2 Down, 14 To Go

Well my S2 semester has begun and I’m slowly starting to wrap my head around the fact that I am, in fact, in school AGAIN and that this is, in fact, my LAST semester.

The first thing that has been hard for me, right off the bat, is of course the early morning wake up calls again and the fact that I know I can’t just come home at night after school and sit and watch TV. Man how I wish I could.

The second thing that’s been hard has been the fact that I’m still continuing to try and exercise and eat right everyday but all I want right now is CHOCOLATE. Hello, stress. Nice of you to show up again. (I will not let this semester de-rail my weight-loss progress!!)

The first couple of weeks have been a whirlwind of information overload and assignments and orientations. We even had a simulation already! Our LAST simulation of nursing school!! It was actually super helpful – more so than any other simulation I’ve completed – and I feel like I REALLY learned a lot from it. We covered topics like IV therapy, oxygen therapy (which masks to use and when/why), as well as giving insulin. Then our simulations covered DKA (diabetic ketoacidosis) and PE (pulmonary embolism).

I met my preceptor last week for my CCI clinical at the VA Emergency Department. She’s awesome and also a former TWU nursing student! I am going to love having clinicals with her…we start next Friday.

I also met my school nurse at the school that I will be attending community clinicals in this semester and she seems super amazing as well. I’m blessed by having great leaders this semester! I start those clinicals next week on Thursdays. My weeks are going to go by SOOOOO fast!

I started applying to hospitals last week and have so far applied to 20 different positions at different hospitals. And then yesterday when I checked my email after finishing up at school I saw that I had an email to schedule an INTERVIEW for this upcoming TUESDAY!!! Already?! I’m so not prepared for this…I’m so not prepared for this…I’m so not prepared for this…

But ready or not I have an interview on Tuesday! It’s for the Emergency Department. I have to put together my portfolios today to have them all ready to go…good thing I already have my references and my letters of recommendation all prepared already! I’ll upload a blog post with my portfolio details a bit later next week.

AND I have a test on Monday in CCI. It’s hard to believe we have a test already and we’ve only completed two weeks of school. 😦 Our instructor assured us that we know the material and that it’s all review for us but it’s still nerve-wracking since the test is worth 25% and I really haven’t even begun to study.

Well that’s all I’ve got for now! Time to go study for my test (with Stars-Wars on in the background…this is serious stuff y’all). Happy weekend!

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Adult Health Simulation, Round 2

Yesterday (Friday) I participated in my last simulation for Senior 1. It was the exact same simulation that I participated in as a Junior 1, only this time I was on the other side of the same coin. It was terrifying…especially after hearing stories of my classmates breaking down into tears on Wednesday (some of us went Wednesday, some of us went Friday).

I had nightmares about this simulation on Thursday night. I dreamt that I froze and couldn’t do anything…and then I dreamt that we were notified that the simulation was canceled due to SNOW! That’s how badly I didn’t want to participate. I knew that I would be all by myself (the instructors had released the wrong schedule to us – the schedule that showed us who we’d be paired with and which patient we’d have) and the pressure was intense. Most of my classmates were paired with another S1 and everybody had two J1s. Except for the lucky few of us that they decided would be alone with their J1s. I was told later that they specifically picked the strongest of us to participate on our own (a blessing and a curse!).

So when I got to campus yesterday morning I reviewed some of the paperwork that we had to chart on and steeled my nerves as best I could. I didn’t feel at all prepared but I had to do it so I just had to deal.

The first thing we did was practice with IV pumps for about 45 minutes. This was EXTREMELY helpful to me since I’d never been able to practice on one in simulation OR clinical. So I actually feel like I could work an IV pump for the first time! I had a lot of fun doing it and I think it really helped me calm down.

Then we moved on into the “ER-triage” part of the simulation. This time, instead of being stationed at one patient to get a thorough history and assessment, the S1s were paired off (except me) and rotated amongst the five patients in order to do a quick assessment and move on. We were supposed to be able to get enough information to be able to prioritize the patients afterward. I thought this part was a bit harder than I was anticipating. Completing a “quick” assessment is not an easy thing for me to do, plus I think I was so nervous and scatterbrained that I did not ask all the right questions or get all of the information that I needed.

