Pulmonary Embolism

I'm on my last clinical day...and I get an interesting case....

I get a 20 yr. old patient who has had tibia and fibula (both lower leg bones) fractures and a dislocated shoulder. Ouch!! He is in a full leg cast and has his upper right arm in a sling. It gets more interesting....Yesterday my patient was diagnosed with a pulmonary embolism. For those who don't know what this is, it is a very serious and life-threatening condition marked by a blood clot that has broken off somewhere in the venous system and lodged itself in the lungs. A blood clot in the lungs produces symptoms of shortness of breath, fever, and low oxygen saturation; basically my patient couldn't breath! They got him on oxygen 2L NC and raised the head of the bed up. He was placed on Coumadin and Lovenox (anticoagulants- blood thinners) to prevent coagulation of red blood cells to form yet another clot. My patient seemed stable and had no symptoms of the pulmonary embolism.

Now how do you get this?? Usually a clot forms at the site of injury, in his case, his leg. Due to in activity, poor circulation, lack of movement of the extremity, and/or poor wound healing, the clot could form and break off. The clot then breaks off and floats in the bloodstream where it will get lodged in the lungs. What amazes me is that he is so young. You rarely see this in patients under 40. Usually there is a history of vascular problems or a serious injury. This scared me.....

So monitoring my patient frequently was a must. He had tachycardia and became febrile a few times but his oxygen saturation was normal. I had to encourage fluids as well as the use of the Incentive Spirometer. It was very important to remind him to deep breath and move around.

The sad part to me was that his family and even the patient seemed to not understand that this was such a big deal. I mean, I'm glad no one was freaking out about it, but it seems like they don't know that this is life-threatening. Back then, like 50s and 60s, a diagnosis of a pulmonary embolism was a death sentence. Now, we know the symptoms and what to expect so we can have an immediate intervention. I know that when I'm in the hospital, I want the whole sha-bang....anti-embolism stockings, SCDs (sequential compression devices-helps with venous flow in the legs), assistance with active range of motion, exercise, fluid intake, IS use, deep breathing......I won't take any chances!

I left my patient in a stable condition. His family was educated on the medications he was to be given. His Hct and Hgb were low so he will be receiving a blood transfusion. My patient has well managed pain, and he is able to work with Physical Therapy about ambulation. He seemed in good spirits :) Though his symptoms are subsiding from the pulmonary embolism, he is now and forever will be at risk for another. So, if he has surgery again, he will have to be monitored very closely.

So I continue to learn with this experience; Life is so precious. Anything can happen at any age; whether you are physically fit or not. Health is important and knowing what is going on is important. That's why I am so glad I am going to be a nurse, because I can teach about the patient's condition and educate them on the severity as well as treatment and recovery. Like my instructor says.... "We aren't here to just take care of you.....we are here to teach you." :)

Urinary Retention

Today I had a patient who was Post-Op day #1 from a Total Right Hip Arthroplasty. He was recovering well with clear lung sounds, adequate pain management, and good voluntary passive range of motion. The Day nurse D/C'd the foley catheter in the morning as well as the hemovac drain. He was on PO medications for pain and nausea medications as well.

Sadly, my patient still hadn't voided all day which concerned me because my patient could have urinary retention. My nurse asked me to perform a bladder scan on the patient to see if the patient had any urine in the bladder. The scan came out to be over 400mL of urine! eeeeek! So we needed to straight cath him right away (which means temporarily drain the bladder). The day nurse completed the task in the afternoon while I was at lunch. Around 1800 I bladder scanned him again with over 400mL of urine, again! So my nurse and I concluded that he needed his foley catheter replaced again.

So, me being all nerdy, I got excited because my nurse told me that I get to insert a foley catheter. Ohh my goodness!! All the instructors at school say, you will really feel like a nurse when you insert a foley catheter. So you know how I was feeling! Instead of explaining the procedure and grossing you out.....my nurse basically helped me step by step just to remind me of what to do. I completed the skill successfully and my patient's bladder was drained and continued to drain the bladder. YAY for new skills! :)

My patient was relieved because having a distended bladder can be painful and uncomfortable. I have the same patient tomorrow, so I hope that he will be able to void on his own :) Until then.....

