Tuesday, February 28, 2006

I am still here...

Things are going well. I have been back to clinical and things haven't changed too much. I hope things are about to change for the better. This past weekend, I stood up for myself and told my preceptor how she made me feel. She pretty much told me to get over it, but applauded my decision to speak up for myself. It seems like she has gotten more tolerable, but I still have at least another two months. My clinical instructor asked me how we were getting along. She already had an idea that we weren't getting along so well, and offered her support. The DiVa is irresistable, I am going to be so sweet to my preceptor, she'll get a toothache.

School is school. Big test tomorrow. The kids are okay. They are going to school like kids are supposed to, they have been doing typical kid stuff. My kitten is still adorable, what more can I say? Everything is just peachy. Soon I will be preparing for my brother's graduation. And speaking of graduation, I think I will post a perfect graduation gift for a nurse list.

Here's Diva's wishlist

Expensive
-Palm pilot
-laptop
-electronic stethoscope
-a new house with three bedrooms (It's a wish list, right?)

Mid-Range
-watch with second hand, time and date (with military time option),and nightlight
-$50 gift certificate to my favorite nursing uniform store
-littman stethoscope engraved DiVa
-gift certificate to a spa/salon for a luxury pedicure, manicure or massage

Bargain
-tote bag
-drug guide
-nice black pen
-lanyard ID holder
-hemostat
-calipers
-scissors
-nursing goggles

Priceless
-support throughout my graduate studies
-weekend babysitting
-unconditional love
-healthy children and family
-my first job in a really great facility that supports new graduates

Forever...

A DiVa

Thursday, February 23, 2006

A DiVa's Perfect Care Plan

Since I was up and all, I thought I would post a copy of the care plan that I got a perfect score on. I wish I could be as optimistic about the test I took yesterday.

P.M. is a 72 year old Caucasian female that was under the care of the student on February 12th 2006. Her growth and development stage at the time of assessment is Stage 8: Ego Integrity vs. Despair. She presented to the Emergency Department on February 10th 2006 after tripping on a rug in her home. P.M. was admitted to the hospital when the x-ray films revealed an internal fracture of the right femur. An open reduction internal fracture repair was performed under general anesthesia on February 11th 2006. In the PACU, the patient was extubated and administered dilaudid and morphine for pain. During this time she became hypotensive and experienced an episode of respiratory distress that resulted in her admittance to the medical intensive care unit.

Medical History includes:
Breast Cancer, emphysema, osteoarthritis, rheumatic fever, hypertension, chronic obstructive pulmonary disease (COPD), hypercholesterolemia, mastectomy of the left breast, left and right carotid endarectomy


Nursing Diagnosis and Evidenced-Based Nursing Interventions

Ineffective gas exchange and respiratory distress related to chronic obstructive pulmonary disease as evidenced by low oxygen saturation, high anxiety and verbal complaint.

Goals:
1. Patient will maintain a pulse ox rating within acceptable range. (92-93)

2. Patient will use the Bipap and venti-mask periodically during hospitalization and resume using the portable oxygen and nasal cannula prior to transfer to a regular floor

3. The patient’s lab values will reflect a normal Ph balance with regard to respiratory performance

4. The patient will report a decrease in respiratory effort

5. The patient will have an absence of adventitious breath sounds

Interventions and Scientific Rationales

- The patient will be given medications as ordered to improve respiratory performance

Rationale: The patient is ordered various medications to help improve respiratory performance. One such medication is Solumedrol. According to the evidence, high-dose prednisolone successfully reduces the inflammatory process in COPD. Side effects include gastric toxicity, fluid retention hyperglycemia and oral candidiasis. These side effects should be monitored carefully, and to prevent adverse effects, corticosteroids should be titrated down to the minimally effective dose after starting with a high dose to treat inflammation, (Jantarakupt and Porock, 2005, Pg. 789)

- The patient’s anxiety should be addressed immediately to prevent the increase of respiratory distress. This includes pharmacological interventions and non-pharmacological interventions such as relaxation/pursed lip breathing and guided imagery.

Rationales: The patient was prescribed various medications to address anxiety. The following paragraphs discuss the scientific evidence that support the pharmacological interventions utilized for this patient.