After the ER we spent a bit of time together as a group prioritizing the patients, and then we moved into the ICU lab in order to take care of our patients for the actual simulation part of it.

I was paired up with two J1s and was given a CHI patient (closed head injury). At this point in the simulation, since everything had been happening in “real time” since Wednesday, my patient had decompensated quite a bit. His GCS (glasgow coma score) was 3 which is usually an indicator of brain death (although it’s not confirmed until other tests have been performed), he was intubated, his ICP was 22 and climbing, and really we were there to make sure his body remained viable.

I really wish we were given more time than 45 minutes in the actually simulation to get things done. I had been told in report that the patient’s ICP was 22 and if it was above 20 for over 5 minutes the physician needed to be called. So the first thing I did was check the patient’s safety equipment, vent settings, IV fluids, and took a quick look at the monitor to make sure that there weren’t any pressing concerns other than his ICP. Then I set about trying to call the physician about his ICP. And after the physician gave me orders to give the ordered Mannitol, it took me FOREVER to give that med! I wasn’t sure how long to IV push the med so I had to call the charge nurse. Well the charge nurse told me it couldn’t be IV push so I had to dilute it and give it IVPB. Then she says “wait, let me double check that,” after I told her the only form we had the Mannitol in was for IVP. Meanwhile the J1s are doing a thorough assessment (thank God) and checking the patient’s blood glucose.

Finally I’m given the go-ahead to give the Mannitol as IVP so I have to draw it up and prepare it, and then give it. Well, while I’m giving it, one of our instructors walks in and goes “that’s enough interventions for now! Time to start cleaning up and preparing for the next shift to come in!”

WHAT?! That wasn’t enough time at all! I didn’t even have time to get anything else done!

At least I didn’t walk out of there crying. I thought I just might. But I really should’ve managed my time better and I should’ve been able to get more done during our shift than just give the Mannitol. Ugh. I’m disappointed in myself.

But hey, that’s the purpose of these simulations, right? Figuring out how to be a nurse and manage time and take care of the patient?

I just hope that next semester when I am (hopefully) following a preceptor around that I will learn very well how to manage time and take care of my patients. I’m ready to be a nurse but I don’t want to feel like I can’t organize well enough for this job!

 

First Impressions, Part 1

My husband told me this morning: “I think you had a breakdown once per semester for J1 and J2. And in just one week of being an S1, you’ve had three.”

I think that sums up what this semester is going to be like for me. Although after surviving week one I’d have to say that I am truly VERY excited about what I’m going to get to learn and do this semester; I just hope I can make it to the end of these 16 weeks and PASS.

The week began rough. We had a child health lecture first and it covered how to communicate with children and then a lecture on the basic assessment of children. I say it began rough because first of all…I’m pretty sure that I don’t want to be a pediatric nurse, so the information in child health just doesn’t GRIP me the way that adult health does.

Second, I felt very “lost” in the lecture on how to communicate with children – almost as though the lecture had begun three weeks ago and I was just now getting into it. We discussed Erickson and Piaget, which I do remember from taking developmental psychology in pre-reqs, but hadn’t refreshed since then. Well this lecture literally had us “hit the ground running.” We were expected to know the different stages of development through Erickson and Piaget and we were expected to interact with that lecture by answering questions according to those developmental theories. Surprisingly I did remember quite a bit from my class two years ago…but I still felt like I’d just stumbled into this class after it’d been in progress for awhile. Not a comforting feeling when it’s your very first lecture of your senior year.

Third, the child assessment lecture really scared me. Children are NOT like adults. You don’t communicate with them the same way, and you don’t care for them the same way. And, although assessment is pretty universal, the way you assess a child feels different than the way you would assess an adult. Our instructor really stressed the importance of a VERY thorough assessment for children – not a focused assessment – because they could be fine one minute and in complete pulmonary arrest the next. That lecture scared me because as out instructor was teaching us how to assess a child, all I kept thinking was that I was going to forget something important and the child would end up in danger because I didn’t check their pulses or something like that! (I don’t think I’ll forget to check pulses, but you get what I’m saying.)

