. Mildly increased fremitus on right side. No tenderness, lumps, bumps, or masses noted upon palpation of chest wall and spinous processes.

Anterior Palpation: Fremitus symmetric bilaterally. No tenderness, lumps, bumps, or masses noted upon palpation of anterior chest wall.

Posterior Percussion: Resonance dominate over lung fields bilaterally upon percussion.

Posterior Auscultation: Clear bronchovesicular breath sounds at level of ICS T1-T4; moderate pitch with mixed quality. Clear vesicular breath sounds at level of ICS T5-T10; low pitch with soft quality. All breath sounds equal bilaterally. Lateral left side – clear breath sounds, low pitch and soft quality, at level of ICS T3 and ICS T5 midaxillary line. Lateral right side – clear breath sounds, low pitch and soft quality, at level of ICS T3, T5, T8 midaxillary line. No adventitious sounds present.

Anterior Ausculatation: Clear bronchovesicular breath sounds, moderate pitch with mixed quality, at level of ICS T2, T3. Clear vesicular breath sounds, low pitch with soft quality, at level of ICS T7. All breath sounds equal bilaterally. No adventitious sounds present.

When we have our Head-to-Toe Check-Offs at the end of the semester in Assessment, we will have 30 minutes to complete a head-to-toe physical assessment on our partner, and then 30 minutes to sit down and document EVERYTHING. I know the end of the semester is forever away, but let’s just say I’m already nervous and stressed about this check-off! I can barely assess my patient with my book and lab guide in front of me, how am I supposed to just pull everything out of my head and know when/how to assess? How am I supposed to document a complete assessment in 30 minutes when it takes me over an hour to document a focused assessment?

Vital Signs Check-Off

My check-off was honestly more nerve-wracking than I thought it would be! Last night and this morning as I was going through the script, I was as calm and cool as a cucumber. I honestly didn’t foresee there being any problems with going through the steps of the check-off and doing so efficiently and competently.

However, when we got into the lab and were broken up into groups (I was in the third group) and started working on our head, scalp, neck and thyroid lab assessments, my hand started to shake and I started sweating. I’m surprised I was even able to document my assessment on my lab partner as we went through our activities! The first and second groups finished with the first phase  of the check-offs, which was the vital signs check off on the SIM-man (the dummy), and began the second phase of check-offs – interacting with a live “patient” – but our group had yet to be called!

Well, just as I felt like I was about to start running around the lab screaming, we were called to go back into the room set up for the first phase of our check-offs. We filed silently into the room, “signed” in, got our bed assignments, and stood beside our beds and dummies. Then our professor started a timer for 5 minutes and we were allowed to begin.

Five minutes doesn’t seem like a lot of time on paper, but it was plenty of time to get the pulse, respirations, and blood pressure of the SIM-man! And after we got the numbers, we had five minutes to sit down and document our findings and what they meant. My SIM-man had a respiratory rate of 16, a pulse of 78, and a blood pressure of 140/90. When we were documenting we also had to answer why we take a palpable systolic pressure before an actual blood pressure, what “systolic” means, and what “diastolic” means. I easily finished documenting within the five minutes given to us, and returned to the lab to wait on the rest of my group.

When the rest of my group returned to the lab, we went two by two – with our lab partners – to our other instructor to complete phase 2 of our check-offs. In this phase, I had to pretend I was in a clinic with my patient (lab partner). I had to start from the beginning by greeting my patient, introducing myself, washing my hands, then taking the temperature and stating the results to my patient. Afterward, I put the blood pressure cuff on the patient and palpated the systolic pressure, stating my findings to the patient. When I was finished with that, I asked her if she had any questions, thanked her for her time, and washed my hands again.

All in all, the entire check-off probably took no more than 20 minutes and was easy-peasy! I can’t believe how nervous and anxious I was, but I’m definitely thankful I’m done. And I passed! Hopefully the head-to-toe assessment at the end of the semester will be just as easy.

 

Home Run!

This weekend, I studied practically from 08:00 to 00:00 (12am), both Saturday and Sunday. Yesterday (Monday) I got to school around 06:30, printed out my week’s worth of powerpoints, assignments, and articles, attended an NSA (Nursing Student Association) meeting until 07:30, and then began studying again until my test assessment test began at 13:00 (1pm).