“Benzodiazepines do not have direct effects on the lungs, but their sedative action is very helpful in reducing anxiety that may induce or exacerbate dyspnea (Quinn, 1999; Rousseau). Because dyspnea intensity is believed to be highly correlated with anxiety (Bruera, Schmitz, Pither, Neumann, & Hanson, 2000), sedatives or anxiolytic drugs may lessen the distress associated with dyspnea). Benzodiazepines may cause excessive sedation, impair thinking, and cause respiratory distress (Cohen et al., 1991; Cowcher & Hanks, 1990). Nurses should monitor the side effects carefully, especially in older adults and in patients with poor kidney or liver function (Macklon, Barton, James, & Rawlins, 1980).” (Jantarakupt and Porock, 2005 Pg. 791)


“Pursed-lip and diaphragmatic breathing have been found to have beneficial results for dyspneic patients, including reduced respiratory rate and control of dyspnea. In addition, pursed-lip and diaphragmatic breathing decrease functional residual capacity, increase respiratory muscle recruitment during inspiration and expiration, reduce the work of the diaphragm, increase tidal volume and alveolar ventilation, improve the ability to perform effective coughing, and improve blood gases (Breslin, 1992; Coppola & Wood, 2001; Sexton, 1990; Vitacca, Clini, Bianchi, & Ambrosino, 1998). The mechanism for breathing techniques for reducing dyspnea can be explained by physiologic changes during performance of breathing. Deep inhalation through the nose followed by slow exhalation through pursed lips increases lung expansion, and decreased time with the airway constricted improves gas exchange in the lungs. When patients perform proper diaphragmatic breathing, abdominal muscle contraction moves the diaphragm downward, providing more space for lung expansion and, therefore, increased gas exchange in the lungs. The physiologic explanation is sufficient to encourage patients with dyspnea to learn and practice the techniques. Because this is such a simple and cost-effective strategy for reducing dyspnea, nurses should teach and encourage patients to practice breathing techniques.” (Jantarakupt and Porock, 2005 Pg. 791-792)

Non-Pharmacological Treatment was used in the care of PM. We utilized relaxation breathing and guided imagery. PM responded positively to light massage of the forehead and guided imagery. In thinking open thoughts and visualizing an open airway, the patient became calmer and showed decreased respiratory effort. The evidence that supports such activities is embodied in the following paragraph:

“Relaxation techniques, including controlled breathing, may help patients control dyspnea and decrease anxiety, thus stopping the vicious cycle of anxiety and dyspnea (Cowcher & Hanks, 1990; Wickham, 1998). Complete muscular relaxation is associated with decreased oxygen consumption, decreased carbon dioxide production, and decreased respiratory rate (Sexton, 1990).” (Jantarakupt and Porock, 2005 Pg. 793)


Evaluation
If the interventions are effective, the patient’s respiratory condition will improve and she will be able to breathe effectively with only a nasal cannula at 3 liters. Since she has impaired lung compliance and directives that prevent intubation/ventilator use one must exercise care and prudence in institution of aggressive treatment.


Credits:

Jantarakupt, P., Porock D., (2005). Dyspnea management in lung cancer: applying the evidence from chronic obstructive pulmonary disease. ONCOLOGY NURSING FORUM, 32. Retrieved Feb 14, 2006, from EBSCO Host.

In Honor of Black History Month

Last year, I talked about Eunice Evers and the Tuskegee experiment. This year, I am going to talk about Lucy, Betsy and Anarcha. The first time I had ever heard this story was during a lecture on minorities and health disparities. In the times that these practices took place, medical professionals regularly took advantage of people especially minorities, the less fortunate (poor) and those who were uneducated. There were no laws or IRB to protect people. Even with laws to protect people, it still happens to this day.

My aunt lived in one of the most impoverished areas of the south. She recently died of cervical and breast cancer at age 46. We found out that she was part of a cancer experiment that administered 15 rounds of chemotherapy in one week as part of the treatment protocol. At the time of her death, she was still receiving chemotherapy IV infusions of Eloxatin. My family will have difficulty litigating because she signed a release. It is my sincere belief that she participated because she had no money to afford treatment, she was misinformed about the implications of the treatment and pride kept her from asking for help from the family. I dedicate this post to her, her surviving children and her grandchildren who are now orphans because of someone's lack of morals and ethics.


