Adult Simulation Lab

I’m actually not quite sure why it was called an adult simulation lab, considering there were two peds patients in the ICU as well. And I got one of them!

So, I’ll start from the beginning. I was in a group of ten J1s (including myself), and as soon as everyone showed up a clinical instructor came up to us and gave us our paperwork for the day. It included a health history, a report sheet, and an assessment sheet. On the back was “nurse’s notes” where we record our documentation for the things done during our shift.

We were then taken to the ER “triage” area to meet our patients and take their vitals signs and get their health history. My partner and I had a 4 year old little boy whose mother brought him into the ER due to a persistent fever and a cough. Because there were no young children brought in to act as actors in our simulation, we had to ask all of our questions to the mom and she had to give us all the pertinent information on our patient. It was fun! And then after we were finished with getting the vital signs and health history, we sat and talked to the “mom” – a current S2 about to graduate – about nursing school and her tips and tricks to make it through while we waited on the S1 students to make their rounds on the patients in triage.

The S1 students then came in, and made their rounds between the 5 patients in the ER triage. My partner and I were pretty quiet as each student came in and got their assessment information, unless they specifically asked us for information. Some of the S1s talked to us and got information from us, but most of them pretty much ignored us as they came in, asked a few questions, and then left again. So that kind of sucked…hopefully when I’m an S1 and doing this simulation again, I’ll be kind to the J1s. Of course, they were probably pretty nervous themselves, and they DID have a whole ton more work to do than we did, since they had to see each of the 5 patients and we were only assigned one.

Then we (the J1s) were released from the ER triage to go sit down and write out a quick care plan on our patient. My partner and I chose three nursing diagnoses that we felt were pertinent to our patient: risk for hyperthermia, risk for injury, and fluid volume deficit. We wrote out our rationales for why we chose those diagnoses, wrote out the nursing interventions for those diagnoses, and then wrote out what patient education we needed to give. In this case, we needed to give the patient education to the mom about what treatments were being given and why.

Afterward, we were ushered into the “ICU” for the next part of the simulation (we were taken into the high fidelity lab!) and we got report from the current J1s assigned to our patient. Once in the ICU, our poor little man seemed like he’d deteriorated. His blood pressure was super low, even with IV fluids hanging, and he was suspected as having meningitis, even though the lab results hadn’t come back yet. My partner and I did our full assessment on him, I talked to his mom a bit about what was going on and why were were running certain tests, and then a “doctor” came in and got pretty agitated with the S1s who were in there because they hadn’t given certain meds that needed to be given before a lumbar puncture. Woah!

So I went with an S1 to the Pyxis to get meds for the patient, but then we realized that one of the meds we were giving had no administration route specified. So we had to call the charge nurse to figure that out, and then the doctor came back and was demanding that someone give the meds that had been ordered over an hour ago so she could perform the lumbar puncture.

It was chaotic! At one point we had 9 people in one tiny little room, not including the mom and the patient themselves! But it was a great learning experience – especially to learn how to work with others on the healthcare team and how to be quick and proficient at completing orders. I felt like I didn’t do much though – the S1s had way more that they needed to do and I felt like I was just in the way most of the time. I didn’t even get to complete a dressing change on the boy’s wrist because by the time we realized that it needed to be changed, the “doctor” and her two “med students” had come back and were about to do the lumbar puncture. And then it was time for my partner and I to leave…where the heck had the time gone??

So we left the boy in the capable hands of the FOUR S1s that had ended up in the room somehow (lol!) and my partner and I went to our post-conference downstairs to talk to another instructor about what we liked, what we didn’t like, and if it was a good learning experience for us or not. We completed a questionnaire/survey, and then we were free to go! In all, we were there a little over 3.5 hours, but it went by SOOO fast. Insane! I can’t imagine what it’ll be like in a real ICU with more than 1 patient that I’m having to take care of…makes me excited to be in the ICU in upcoming semesters. πŸ™‚

All in all I really enjoyed the experience, and I wish were had more of them in a semester! And I can’t wait until my S1 semester when I get to do that one over again, only as an S1!

Also…now it’s Saturday. You know what that means?? I only have one more pharm quiz, my HESI next week, and then FINALS the week after that and I’ll be DONE DONE DONE!!!

 

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Good and (Somewhat) Bad

*Good*

Head-to-toe assessment check off: I PASSED!

As I stated in my previous post, I felt pretty prepared for the check off and at that point was just ready to get it done. I arrived on campus around 1100 and Β ran in to some classmates who had just finished their adult lab simulation. They said it was a blast, which makes me even more excited for it tomorrow!!

Anyway, around 1130 I entered the room that they had set aside for those who were waiting to take the check off, and my classmates and I chatted nervously as we waited for the first of us to be called up. We didn’t have to wait long! About ten minutes later both instructors came in and called four of us, and of course I was one of those four. But I was ready!