I wasn’t too nervous about the assessment test because I felt like I knew the material really well. The test covered general survey of the patient, cultural awareness, nose/mouth/throat, breast & lymphatic tissues, and  lung/thoracic assessments. There were a TON of questions about breath & lung sounds – and identifying which sounds corresponded to which “abnormal” physiologic disorder/disease. I’m glad I went over all the lung/thoracic cage abnormals! I ended up with 96 on my assessment test. Yay!

After my assessment test/lecture I stayed up on campus until 20:00 (8pm), studying in the library with classmates for pharm. Actually, I was just in the study room with them listening to music while they studied with each other, haha. But it worked…it helped keep me focused!

I was super nervous about pharm, especially while studying last night and realizing I knew nothing. Ahh!! I stayed up until 00:00 (12am), finally went to bed, and set my alarm for four hours later – 04:00. I got up again and started studying MORE pharm, and continued studying after getting to school.

Well, 09:00 came – and it was time for the test. I was freaking out! I knew I hadn’t studied as well as I should have; believe me, cramming the weekend before a test is NOT a good idea. I felt like I was going to throw up, which is very abnormal for me. I usually DO NOT have text anxiety at all, but I felt like I had prepared very lousily and just didn’t feel comfortable with the material.

By the grace of God…I walked out of that test feeling great. I had circled about 5 questions that I was unsure of whether or not I knew the answer, which is normal for me. I usually walk out of a test with about 3-5 questions circled.

Waiting on that test grade was torture! We had a pharm lecture immediately following the test on psychopharmacology: benzodiazepines (for anxiety), lithium carbonate (anti-mania), and MAOIs/tricyclics/SSRIs (anti-depressants). By the end of our lecture, however, our grades were up and we couldn’t get to computers fast enough.

I got another 96!!!

I am SO GLAD TO BE DONE WITH THAT TEST.

Tonight I celebrated by eating too much Chicken Express and watching Grey’s Anatomy. 🙂 Now I just have to pass my vital signs check-off tomorrow and my medical math test on Friday, and I can kiss this week goodbye!

One of the drug charts that I used to study with. I had 11 total!

One of the drug charts that I used to study with. I had 11 total!

Skills Lab

I love skills lab on Friday mornings! It’s absolutely my favorite class, and I can’t wait until our skills lab turns in to clinicals in a couple of weeks. 🙂

This past Friday, we learned how to set up a sterile field and don sterile gloves using sterile technique. It was fun for me because I’d just seen a nurse use sterile technique on Thursday when I was volunteering at Children’s Medical Center – she was changing a PICC line dressing on a baby (who screamed, by the way) – and I was curious as to how the whole sterile process really worked. Well, we learned it on Friday. And it is certainly no easy feat to remember not to drop your hands below your waist or reach across your sterile field to grab stuff. It took a lot of concentration and I was super slow as I used sterile technique to change a “wound” on Mr. Mann – our simulation dummy in lab.

Mr. Mann - look at the poor guy's abdomen!

Mr. Mann – look at the poor guy’s abdomen!

So we also learned how to change wounds using wet-to-moist dressing changes (and sterile technique). It wasn’t difficult at all, but having to remember that everything I was using was sterile and thus I needed to proceed carefully to keep it sterile was interesting. I hope one day it’s second nature for me and I’m not so slow and clumsy with procedures using sterile technique! This is where practice makes perfect, right? We also learned how to assess wounds and document our findings. How much drainage is there? What’s the color and nature of the drainage? How long/wide/deep is the wound? Any odors noted? Is it healing (is there granulation tissue)? And so on and so forth.

After learning dressing changes, we learned how to do an indwelling (Foley) urinary catheterization. Best skill of the day! We had a lot of fun with it, but I’m sure in an actual situation it’ll be much more nerve wracking…let’s just say I’m positive the urethral opening on a penis or vagina is NOT as large as the ones in lab were! 😉

Adding lubricant to the catheter.

Adding lubricant to the catheter. Why do I look so happy?! 

Deep concentration in order not to contaminate my sterile (right) hand as I insert the Foley.

Deep concentration in order not to contaminate my sterile (right) hand as I insert the Foley.

Inflating the balloon! Yay!

Inflating the balloon! Yay!

After learning our skills, my partner and I thanked Mr. Mann for his cooperation:

No, she wasn't really listening to him through his clothes...it's just for posing purposes ;)

No, she wasn’t really listening to him through his clothes…it’s just for posing purposes 😉

Aren't we all cute? And don't we already looked tired from this thing called nursing school??

Aren’t we all cute? And don’t we already looked tired from this thing called nursing school??