Many people refer to Dr. Marion Sims as the father of modern gynecology. He invented a tool called the speculum that is used to visualize the female reproductive anatomy. He also invented countless gynecological tools and and pioneered gynecological surgeries. Sounds great, right? Think again. This person was a physician back in the mid-1800's when medicine wasn't exactly a science. There was no evidence based practice and most of what was known about medicine was discovered by accident. As I am sure one could imagine, people weren't exactly lining up for treatment so what group of disadvantaged people were used for medical experiments that helped physicians like Dr. Sims develop instruments such as forceps and the speculum? If you guessed African slaves brought to America against their own will and immigrants, you are absolutely correct.

The slavemasters lost money if their slaves were incapable of working due to illness, so Dr. Sims was commissioned to remedy the ailments of slave women after childbirth. It is estimated that he performed hundreds of surgeries on slave women. Most of them are nameless, but there are three slaves in particular that Sims practiced on frequently. They were named Lucy, Betsy and Anarcha. Most of these surgeries were without anesthesia because it was believed that African Americans had higher pain thresholds than whites. Antibiotics weren't used, so after these surgeries, the patients developed overwhelming infections. It was through the sacrifice of Lucy, Betsy, Anarcha and many other slaves that helped physicians develop what we know today as modern medicine. ( I am almost positive experimenting on slaves must have been a popular practice among many physicians of the time.)

So ladies, the next time you are on the table in that uncomfortable position, think of how it must have felt for Anarcha, Lucy and Betsy and say a little prayer for them. Their unrecognized contribution to gynecology has made it possible for us to take better care of ourselves. I love you Auntie Rose, rest in peace.

Always,

a DiVa...

Links to references

Anarcha's Story
Author: Alexandria C. Lynch, MS III
http://www.nathanielturner.com/anarchas_story.htm

J. Marion Sims:One Among Many Monumental Mistakes
Author: Wendy Brinker
http://www.coax.net/people/lwf/JM_SIMS.HTM

http://www.medscape.com/viewarticle/479892_print
J. Marion Sims, the Father of Gynecology: Hero or Villain?
Author: Jeffrey S sartin

Saturday, February 18, 2006

Getting to know the DiVa

Welcome to the 2006 beginning of the year edition of Getting to know your friends.
What you do is copy (not forward) this entire e-mail and paste it onto a new e-mail that you'll send.
Change all the answers so they apply to you, and then send this to a whole bunch of people including the person
who sent it to You. The theory is that you will learn a lot of little things about your friends, if you did not
know them already.

1. What time did you get up this morning?
I didn't sleep as I worked the night shift In the ICU, but then again I usually don't sleep because my fiance snores like a semi truck. So when I work it is about 1430 in the afternoon. When I am not at work, 0630-0730.

2. Diamonds or pearls?
Diamonds I suppose, I don't wear much jewelry

3. What was the last film you saw at the cinema?
King Kong

4. What is your favorite TV show?
Reality TV pick a show, any show...

5. What do you usually have for breakfast?
No time for breakfast usually. A bagel with cream cheese and a fruit smoothie.

6. Favorite cuisine?
Chinese/Mexican (Thanksgiving food is my all-time favorite!)

7. What is your middle name?
It's a secret

8. What food do you dislike?
Most dairy products (except butter, yogurt and ice cream), Liver, Mushrooms, Scallops and Head Cheese (Eww!)

