I thought a CABG was a vegetable!

Well, I have officially finished patho! Actually, I still have the final, but I have finished sitting in the patho classroom taking notes. It's pretty surreal. And a little scary. Scary? Yes, indeed. It means that all the checks are in the box. Nothing now stands in the way between myself and nursing school. There's no hiding now. Nursing school is looming large. I'm terrified and SO excited!

So, when you're a nurse, there are a million different abbreviations you have to know. Wait for it... Since we have to know them, we have to test over them, naturally. Not so bad, right? Well, it wouldn't be...if you didn't have to make an 80% on the test or FAIL the class. And if you saw the list of abbreviations, you would find your knees trembling. Here are a few examples: ESRF=End Stage Renal Failure. HS= hour of sleep= bedtime. NPO= Nothing Per Os= Nothing by mouth. LOC=Level of consciousness OR Laxative of Choice. (Not to be used interchangeably.) VDRL= Venereal Disease Research Lab. I can now write whole sentences without actually using any words. Four short semesters, and you could too! Anyways, we took the test, and I did fine. But it was hard work, and I know I'm going to have to keep studying because I do NOT need to brain dump these! Do you want your nurse coming into your room and telling you your chart says "muscular dystrophy" when in reality, it just says "medical doctor"? I think not. So, next time you visit your friendly neighborhood doctor, make sure you take the time to thank your nurse for learning those abbreviations. I mean, if I need a VDRL (and I DON'T!), I don't want her wondering what in the world that is!

So, now we head into finals week. My gameplan is to finish studying for P-cubed this week so that next week can be devoted to patho. I'll, um, let you know how that goes. After finals, there's a cruise to Alaska in my future!, painting of my family room (so long blue!), and then summer skills class! I hope you find your summer blessed, and I'll talk to you again in a few days.

The Gender-Ambiguous Plastic Dragon

Hey Everyone!

Okay, now about simulation. I wrote that last post just before simulation, and then I navigated away from the website err I could post it.(As an aside, I find it ironic that 'navigate' is the appropriate word in this instance since I did anything BUT navigate. Really, I more 'drifted without an oar' to the other webpage.) I, um, did not like that. So, it's taken me until now to work up the gumption to write it all out again, only to realize that the whole thing was saved as a draft. Anyways, um, enjoy.

This semester has been so different from my previous semesters. I remember sitting in class on the first day this year and thinking how very long it would be (and how many projects were due!) before we were out for the summer...and on to actual nursing school! However, yesterday was the last academic day before Dead Week. (Dead Week is HU's term for the week before exams.) I awoke this morning to the realization that in less than 2 weeks, this semester will be behind me. Whoa! And so much has happened!

A couple of weeks ago we finished up our clinical rotation. I learned so much about caring for patients during that time. However, we knew that once we finished clinical, SIMULATION was looming large. Gulp! What's simulation, you may ask? Well, I'll tell you. Simulation is this final 'test of skills' for gullible nursing students. (Said with love.) In my mind, I liken it to the medical equivalent of a knight's dragon-slaying festival. Except in the end instead of getting to kiss a, um, er, prince, we get to SURVIVE. To the next phase of nursing school. So anyways, we had simulation. Basically, this is a five-station test of abilities. When I arrived, I was sent to a table with all these cards lying face-down. Cue cold sweat. I drew one with trembling hand, and it said "Sterile Gloves, sterile field." Sweet! As you may have deduced, at this station, we each had to draw a card and then perform whatever skill it said on the back. I was THRILLED to get the one I did. A girl next to me pulled Soap Suds Enema. You do the math. So, I set up my sterile field (an activity which I rather enjoy anyway), and all was well. Got a 100% on that part. Yipee! First dragon down, four to go.

Next, I went to do my 'bedside assessment.' Okay, you have to understand that this assessment is on a plastic, gender-neutral manaquin who, if 'he' were to be a real person, would be dead from all the things wrong with 'him'. This guy has a section of abdomen that pulls right out of his stomach. He has 'interchangeable' genitalia...you never know what you're going to get. One eye is permanantely rolled off to the side...a sign of SEVERE brain damage. His arm sometimes gets stuck in the "up" position. No bueno. So, here I am doing this bedside assessment on a dude(?) who has no heartbeat, lung sounds, or bowel sounds. I fought the urge to giggle as I declared him positive for PERRLA (a check of the eyes/neuro), since, well, his pupils had zero function. At any rate, he survived my thorough bedside check. Agent Bedpan was the 'checker' on that one. She is so funny, yet scary at the same time. When I finished (and we only had 10 minutes), she said, "Are you SURE there's not something else you want to check?" Fortunately for me, some of the older students had tipped me off that she would do this and that it didn't mean anything. I told her "yes" with a smile. Two dragons down, 3 to go.