So that was Monday…and on Tuesday we had our first adult 2 lecture and mental health lecture. Adult began with a subject I love: the heart. However, we were given so much information in that lecture that I felt like we’d been given two weeks of information in only 3 hours. I’m wondering how I’m going to study for all that information and remember it all! And this information was just so different from previous material in Adult 1; it was more INTENSE and dealt with high-acuity diseases of the heart rather than the normal CHF, such as endocarditis, cardiomyopathy, pericarditis, cardiac tamponade, heart transplants, valve stenosis & regurgitation, valve replacements, and aortic aneurysms & dissections (yes, ALL of that in only 3 hours!).

I wasn’t sure what to expect in our mental health lecture but I’d like to say that I was pleasantly surprised. I’ve been dreading mental health since the first day of J1, however after just the one lecture on Tuesday and the follow-up lecture on Friday, I’m already convinced of how IMPORTANT it is for nursing students to take a mental health course and for nurses to understand mental health in EVERY aspect of nursing practice. And here’s why: no matter what kind of nurse you are, you will always need the skills of being able to communicate therapeutically with your patients and their family members.

Our lecture on Tuesday was a basic introductory lecture: why mental health is important, the different theories of psychology and why we study them, and an introduction to managed mental health care. On Friday (our mental health orientation, as it was called), we watched a video on mental health nurses – what they do and why it’s so important to them. That video made me cry for sure. Then we discussed the “therapeutic nurse-patient relationship”, the differences between sympathy and empathy, and how to recognize anxiety in ourselves and what to do about it.

So my first impressions from the lecture portions of this week: I think child health will be important but not really interesting for me (we’ll see how that changes once we start clinical). Adult health will be AWESOME but possibly quite overwhelming. And mental health will be something that I’ll look forward to every week (how unexpected!).

And why the breakdowns this week? I’m still not even quite sure. I think I’m just super stressed right now and every little thing makes me want to cry. There is a point at which, as a nursing student, you may be trying to do to much, and I think I might be there. But then again maybe I’m just trying to adjust to the different intensity of this semester and I’ll be fine once I get my feet on solid ground and can run with the rest of them.

We’ll see…

 

Close Call

I just barely scraped by. BARELY.

That adult health final was rough. I just can’t even put into words how hard that final was. It made me feel like I hadn’t learned ONE thing all semester. I certainly thought I was prepared…but let me tell you after having received As on all my previous tests, this final felt like a punch in the gut. I LOVE learning about adult health, but this final certainly wasn’t reflective of that.

I took the test and then, even though it was online, I didn’t get my grade right away. 😦 About an hour later, a classmate posted on Facebook that the grades were up so I booked it onto our blackboard site and scrolled down to the bottom.

I made an 80.

I felt my heart drop. I needed an 82 to get an A in the class. It was the same exact scenario from last semester with my Assessment final!!

But then I remembered that I got 2 points for my final grade due to my HESI score. So I texted my instructor to ask her if the grades had our HESI points added to them already or not.

THEY DIDN’T!!!

So I ended up making an 82 and getting an 89.5% overall course grade, which rounds to a 90, which equals an A!

Seriously, scraped by. Barely. But I’m super happy that I made an A and super excited that my Adult Health 1 class is OVER!

J2.1

Ok, so I didn’t get around to writing this post on Friday night. That’s because I decided to sleep Friday night, stay up all day Saturday, and then go into work Saturday night without having slept beforehand. Not sure that was a good choice…this morning I came home, slept from about 0900-1200, and then got up and tried to get some reading/assignments done, but ended up falling back asleep on the hubby’s lap while we watched Avengers. And I have yet to get anything school-related done; but maybe that’s ok. Maybe I was meant to just de-stress from the past week today.

First week of the second semester of nursing school = done! Maybe it wasn’t completed super successfully but it’s behind me now and I’m in the throes of trying to get caught up and organized for the rest of the 15 weeks ahead of me. I’m feeling a bit freaked about this semester already and I think it’s because I just don’t feel like I got off on the right foot.

First of all, I wasn’t able to complete any of the required reading before Monday, and I’ve heard that it’s a GOOD idea to read for my OB and especially Adult 1 classes – usually nursing students can get away with either not reading or just skimming the chapters. And my first Adult 1 test is now in 2 weeks, and I’m so behind on the reading (as in, I should have had several chapters read by now) that is stressing me out and giving me headaches. Seriously.