9. What is your favorite CD at the moment?
The Black Eye Peas/Monkey Business

10. What did you want for Christmas?
Money/I-Pod/laptop

11. Favorite sandwich?
A sandwich I call the Turkey Taco (1 piece of bread folded in half with turkey and cheese)

12. What characteristics do you despise?
Dishonesty, Deceit, Arrogance, mean people in general.

13. Favorite items of clothing?
My velour jogging suits, I could wear them every day

14. If you could go anywhere in the world on Vacation, where would it be? Africa/Dominican Republic/Greece

15. What color is your bathroom?
Peach

16. Favorite brand of clothing?
Old Navy.

17. Where would you retire to?
The south.

18. What was your most memorable birthday?
15th, my cake had a picture of Prince on it...It was so cool!

19. Favorite sport to watch?
Ice Skating

20. What is the farthest place you are sending this?
Columbus...I think

21. When is your birthday?
This past week

23. Are you a morning person or a night person?
Morning

24. Pets?
We were never allowed to have pets as children, so I would have to say my new kitten rules the roost.

25. What did you want to be when you were little?
A cosmetologist and an entertainer

26. How old are you today?
Around the mid-thirties

27. What is your favorite candy?
Chocolate with Almonds and Sour Candy

28. What is your favorite flower?
Lily (stargazer and Calla)

29. What is a day on the calendar you are looking forward to?
May 2006 (Graduation from Nursing school!)

30. Where do you want to be right now?
Fast asleep, with all of my papers and studying mysteriously completed

31. Person most likely to return this?
My sisters

32. Person least likely to return this:
DiVa. I am surprised that I had time to fill out this questionnaire.

Friday, February 17, 2006

My Birthday....No really it was happy!

I had a really great birthday this year. I planned to sleep in, but I had to get the kids off to school and go to the dentist. My friend and my sister called me to say happy birthday. What a pleasant surprise. I went to the Dentist. Good news, no new cavities. I love going to get my teeth cleaned. I would love to get them all prettied up like those videos they show in the waiting room. I asked the dentist about the cost and he said about $1000...per tooth! And most people get 6-8 teeth done. I guess I don't really need the DaVinci veneers because I have nice teeth already. (The DiVa is so vain...) And sometimes, when people get those veneers, their teeth resemble chiclets. After I left the dentist, I spent the rest of the afternoon with my mother. We had a nice talk. For dinner, we had Chipotle and cake. And here I am at home.

As a reflect on my life I must say, I've been blessed. I have two healthy children. My parents are still living, and are able to see my accomplish things in my life that make them proud. Soon I will have a career, instead of a job. Life is pretty good. Lately, my sister and I have been trying to develop a closer relationship. I think that we could help each other. My sister wants very badly to be an Art Therapist. She is a phenomenal artist and she loves helping people to express their feelings through art. But she would need to get her undergraduate and master's degrees which to a 24 year old seems like a lifetime of school. My brother will be graduating from bootcamp soon. Our family is supposed to go there to support him. I hope that this military thing works out for him. Since he signed on for five years, I suppose that he will have to make it work. My baby brother wants to become a professional musician. When I hung out with my Mom today, we listened to some of his recordings. He is actually kinda good. My Dad is returning from his sister's funeral. He is talking about selling the house and moving to the south to take care of the land and other things my grandparents left behind. I think he should do it because he deserves to retire. He has worked hard enough.

I received a lot of good news from school today. I am doing a lot better than I thought I was, and that is a huge relief. I have been asked to participate in projects and create presentations to illustrate and display my talents, which to me, says that they value my work. I have needed to hear that for a while, or at least feel that. One of the other non-traditional students and myself went out for lunch for my birthday on Wednesday. We talked and had a really great time. Instead of trying to get to know people who had ill will for me, I should have spent more time developing a relationship with her. We had such a great time. We have so much in common and we perceive many of the same aspects of school the same way. And she is so sweet, she wouldn't let me pay. Next week is her birthday, so then she won't be allowed to pay. For the most part I am truly happy. Really. I cannot complain, well at least until I have another clinical day with Nurse Wratchet.

DiVa, not ashamed to admit that she is a whiner...

Tuesday, February 14, 2006

Free at Last...

I am off tonight. I needed a break. I just finished working four twelve hour clinical days in a row and I am so tired. My preceptor said that she sometimes works six 12 hour clinical days in a row so that she can have 8 days in a row off. I imagine that it is cool if you want to go on vacation or something. But by the fourth day you would probably snap someone's head off.

Since I brought up my preceptor, I might as well tell you about last night. When she came in she told me that at some point today she wanted to talk to me because she realized that the whole time I have been in the unit, she had only been telling me every thing that I am doing wrong. She said that there are a lot of things that I do right and that she should probably tell me. (You think so?) She has been riding me down all weekend. At one point I was seriously thinking about not going in, but like I said before, I can't let this bitch have the satisfaction of scaring me away from the clinical.

I was in the med room, gathering my 2000 meds when I heard the door open. My clinical instructor made a surprise visit. I have never been happier in my life to see one of the instructors from my own school. (Did I just say that?) Any who, she asked me how things were going and I told her about my heavy Saturday night. Just as I was beginning to tell her about my preceptor-student relationship, my preceptor walked in the door. I felt that the conversation was not appropriate at the time, so I figured that I would wait.