After the bedside assessment, I went over to this little curtained cubicle where there was a 'plastic patient' surrounded by tons of nursing errors. We had ten minutes to write down ten errors, along with rationale for why these errors were aggregious. I started by looking at his chart, which was a good thing because the bulk of the errors were in nurses'not following the doctor's orders. (I don't know what people did who didn't check the chart until the end. Gulp!) For instance, he was allergic to dairy, but on his table was cereal covered in milk. He couldn't have penicillin, but someone had left a vial of penicillin by his bed. Double whammy!! He was on a lo cal diet, but his breakfast consisted of eggs, bacon, cereal, banana, apple, toast, coffee, and...pound cake. Umkay. Anyways, I found 10 things. No problemo. Three dragons down, two to go.

Now, came the dosage calculation test. I was, I admit, a little nervous about this one. We had done a dosage test earlier in the semester that you had to get a 90% on, and I rocked it. (Lot's of good that's going to do me now, right?) I hadn't spent much time on dosage before simulation, so in the back of my mind I was worried that this was not going to go well. However, I found that my mind worked fine. No absent seizures. Nothing like that. I did well, and felt good. Four dragons down, only one to go!

So far, everything's been great! I'm starting to think I might actually make a skilled nurse someday. Then, I went to the fifth and final station. The Scare Plan. I, uh, mean Care Plan. I was prepared to diagnose 'acute pain' or 'risk for immobility.' Good to go. Yet, when I flipped my little 'case scenario' card over, I had pulled a middle age man who was obviously clinically depressed. His wife had died and he wanted to die too. Simple, right? Uh, no. I could not remember if nurses could diagnose depression. (We have this list called the NANDA which tells us all the possible nursing diagnoses. Nurses can't diagnose, say, renal failure. We diagnose things that renal failure might do, such as skin integrity breakdowns or immobilaztion.) So, I sat there racking my brain trying to figure out if depression is on the NANDA or not. At some point, I managed to remember that Loneliness is on the NANDA, so I went with it. Ick. It went fine, but I was frustrated because I felt that my care plan didn't accurately reflect my abilities. Sheesh. I'll say four and a half dragons down, one-half left on the court. Oh well. Can't change it now.

The next day in class, we got our results back. I did great overall, but I did lament the lost care plan points. Now, the hardest stuff for the semester is behind us. I took that make-up patho test yesterday, so it's off to finals here in a week. Yay!

I hadn't planned on going to school this summer, but now Junior Skills is being offered over the summer, and I need to do that. It will make my fall semester a billion times better. So, stay tuned. Things should get interesting.

Craziness!

Things have been really good lately. Last week, I finished up the P-cubed clinical. It turned out to be a very positive experience. What I learned: I really don't mind giving bed baths and changing bed pans. However, I do long for the day when the ratio of a.m. care to non-a.m. care is tipped in the favor of the "non". I want to be a nurse who is willing to get her hands dirty...but I really enjoy the 'thinking' part of nursing more. When we gave meds, for instance, I loved the process of all the checks we have to do. There's this thing called the Six Rights: Drug, patient, dose, route, time, and circumstance. For every medication you give, you MUST ensure that all Six Rights are met. Or it's a no-go. That was fun for me, as was checking all my dosages. Even more than that, I love looking at lab values and trying to figure out why the numbers are off. Or, if one number is off, what other numbers are likely to be off with it. It's like figuring out a puzzle. Sweet! In other news, Nurse Rockstar has left us. She's NOT dead...just post-op. Ergo, we now have another teacher, whom I really love. Nurse Rockstar's shoes would be difficult (and intimidating) for anyone to fill, but our new teacher fills them well. I'm very happy about this. Very. We have our last non-final-exam patho test tomorrow, but I have a fever, so I think I'll probably ending up taking the make-up exam next Friday. Thursday, we have the biggest day of the semester. Drum roll please...SIMULATION. And I will tell you about it in the next post. I know you'll be on the edge of your seat. Try to stay calm. That rapid heart rate isn't good for your vascular system.

A break. Hooray.

Well, I realize it's been a while since I wrote, and I'm sorry about that. Things have been C-R-A-Z-Y!! P-cubed has been going fine. Lots of poop and vomit and urine and other yummy stuff that I'm now intimately acquainted with how to clean. No, that is NOT a complaint. Just information. Ahem. I guess the biggest thing for me is that last Thursday I gave medication for the very first time. It was only by mouth (PO if you're a nursing student. It means 'per os'). But, it was really fun to study the MAR (Medication Administration Report, I think) and make sure I was giving the right dose at the right time via the right route to the right patient for the right reason. Be thankful your nurses do this!! It was nice. I also got to see a REALLY cool procedure. Did you know you can see the back of the heart through the esophagus? You can. And it's beautiful.