Open Abdominal Wound

So today I had a patient who was admitted with a bowel obstruction. My patient currently has Diverticulitis as well which together can create serious problems. For those who don't know what Diverticulitis is; it is a condition involving the diverticula (pouches in the walls) in the intestines. These pouches can become inflamed or infected. For my patient, they became infected....So they opened him up from just above the navel all the way to just above his bladder (basically right down his abdominal muscle line). They removed some of his intestine and created an ostomy temporarily so the bowel could heal before they opened him up again to continue to repair his digestive system.

I was able to work with my patient who was in between the two surgeries. They decided to leave the wound semi-open because they were going to open up the same area in surgery in a few months. The wound was about 1 1/2 inches deep and you could see the stitches connecting the lowest layer of the tissue. So my wound; about 18 inches long, 1 1/2 inches deep and about 3 inches wide. Ohh my goodness! :)

My nurse came up to me and told me to do the wound care on this patient; basically replace the old bandages. She told me up front, you need to keep a straight face, show no emotion when you look at the wound. I did very well :)

So I put on sterile gloves and packed the wound with soaked sterile saline gauze. Then I placed two Abd bandages along with soft tape. The Patient had no pain or tenderness as I was bandaging the wound. I'm so grateful that I got to perform that skill!

Now my patient will go back into surgery in 3 months and reverse the colostomy and completely close the wound. Yay for recovery!

Cervical Vertebral Disc Repair

Today I had a patient who had surgery on a few of their cervical vertebral discs located in her neck. This wasn't her first surgery on that area which helped her know what to expect with her recovery. She came in to my unit during my shift and was able to relieve her pain with PO (oral) medications. That is not so common considering most patients Post-Anesthesia have to be given every thing through IV due to nausea. She was recovering fast!

One of the most important assessment tools that I had to use involved frequent Neuro Checks. These involved looking at pupil dilation and constriction, extremity strength, presence of numbness or tingling, and movement. So I began her assessment; I took my penlight and looked for equal reactivity of both pupils to determine brain function as pupil dilation involves cranial nerves. I then asked if she was having any numbness or tingling in her hands. She complained of numbness in her right hand which she said had prior to surgery. Then I had her squeeze both my hands to feel if their was equal strength in both her upper extremities. Both were fine. Now onto the lower extremities; I had her Dorsoflex her feet, which meant to lift up her toes, push down on my hands with her toes, and I had her wiggle all her digits so I could look for adequate movements. Along with the Neuro checks, I also checked for adequate circulation by checking pedal pulses, capillary refill in the nail beds, and feeling/observing for warmth, coloration, and movements.

It is important to assess these things especially for patients who have had any sort of spinal/vertebral surgery because of the risk for spinal cord injury. The spinal cord is a part of the central nervous system thereby contributing a major part in bodily functioning and voluntary movements.

My patient was discharged at the beginning of Post-Op day #2! Crazy good! :) It was an amazing recovery!

Low Oxygen Saturation

So today I was assigned a patient who was post-op day #2 from a Right Total Knee Replacement surgery. She was on her road to recovery. She is still struggling with ambulating and she has been getting assistance using a walker to get around. The previous nurse reported to me that my patient's oxygen levels have been in the 80s. She was given 2L oxygen through a nasal cannula to keep her oxygen saturation levels up.

So here is an experiment for you. . . try to breathe through a straw, plug your nose, and slowly take breaths for 2 min. First of all, that is how an a patient with Emphysema feels when they try to breathe. After breathing for 2 min, your oxygen saturation goes down to about 93%. That's when it's difficult to breathe. Can you imagine what it would feel like to be sating at 83%??? Talk about oxygen deprivation!

Well, I freak out about this sort of thing. I told her to take a few deep breaths and that got her oxygen level to the 90s. I gave her 2L of oxygen by nasal cannula again and she seemed to be doing a lot better. It worries me though. I don't like it when a patient has to be on oxygen after a surgery. I talked to my nurse about it and she said they might have to order a chest x-ray if she can't keep her oxygen levels up on room air.

I continued to assess her lungs and encouraged the use of her incentive spirometer. I left my clinical rotation while she was still on oxygen. I'm hoping, during report tomorrow, that she improved overnight.