My preceptor started trying to explain why she was being so mean to me as if she were trying to cover herself. She started doing the same things that she does whenever she wants to challenge a doctor's order. Our ICU has residents that are still very young. They are probably no older than maybe 25. So she comes up and stands about six inches away from their faces. She tells them what she wants to do and gives a plausible medical rationale to defend her position. She continues to talk until the only alternative left is to agree with what she is saying. She makes statements that you have to respond to by saying yes. She never lets them have the last word. Ever. My clinical instructor could see what was going on. She kept telling me, (after she left,) to be assertive with what I need. Easier said than done.

I am not afraid to tell this lady how I feel. Anyone who reads this blog knows that whenever I tell people how I feel, I get in trouble. So I can't exactly do that. I have to be very careful. I am going to go back to the clinical site in two weeks for more hours. I will gauge things then, when I am not tired.

Happy Valentine's Day. My sweetie and I aren't having the best time right now. Nursing school has put serious strain on our relationship. We had a big argument this morning. We are avoiding the inevitable. Our relationship probably won't last for long. I am seriously considering taking a job and trying to make it for the next three months. I have already been through the worst part of nursing school. It isn't anyone's fault. We both contributed to this whole thing not working. Sometimes I feel like I am moving forward with my life, and he is standing still. I have changed so much since I have started going back to school. He is not always very encouraging. He doesn't like helping out around the house, and he is awful at managing finances. I think us going our separate ways is going to be the best thing. The funny thing is that throughout my twenties I was so afraid of being alone, and now since I have traveled abroad and learned about how far I can go if I get focused I am not afraid anymore. I would rather be happy and alone than with someone and miserable. Life is too short. I wish I had a better story to tell about this, but I don't.

Well, back to studies. I hope everyone else in cyberspace is having a great week.

DiVa...still trying to find her place in the universe

Monday, February 13, 2006

Clinical Day Four

Last night was better than the night before. I really have to stop saying that people are cool before I really get to know them. I can't believe it, but my preceptor told me to MY FACE that she was trying to make me cry. I wouldn't give that bitch the satisfaction of seeing me cry. I was pretty close to being discourteous and unprofessional, but if I think if it gets much worse, I am going to tell my clinical instructor and I am getting re-assigned. Before I do all that though, I am about to show this bitch that she has no power over me. We don't have fun conversations at all anymore. The extent of my interaction is strictly professional. I think that she sees that I am not for her shit anymore. She is still talking like she has some sense but every now and then she will say a smart ass comment about something I did wrong and I feel like kicking her ass.

Then I was in the break room and this nurse was talking about another nurse who is sooo great. Then she said some crap like "I am so glad you moved from Texas, because all those "people" moved there from Louisiana and the crime rate just went through the roof." Hmmm. What people are you referring too? Would that be the poor people or the black people? I am sure it must have been the refugees and not the survivors. I am ultra sensitive these days(probably from fatigue), but then I can't be that far off because I overheard people discussing my preceptorship as though I wasn't even in the room. They said, "I can't believe she has a student, first they wanted M to take the student and then someone said what about S. S is mean as hell and she is direct, but she is a damn good nurse and the student will leave here knowing something. S is so smart. She really knows her stuff." How did they know that the DiVa didn't come here knowing something? While I still believe that S does possess a breadth of knowledge that exceeds mine, I still maintain that her personality leaves something to be desired. On several occasions last night she said, "I am trying to be patient with you, and I can only be nice for so long." On day three! Time to start biting back...

I am one of those type of people who get more anxious when I get yelled at, and this lady seems to think that being threatening is educational. I have to keep reminding myself that last night was only my third clinical day and tonight is my fourth. My clinical instructor said I am being too hard on myself because what I am attempting to do now is what I should be able to do at the end of the semester. I feel like S is pushing me. It won't be long before I tell her, and of course I will share it.

Anywho, I have soo much homework. I still have to find an evidenced based article for my paper. Tomorrow is Valentine's Day and every year the kids and I make their cards to share with the other kids in their class. That will have to be done with Dad. Speaking of Dads, my father's baby sister died a few days ago. Everyone is preparing to go out of town for the funeral. I hate seeing my father so sad. I may not get to go because he needs me to stay here and attend to things. In a way, I want to go there to support her children and the rest of my family. Well, I suppose I will go ahead and get ready for tonight's clinical experience. Wish me luck...