Secondly, there are so many assignments due within the first few weeks that I don’t even know where to begin on them. I sit here and think about what needs to be done and then I end up so overwhelmed that all I want to do is sleep. Eek! So I really need to just take it all with baby steps so at least I’m accomplishing SOMETHING and not just sitting on the couch like a zombie… (which I pretty much did once getting home from class every single day this week. Another reason I’m feeling like I got off on the wrong foot).

Third, I knew that I had to work last night, which meant a little less time this weekend to study and complete assignments, but I knew I could work around that since I had today (after a nap) and Monday free to be able to get some stuff done. Well I looked at my schedule on Thursday and realized quite belatedly that I also have to work tomorrow (Monday). So now I’m freaking out because I’m just wondering how I’m going to be able to get it all done. I want to be a great student this semester, I really do…but I’ve never worked AND gone to school at the same time before and I know it’ll be quite an adjustment until I get used to it. So hopefully I don’t screw myself in the process.

Especially since I was SUPPOSED to get some stuff done today and I’ll I’ve managed to do is sit around and chill.

Sooo…moving on and hoping this week is a bit on the stronger side for me. At least we get to learn how to start IVs this week!! 🙂

P.S.: I almost got to start an IV at work yesterday on one of my co-workers. She totally would’ve let me do it, except we got swamped and ran out of time. 😦 Maybe next time I work with her.

Don’t Have Enough TIME!!

April is going to be CRAZY and I do not know right now how I am going to accomplish everything…at least, to the degree that I want to. And, I really should be completing preclinical/studying right now but I’m procrastinating big time. 😦

Just to highlight everything happening this month:

  • 3rd assessment and pharmacology tests (next week!)
  • Final vital signs check off (also next week!)
  • Professionalism paper (still haven’t written it – oops; and it’s due next week)
  • Group presentation or Conference presentation
  • Head-to-Toe assessment check off
  • Adult Simulation Lab for Concepts
  • Concepts HESI

This is all on top of the regular lecture, tutoring, pre-clinical, and clinical schedules and all the paperwork/studying that goes with them. My group presentation – if I’m not picked for the conference presentation – is in a week and a half and in that time I have to take 2 tests, pass a check off, write a paper, and find time to research health care reform and how it affects the nursing profession (my group presentation topic) and put together my powerpoint on it.

Oh my…I’ll be so thankful when April is over. Because the first week of May is finals, and then I will be DONE with my first semester of nursing school!

First Clinical Experience!!

Yesterday (Friday) was my very first clinical!! To recount the experience, however, I have to start from Thursday afternoon when my entire clinical group met to complete our pre-clinical.

Pre-clinical basically involves going to the hospital to “pick” out a patient (the charge nurse assigns one to you) and accessing their chart to get some required information on them. We have to be able to complete part of the patient’s care plan before going to clinicals the next day so knowing their information ahead of time is essential. After our clinical instructor led us through some directions she released us into the hospital to go to our respective floors and we were then…on our own. Gulp!

One of my classmates was in charge of getting 5 patients from the charge nurse, and once we each had our room numbers we were free to get on the computer and access their charts.

It took me forever to get on the computer!! The first computer I picked out just wouldn’t work with my username and password, and so after about 10 minutes of trying every different password I had been given for different systems (the computer, the workstation on wheels, and the omnicell), I approached the charge nurse and asked for her help. She came over to me and then told me that the computer I was on just hadn’t been working in awhile. Oops! So I changed computers and was finally able to get on and access my patient’s chart.

I had to find my patient’s admitting diagnosis, the history of their present illness, their past medical history, any current or past surgical history, the meds they were on while in the hospital, their lab values, and any diagnostic tests run on them while in the hospital and the results of those tests. It took me about 2 hours in total to navigate the computerized chart, find the information I needed, write it all down, and then read the attending physician’s progress notes to get any additional information that may help me while dealing with my patient. It was a lot! And let me tell you, it is TRUE when you hear that physician’s handwriting SUCKS! I couldn’t really read the progress notes because they seriously looked like hieroglyphics…which is why most hospitals are going with completely computerized charting. My hospital, however, is in the midst of making that transition so while everything else was on the computer chart, the progress notes were unfortunately still handwritten.