Ohh the importance of oxygen. Every breathe we take supplies every living cell in our body with oxygen which is needed for cellular respiration to create energy for our body's tissues and organs. We can't live with out it. Every breath keeps us alive. . . "The Lord God formed man from the dust of the ground and breathed into his nostrils the breath of life, and the man became a living being," (Genesis 2:7).

You could imagine how I was feeling today! My poor patient breathing without oxygen getting to her body. I'm so grateful I could be there to help. I'm hoping for a change for the better :)

Total Bilateral Hip Arthroplasty

One of my patients I had during the last two clinical days was recovering from a Total Bilateral Hip Arthroplasty, in other words he had both his hips replaced. I asked the nurse about this procedure and they said that they rarely do both hips at once because the recovery time is lengthened too long which could lead to other health problems. Because my patient was 52yrs old, he was young enough to handle the recovery period.

We will call him "G" for short. G is an athlete who developed arthritis in his hips. He had no significant medical history except for a tonsilectomy. My focus of care was to make sure my patient had a good recovery which required movements, breathing exercises and assisting with activities of daily living. All during the shift I was able to encourage deep breathing and the use of the incentive spirometer which helped expand his lungs and increase oxygen and waste product exchange in the body. It is important to stress these activities because when under anesthesia, mechanical ventilation is used and fluid can accumulate making it difficult to breathe. A goal for a nurse with a post-op patient is to keep those lungs free of fluid and to make sure the patient is getting an adequate oxygen supply. I assessed my patient at 82% oxygen saturation, my first response was..."G can you take a few deep breaths for me?" He did so and brought his oxygen level to 96%. That's how easy it was. We just have to keep making sure they breathe!! Other times coughing will help.

The most exciting thing that happened with my patient was getting him up to a walker and walking him all the way down the hallway which is about 150'+ feet. The day before I walked him about 20.' What an improvement! I was so impressed with someone who was post-op only 2 days with BOTH hips replaced to have such an incredible improvement! I was so happy! I told him I would go get him a butterfinger for walking that much (I had caught him eating one earlier) and he said, "Where are your angel wings? Are you hiding them from me?" haha! He was such a sweetie!

It's great to see that patients who have such a huge surgery improve that much! It warms my heart to hear that G is actually going home today, walking, with pain free movements, with a smile! So glad I could be a part of his recovery! :)

Confidence?

This week was hectic; work, school, more work, clinical day #3, clinical day #4, all day class friday, ECG class....eeeeesccch...Let's just say I was ready to go home today...

I had an interesting day on Thursday, clinical day #4. It's amazing how one little thing can effect your whole entire day; the way you think, your confidence, your reflexes, your attitude, even your spirit. Right before my clinical rotation, I checked my grades online for one of my assignments. I didn't do so well, but that itself isn't a complete turn around for me. I had comments from my teacher saying, "You missed the mark," "This is sloppy," "This worries me," "If I was your supervisor, I would report you for writing this," "I want you to talk to the class about this assignment," "You need to explain to the class about what you wrote." ..........

So, I wasn't feeling to good after this. My confidence level just plummeted. I didn't understand what I did wrong. I also didn't appreciate him telling me to display my work in front of the class like.. "this is what not to do." So I emailed him and told him how I felt about it. But, I had no time to talk to the instructor personally because of clinical.

So clinical comes fast, and I get there a little early to receive report on my patient that I had the previous day. CW was stable, but had low Hct and low Hgb (lab values that show the amount of hemoglobin in the blood) These values were low which led to the decision to transfuse blood. His blood pressure was low the previous day too so Diuretics (water pills) were held as well as the Atenolol (High blood pressure medication). It was important for my to monitor his blood pressure, pulse, temp, and oxygen levels as blood was being transfused. CW had improved Hct, Hgb, and BP after an hour after the transfusion. So my day began with the transfusion, I couldn't do much because I wasn't checked off for those skills yet except for vitals. I was grateful though because my mind was elsewhere. I felt like I couldn't do anything at this point......