-DiVa...sort of wishing that nursing knowledge could be downloaded into my mental port like on the Matrix

Sunday, February 12, 2006

The DiVa is in over her head

I had a rough night last night. I think my preceptor knew it because she said that I looked like I was going to cry a couple of times. This is hard ass work. ICU must mean "I see you!" because last night I was in my patient's room all night long. I had to do vitals every 15 minutes and I had this neosynephrine drip that had to be titrated almost once an hour. I kept losing things and forgetting things all night long, and I suddenly forgot every medicine, every disease state and every nursing intervention I learned. I was tired as hell too! I have a new found respect for nurses who work third shift. I can't be you, on my best day.

What makes it worse is that my preceptor was messin' with me. My confidence is low already because I swear I know what I am doing, util she asks me something. Then I forget everything. She expects that by the end of my experience, I will take care of her patients and she will watch me. This may happen, but this is only day three...well four today. I need to get ready to go. Say a prayer for me...

-DiVa...anxious as heck that she will kill someone tonight

Friday, February 10, 2006

Insomnia and Inspiration

I can't sleep. So I might as well stay up until the kids are off to school. Tonight is my first real night of clinical. Regardless of my ambition, I have decided that I will not be taking a patient by myself. There's no one to impress. I am more concerned with patient safety, and given the fact that it is an intensive care unit, I think I should pace myself a little bit. At least until I know how to find stuff on the crash cart.

Our school gave us a practice NCLEX test recently. I scored exceptionally well on it. I can't believe it myself. Having one of those super high GPA's does not matter anyway; I just need to focus on the big test. The way that our school does things is that if you do well on this test, then they will give you their blessing to take the big test. This is done so that the school can maintain its accreditation and have a high pass rate to attract other students. I have other ideas besides test scores that will help them to achieve this but that is another blog post.

As we are approaching graduation, school seems to be a bit more tolerable than usual. I guess we are all too tired for drama. Class is class. I am doing my best to keep up with the reading assignments. I have a patient care plan due soon that requires me to find evidenced based nursing articles to support my nursing interventions. A sort of why we do what we do thing.

Shhh! I got my student aid check. Happy days are here again, and it was just in time because I was about to lose the farm. I am so relieved. I just have to wait for the bank to remove the hold and I will be back on track.

Family
The children are okay. I have had to speak to the school more regularly about my son. He is going through something right now. I wish I knew how to help him when he is having a hard time like this. We thought that he might have ADHD, so we had him on Strattera. My ex fought me about his son "being on meds" even though he likes to have an occasional toke, (it's more than occasional). His grand mother fought me on the meds too, but there was nothing, (besides the esophageal varices) that could come between her and her Paxil and E&J. His Dad fought me on him seeing a therapist because he didn't agree with me "putting those people in our business". I feel like I am stuck because I can't spank him either. I could always put him in a psychiatric hospital. I did that once when he was really out of control.

Two years ago, my son's teacher was calling me everyday with something. This went on from Sept-Jan of his third grade year. Then finally she called me and told me that he was drooling on his desk and threatening to hurt himself. Before he came home from latchkey, I called a psych hospital for children and told them that I was afraid that he might hurt himself. They admitted him right away. My friends and family thought I was crazy. The psychiatrist and case manager told me that we needed to take a break from each other. So I wasn't allowed to visit him for a few days and he could only call me once a day. This went on for about a month.

Every time my cell phone rang I was going crazy. I was trying to keep up with the clinical hours, and my daughter still had to go to daycare because she was too young for kindergarten. Everything suffered. I didn't get the grades that I wanted to the year before last because I spent all of my energy on my son. He is more important than a 4.0 in college. Since then, we haven't had the problems with depression or bizarre behavior. Now his problem is anger management, work ethic and self-esteem. I will help this kid get his stuff together so help me.