 

***

Sooooo that was my Friday. And as much fun as that was, now I’m stuck studying for three tests and one vital signs check-off next week and I’m so stressed I feel like I’m going to explode. Don’t you love how I’m procrastinating by writing this blog post?? Haha. Last night I was up until 1am trying to study for pharm. Today, I have to study for assessment (test is tomorrow!!) and then more pharm (I’m never going to know all these drugs by Tuesday). My vital signs check-off is on Wednesday, and then I have a medical dosage calculations math test on Friday, and that will conclude my week. I can survive for one week!

My classmates and I are surviving off of these...I drink the doubleshot espresso. Delicious!

My classmates and I are surviving off of these…I drink the doubleshot espresso. Delicious!

Pharm notes...

Pharm notes…

My babies are super sad that I'm not able to play with them :(

My babies are super sad that I’m not able to play with them 😦

 

PS: click the links within the text to watch youtube videos on those skills. 

First Test of Nursing School DONE!

It went well! We were released from pharmacology early this morning because our guest speaker – a CRNA – didn’t show up. I was looking forward to hearing her lecture because there is definitely a part of me that’s interested in what a CRNA does…hopefully we’ll get that lecture at a later date. Anyway, I used the extra time to study with a couple of classmates. We were scrambling to learn the last little bit of our abbreviations that we were going to be tested over (A-L); it paid off as all three of us got the abbreviation questions correct! Lol.

Our test covered asepsis and infection control, hygiene, mobility, safety, communication, documentation/delegation, and ethics. I had some trouble with communication and ethics, but overall felt like I had a good solid grasp on most of the material and walked out of the test feeling pretty good.

Honestly, I thought I’d score in the upper 80’s, but I ended up making a 92!

I’m satisfied with today’s performance…and now on to studying for the next big hurdle – pharmacology!!

 

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Last minute cram session for the concepts test!

 

 

It’s Saturday…

And while I should really be studying for my upcoming *first* nursing school test, I’ve decided to take the day off and enjoy a day free of books and stress. In truth, I wouldn’t be able to focus anyway and so would then be aimlessly staring at an open book and feeling bad about the fact that I was wasting my day away.

It’s been a full three weeks of nursing school, and so far I definitely have done a poor job of finding a rhythm and actually studying. My day normally starts around 5am, and by the time I get home it’s around 8pm. At that point I usually find myself putting on a TV show and relaxing and telling myself that “I’ll study tomorrow; i’ll do better tomorrow,” because I’m so worn out by the long day that I’ve spent on campus that I can’t even fathom putting in more hours studying.

3 weeks later…and I have a concepts test on Tuesday that I am in no way prepared for. And two tests (pharmacology & assessment) the week after that I haven’t been studying for either; even though I’ve made flashcards for both classes but have yet to review them. I’m super stressed right now about pharmacology considering the fact that I have upwards of 50 drugs (so far) to learn and memorize and at this point I only have a little over a week to do it in.

I don’t have any excuses other than the fact that I’m really overwhelmed with everything we’re expected to read, learn, know, and do, and I don’t even know where to begin with all of it. I’m so stressed out by everything that I’m supposed to do that I decide not to do anything at all.

Now how ironic is that?

And yet what have I been doing with my “free” day today? Part of my time has been spent online trying to find a free clinic to volunteer at, researching the “Summer III Externship Program” at Mayo Clinic, and thinking about where I want this nursing journey to lead me. One day, I’m hoping that after working 2-3 years at a great hospital I can apply to a great DNP graduate program and take my life in that direction. But how am I supposed to accomplish these things if I can’t even focus on this present moment and do a great job in nursing school?

I need to get my act together! No matter if I get home at 7 or 8pm at night – or even if I just decide to stay up at school after my last class – I need to STUDY. And study hardcore. During breaks between classes, I need to study. And when I’m on the treadmill, I need to study. And when I’m eating dinner, I need to study. Because I”m not going to get anywhere in life if I can’t put energy, dedication, and hard work into this gift that I’ve been given.

I just can’t understand why I’m struggling so much with this. Why is it so hard for me to put my nose to the grindstone and “just do it”? Especially considering how badly I’ve wanted this for the past two years. And especially considering where I want my life to go after nursing school – none of which will be possible if I can’t graduate as the best nurse I can be with an equally great GPA.

Ok, enough of my rant and pity party. I can do this!! It’s definitely going to take some adjustment and it’s certainly been a learning curve so far. But I want this so bad, and I need to remember that. Now is not the time to give up on my dream. I can do this.