December 2, 2008

I started with 3 patients. But in reality I took care of 2. One of the patients went for an Ultra Sound of the carotid artery, she came in with complaints of SOb and chest pain. The entire time I was there, she never cam back.

Another patient was bed ridden. With a PEG tube, NG tube, on IV fluid, who cam in from anursing home with hyponatremia, seizures, and acidosis. She was aphasic as well . NPO for about the past 3-4 days because the GI doctor was still figuring out what was wrong, if she had any further complications. It was heart breaking. Poor woman couldnt speak, and she was also on 02. AM care was given, and the PEG dressing was changed. She was also NPO for all her meds through PEg. All that was given to her was sub q lovenox, and insulin for her diabetes.

The other patient was being discharged that day. She came in with chest pain also. She was a very sweet old lady. I gave her antibiotics for the day (prophylaxis) before she left and some medication for HTN, and anticougulants. During the middle of the day she was discharged. i met one of her relatives and she thanked me for the help. Pulled out her IV and she was off.

I learned today to keep on top of things. To tell you the truth I have no reflection on the day except I kept on having dreams about the patient with the PEG tube, I felt as if there was more that needed to be done for her. I prayed for her.

May God bless you all.

Novemebr 26, 2008

Today... there was an internal conflict. Nurses deal with it on common grounds.

What happenes when a patient asks for pain medication (Dilaudid) and knows exactly when they are scheduled (PRN) and claims they have a pain rating of 7 and their face is showing a 4 or less, or when returning from the medication area with the Dilaudid in hand you find the patient sleeping?

Can we accuse of abuse?

Very difficult questions: do we continue giving the medication, or deny them. We have bjective and subjective data but when it somes to pain, isn't it very subjective???

Hard questions. I learned to pick up on signs, and I also learned to pray for them. Waht mroe can one do? Until you see an extreme behavior for example the patient screaming "Give me the medication! I want it!"

November 25, 2008

Today's adventure was similar to the others. I'e adapted well to managing my time and also how to managae patient care. I still acknowledge that I am in ned of learning mor skills but I understand that comes with time and exposure.

Today I've learned to always treat every patient you care for or even see with an undying care for them. I was asked by a nurse assistant to sit in and monitor a patient who was on constant watch. To my surprise, this very patient I had taken care of about a couple months ago while I was in my Advance Med-Surge Clinical Rotations. It was greta to see him again and at the same time very disapointing.

Throughout his stay, months ago, he was very uncompliant. He had respiratory problems to start, and his diagnosis I completely forgot, but after a couple of weeks he was inserted a couple of chest tubes. Still being uncompliant he seemed to have dislodged his chest tube, which he then started screaming. One of the nurses thought he was a drug addict, to pain medications. It could have been true, but I didn't want to label him that way. I still took care of him, not judging and accepting him as any regular human being who is hospitalized. He then left.

Today, like I said, I was surprised to see him. He told me he was in the ER and recenlty arrived on 5 main about 2 days ago. What haoppened to him at home, one can only tell. I did not want to ask, to tell you the truth, he looked really bad, he was SOB and had weezes bilaterall, upper lobes. I did not want to bother him because I wanted him to rest. And again, he was very noncomplaint, he kept walking around, seemed very anxious, and that did not help his breathing which demanded his body to take rests. After a while one of the nurses gave him Zanax for anxiety.

When he saw me, he recognized me, and it was a very nice rememberance, but at the same time it was dissapponting seeing him there. Nontheless, we must trrat all patients withh respect and care as nurses. We must not lok down, but encourage them to get better,

November 19, 2008

Not much excitement today. I had the same patients and a new precursor.

To tell you the truth I enjoyed keeping the same patients. After a while they become accostomed to you, and develope a relationship, a professional relationship. Towards the end of the day they become more comfortable with and you start seeing the conversations you have with them take a detour and become very personal. As a nurse, you wil be there to re-direct them, but also help them wherever they might need it, wether it's spiritual, physical, or emotional.

I can see myself being a med-surge nurse. I can see myself aiding the patients and being there with them, talking about several things. Whatever it takes to get them up and running again.

A nurse is holistic.

November 18, 2008

In the profession of nursing and in life there will be challenges awaiting. How we handle those challenges will form us into an individual who is open to examination and learns or we setle with defeat and our fate is determined by "circumstance" instead of our own will.

Today I had two patients, with genral problems. One came in with chest pain and the other came in with abdominal pain due to a hernia which was operated on. Nontheless I was assigned a 3rd patient whom I hesitated on taking care. You see, the patient was thouroughly confused. This patient came in with cellulitis and gangrene on the left foot which was amputated. Several times while trying to take vital signs she would scream out "No!" I tell you, it freaked me out, and she was resisteant towards everything I did. I had to get the courage somehow to go in there and be confident, which leads me to the lesson of the day.

We are students. We are learning. We wil always learn. During these times, we must try to absorb as much knowledge and skill as we possibly can while we lack the license and while we are still in school. I asked the nurse to come in with me. I dug in deep and really wanted to go in there. The nurse who was teaching me told me that in her clinical experiences she would have preferred patients like these in order for her confidence to increase as well as learn how to take care of this particular patient.

