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.