So my nurse, Mayra, was a 6 month new grad so she was learning as well. I had to do a lot! The pressure was on me to take care of this patient basically by myself because Mayra was new. So here I am after the transfusion with lots to do. Medications, Lovenox injection (blood thinner), teach about Lovenox (because CW will be doing this at home), VS every 4hr, encourage deep breathing and use of incentive spirometer, help to bathroom, ambulate in hallways, encourage physical therapy exercises, IV therapy and fluids, pain management, shift assessment, reassessments every 4hr, and making sure CW is okay checking every hr.

This didn't include helping Mayra with her other patients. I can't believe I will have at least 4 patients every shift. Thank God for nursing assistants! :)

Though I was losing it and my confidence was low, I knew I was going to make it through the day. God got me through and in a great way. I was so busy, I forgot about my assignment and my feedback. I actually now feel like I can have a second patient. Slowly but surely add a patient every clinical day....

Then to make my day better...Mayra said she was quitting next summer and I asked her if I could have her job....she was like "Ya! Take it, it's yours!" I would cry if I got a job there.....my goodness.....

So what to get out of today......I will get hit with situations like this, but it's in God's hands. If you ask, he will provide. God is my confidence.....

Aaaaamen...and now off to week 4!

Shadowing

Shadowing....the word to describe the action of following an RN around like you are glued to them. You become the observer, the questioner, the learner, and yes on occasion....the annoyance. I'm always afraid to start clinicals up every term because the first day is always a shadowing day. Before I get in the hospital, "God please please please may I have a good nurse." I go to my floor and the charge nurse orients the new shift nurses and says; "Alright, Tracey, Kristin, and Kathryn get student nurses today. I instantly see it on their faces. It makes me laugh!! I'm prepared for the worst...

Of course you introduce yourself, tell them it's your first day, tell them you are shadowing, on and on. Then the craziness begins. First of all, there are three kinds of nurses. One where you watch everything, and I mean everything; One where you get to help out and learn some; and one where you will DO all sorts of things with a ton of education (you would be lucky to get this one). Now this doesn't mean that any of these nurses have great attitudes or poor attitudes. It's the luck of the draw.

So I get paired up with TC. She is great! She's a little on the "I wish I didn't have a student" mind set, but I don't blame her. I'm just extra weight to carry. So I follow, observe, research, and that's about it. What a long day of that!!

Day 2 comes along with JB. What an incredible blessing she was!!! She let me do so much and yet she was there if I needed her!

One thing I learned, is how the RN you shadow soon becomes your shadow. Instead of you following them around, they tend to follow you around making sure you are doing everything right. I'm going on day 3 next week and I will have a patient all to myself. I'm so thankful I have my RN watching my every move. I'm still afraid I will miss something. I guess this is the learning experience.....you shadow them, they follow you....slowly slowly letting you on your own until you take your big exam.....then BAM your a nurse!

Thank God for those incredible RNs that are willing to take a student. I know when I'm a nurse I'm going to say, "bring on the students! They can shadow me all they want!"

Ohhh I can't wait to get there!!!!.......Until next week....

Wound Care

I have always been interested in blood and guts. I know that sounds weird and disturbing, but the human body is absolutely amazing. What's not to like about God's greatest creation??! I enjoy looking at cadavers and dissecting organs. In AP Biology I had both my hands in a dead cat observing the kidneys, digestive organs, the heart, lungs, etc. Anatomy & Physiology is one of my greatest passions. I can't tell you how many times someone has showed me an injury or a wound expecting me to turn away. And I do the exact opposite. One of my friends asked me if I wanted to go hunting with him, and my response was can I help cut it apart. I'm gruesome I know.

I have been thinking about what department I want to be in. I have changed my mind so many times; OB, Peds, Surgery, ICU, OB again, etc. At my last clinical, I learned that there was a wound care nurse that goes around to different departments and bandages up patient's wounds whether they are children or adults. I have been told that wound care nursing is an art. Oh how I would love to dive deeper in this department! I want to learn about wounds and healing!

The cool thing about this department is that I could use it at home, with my friends, and even other countries if I get the opportunity. I would love to be able to travel to trauma centers in other countries and apply my nursing skills. So many opportunities out there!!!

Where ever God leads me . . . . .