I was able to go first (as in be the first one to assess) which I was very thankful for. I didn’t want to have to sit and wait through my partner’s assessment on me before doing it myself. So I went ahead and gathered my supplies, cleaned my stethoscope, washed my hands, took a DEEP breath, and told my instructor that I was ready.

It took me less than 30 minutes to complete my full assessment, and I only forgot to palpate the frontal and maxillary sinuses! (And I had time to go back and complete that, which meant that I got points for it!)

I couldn’t finish all the documentation within the allotted 15 minutes, but I sure did try. But then again, every single classmate I talked to said they weren’t able to complete the documentation either. But on my way out, my instructor said that I did a very, very good job and that she was very impressed with me. πŸ™‚ Score!!

So SO SOOOO happy that I’m done with that assessment check off! And so thankful that Steven allowed me to practice on him every single night for a week straight. He’s such an awesome husband. πŸ˜‰

*Bad*

I found out yesterday that I am definitely not in the clinical group that will be going to the VA next semester. 😦 I’m pretty disappointed but not super crushed; I’m choosing to believe that there’s a reason that I’m not at the VA next semester and I’m hoping that I will learn just as much, if not more, at a different hospital that I’ll be at next semester; and maybe it will be an even better fit for me than the VA would have been. And no, I don’t know yet where my clinicals will be – wish I did!!

Sunday Thoughts

My head-to-toe assessment is this Wednesday. I know, I sound like a broken record, but thought of this test at one point terrified me. Now, I’ve been studying with Steven every single day for a week, and I actually know ALL of the 96 steps to be performed! I have no idea how long it takes me though, so today Steven and I are going to do it about twice – maybe more – and have the timer going. Hopefully it’s right at or under the 30min mark. Then Monday and Tuesday night we’ll do it once more, and at that point I’m just going to have to be ready for it!

I’ve applied to about 70 PRN PCA/PCT jobs in my area. This week, I’m going to apply to the part-time positions, and then cross my fingers and wait for results. I’m pretty nervous actually, because many hospitals want 6mo to a full year of experience, of which I don’t have. So I’m just taking a chance that they will disregard that requirement since I’m in nursing school and I already have my CNA license.

Starting with tomorrow, I only have two weeks of actual classes left before finals week. How did that happen? I’ve done all requirements, taken all tests, finished all projects, gone to every clinical…and it’s hard to believe that I’m almost done when just a month ago I was so overwhelmed when looking at the calendar. Now I only have my assessment check off, an adult lab simulation (which is for experience only), my concepts HESI, and then finals week to get through before summer break!! It all seems completely doable now. Wow.

I can’t wait to find out where my clinicals will be for J2 semester…and then register for classes. As of right now, hopefully this summer I’ll be working and taking an EKG elective (towards the end of summer). And, of course, relaxing before the next semester of nursing school starts!

 

 

It’s Over

Yesterday was our last day at Methodist for our clinicals! 😦 It’s amazing how fast that time flew by. Wasn’t I just writing about my first clinical experience? And now it’s over for the semester.

Our clinical experience yesterday was a little bit different than previous weeks. For this clinical, we didn’t go up to the hospital the evening before and pick out our patient because we didn’t have any pre-clinical paperwork (and no post-clinical paperwork, either, for that matter). Instead, we arrived yesterday morning with a different plan and different paperwork.

What we were to do was go up to our unit, approach a nurse, and have her assign us a patient and give report on them. Then we needed to look up their chart and get pertinent info on them to fill out our new paperwork (which would be used for SBAR report later), and then we were supposed to take care of our patient as a nurse while simultaneously searching the unit for injections to give.

It was hard getting all that done in only the 4 hours we had on the unit! (We left the unit at 1100 in order to get lunch and go to post-conference early.) And it’s also very weird going in without having any prior knowledge on your patient – just as a nurse does for every shift. I’m glad we got to experience that though.

Aside from getting all the pertinent info on my patient and taking care of them, I also hunted down one patient’s insulin injection (using the flexpen) and then a pneumococcal vaccination for a yet another patient. I was SUPER excited about the pneumovax because it was an intramuscular shot and would be my very first one!

Well my first IM injection didn’t go so well for me. 😦 I educated the patient on the vaccine and why it was needed, prepped their arm with rubbing alcohol, got myself ready, positioned the needle, prepared them with a countdown, and stuck them in the deltoid.

It was horrible.

Giving an injection into muscle is a very different tactile feeling from giving an injection into fat. I’m sure the more of these shots I give it won’t matter to me any more, but this one sucked because I wasn’t prepared for the difference in resistance. The patient winced and moved away, the needle pulled out of their arm, and I was left standing there knowing that I had to do it all over again.

So I had to clean the needle off with an alcohol swab, calmly tell them that I had to try again, and then give it another go. This time it worked and I was able to inject the vaccination, but I felt so bad for them.

Hopefully next time goes so much smoother.

