Awesome Video Explaining ABG Analysis

This is an awesome lecture talking about a simple way to analyze and interpret ABGs! Love this lecture!

H1N1 Vaccination Madness (and grade update!)

The H1N1 clinic we held was a success, however, about 3,000 people were anticipated and we only immunized roughly 1,000. I probably did 50 vaccinations myself, thus removing any and all nervousness about giving intramuscular shots! I joked that I was so nervous about giving a shot that I didn't eat all day, then, after I gave my first shot and realized it was no big deal, I immediately got hungry.

My grades took a turn for the better now! I got a 95% on my nursing care plan and a 94% on my third theory exam. So, my grade card looks like this:

Theory Grade (50% of grade):
Exam #1: 78%
Exam #2: 87%
Exam #3: 95%
Exam #4: Still pending...
Writing Assignment: P
Current Grade: 86.66666%>87%

Lab/Clinical Grade (50% of grade):
Skills Quiz #1: 97%
Skills Quiz #2: 76%
Skills Quiz #3: 94%
Skills Quiz #4: Still pending...
Graded Nursing Care Plan #1: 95%
Graded Nursing Care Plan #2: Still pending...
Current Grade: 90.5%>91%

Current Total Grade in Class: 89%

Note: This grade will be slightly lower due to lab deductions from that damned drug calculation test and that dumb incident where I took equipment into a contact isolation room!


I seem to be sitting pretty comfortably at a high 'B' right now, even with my point deductions. I don't anticipate getting a bad grade on my second graded care plan. That leaves the two tests... I'm a little concerned about theory test #4 because it has electrolytes, fluid balance, and acid base on it. Those are not particularly difficult subjects, but as with any nursing subject, if you don't take the test after totally absorbing the information on the subject matter, you will probably not do well. I'm probably going to post up some helpful YouTube video lectures soon that I've been listening to on my iPhone while driving! ;)

I'm probably done with my clinical experiences until late January. You are allowed to miss 11 clinical hours a semester, and I've missed none, so I may just skip the last clinical. I love the experience, but trust me, a day off is really in order. I've literally not had a day off since the first day of nursing school; remember I work two jobs as well as go to school.`

Another great little tidbit of information is that my instructor for the second part of nursing, starting on January 17, 2010, is the instructor that failed me last year, thus delaying my nursing career another year. I'm not saying it was totally unfair. It's just that I don't think my learning style and her teaching style mesh well.

I'm a bit worried about that and the NUR151 course is signficantly more difficult than NUR101; this is where we insert foleys, NG tubes, start IVs, administer IV medications, etc. However, the theory instructor, is a really cool guy and I'm really excited to have him; everyone says he is phenominal.

Anyhow... a break is forthcoming and I'm all over it! I need some down time!

Skills Lab Down, Waiting for Care Plan Result

Well, this week was a weird clinical.

My patient was autistic and he was admitted for pneumonia. One of the employees from the facility the patient lived at was sitting with him the entire clinical experience.

Very interesting this guy was. Here's a sample conversation:

Me: "Okay , I need to listen to your lungs with this stethoscope."
Patient: "I don't want to. Bye Bye"
Me:"It's rude to say bye-bye when I'm still standing here ."
Patient: "Bye-Bye."
Me:"I'm not leaving right now."
Patient: "Sit down. Right there."
Me:"Right here?"
Patient: "Yes.
Me:"Ok I'm going to sit down."
Patient: "Thank you. I sorry. I sorry."
Me: "It's ok. You are behaving now."

Now picture a complete head-to-toe assessment. Yeah it was that good! The funniest thing that happened was when I discovered he absolutely loved cartoons.

His caretakers were dressed in street clothes, and to me, appeared a bit rough around the edges. They continously watched BET, VH1, MTV, and E!. Well this lady asked me to watch him while she took a personal call in the hallway on her bluetooth headset.

I asked him if he liked cartoons and he said "Yes" which meant that he really liked cartoons, because most questions that you asked him he wouldn't even respond to. So I turned on cartoons right before the clinical was over. When the lady returned, she was not able to change the channel because the patient would have absolutely flipped out. So she got stuck watching BOOMERANG channel for the rest of the night! ;)

In other news, I got a 90% on my skills lab quiz 3. Very excited about this because I'd really have to bomb out now to make it through the whole NUR101 class! I also took a chapter exam the other night and I have a pretty good gut feeling I did really well.