I learned... confidence. It is something people learn at a different pace. Nontheless, courage it the significant characteristic which will make us great nurses. And nontheless, the day ended great. I learned how to deal with that certain patient which wil benefit me in the futre and build my nursing skills.

November 12, 2008

This day I was absent.

November 11, 2008

Arrival time... 7 a.m. Patients assigned...2.

This week I "uped" the ante. I was assigned two veyr distinct patients, with the same precursor I was provided with last week. One of my patient came in with hyponatremia, he was sent to dialysis early in the morning. He had a peg tube, hep lock to the left arm, on O2 nasal canula 2L, and he had a grouch on his chest for the purpose of dialisis. The other patient came in with Chest pain r/o MI. He had a history of HTN, COPD, emphyzema, parkinson's disease, schizophrenia.. the works. He was incontinent and had mild tremors on both arms as well as O2 nasal canula at 2L.

We all understand the importance of team work and trust, but often times in this field we need to take actions into our own hands. One of the important lessons today was about organization, initiative, and trust. My precursor taught me to do an initial walk in of all the patient's assigned. While in the room introduce yourself and generaly asses the room and anything the patient is being given, wether it's O2, or IV. Then continue until you finish and return to the main desk to gather report. In this case you will be doing not only a double check but you generally have an idea of what the night nurse did before the shift completely transferred.

Sometimes the report is consistent and in depth while other times it lacks substance and thus questions are asked and more inforamtion needs to be digged. In this field you can trust the words of many but always remember to take matters into your own hand especially when it is your role, and your advocacy for the patient.

For all that read.. I dedicate this song for all those workers spending their time boosting and aiding the economy.

Just a song to enjoy while working-------> http://www.youtube.com/watch?v=NJDF9uyDWH4

November 5, 2008

Starting off the day during clinicals the nurse I was following helped me organize the way I would handle out the daily acitivities. She had about 5 patients and I was assigned 1. She made sure the first thing she did when she got into work was to make sure if the Doctor placed any new orders.

After she made sure there wasn't anything new, and also reviewing the over night check up she got to work. She reviewed her medication and started gathering her materials and drugs. I helped one of the patients by taking Vital Signs and administering medication. It was 2 PO meds, Keppra (anticonvulsant) and Nexium. A little teaching was given to the paitent and continual monitoring. She was scheduled for neuro checks every sift and so I proceeded with checking her eyes (reflex, motor, vision), and motor movements.

One of the things I learned today was organization. Organization is key if you want to make sure you are performing well. Without organization you will be running around ot knowing what to do. As a professional we must plan, and then act but remembering to always assess.

The rest of the day I was helping her take vitals and talking to the patients. We had one admission and they needed a spanish translator. I volunteered to help and it made the process a lot easier. All in all, it was a great day.

It is wise to know at least two languages here in Miami. Spanish and English both work well.

Keppra

Novemebr 4, 2008

(0750) Today starts the first day of leadership and about 6 weeks in counting til graduation. This morning I have set up an "online blog spot." It is to shift from modern day journal writing to a modern online paper-less format. I believe it will suit the professors and students in this modern era. The internet itself and computers can be used in such unique and interesting ways.
Right now, I am at the Miami Heart Institute waiting for the orientation so that we may receive our hospital ID bages to begin working.

(2040) Today was a very productive day. Professor Walker assigned me to the 5th Floor (Med Surge/ Tele/ Oncology) at Mt. Sinai. I was introduced to a nurse who really iunspired me to learn. She gave me an over view of the floor and how she organizes herself. Just like every nurse has their way of working, we all must find our way. To provide comfort and ease. I was assigned about 4-5 patients. Aside from taking vital signs such as blood pressure, heart rate, respiratory rate, temperature and pain. I also took the blood sugar level of one of the patients. These skills helped me refresh. I also took into consideration the amount of time I've placed into clinical hours and realized how much I've learned as well realizing how much confidence I've gained.

One of the patients came in with SOB and had a history of CHF. She was scheduled for placement of an AICD. (http://www.heartonline.org/defibrillator.htm) Before the procedure her BP was taken twice. The reading were 100/80, and 90/50. Nontheless she returned after surgery and her VS were scheduled q15 min x 1 hour. On two of the readings her Bp was 90/50, and again 90/50 and she was asymptomatic . One of the Doctor's came in and told the nurse to give the pt Lasix and morphine stat.

Upon receiving the order the nurse questioned. She was concrned that giving Lasix could lower the BP to a point of shock. She asked the council of two other nurses and they told her to question the Doctor. The Doctor said that it was for the pulmonary edema, which she did not detect on her assessment. Then another Doctor came in and assessed the pt. After a thorough assessment, also taking BP (110/80) and assessing lung sounds this Doctor who was taking care of the pt told the nurse to hold the medication and to not give it. This experienced served me very well in distinguishing when is the right time to question an order. It taught me the importance of knowing my medication before administration. Most importantly, we are advocates and responsible for the health of our patients. We must make sure we know what we are doing and of course question and reconsider when we realize that the pts life and/or health is in jeapordy. Over all, the clinical day taught me various things. The one important lesson I earned today is that you can never be a complete robot and "following orders." It is always better, if insecure, to ask questions to reassure yourself as well as corrolate information to enhance not just your education but the pts as well.