Nearing the End

I’ve had this blog quite awhile. And I obviously haven’t posted since forever ago. To catch up:

  • RN year classes = passed
  • Kaplan review course in Box Office building over University Field (what an odd location . . . ) = done
  • Boards = scheduled
  • Wedding = 18 days away

Needless to say, planning a wedding while trying to pass nursing classes can be a death sentence if pressure isn’t your thing. Though – pressure isn’t particularly my thing, and I managed. (Trust me when I say that there’s hope for anyone because of that.)

QUALIFIER! I only managed with the help of my wonderful fiance, family, friends, and teachers. They helped me remember why I was doing this (Soli Deo gloria, of course), and that, in the words of our Kaplan instructor, “I am more than minimally competent”.

Speaking of “minimally competent” . . . really, nursing board? I know that’s a perfectly good (and reasonable) goal for the nurses you want to license and set loose upon the floors of many a facility, but way to make us feel terrified and potentially stupid. Maybe next time just keep that to yourselves. Tell us that . . the test determines if we learned what we ought to have learned in school. I suppose that’s the same, but it’s all in how you say it. If I want to tell a mother that she shouldn’t let her child have quite so many unhealthy foods, I’m not going to patronizingly tell her that, “When you bring Johnny here for a checkup, you’re letting me see if you’re capable of feeding him like a nurturing mother should.” Noooo way. Maybe something more like, “When you bring Johnny in for a checkup, we’re just making sure that he is healthy. Would you like to talk about appropriate nutrition for a five-year-old?”

That makes perfect sense to me, but it might seem far-fetched for everyone else. Excuse the wild mind of a boards-studying bride-to-be.

But here’s something that I was chuckling at: Wiki teaches us how to pass the NCLEX-RN.

I like the first step. “Pay attention in nursing school.” Oh! Right! Of course. What a good idea. If you’re wiki-ing how to pass this test, chances are you didn’t pay attention in class or when your teachers taught you how to apply and the requirements. I’ve gathered that it’s pretty common to see boards requiring a boards-prep class before becoming eligible to test at all.

Step three is, “If you are unclear on a concept, be dogged about learning it.” Now, as I understand the word “dogged”, it is akin to words like, “obstinate”, “stubborn”, “pertinacious”. I don’t know about everyone else, but when I start getting “dogged”, I start getting “mad”. And yes, I mean that in the true sense of the word. At least at this point, I really would rather not get dogged about anything. Determined, yes, because I’m more level-headed at that stage.

The last step – Thank you, Wiki. That sounds like a good idea. And then I’ll hit refresh every two minutes after midnight on the state board site. Maybe a Red Bull would be a good treat.

But enough of that.

I don’t plan to keep this blog up. I haven’t decided whether or not to delete it, but I’m certainly leaning towards that. We’ll have to see what the next couple of weeks bring.

Happy test taking – You are more than minimally competent!

Ouch!

It’s no secret that I work with the long-term facility geriatric patients. Therefore, of course, I don’t do anything impressive like insert (or, in our cases as nurses, assist with) chest tubes, remove teeth, wipe off gsw’s or anything crazy like that or possible in an acute care (I’m thinking mainly trauma, here) arena.

But I still do plenty of things that could be considered painful. I flush my patient’s PICC (yes, LPN’s are allowed to do such in Minnesota) lines, insert catheters both of the indwelling and straight kind, blood glucose checks (nearly everyone flinches and whines when I dig out the little finger puncher), jab a syringe full of 80 units of Lantus into thighs and arms and abdomens, change dressings of various sizes and strange wounds, remove stitches and staples, and other things that I can’t think of right now.  Due to facility protocol, we have to dig out the EZ hoyer lift when someone’s on the floor – no matter the situation. I’m in there with other staff, grabbing vitals and stuffing the sheet under them and popping them out like a shoe horn from under the bed.

Of course, there are other things that I’d like to think matter. I’m there when the family needs someone to talk to. I warm up that blanket in the fancy microwave so I can keep my patient warm. I nod and bend over so I can listen to the patient convinced that someone’s poisoning her. I laugh and sing along with the patient singing every song in her book while she waits for her pills. I’m there when others aren’t – whether they can or cannot, whether they’re afraid of everything involved in caring for someone or they just don’t have the space to.

All the same, this image?

While I never actually say it, I’m afraid to admit that it makes me chuckle a bit.

When I dig out that catheter, when I wipe a patient’s finger vigorously with an alcohol swab in preparation for a stick, I won’t tell them it doesn’t hurt. Pain perception is in the mind. My mind is different from my patient’s. It may not hurt me so much as it irritates me, but it may seem excruciating to them. I don’t say, “little poke!”. I say, “Quick poke here.” right as I click. I ask the patient to take a deep breath and explain that the pressure will be gone soon as I put the tubing in for a catheter.

I’m not perfect. But I’ve been a patient that’s heard, “Oh, it doesn’t hurt, you’ll be fine.” Maybe my pain perception is horrible. Maybe I’m a wimp, and I can’t take too much. These are entirely possible, but I won’t tell my patient something that I don’t know.

So, nurses:

Keep it real! You don’t know if it’ll hurt.

Making Sense

Now I see why I didn’t work last year.