My grandmother is improving. I am glad. My auntie is not I am afraid. My Dad's baby sister is on life support and they have only given her a few days to live. This was unexpected. She had breast cancer, but she didn't get treated because she was afraid. She decided to get treatment about 3-4 years later, but now it is too late. I can't imagine what will happen to the children. She was only 43 years old at the oldest. She had a 12 year old daughter and she was raising her 5 grandchildren, (ages 15-2). So now, there is no one. I imagine that I may be asked to help with a few, but then again my cousin might have to step up and take care of her responsibilities. I really can't afford another child to be responsible for at this time.

On a positive note...
My brother is graduating from boot camp. We are all going to South Carolina to celebrate. I am so proud of him. For a minute, I wasn't convinced that this marines thing was a good idea but maybe this was what he needed. Oh and let's not forget I graduate in about three months! Okay time to get the kids ready for school. I hope that whoever reads this has a blessed and inspired day.

G’night (or good day as the case may be)
DiVa

Friday, February 03, 2006

My new preceptor...

Rocks! I love my new preceptor. I know, it is too soon to be so optimistic, but what the hell. She is really great. I went to the unit to meet her and have a tour of the facility. When I arrived on the floor she was attending to a patient. So I put my things in a conference room and stepped inside the door to check out her style.

She had a patient that was a bit heavy. (Please, don't take this the wrong way, because I too am a little bit heavy but this is a different thing.) Her patient weighed at least 500lbs. I was trying to figure out which nurse was her because there were only three people in the room. The patient was crying because she was being transferred from one bed to the other, and on her way to the hospital she had been dropped by EMS twice, and there were ten people assisting with the lift. I probably would have been scared too, because we were a team of only four! Finally someone said my preceptor's name and she looked up. She is normal. She is not a tiny, little cute nurse with the frosted pony-tail and the two carat diamond ring. She has lived, she doesn't wear a whole lot of make-up, and she is over thirty. And she has a wonderful sense of humor. She is real, and she is not afraid to get dirty. She has a husband that has a blue collar job and a cat that she adores. She really loves nursing and is devoted to patient care. I like that. This is the type of nurse I have been waiting to see for quite some time now.

I decided to slip on a pair of gloves and jump in. I listened to the conversation and watched what was going on in the room. As I heard a need expressed I gathered the necessary items... a extra sheet, a towel, a sliding board. The patient became hysterical. My preceptor gave her a directive to calm down and cut it out. In my amazement, the patient calmed down and she wasn't offended by her stern tone. Since this patient was larger, we had to turn her very large midsection first, and then try to move the upper and lower body with the assist of a draw sheet. It sounds a lot more complicated than it is, but it is pretty simple. I grabbed the Foley and placed it out of harm's way. As they counted for the lift, I grabbed the patient's feet and made sure that her lower half followed her upper half. to be honest, my preceptor moved that patient by herself. I couldn't believe how strong she was, but she was so worried about me hurting my back that she wouldn't let me help her more.

Once we finished, we went on a tour of the unit and she told me about some of the policies, what I am allowed to do and so on. Then I told her about my class and what we would be working on etc. She helped me with the ECG strips and ACLS drugs. Then the phone rang. We were to receive a patient from the emergency department with a femoral pseudo-aneurysm. They made it sound like we were just going to be babysitting the bulging groin until the surgical service stepped in. Why did his aneurysm rupture while we were completing his assessment? My preceptor sat there holding pressure to the site until the doctors arrived. In the meantime, I tried to comfort the wife. I offered her coffee, we talked about her grandchildren and every now and then she asked me a question about what was going on. I told her that they were just applying pressure to the site and that her husband was talking and making jokes. She didn't dare come into the room because she just couldn't bear the sight of seeing her husband like that. I took the q15 minute vitals. I did the 12 lead ECG. I felt so helpful. I had only planned on staying for a two hours and I ended up staying all night long. And that was my first clinical day.

The hospitality of the facility is just awesome. I could really see myself working in this hospital. Everyone is helpful and mostly friendly. The preceptor tried to forewarn me in advance about what it is like to be new and the different types of personalities. She also talked about her personality and what to expect. She sincerely is trying to socialize me into the profession. This hospital is a county hospital, so the whole climate is different. Regular everyday people as patients and employees. Not a whole lot of arrogance. The only hang-up is that this facility is very far from my home. It is almost and hour drive. But I anticipate that I will learn alot. I am just really tired. So I am going to call it a night.

Yawn...DiVa