Taking a Break…

I finally have a moment to breathe! Although I really shouldn’t, because there are SO many other things that I could be doing right now instead of sitting here playing on the computer. But you know how it goes. 😉

I don’t think I’ve had any more than 13-14 hours of sleep since Friday night…it’s been tough going around here! Due to going out of town for a wedding on Saturday and staying up until past 0100 (what a great night!) and then getting up at 0500 Sunday morning to hit the road again to get home, I really didn’t have Saturday to use for studying at all. So as soon as we got home Sunday morning (around 0900) I began studying for my assessment test and that didn’t stop until 2300. Then up again at 0500 to leave by 0520 and get to campus by 0600 (the earliest we’re allowed on campus!) and I proceeded to study until test time at 1400 – aside from a brief break for my advising appointment for the J2 semester. I can’t believe I’m already about to register for J2!

Thankfully, even with the short cram time and the HUGE about of knowledge we needed to know for our assessment exam, I ended up making a 94!

We didn’t have lecture after our exam (technically we’re done with assessment now until the final) so I was able to get home early. I used that extra time to cram for pharm…again staying up until late (2300) and then getting up at 0300 to study some more before going to campus. Studied HARDCORE this morning until about 0845, and then it was test time!

And honestly I don’t know how I pulled it off, but I made a 92 on the exam today. Whoop!

Tonight I had planned on working on my professionalism paper, but now I just can’t even bring myself to do anything. I’m so tired I just want to focus on nothing and enjoy the brief respite. So I guess I’ll do that tomorrow morning, and then begin the research for my group project. Somewhere in there I have to do my preclinical and complete the care plan too (although it’s the last one – yay!)

In awesome news, today we got the list of clinical sites for our J2 semester. There were 11 paired clinical sites (1 site for Adult 1 and 1 site for Womens Health) that we had to rank from 1-6. It took me FOREVER but I finally finished ranking it, and my number one choice is Parkland for Womens Health and Presbyterian Denton for Adult 1. Crossing my fingers! We should know by mid-June (I think?!) which clinicals we’re at for next semester.

So yup…nothing too exciting to share at this point. I’m just holding on until the end of April!

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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!

Screwed on Backwards…

…my head, that is. This week has been CRAZY and I think this “nursing school” schedule is finally catching up to me. Last Thursday before pre-clinical I forgot my lab coat (we have to wear business casual and a lab coat for pre-clinical); I had to leave my volunteer shift at Children’s early in order to be able to go back home (Ft. Worth) and get it before I could go straight back to Dallas again. I was in traffic for TWO HOURS round trip just because I forgot it. NEVER AGAIN.

This past Wednesday, I forgot my stethoscope for assessment lab. I was able to borrow my partner’s for the BP measurement, but then we were able to practice for our final vital signs check-off coming up in a couple of weeks (listening to heart and lung sounds and differentiating normal from abnormal) and I had to use one of the cheap lab stethoscopes. It worked fine, but the quality was so much worse than mine. Fortunately I can differentiate between crackles and wheezes really well already. I was hoping my lab instructor didn’t notice that I’d forgotten my stethoscope, but she did. She didn’t give me much grief about it though, thank goodness.

Then last night (Thursday) I went to pre-clinical and got my patient from the charge nurse, accessed their chart and wrote down all their information, wrote down their room number on the documentation form that we (students) all sign in and out of, and went home. Well, just as I got home and started preparing my pre-clinical paperwork, I get a call from one of my classmates saying that she noticed that I and another classmate had the same patient. Because my other classmate had been to the hospital first, and written down the room number first, I no longer had a patient.

I was furious with myself. I didn’t even CHECK to see what patients my other classmates had on that documentation form before I left – which is the whole purpose for having that piece of paper in the first place!!

So I finally had my nursing school breakdown last night, bawling when I realized my mistake. I was just so certain that I would get an “unsatisfactory” because I hadn’t paid attention enough to realize that I got my pre-clinical information on a patient that one of my other classmates already had. It was too late at that point to go back to the hospital and pick out another patient, which now also meant that I wouldn’t have any care plan work completed this morning before clinical.

I called my clinical instructor last night and told her what happened, barely keeping from crying on the phone with her – I was that upset. But thankfully I have the greatest and most laid-back clinical instructor ever! She told me it was ok, I would just have to get a patient in the morning and instead of “front loading” my clinical paperwork (getting some of it done before clinical), I would have to “back load” it and do it ALL after clinical today. Fine with me!

And lastly, TODAY, after getting a new patient from my nurse and getting report, I realized that I left my ID in the car! I can only access Methodist’s system with my code, of which I have on the back of my ID and have not yet memorized. So I had to run back out to my car and get my ID, which wasted about 20 minutes of my morning because the employee parking lot is FOREVER away from the hospital entrance.

That has been my week so far…hopefully that’s all the screwing up I’m going to do for awhile because it’s exhausting and I’m tired of feeling like my brain just isn’t there anymore!!

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?