Drugs & Advice

I am just about done with summer. Sadly, school will be back with more homework and less time with friends. It was great while it lasted. I am excited to get back into the hospital to be in contact with people. This term will be mental health. I am really nervous about this division of Nursing. I have heard horror stories, but I am going into it with a positive attitude and I know I will have Jesus to get me through it. Who knows? I may like it.

I finished my summer term of Pharmacology just about 6 weeks ago. So I had about half a summer. There are so many drugs it is so overwhelming. I passed the class nearly 100% but still feel unprepared with drug compatibilities and adverse effects. It's so much information. Luckily, they tell you that you won't have to know everything because you will learn most of it on the job. Makes me feel a little better knowing I will have resources at the nursing station to help me :)

One thing that I have noticed this summer is the attraction of people needing advice from me as a student nurse. Because I am still in training, I am afraid I will give away false information. I want to be licensed before I give advice. The little things I feel more confident about like the use of over-the-counter medications, hot and cold compresses, simple wound care, and nutrition. Especially the drugs; my dad has been having back pain and has been taking "drug cocktails" as he calls it. Oxycodone (Percocet), Ibuprofen (Advil), and Valium. Talk about put you to sleep. My dad is a pretty big guy so he can handle higher dosages. I have been closely monitoring that according to his Doctor's orders. Every now and then I tell him to ease off the drugs to see if the pain level has gone down. He is just on 4 Advil a day now. Thank the Lord! :) My friends all come to me for drugs too. Because I get Migraines, I have pills in my purse all the time. I'm like a walking medicine cabinet and drug book. I love it!! I got to tell you, it does make me feel good inside that my friends come to me for advice. :) It's like I have already begun my nursing practice! Yay for knowledge! :)

Now off to Mental Health term :) Until then.....

First Aid Kit!

The other day, I was invited to a graduation party/bonfire for a bunch of my friends who graduated this year! It was really exciting! While at this party, we were throwing around a football and my "bestie" didn't catch the football and apparently dislocated her finger. She flipped out and popped it back in. In serious pain, she started to feel dizzy walking to the house. Feeling compelled to help her out, I went to check out the situation.

I found her in a bedroom with a package of frozen bacon on her hand. "I can't move it, it hurts so bad." hmmmmm well what resources do I have to help her. I found a large tongue depressor, cloth, a safety pin, and some masking tape. She was able to move it, but she was in so much pain. her thumb swelled up pretty good, so I left it loose enough for the inflammation. I wrapped it enough to where she couldn't move her thumb. She then carried a bag of frozen coconut balls the rest of the night. I would say I did a pretty good job with what I had. I told her to go get it checked out. Half her hand was black and blue. = /

After that experience, I was like "I need a first aid kit, bad!" So walmart here I come! I got this tool box looking thing and made my own. I bought a first aid kit that had band-aids and such, but I wanted a "heavy-duty" first aid kit. So here's what I got . . . band-aids of all sizes, a tube of neosporin, a tube of anti-itch cream, a bottle of Tylenol, adhesive ace bandages, cloth ace bandages, 4X4 gauze pads, tongue depressors, tweezers, alcohol swabs, anti-septic swabs, gloves, burn-gel, roll of gauze, steri-strips, cold pack, scissors, first-aid tape, rubbing alcohol, cotton swabs, and the only thing I can think of that I needed was a thermometer. So my first aid kit looked pretty good! And this will last me a while!! :)

I was soooooo excited! Because the majority of my closest friends are guys, I feel like having this first aid kit was a pretty darn good idea! haha :)

Phew. . . . I Made It!

Besides all of the great experiences at clinicals, I still have lecture to think about. This last term was the hardest for me. Besides Pathophysiology, concept maps, discussion board posts, and clinical prep work, I had lecture NRS 112. I already knew from the beginning going in that class that it was going to be tough. I only had three exams in that class and one quiz. I passed the first midterm of 40 questions barely. I fell short on the second one, but aced the quiz. So here I am on the line with a 78% in the class. And here comes the final day of school with a final of 80 questions cumulative with added renal, gastro-intestinal, endocrine, and basically all the body's systems crammed into one final with an hour and 45 minutes to take.