After our shift for the day, we went to post-conference and then we learned how to use SBAR to give report to the “oncoming nurse” for our patient (in other words, we gave report to each other). It was awesome! And also incredibly challenging. You have to have so much information on your patient and be able and ready to report it in a manner that helps the oncoming nurse out and provides for continuity of care for that patient. I can see why many new nurse graduates have a hard time with this part of the job. It took us forever, too…we were there until 1330 giving report when usually we leave the hospital by 1245!

SBAR –Β Situation, Background, Assessment, and Recommendation.Β It is a reporting tool used by nurses and doctors in order to concisely and accurately give report to one another on patients. First we give the patient’s situation: their name, age, if they are on any isolation precautions, and their code status. Then we give the patient’s background: why they were admitted to the hospital and what treatments are being done for their diagnosis. Then we give our assessment of the patient: what their vital signs were, any findings in our physical assessment that shifted (either to good or bad) during our shift, what meds were given during our shift, what their plan of care is, and this list could go on and on. Finally, we give our recommendations for the patient: do we think any meds need to be changed? Could the patient’s plan of care be updated? Etc…

It was a great last clinical and I’m already so eager to start next semester’s adult health 1 and woman’s clinicals!!

Post-conference - giving our SBAR reports to one another!

Post-conference – giving our SBAR reports to one another!

One More Thing Crossed Off The List!

Yesterday was our group presentation/speech competency exam, and I’m happy to say that everyone presenting yesterday passed with a grade of 95% or higher!!

Unfortunately, when I was rehearsing on Monday night, I realized that my speech was WAY too long (we only had 5 minutes each to speak, otherwise we were penalized) so I had to cut a lot of it out. I think that detracted from my speech too much so I’m not quite sure that my message was all that great…but thankfully my presentation of the information went well, which I daresay was more important than the content anyway.

Super happy to be done, however! Yesterday several of my clinical group went out afterward to celebrate with margaritas…and then when I got home I further rewarded myself by doing absolutely NOTHING school related. πŸ™‚

Here we are ALL smiles after finishing our presentation!

Here we are ALL smiles after finishing our presentation!

Resume & Applications

Well I finally put together my resume this weekend (and finished my group project, too!). Not fun. But hey, I have it now which means no more excuses for not applying to things I want – like an externship this summer that I passed on because I didn’t have a resume!

Today…finishing my care plan and applying to PCA/PCT jobs for the summer. Wish me luck! πŸ™‚

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Final Vital Signs Check Off

It went smooth and this time I wasn’t nervous at all. Well…ok, maybe a few butterflies in the stomach. I mean, how could you be perfectly ok when you’re trying to complete a check off and you’re being timed??

We were again split of in groups of six, and I was in the third group to go. When we were called up, we went back into the room that we were in for our first vital signs check off (in February, I think it was?) and we signed in and got our bed assignments. We joked around a bit with our professor (love her!) and then stationed ourselves bedside, raised the beds up, lowered the bed rails, and then the timer was started.

Eight minutes is actually a TON of time to get vitals on the SIM-man. In fact, on some of them I checked them twice just because I had the time and I wanted to be as close as possible! The normal/abnormal breath and normal/abnormal heart sounds weren’t at all hard to differentiate between, either. And when the timer went off for our first SIM-man, we went to our next dude and did it all over again. And, we all passed! πŸ™‚

And, by the way, I finally finished my professionalism paper…completed it yesterday in two hours! Now all I have for the rest of the semester is three pharm quizzes, my group presentation, the head-to-toe assessment, an adult lab hospital simulation, and then FINALS! Wow! Let the countdown begin! πŸ˜‰

Switcheroo

I decided today that I didn’t like my preference list for my J2 clincals…so I changed my rankings. Now, number one on my list is the Dallas VA Medical Center (for Adult 1) and Presbyterian Dallas (for Womens Health). Now I’m TRULY crossing my fingers…because although I’ve heard the VA is stressful, it’s also FULL of opportunity and I really hope I get that clinical.

I won’t know until June though! AHHHHH!!!!

Rain, Rain, Stay Today

It’s beautifully cold and rainy over here and I just want to remain in bed all day and watch Friends and Grey’s Anatomy and eat Reese’s Peanut Butter Cups and drink hot chocolate and stay in my sweats and play with my puppies on the bed. (Was that enough of a run-on sentence for you? πŸ˜‰ )

Today’s my final vital sign check off in assessment lab…I’m not too worried, thankfully. We’re going to be doing the same thing as the first vital signs check off except when we’re listening to the dummy’s respirations we also need to identify his breath sounds (normal, crackles, Β or wheezing), and when we’re done getting his vital signs we have to move to the computer and identify heart sounds (normal or murmur). And we have two dummies this time instead of one, with 16 total minutes to complete the check off in.

Afterwards, we have to continue practicing our head-to-toe check off (2 weeks from today) which I’m WAY more worried/anxious about.

Also, I have still not started my professionalism paper, although at least now I know which provision of the Code of Ethics I’m focusing on. (Procrastinate MUCH, anyone?!)