By the time I got home, it was already 1930. I ate quickly and then got to work on finishing the part of my care plan that I had to have finished by morning. Because I had to write out the pathophysiology of the patient’s admitting diagnosis and relate the pathophysiology to the symptoms the patient was having, using that pathophysiology to find 5 nursing diagnoses and their rationales to apply to the patient – as well as look up EVERY SINGLE MED they were on and describe the adverse side effects, and implications of those effects that I had to be watching for during the clinical – finishing my care plan took me until 0230!! (And I’m sure there was a better way of wording that sentence so that it wasn’t so long and convoluted; however my head is tired and not quite working right now.)

What my desk looked like when I started my care plan...

What my desk looked like when I started my care plan…

...What my desk looked like by the time I finished and went to bed.

…What my desk looked like by the time I finished and went to bed.

 

 

And then I had to get up at 0430 in order to get ready to leave the house by 0545 so I could be at the hospital by 0630 – so I only got 2 whole hours of sleep the night before. Needless to say I was moving extremely slow Friday morning and coffee was my best friend.

We were all at the hospital by 0630 and because it was dark outside the hospital was still lit up – and gorgeous!

Methodist Dallas Medical Center

Methodist Dallas Medical Center

So we went up to our floors – 5 in our group on floor 10 (med-surg/gynecology) and 5 in our group on floor 6 (med-surge/telemetry) – and began our day! Mine started off really hesitantly because I just seemed to freeze once I was on the floor. Man I wish that would stop happening. I went into my patient’s room and introduced myself and we had a great conversation about coffee…and then I told them I would be back. I still had no idea who their nurse was and I needed to introduce myself! About about 10-15 minutes of rabbit trails I finally found the nurse and introduced myself to them, hoping with crossed fingers that my nurse wouldn’t be one of those who “eat their young.” They weren’t – in fact they almost seemed to welcome to fact that they’d have a student – and I let them know which patient I would be helping out with and also the fact that I was available to do vital signs on all of their patients for the day. They seemed to appreciate that fact and went on about their business.

And I was left to do my business…except I had no idea what that was. What was I supposed to do now? For some reason I completely forgot that I was supposed to do everything on my care plan for the day and I just kind of faltered outside my patient’s room for a couple of minutes completely unsure of what to do next.

I finally texted my clinical instructor to come find me, and once she was with me she gently reminded me that I had a full assessment to do on my patient, plus I needed to look in the patient’s chart for which meds were due and at what time they were due. Then I needed to do an interview and a complete history on my patient (if I had time) and help out with any tasks that came up such as bathing, linen changes, etc.

Ok! I had a game plan now and I set about to accomplish it. I looked up the patient’s chart and there were a few things that had been added/changed since the previous night so I wrote that down, made a list of the meds that I needed to give my patient, and then went back into my patient’s room and did my full assessment on them. They were the best first patient a student nurse could ever ask for! I was very blessed and lucky because they were so awesome, sweet and patient, and let me do anything and ask anything. After the assessment I was fortunate to have physical therapy come in immediately after and work with my patient. That gave me the opportunity to assess their musculoskeletal/physical abilities and strength; also while they were out of bed I took that opportunity to change the linens and make their bed.

By that time it was around 9am (yes all of that took FOREVER! I’m slow) and my instructor came to find me so she could help/observe me give meds. She walked me through getting all my supplies for a sub-Q injection, working the omnicell to get all my meds, doing the first and second medication administration checks, and pulling up the medication for the injection (Heparin). After that we went into the patient’s room, did the third administration check of comparing the meds to the MAR, scanned the patient’s armband, and I put all of their meds into a cup for them because they stated they could swallow them all at once. I informed the patient of what meds they were about to take and why, and then they certainly did swallow them all at once!

Then I prepared them for the heparin injection, took a deep breath…

…and gave my first ever injection!!!

It wasn’t weird, but yet at the same time it was. I mean, I was purposely stabbing a sharp object into another human being’s skin! How can that not be weird?

I then helped clean up my patient’s room, get them comfortable in bed (they were in a chair since having walked with PT), and made sure they had everything they needed. I watched the PCT draw blood for some laboratory tests, and by that time it was time to start rounding on my nurse’s other patients in order to take vital signs. I started with my patient first, of course, and then got everyone else. And by the time I was done taking vital signs and documenting them on everyone, it was time for lunch and post-conference with my clinical group!