8:00am comes around and I sit at that computer praying. I needed 55 correct to pass or I would have to take that class over again in the fall. Not only would I have to redo clinicals and lecture, I also wouldn't be with my nursing group of 40 students that I have been with for the past 6 months. So along with the nervousness and anxiety, the migraines came in once a day for the last two weeks of school. STRESS!!!!

My instructor typed in the password and so it began. I got to say, the select all apply questions were horrible. I knew endocrine pretty well and I aced cardio! I still left the exam scared....

It wasn't summer for me yet until I got that grade. Prayers are powerful and God is so good to us. I couldn't ask for a better start to my summer vacation. I got 64 out of 80! I got a B!!

Hello to summer vacation and goodbye to my first year of nursing school. I got the hardest term over with, so they say. I am now officially halfway to my calling of grace!!! :) So excited! Thank you Jesus! :)

Moments Like These . . .

I had a God moment the other day. . .


On Wednesdays I have to go to the hospital to look at my patient assignments for the next two days. This is because I can look up their medications and treatment options to be prepared to provide patient care for them. My patient was a 19 year old girl who was admitted with Cholelithiasis (Gall stones) and had surgery the previous day for a Laproscopic Cholecystectomy (Gall Bladder Removal). She had a care plan full of information about familial issues and anxiety. So going into this, I was a little nervous with who I would meet.

Remembering the "shoes" I would have to wear, I went in her room and met this girl who is about my age. I took her vitals and completed a morning assessment, and I was able to give her anti-anxiety medications along with a warm blanket and some sprite :) So far so good . . .

Then after assessing her again, I noticed dim bases in her lungs posteriorly (very quiet breath sounds on the bases of the lungs on her back side). Her oxygen sats were at 87% (which we want to keep at above 95%). I talked to the nurse and she told me to give 2L oxygen through a nasal cannula. I gave her the oxygen and encouraged her to sit up once in a while and use her Incentive spirometer (a device used to expand your lungs when you breathe in). I was able to get her to use her spirometer three times in the time that I was there :) and none of the nurses got her to use it. Her oxygen levels went back up to the upper 90s and she didn't have to use the oxygen anymore.

The next day before her discharge, I got her to get up and walk the halls of the nursing floor to make sure she wasn't dizzy at all before she went home. I learned a lot from her then, how she went to my school, she wants to study pre-med, and how she feels she doesn't have a lot of friends. At this point, I realized how much I could relate to her. I have been where she was. It was nice to be able to talk to someone who has had similar experiences that I have had. We talked about Grey's Anatomy and House too which made her smile. To know that you can make a patient smile when they are at their worst, just makes me feel so good.

I had a talk with my instructor just after my patient was discharged and she told me the most amazing thing.... She told me that she assigned that patient to me on purpose because she has seen the impact I have made on my patients. She knew that I would be a good nurse to that patient because she knew that I would show the compassion for her no matter what her situation was. She also told me how she has been so "tickled" by my performance during clinicals. And then she said... That I will be a great nurse, no doubt about it. :)

Experiencing a day like this, tells me that I am heading in the right direction. I'm continuing to stay on the right path that will lead me to fulfill my purpose in life. Thank you God for moments like these :)

A Busy Busy Clinical Day

Clinical Day # 3 . . . .

So today was an interesting day. I had a patient assigned to me that was completely dependent on nursing care. My instructor wanted us to take complete care of our patients and give medications with IV care. I was completely overwhelmed. . . .I needed some encouragement at that point. Thank you Jesus for a boost of energy! :D

So to paint a little picture . . . my patient admitted to the medical-surgical floor for wound care and recovery from her surgery in February. She is very obese with multiple wounds (I won't go in detail). She has a wound vac (system used to drain wounds) and has Diabetes. Along with a crazy list of medications, she had a tracheostomy and a central line (IV line which goes straight to the veins near the heart) which I couldn't provide care on because I didn't know how. So here I was with a patient completely dependent on me and I couldn't practice any of my nursing skills. My nurse was overwhelmed as well, even with my help.