In other news, Nurse Rockstar gave us a test yesterday. It was on the heart, pancreas, liver, and gall bladder. Yipee! I think I did just fine. I am having a sever drought of motivation right now. Maybe it's because we only have FOUR weeks of school left, or maybe it's just because I'm tired, or maybe (and this is probably it, in all honesty) it's because it's SO pretty outside! I just wanna go out and play with my sweet kiddos/cheerleaders!! At any rate, we'll probably get our tests back tomorrow, and, while I do want to get a good grade, I feel like I did what I could. We'll, um, see how it goes.

Coming up, we have something called clinical seminar for P-cubed. I'm not sure what that is. In Patho, we have hormones up next. Now THAT will be fun. Hormones are REALLY cool because they make you think, um, like a nurse. 'If this substance is released, what can I expect to see in my body?' Conversely, 'If I have these symptoms, what substance (hormone) is likely being released?' It's like trying to solve a puzzle. Sweet!

I'll keep you posted.

The one that was hard to write.

Hello again!

Sorry it's been so very long since my last post. I just realized I never even posted since our first clinical. Wow. Things have been busy! As I write, I have two clinical days, two patho tests, and ALL of my semester's validations under my belt...and it feels GOOD! Um, where to start?

Clinical has been both fun and exciting. (And scary at first!) But, my first day I was blessed with the coolest girl, Meg, who is 2 semesters ahead of me in Harding's nursing program. We were inadvertantly assigned to the same patient. At first, I thought I would have to switch to a new patient, but we soon realized that we needed to 'attempt' completely different skills, so we decided to work together. And I'm SO glad! It was so great that first day just to be in the room with a more experienced student. It gave me that extra boost of confidence to really try out my skills. She also showed me basic things like where all the supplies were kept and how to work the computer system. Meg, wherever you are, you're the bomb diggity!

On the second clinical day, there were no advanced HU students with us, so I was on my own. And it went great. I spent my day giving bed baths and bedside assessments. Now, this may not seem like a great deal of fun, and it really wasn't. BUT, it made me a better nurse. I got those experiences under my belt. And someday when I'm an RN and all the techs are busy, I won't balk at giving the bed bath myself. Also, a little shout out to the RN's of 2North! They are simply amazing. Kind, caring, and with the heart of a teacher. For the rest of my life, when I have a nursing student come work on my floor, I will keep your kindness in mind and do all that I can to help that student and teach her. You have been amazing.

Then, came sadness.

(Family members, you may want to stop reading here.)

Thursday, after clinical, I received a phone call from Handsome Kenny that Grandmother Robertson, a graceful, elegant woman of 96 years, was in the hospital. This news wasn't particularly alarming, because she had been in and out of the hospital many times over the past couple of years. I ate lunch with my clinical group (which has become a Thursday tradition) and headed back over to the hospital. When I walked in the room, I knew right away that things were not good. You know, I have put a lot of thought, actually, into what I would do when I knew a patient was not going to have a good outcome. You know? You have to be ready for those things as a nurse. And as a nursing student, I have learned quite a bit about medical signs and symptoms and how to reach out to a patient's family. But nothing had prepared me for being a nursing student standing in the room with a family member who was, well, on the point of death. When I walked in, I saw immediately that Grandmother's hands were blue. We read about cyanosis, a condition that is caused when not enough oxygen is perfusing to the tissue of extremities. The body actually causes this...it 'shunts' blood away from those extremities towards the vital organs. It's a beautiful defense system that God gave us. What's a missing toe if our heart is still working, right? Anyways, this was my first time to not just read about cyanosis, but to see it. I was not ready. Her fingers were blue. Her nose was blue. Her lips were even darker. It alarmed me, but I tried to hide it as best I could. Soon, I could see Grandmother using her accessory muscles to breathe. Again, we read about accessory muscles all the time. But seeing it was so different from what I expected. The nurses were talking about lab values and pH levels, and I understood all of it, but it frightened me because I knew that they all pointed towards an unhappy ending. As I stood by her head, the nurses left. I was watching her accessory muscles as she breathed, and then, all of a sudden, those muscles quit working. It took me a second to realize that this was it. It was happening. I told Kenny to get the nurse, but he (or I, really) wasn't convinced that she wasn't breathing. Quickly, though, I knew I was right, and I raced into the hall yelling for a nurse. She came quickly and confirmed what I already knew to be the truth: Grandmother was gone. She had left us. It was a hard, hard day.

