Today was an adventure......
I was assigned to a nurse who had me do everything...and I mean EVERYTHING! My patient had a vaginal/uterine prolapse with a rectocele and a cystocele (those words look up yourselves, it's kinda gross) meaning...her organs were falling "down." She had a partial Hysterectomy. This lady spoke spanish and had her husband at bedside to interpret for her.
Sadly, after surgery, this lady had urinary retention. According to Doctor's Orders, she was supposed to be bladder scanned every 2-3 hours to check for urinary retention. If the scan was over 160mls, a straight catheterization procedure had to be done. My nurse did the first one, because the patient had over 275mls still in her bladder even after she attempted to void. She tolerated the procedure well. After another 2hrs, I bladder scanned her again, and sure enough she had over 250mls in her bladder. Then it was my turn. It was my first straight cath procedure...aaaand I was successful! :)
After the third time, the Doctor ordered to have a foley placed. The foley catheter is always more complicated. Of course, my nurse had me do that too! It went well, not as well as I would have liked, but it was successful. I need to get my psychomotor skills down! It was especially difficult because her tissue was swollen due to the surgery. And, on top of that, it was extra painful.
After that, I got to teach her husband about the foley and how to measure urine output because they were going to be going home with some equipment. She had to take the foley home with her. After that I gave a Tdap injection (tetanus), and a Flu shot! I was so so so so happy to be able to perform those skills! Like I was jumping up and down...I'm such a nerd!
After the patient and the husband received some teaching and information about home care, I got to wheel out the patient to be picked up by her husband. During that time, I got to try out my spanish. It was gutsy, considering my 4 years of spanish was about 4 years ago. :p Surprisingly, I did quite well. I couldn't understand most of what she was saying but I got to talk to her about her family, her hospital stay, and she actually complimented me (or so I thought). "Cuantos anos tienes tu?" "tienes hermanos, padres?" "Donde vives?" And I could actually answer those. I thought it was hopeless. God definitely helped me out with that :)
I said my goodbyes, and off they went. Discharging makes sad, though it is a total good thing. I just develop relationships and I get attached which is not always a good thing haha! Overall, today was good, very good. Lots of learning experience! Thank you Lord God for all your incredible blessings. It was such a great day! :)
Thursday, February 10, 2011
Wednesday, February 9, 2011
More Can Come Even After Delivery
It's hard for me to put myself in a patient's position unless I have experienced exactly what they have experienced. It's definitely a learned skill to be able to interpret exactly what that patient needs. Everyone is different and condition will vary with each person. When I think about pregnancy, I think about the similarities; trimesters, morning sickness, 9 months, weight gain, fetal heart tones, fetal movement, nutrition, "water-breaking," dilation, labor, delivery, etc. But, there are so many other things that can happen; fetal distress, miscarriage, preeclampsia (characterized by high blood pressure leading to seizures), late deceleration of fetal heart beats, emergency C-sections, meconium aspirations, episiotomies, placenta abruptio (when placenta detaches from the uterine wall too early), premature contractions, still borns, etc. When you have your first pregnancy appointment, you make plans as to how you would like this pregnancy to go; do I want to do a "natural birth?" prenatal vitamins? Doctor's appointments? finances? hospital stay? C-section? etc. Sometimes it doesn't go exactly as planned......
The reason I wrote this out is because I had a patient today that had some traumatic experiences. This woman gave birth to a beautiful baby girl just after midnight. The baby had normal apgar scores and was breathing and crying. Sadly, the mom had to undergo a 3rd degree laceration. Basically, she tore almost all the way from the vagina to the rectum. OUCH! Upon arrival to the newborn care unit, the baby wasn't feeding well. The baby won't breastfeed and over the rest of the morning-afternoon the baby lost almost 10% of it's body weight. This is dangerous. So in order to help the baby, we had to give the baby supplemental feedings (bottle). This is such a sad sad thing because usually you want the mom to breastfeed the baby for months not just a few hours. She was so sad, so so sad. It was an emotional day.
Later in the day, mom started feeling some more pain in her vaginal area. During an assessment, we noticed that her stitches were coming lose. The Doctor came to assess the area, and concluded that she needed to go into surgery again. Poor mom had to leave the baby and go into surgery. So, we called for the IV team and we got her prepared for surgery. About 4-5 hours later, the family was back together and were able to go home the next morning.
It's so sad to hear these things! Especially when they are such nice and sweet people. One thing I continue to learn is that plans change. Things can change completely without knowing. Whether they are good or bad, they help strengthen our character. I know if this happened to me, I would be totally grateful that I left the hospital with a beautiful baby girl. Through the rain and the storm, there can always be some sunshine. :)
The reason I wrote this out is because I had a patient today that had some traumatic experiences. This woman gave birth to a beautiful baby girl just after midnight. The baby had normal apgar scores and was breathing and crying. Sadly, the mom had to undergo a 3rd degree laceration. Basically, she tore almost all the way from the vagina to the rectum. OUCH! Upon arrival to the newborn care unit, the baby wasn't feeding well. The baby won't breastfeed and over the rest of the morning-afternoon the baby lost almost 10% of it's body weight. This is dangerous. So in order to help the baby, we had to give the baby supplemental feedings (bottle). This is such a sad sad thing because usually you want the mom to breastfeed the baby for months not just a few hours. She was so sad, so so sad. It was an emotional day.