My clinical day started off slow, but it got much better and by the end I didn’t want it to end! I finally felt like I was getting into a good groove. But WOW. The amount of work that nurses have to do and the knowledge that they must always know in relation to their patients is astounding. I only had one patient and I certainly wasn’t able to get everything done with them that I had wanted to do for the day (like giving a shower); I can’t imagine what my nurse was going through trying to care for and give meds to 5 patients!

We were all still smiling by the end of the day though so that’s good. I can’t wait until next week…hopefully I’ll be way more prepared and know exactly what I’m supposed to be doing, and maybe I’ll even have some time to shadow my nurse and watch them care for their patients and do procedures with them that I’m not able to do yet!

Still smiling!

Still smiling!

 

 

Wahoo!!!

I made it! I made it through 8 weeks of a completely different learning experience,  unlike any I’ve ever encountered before, and now I’m on the other side. It’s SPRING BREAK!!

I figured I’d give a recounting of my check off, and also highlight why it is so important that you check the MAR (Medication Administration Record) 3 times before you give medication to a patient. Doing that last check against the MAR saved me during my check off yesterday!

A week ago Friday my clinical group was given a piece of paper with 10 different time slots on it, starting at 0800. We had to sign our names in a time slot of our choosing, in order to pick when we would begin our check off. I tried to get the first slot, but I ended up with the second  slot – at 0835 – which I was super happy about considering I was one of the last to sign the piece of paper. I’m one who would rather just get it done and over with and not wait for the dreaded moment; I was also told by my mentor that I should sign up for the earliest spot possible so that I don’t have to wait around and hear about my other classmates’ experiences before doing it myself. Pretty good advice if you ask me!

So yesterday I got to school around 0700, prepared to sit around and go over the 4 case studies one more time to review the steps and put myself in the mindset for the check off. In reality, however, I got to school, went into the classroom, and then talked with my classmates for an hour until my first classmate was called up to go do her check off. But I’m thankful it turned out that way, because while I was reviewing the steps of the different check offs with my classmates – in between chit-chatting about all sorts of other topics – it was in a much more laid back and relaxing manner and I felt the tension drain out of my body. We all knew we were ready, whether we were nervous about it or not.

At 0835, right on the dot, my clinical instructor came to the classroom and called me. Instantly I felt my nerves go on high-alert and my heart started racing. We walked into the high-fidelity lab area (I can’t wait until I’m a J2 and actually have labs in that area!) and my clinical instructor pointed to a bowl with folded up pieces of paper in it and told me to pick a number.

I was just praying and hoping I got the insulin administration/sterile dry dressing change case study when I pulled out that piece of paper…

And I did!! I felt my heart calm just a tad and I was instructed to go “shopping” for my supplies and then meet my instructor in the patient room.

My supplies consisted of an insulin syringe, the insulin itself (both Regular and NPH), alcohol swabs, sterile gloves, 2 packages of 4X4s, bacitracin ointment, and tape. I took myself and the supplies into the patient room, washed my hands, and then…just stood there.

I was frozen! I knew I was supposed to get the morning blood glucose from my instructor but I just could not remember what to do next. And this wasn’t even a hard skill! I think it was just the fact that my instructor was just sitting there watching me, with a timer going (we only got 30 minutes), not saying anything, that messed me up. But I finally took a deep breath and just let my hands take over, knowing that I knew the information and just needed to get over myself.

I got the blood glucose from my instructor, compared it to the sliding scale in order to know how much regular insulin to give, calculated the total amount of regular and NPH insulin to draw up, drew everything up correctly without any air bubbles, explained the procedure to the patient, checked the patient’s wristband against the MAR, double-checked the medication on the MAR…

…and realized that I read the sliding scale wrong and was only giving 2 units of regular insulin when I was supposed to be giving 4.

“Oh crap!”

I actually said this out loud, and then cringed, looking at my instructor to see her smiling a bit. I apologized for my language (I wasn’t sure that word is one that offends her or not, but either way it’s not professional) and I told her about my mistake. She nodded her head and then told me it’s a good thing that I’d checked the MAR again the way I was supposed to and caught my mistake! I told her I’d go ahead and draw up more insulin in a new syringe, with the correct amount, but she told me that that wasn’t necessary since the check off was about seeing if I could complete a skill correctly and she’d already seen me draw up the insulins correctly – even though it wasn’t the correct amount.