What I take from this experience, though, is that what you read about in a book and what that looks like in real life are two different things. And that's okay. Also, I learned that I can keep my cool when I'm frightened. Finally, and most importantly, I learned what it looks like to die with grace and dignity. Those nurses knew what was going on, but they did not show fear. We exchanged meaningful looks, looks that communicated the gravity of the situation, but neither they nor I shared that fear with the family. And I appreciate their discretion. I spent a couple of days being upset that they chose not to tell the family members what they knew was happening. But the truth is that I made the same choice. I learned from them that day. And the next time I'm in the room with a dying patient, I will see Grandmother lying in that bed, and I will be reminded to give that patient grace and dignity to the very best of my ability. Because that patient may be somebody's Grandmother too.

Grandmother is up in heaven pestering Grandaddy Robertson, so she's doing just fine. We all miss her, but we are happy for her. People have reached out to the family in ways that I never even would have considered. Bringing us food, babysitting our children, even providing us with paper cups, plates, and napkins so no one has to wash dishes. I feel so loved and blessed. And I will definitely pay it forward. Because that is exactly what Grandmother would have done. She was one of a kind.

And now, it's Monday evening of spring break week. My family and I are about to head over to my in-laws' house for one final meal before all the extended family goes back to their various residential locations. As for me, well, I suppose that I will try to get some studying in this week. And for some reason I have the compulsion to paint a room. I think it would be cathartic. We'll see if I do it or not. Either way, I'm ready to get back to the hospital, shake out the jitters, and get back to normal.

Talk to you soon.

Angie

Rockstar In Training

So, we finally got back our pathophysiology tests (Nurse Rockstar's class) on Monday, and I was very pleasantly surprised. Sometimes, it's nice to have a victory. Banzai!!!!! Then, today we had a special section with Nurse Rockstar since we've missed so much class due to snow. We were learning about acidosis and alkalosis. Basically, when you hold your breath, your body collects carbon dioxide, and that equals, drum roll please, acidosis. However, when you hyperventilate, you take in loads of oxygen and dump out loads of carbon dioxide. That is alkalosis. It all has to do with hydrogens and pH and Razorback Barbie...I dunno. All I know is, today in class I felt, well, able. I knew the answers to the questions she was asking us. Today, for the first time, I felt like I was thinking like a nurse. It was an extraordinary feeling. I always thought I would first have that feeling in the clinical setting because that's when you're actually caring for patients. But I was wrong. I felt it in a little classroom on a Friday afternoon nowhere near a patient. And I liked it. To my astonishment, I'm finding that I like the geeky, nerdy, sciency part of nursing as much or more than the hands-on stuff. That could be because I haven't gotten to do much hands-on stuff (which changes next week!), or that I'm a little intimidated by the prospect of accidentally killing someome, but no matter the reason I'm saying right here, right now,that I enjoy science. Officially. And I'm a Rockstar in Training. (Which is, of course, the end result of training with Nurse Rockstar.)

Water, the 8th Grade Girl

Just a quick update:

Off to Nurse Rockstar's class to get back our FIRST exam! Yikes! I felt like it wasn't hard, but, then again, so did everyone else. I'll let you know how it goes. In that class, we're starting to study hydrostatic pressure and oncotic pressure. Fun, huh?! Actually, it is so cool. Basically, all you really have to know, is that water follows, um, non-water. It's drawn to it. It's like that eighth grade girl who has a crush on some guy and follows him around everywhere while scribbling his last name (after her first name) all over her notebook. (Of course, I never did that...) Anyways, so when someone has edema (swelling), you have to figure out why water is following something out of the veins into surrounding tissue. It's elementary, my dear Watson. I think it's pretty stinking cool.

Agent Bedpan is teaching us about nursing diagnoses. And goal setting. And interventions. When I see a patient, I need to figure out what is wrong, and what COULD go wrong. Then, I set a goal for the patient (what the patient is supposed to do. I.e. get out of bed every four hours.) Then, I come up with my intervention, i.e. Assist patient in getting out of bed every four hours. And for all of this, I need to provide a rationale: Getting out of bed will improve patient's circulation. Capish? How do you spell Capish anyways? I only know the word because Blossom used to say it on her show, and I thought it sounded cool. Of course, none of the students I go to school with have even heard of Blossom.

So, now, I need to read about edema and pressure and water and so on. And eat. I shant forget to eat. I hope you are feeling blessed. See you later!

P.S. As an aside, I had to take all three of my kids to school with me today because they all had a snow day. As we were leaving, Archie (my 4 year old) slid on the ice and fell. He atood back up super-embarassed. Almost immediately, two college guys who were walking near us slipped nearly simultaneously and fell on their behinds. Archie saw how funny it was and felt, well, cool. God provides in the most curious ways.