Feeling optimistic, I helped out when I could and tried to stay out of my nurse's way. But ohhh my goodness did I get to see a lot!!! This makes me look like a complete nerd but I was so into the wounds. I was constantly asking questions and curious about the care and how she got them. My nurse was nice enough to let me dress some of the wounds . . . Yay! :)

My nurse had another patient who was in isolation with severe wounds. She had previously fired a few nurses and has been as the charge nurse would say "difficult." She disconntected her IV and walked out of isolation in the hall. There was some hostility and scares going on. Luckily, everything came back to normal. We were just worried about her condition and the other patients that could have been involved with her isolation precautions.

Suddenly, a patient's wife came running out to me yelling that her husband couldn't breathe!!! scary!! So my fellow student and I ran to a nurse and they called the Rapid Response Team down from ICU to help with his breathing. He is stable now. . . Yay!! :) Talk about a rush!!

Something on my mind today . . . .

It is really sad for me to see some patients in these conditions. And even worse when they could have prevented their condition from getting worse. When I look at the big picture, that's my job. As a nurse providing patient teaching is a very important factor. Unfortunately, encouragement only goes so far. Some patients don't care to listen, so just taking care of their current condition becomes your priority. So many patients I have come in contact with, including today's, don't care about recovering or about their condition. For patients who don't care about their condition or about getting better, all you can do is tend to their needs and hope for a fast recovery. You become a nurse who gets the patient through life day by day instead of improving the quality of life. We do what's best for the patient and what they ask of us.

If only ALL patients could see that we are here to help them to get out of the hospital; not because we don't care for them while they are here, but because we want them to be out LIVING!!!

Ok now on to Clinical day # 4. . . . .

The Shoes You Wear

You never know who you're going to meet in the hospital. You can have new patients to work with every day. The hospital is full of variety in people; people of different cultures, people with medical histories, people with severe injuries, people with life-long illnesses, people on hospice, people with altered mental statuses, people with addictions, people with family, people who are scared, and people who are in need. Walking through those doors, I don't know who I am going to meet and who I am going to take care of today.

The first thing I learned about patients is that you need to put yourself in their shoes. Nursing is not about a job, getting the tasks done for the day, or passing meds. It's about the patient and caring for their condition in all aspects. If they feel pain, you feel their pain. If they are upset, you feel for them. As you wear their shoes, you become the eyes, ears, and voice for the patient.

God tells us in the bible that we must strive to be like Christ. We often come to the question, "What would Jesus do?" in any situation. If Jesus were in my shoes, what would he do? The same aspect applies to nursing; If I were in the shoes of my patient, what would I do? and also... What would Jesus do to help my patient?

It's important when you get to a patient's room that you apply your values and expect the unexpected. Again, you never know who you are going to meet. Have patience with patients. If you are patient with a patient, most likely they will be patient with you.

So when I get to that patient's room, I put on their shoes, so I can be the eyes, ears, and voice for them........

And So It Begins....

Nursing school, where grades don't matter. You just need to survive. Yes, the studying is constant and the information seems endless, but according to the instructors, 'everything' is need to know information. I now find myself thinking about Pathophysiology in my sleep. I have day dreams of neurotransmitters and Malignant Hyperthermia. If you open my closet, you would be surprised to see that I have more nursing books than shoes. I really know I am a nursing student when I would rather perform physical assessments on my friends than watch basketball on TV (for me that's saying a lot).

But my journey really begins with clinical. I am about to start my first day in the hospital with patients. I am missing lecture at this point because it basically feels like I have to put my newly learned skills to the test on real people; people who are sick, who need attention, who are in pain, and who are just as scared as I am to be in the hospital. Practicing on manikins seemed like no practice at all. Ohhh the nerves!!!

I started this blog to show you my journey of nursing; the things I see, the nurses, the skills, the patients, the compassion. Nursing is a profession of patience, understanding, kindness, respect, and fidelity. I am taking you along on this road to see what I see and experience the profession of nursing as I will be experiencing it.

So here I am.... blue scrubs, stethoscope, clinical passport, and pen in hand. I close my eyes..."God, please give me strength to make it through the day. Help me to be patient and kind. You have chosen this path for me and I have faith that you will help me continue on this path.' ...I take a deep breath, open my eyes....and I walk through the hospital doors to begin my calling of grace. . . . . . .