Balancing School and work and family and friends is starting to get to me. It’s starting to get to nearly all of us, and we’ve already had one dropout due to it. The wind sings outside with the huge temptation to just sit and look at all of the beauty, and we put in earplugs or ear-buds to tune it out.  Oh well. It’s only till May, right?

On a slightly different note, I have a question for both patient and nurse(ing student).  In my last post, I mentioned a cardiac case study that I needed to have completed, and now’s the time people are required to post “peer responses” to them on the class discussion board.

Here’s the case with the specific question I’d like your input on:

You are the charge nurse working in a long term care center. Mabel is an 85 year old resident with a long history of congestive heart failure, a myocardial infarction 3 years ago, COPD, hypertension, and degenerative joint disease. Her medications include: furosemide 20 mg QD, enalapril maleate (Vasotec) 5 mg QD, digoxin 0.125 mg QD, KCL (potassium chloride) 40 mEq QD, and ibuprofen (Motrin) 200 mg QID. 

Today, Mabel (who is consistently alert and oriented x3) complains that she “just doesn’t feel right.” The nursing assistant reports that Mabel’s pulse is weak and irregular at 116 bpm and her skin feels cooler than usual. You go to her room for further assessment.

After reviewing the ECG, the physician decides that Mable is in atrial fibrillation. Mabel is again alert and oriented and her daughter is with her. 

6)    How would you explain atrial fibrillation to Mabel and her daughter?
Because the condition is being explained to those outside the medical field that are most likely frightened at this diagnosis, it is important to bring the explanation to their level of their understanding. An important thing to make sure of before explaining what afib is is to provide any education (if needed) on how the heart works – its parts, what they do, etc..

Atrial fibrillation is the fibrillation of the atria of the heart. Fibrillation resembles a sort of quivering. The heart rate is quick and irregular. This means that instead of moving all of the blood from the atria, the atria will have some significant pooling. The ventricals of the heart can beat more rapidly, causing the ventricals to have decreased filling. Because of this, there is a decreased cardiac output. (Iggy, 745)

Atrial fibrillation can be caused by many different things:

  •  High blood pressure (hypertension)
  •  Diabetes
  •  Congestive heart failure
  •  Valvular disease
  •  Male gender

We can assume that Mabel’s atrial fibrillation is due to her congestive heart failure.

Another important thing would be to discuss the treatment for atrial fibrillation.  But this education would probably be best provided when the doctor orders the treatment(s).

There is no offense implied in “bringing the explanation to their level.” I know that it would be difficult to have an explanation of something I didn’t understand in the most complicated unfamiliar jargon presented to me. I’m hoping that this part isn’t insulting anyone’s intelligence.

Now, some of the peer responses I’ve gotten back are saying that I should include things like how atrial fibrillation can increase Mabel’s chance of death, and stroke (she already has CHF). I didn’t add this at this time, quite frankly, because this was what I believed was the initial explanation.

But what do you think? Is this an explanation that is easy to understand or no? And, what should I add or take away from it to make it more beneficial for Mabel and her daughter?

Thanks!

(P.S. Don’t read into any incorrect form of grammar here . . . I didn’t exactly take the time to iron out all of the wrinkles.)

 

August

It’s rather shameful to not be posting anything lately. Especially with so much going on.

I got the job that I mentioned in my last post. And, while I love the job, I can see why some CNA’s never want to become nurses.

The CNA has a lot of the “dirty work” and more physically demanding work at a long-term facility. It hurts your back, it takes a lot of time, and occasionally becomes somewhat tedious. It’s a wonderful job to help people, and it requires an extreme amount of patience and humility. Lights are going off all of the time, residents can become angry with you, you often go home with soiled scrubs, and if the nurse isn’t a fair and good one, you’re in for a long shift. You watch the nurses as the move about the halls only walking, usually with no need to run. They sit behind the high-countered desk so that you’ve no idea what they’re doing. They ask you to answer the call lights when their ten-minute pager goes off, and if they come in to give pills or insulin while you’re working, you need to stop and step aside. I’ve seen countless aides become bitter with their nurses or nurse managers – and I can see why, though if they only knew . .

Responsibility jumps up about thirty notches, pills have to be given by a certain time, phones ring and ring until you answer them, ostomy bags of various types need changed, notes need written, orders recorded, each little bruise, skin tear and trip need recorded on not one but many forms, and so on. You need to keep track of the groups and aides, and that often means interrupting their work to remind them of something. There are no case studies, but case studies weren’t nearly so threatening.

The first few shifts were a bit daunting even though I was being trained. I’ve flown solo a few times now, and this weekend will mark the beginning of the rest of my job there. I’m still learning a lot about the various medications, what can and can’t be crushed, who likes applesauce or pudding, who exactly needs just a blood sugar check and not insulin, and what reputation the residents and aides are giving me.

I really am enjoying it, and hope that I’ll get the hang of everything quickly for the rest of my coworkers and duties’ sake. I’m still a bit slow and somewhat clueless, so the quicker I get things down, the better.

I’ll be switching to part-time beginning on Monday. I was able to get the position with forty hours per pay period, and that allows me the scholarship the home offers. I still need to order a rather large amount of textbooks, pay tuition and finalize the last details for school on the twenty-second. But with the scholarship, the money spent will all be reimbursed.

Here’s hoping I don’t leave for so long next time.