So I went ahead and injected the insulin into a nerf football (we can’t inject the dummies), pulled the syringe out, activated the safety feature, and then threw it away into the sharps container. After washing my hands,making the patient comfortable again and cleaning up my area, I then prepared myself to perform the sterile dry dressing change.

I completed the sterile dry dressing change without any problems whatsoever, and thankfully didn’t contaminate my sterile field when I had it set up! Once I was done with that, I again washed my hands, cleaned up, and made the patient comfortable. My instructor gave me a few pointers to look out for in the instance that I HAD given an insulin injection with too little insulin (the patient would be hyperglycemic by lunchtime), reminded me to always perform those checks against the MAR, and then told me a did a great job and I needed to finish up by documenting.

My documentation was sloppy, in my opinion. Not because I didn’t get all the information down that I needed to, but because my handwriting was shaky and all over the place, and on the MAR I wrote all over it and it wasn’t organized very neatly. But, I finished my documentation, gave it to my instructor, she told me I passed, and I was FREE!!

It is amazing how fast the time flew through that check off. I know I used every available minute due to just being nervous and slow, but thankfully I didn’t run over and I passed. Again, I’m SO glad I checked the MAR again before administering the medication…and I’m so thankful that that wasn’t a REAL situation in which I gave an insulin injection with the wrong amount of insulin!!

I don’t have any big plans for this week of spring break, other than to catch up on some assessment reading, write my resume (I want to get a job as a tech this summer!), write a short 2-pg paper for concepts class, get my hair done, and hang out with family and friends! Hopefully by the time school starts up again I’ll feel relaxed and rested, and ready to give my ALL for the next 8 weeks of J1 semester. 🙂

Alllllllmost Spring Break!!

It’s hard to sit here and realize that I am nearly halfway done with my first nursing school semester. While on one hand it has been a long 8 weeks full of new experiences and new ways of being taught, stretched, and tormented ;), on the other hand these past 8 weeks have gone by so fast that I feel like my head is literally spinning from the pace of it all.

This week in particular has been rough – especially this past weekend. I had my 2nd assessment test on Monday and my 2nd pharm test on Tuesday, and I think from Friday to Tuesday night I slept just enough to make sure I wasn’t a zombie and that was about it. I was so dead on my feet after the test on Tuesday that I honestly can’t even remember what we talked about in my pharm or concepts classes afterwards. (But at least I was there – half my class went home after the pharm test!).

The assessment test covered mental status assessment, nutrition, head & neck, heart & neck vessels, the peripheral vascular system, the lymphatic system, and the neurological system. It was a TON for one test and unfortunately for me I did NOT study the way I should’ve. Honestly, I don’t understand why I wait until the weekend before a test to study because it doesn’t pay off. I ended up with an 86 (my first nursing school B!) on that test….

…And I ended up with an 86 on my pharm test as well. My pharm test covered psych drugs (for anxiety, schizophrenia, and depression), endocrine drugs (for diabetes mellitus, hypothyroidism, hyperthyroidism, growth hormone insufficiencies, antidiuretic hormone insufficiencies, glucocorticoids, and drugs to increase bone density and stop osteoporosis), blood drugs (antiplatelet, anticoagulation, and thrombolytics), and IV therapy.

I’m upset with myself about those B’s. I know I could’ve started studying earlier and studied better; it’s not the fact that those grades are B’s that upsets me as much as it’s the fact that I know I didn’t do my best job. If I’d done the best I could and still made B’s, then I would not be frustrated right now about it. I am ok with making B’s and even C’s if I know I worked my behind off for those grades!

It’s certainly great motivation to step up my game! I don’t want any more B’s because I didn’t study the way I should have.

And now, the only thing standing between me and spring break is my concepts check off tomorrow morning!! I have today off, which means I will be practicing ALL day and running through the steps over and over in my head, so that no matter which skill I pull out of the hat tomorrow I will be prepared and will ROCK my check off! 🙂 I am certainly anxious about it right now, but I’ve practiced in lab a couple of times and it’s now just a matter of making sure I don’t forget any of the steps or any of the supplies I need while performing the skill.

Ahh! We shall see!

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?