Want some more exciting news? I am going to be at a community-sponsored H1N1 vaccine clinic! It's going to be awesome because they are expecting thousands of people and I'm going to get a ton of practice doing my IM shots. The seasonal flu shots are given at a clinic at the hospital and the line has wrapped around the hospital twice. The H1N1 turnout is expected to be so large that they had to move the clinic to a local convention center.

My participation in my first ever community health clinic will be a mass vaccincination during a pandemic, which is something that doesn't often happen; even my nursing instructor has never given vaccines in a pandemic situation before.

Things are really looking pretty well as far as nursing school is concerned; now if only my family life didn't suffer as badly as it does because of my massive amount of school and work I'd be feeling truly happy.

Graded Care Plan Due Tomorrow

I've got a graded care plan due tomorrow. This is a very important part of my lab grade. My lab grade is calculated as follows:

Skill Lab Exam #1
Skill Lab Exam #2
Skill Lab Exam #3
Skill Lab Exam #4
Graded NCP #1
Graded NCP #2

I've done three exams so far and I am still waiting on my grade for the last one, which was skills lab exam #3. I have done pretty good, definitely passable so far, and I actually feel pretty good about the exam I'm waiting to be graded.

I have to complete the evaluation portion of my nursing care plan and turn it in by tomorrow.

Care plans friggin' suck. I get out of school at 9:30pm on Wednesday and have to have my care plan ready to roll by 2:00pm on Thursday. This doesn't sound that bad until you consider all of components of our care plans; and just for fun, I'm going to keep track of the pages I was responsible for this week:

1. Minimum of five nursing diagnoses, one of which has to be psychosocial, and each diagnosis needs to have its own two-page "care plan" done, complete with signs, symptoms, etiology, outcomes, interventions, rationales (page number, author, and book cited), and an evaulation. Five diagnoses x 2 pages = first 10 pages of the care plan.
2. Medication summary sheet. Every med my patient is on, sorted by whether they are on it at home or only at the hospital, with trade name, generic name, route, does, frequency, and time. We are now up to 11 pages.
3. Medication cards. These are cards for each individual drug. Must include trade name, generic name, class, subclass, side effects, therapeutic effect, and nursing implications. I've seen people with up to 27 medications. That would be 27 pages. My patient last week had 12. We'll add 12 pages to the grand total. We are up to 23 pages of my care plan right now.
4. Disease processes. These are cards, actually more like a whole sheet of paper, stating etiology, pathophysiology, definition, labs, diagnostic tests, and other information about your patient's disease process. Elderly patients almost always have more than one active disease process. My patient only had a meager 3 disease processes. Up my care plan to 26 pages.
5. Assessment. Our assessment tool paperwork is approximately 14 pages of assessment that covers everything from the layout of their home to the date of their last pap smear. We are up to 40 pages in about 18 hours.... and I'd at least recommend trying to sleep before clinical!

My patient that I had for my graded care plan was absolutely great! It was definitely easy to write a care plan for her because she was a great historian about her past health history and her disease processes included some easily identifiable signs and symptoms that make diagnosing very easy. She had COPD, osteoarthritis, and a stage 2 decubitis on her sacrum. These are very easy to write a care plan for because they just scream "Ineffective Breathing Pattern", "Activity Intolerance", "Impaired Gas Exchange", "Impaired Physical Mobility", and "Impaired Skin Integrity"... relatively easy compared to others I have had!

There wasn't really much to do for her. I gave her meds, did fingersticks, repositioned her, helped her to the can, encouraged fluids, and measured intake and output. It was a very easy day for me, so I decided to help out my classmates.

Definitely the story of the day was when me and my male classmate had to clean his total care patient up after she had a BM. We were cleaning her up, and I know I shouldn't find this as funny as I did, but she passed... ahem, flatus... and blew dots of diarrhea all over my buddy's white scrubs. It was definitely gross, but I couldn't do anything but laugh!

In all seriousness, I got into this nursing thing for the money.. at first. As it turns out, I really enjoy this work. It's hard, and can be downright gross, but helping people definitely gives you a sense of satisfaction that you'd be hard-pressed to have doing some menial job. You feel important; your decisions affect the life of someone else and ultimately their satisfaction is what tells you whether or not you are doing a good job.

Alcohol Withdrawal is a Bitch

I just had my first experience with an elderly alcholic (of many, many years) detoxing after a surgery and in the rehab hospital. Not one I'll likely be forgetting...

