First of all, let me just tell you that it is currently 62 degrees outside here in DFW, and I am so giddy about it that I actually woke up EARLY this morning (on a Saturday!) just to enjoy the weather!!
Yesterday we had our J2 math test and our adult 1 lab simulation. The lab simulation was a ton of fun and I really felt way more confident during this one than I did when we had our first lab simulation last semester.
So the morning started out with our math test – a ten question test covering a few concepts from last semester and then the IV concepts from this semester. I felt pretty confident; I’m great with math and I had covered all the modules that we were supposed to review with ease. So myself and some classmates got to school about 0700 to have time to do some practice problems and we got through them just fine…and then we gave ourselves a pat on the back, sucked in a deep breath, and walked into the classroom.
We’re supposed to pass our math tests with a 90% and we have three chances to take the math test and pass. If we don’t get at least a 90% during any one of those three times, then we are kicked from the program. Honestly I walked in there expecting to get a 100% but I walked out with a 90%. Which is fine by me because I passed! A few of my other classmates weren’t so lucky. So they will have to take the retake and hope that it goes better next time.
Then we started our “clinical” day in the lab right after that. For the first hour, we had to get report for our patient and then make a quick care-map on him. (I will tell you right now that I like the care-map format better than the care plans we were doing last semester!). Afterwards, we had an hour spent in the skills lab reviewing oxygen therapy and pushing IV meds. I was one of the lucky two who was made to demonstrate pushing IV lasix in front of my other classmates! 😉 But it was AWESOME. I can’t wait until I’m doing this for real in the hospital.
After our skills lab we were then given the go-ahead to take care of our “patient.” We walked into the high-fidelity lab and were introduced to our patient, who was currently in respiratory distress due to the fact that he had congestive heart failure and had not been taking his “water pills” (lasix) for the past few days. His shortness of breath was what landed him in the hospital and we were there to get his condition back under control.
We had orders for a nasal cannula at 2-5 LPM until his O2 sats were higher than 90, and if his O2 sats didn’t improve with that we were to call the doctor. When we first walked into his room his sats were at 86, so we immediately put the cannula on him and watched for any results. Nada.
As one of my classmates went to the pyxis to get his mornings meds, I ended up calling the doctor to ask what she wanted done about our patients O2 sats. She basically told me to give the patient his meds and gave me an oral order to push 40mg IV lasix. I repeated the order back to her and then hung up, relaying that information to my other classmate getting the meds.
All the while, the patient is complaining that he can’t breath and isn’t comfortable and we’re trying to calm him down, while I have another classmate studying the patient’s labs and making sure that he is ok to take the meds he’s been prescribed (his potassium value was ok, so he could take his digoxin and lasix).
We ended up giving him all of his meds and his lasix; we noted his O2 sats come up and his tachycardia and hypertension resolve due to the ACE inhibitor and beta blocker. We thought we were doing great until his O2 sats dropped below 90 again and when he urinated he only gave us an output of 200ml.
So we called the doctor again and asked her if we could put him on a simple rebreather mask and give him another dose of lasix. She agreed with us so we put on the simple rebreather mask at 8 LPM and gave the patient 80mg IV lasix. After the slow 4-minute push, within half an hour the patient urinated 500ml and his O2 sats finally were up to 98. He was no longer cyanotic and he was thanking us profusely for making him feel better!
So yeah. We rocked that simulation and our instructor was practically beaming when she came to get us (our simulations are all being seen through cameras in the ceiling). She was so excited about our performance and only had a few constructive tips to give (don’t handle the urinal without gloves on!!).
Soooooo AFTER our simulation we then had to demonstrate patient discharge teaching. Taking turns, we each had to be the patient and the nurse giving the discharge teaching. The fun part about all this? We were being TAPED. Our instructor is going to end up pulling the best one and showing it to us in class. EEEK!
And then we were done! And it was an awesome day at school. Our next simulation is in L&D next month and I’m super excited about that one too. I’m sure it’ll be hilarious! 😉