In addition to attempting to get up even though he was unable to stand without assistance, I was cursed out for nearly nine hours straight: he threw everything in the book at me and then some! I tried using my "textbook" nursing skills for distraction; to get him to not attempt to get out of bed by politely offering to assist him use a urinal if he needed to go to the bathroom, get him some water if he needed, get him sat up in bed if need be, blah, blah, BLAH.

Turns out severely detoxing alcoholics experience hallucinations. He kept reaching for non-existant bugs, he kept rubbing the floor tiles insisting it was sand, and he kept trying to go into "his dining room" because he didn't even know he was in the hospital.

Being a generous CNA-by-job and nursing-student-by-night, I attempted to offer said patient some fluids. Bad move. Those water mugs are heavy and giving one to a halluncinogenic detoxing alcoholic, albeit a very old one, is a recipe for disaster as I soon learned since it's the equivalent of handing him a small club.

I got cracked twice in the left eye and nearly a whole liter of ice spilled on me before I managed to get it away from him without harming him in any way...

Stacks of incident report paperwork and a semi-shiner later, I've learned a valuable lesson.

Hold the damned cup!

Some cool developments!

Well, nursing school is going along fairly well. I had a skills check, which is essentially a 45 minute period of time in which me, my instructor, and a dummy are in a room and I have to practice my "skills" on them. These are the skills I was expected to have mastered.

1. Assessing heart sounds
2. Assessing lung sounds
3. Assessing bowel sounds
4. Assessing vascular abdominal sounds
5. Administering a bolus or continuous feeding (open and closed systems)
6. Administering any medication (other than IV or obviously IV push)
   

It was nerve racking. I've never had such horrible test anxiety in my life. Not to mention my instructor threw some curve balls at me. Assessing the lungs, heart, abdominal vascular sounds, and bowel sounds were fairly simple but she threw some landmark questions at me that were pretty specific. We are required to know exact landmarks, so if she asked me where I might expect to hear the S₂ heart sound loudest, unfortunately, "Right there!" is not an appropriate answer: it would of course be at the fifth intercostal space, midclavicular line.

The tube feeding was fairly easy;I just remember that on skills check I have to check the pH of stomach acid each time before administration, but in all honesty, I don't think I've ever actually seen this done on the job.

The tough ones were the meds; they threw some tricky ones at me to catch. Doctor orders for enteric-coated pills to be crushed and given through patient's NG tube, antihypertensives that required me to take an apical pulse for 1 minute and ended up being contraindicated, drugs given in larger-than-therapeutic doses, and sublingual nitroglycerin pills for an NPO patient (which I remembered that the benefit of nitro, as long as it's sublingual, outweighs the risk in an NPO patient).

I made it through though and am happy to be continuing my clinicals in a larger, more-renowned hospital with much sicker patients than the last hospital I did my clinicals at.

Oh, even more good news! If you read my last blog post, you know I was waiting for a grade for an exam. I got an 87%... that's freakin' awesome! That brings my theory grade to 83%. I'm sitting pretty on that for right now. I expect I'll be completing this class successfully, unlike last year.

Yesterday, I also got a free H1N1 vaccine because of being a nursing student. This is wonderful news because if I brought this home to my kids, I would be devastated. Secondly, if I caught H1N1, the resulting isolation and week of recovery time would likely destroy any chance of completing nursing school.

I also have attended an interdisciplinary workshop on elderly assessment. I got some great tips from physical therapy on determining fall risk, a great screening tool for geriatric depression, a "brown bag review" program, and some other really helpful stuff.

All-in-all, it's been a pretty positive nursing experience for the last two weeks. Things are looking up and I really think I'm going to be successful this year!

Sickest Patient Yet!

After complaining that my patient's keep getting discharged my instructor this clinical gave me my sickest patient ever!

My patient was a 94 year-old, tube-fed, dementia, and Alzeimer's patient with a C.Dif infection and a UTI. She also had stage

The only three words she could say was "Ouch", "Damn it", and "No". What I found quite interesting was that the nurse charted the patient moaning when she was turned but she said "No!" when asked if she was experiencing pain.

Anyhow, the clinical experience was pretty bland overall. I got to administer her PO meds through her NG tube and I did all the tube care (hanging feedings, flushing, etc.), which is pretty cool. I'm a little eager to do a few IM injections too, ever since I learned how!

I'm pretty much freaking out because I have a major test grade coming soon... Already took the test, but I wanna see the grade!!!