Later in the day, mom started feeling some more pain in her vaginal area. During an assessment, we noticed that her stitches were coming lose. The Doctor came to assess the area, and concluded that she needed to go into surgery again. Poor mom had to leave the baby and go into surgery. So, we called for the IV team and we got her prepared for surgery. About 4-5 hours later, the family was back together and were able to go home the next morning.
It's so sad to hear these things! Especially when they are such nice and sweet people. One thing I continue to learn is that plans change. Things can change completely without knowing. Whether they are good or bad, they help strengthen our character. I know if this happened to me, I would be totally grateful that I left the hospital with a beautiful baby girl. Through the rain and the storm, there can always be some sunshine. :)
Wednesday, February 2, 2011
Days Like These. . . .
Today was a great day! Full of God's amazing blessings!
12:30PM on the unit....right away I was assigned to a nurse! She was absolutely amazing! I learned so much from her! (blessing #1) I love being with someone who really wants to have a student.
The day began with a test. My nurse asked me if I would like to give two injections; Tdap (Tetanus, Diphtheria, Pertussis) and MMR (measles, mumps, rubella). I have only given like two Flu shots before so I was totally game for this. I do need practice drawing up medications. I do think my psychomotor skills need some work. So she put me on the spot. What needles do you use? How do you inject the medication? Do you have to mix the medication? What teaching do you have to do? Overall, the whole thing went well. I can now say I have given Tdap and MMR :) another thing off my list! (Blessing #2)
At around 3pm, my nurse went to lunch and told me certain things to do for her patients. So, I was left in charge with an RN as my backup only if I needed her. When she left, I had 3 patients with 1 baby; they consider that 4 patients. I felt so amazing then.....I was forced to take control! whoo! (blessing #3)
Then I was put to work; making beds, filling waters, getting linens, cleaning sitz bath, passing meds, baby vitals, discontinuing IVs, patient teaching, measuring I&Os, discharging info, and a whole lot of documentation. I was so glad to take the majority of the patient care (blessing #4) I kept busy! Time just flew by!
During shift change, I was able to learn a lot about Magnesium drips, Pre-eclampsia, neo-puffs, breastfeeding, witch hazel, dermaplast, and illeo-sacral belts. I learned a lot! (Blessing# 5) I had a patient today that had her pubic bone break apart during delivery! OUCH!!!!!! I cringed when I heard that. This sacral belt but pressure on the pelvis to bring the bones together. During the next 6 weeks, she will have to wear the belt so the cartilage can repair. 2mg of Dilaudid should kill that pain ;)
Toward the end of the day, my nurse gave me a great review, and I mean a great evaluation! She even told my instructor about me! AND she wants to work with me again :) (Blessing #6) All in all, I had an amazing day. Today I felt like a nurse. I felt like I knew what I was doing, and my nurse thought so as well. I was so blessed today. I can't thank God enough for these incredible experiences!!!! He is soooooooooooooo Good!!! :) It's days like these that build my confidence. It's days like these that make me feel like I'm a nurse! :)
12:30PM on the unit....right away I was assigned to a nurse! She was absolutely amazing! I learned so much from her! (blessing #1) I love being with someone who really wants to have a student.
The day began with a test. My nurse asked me if I would like to give two injections; Tdap (Tetanus, Diphtheria, Pertussis) and MMR (measles, mumps, rubella). I have only given like two Flu shots before so I was totally game for this. I do need practice drawing up medications. I do think my psychomotor skills need some work. So she put me on the spot. What needles do you use? How do you inject the medication? Do you have to mix the medication? What teaching do you have to do? Overall, the whole thing went well. I can now say I have given Tdap and MMR :) another thing off my list! (Blessing #2)
At around 3pm, my nurse went to lunch and told me certain things to do for her patients. So, I was left in charge with an RN as my backup only if I needed her. When she left, I had 3 patients with 1 baby; they consider that 4 patients. I felt so amazing then.....I was forced to take control! whoo! (blessing #3)
Then I was put to work; making beds, filling waters, getting linens, cleaning sitz bath, passing meds, baby vitals, discontinuing IVs, patient teaching, measuring I&Os, discharging info, and a whole lot of documentation. I was so glad to take the majority of the patient care (blessing #4) I kept busy! Time just flew by!
During shift change, I was able to learn a lot about Magnesium drips, Pre-eclampsia, neo-puffs, breastfeeding, witch hazel, dermaplast, and illeo-sacral belts. I learned a lot! (Blessing# 5) I had a patient today that had her pubic bone break apart during delivery! OUCH!!!!!! I cringed when I heard that. This sacral belt but pressure on the pelvis to bring the bones together. During the next 6 weeks, she will have to wear the belt so the cartilage can repair. 2mg of Dilaudid should kill that pain ;)
Toward the end of the day, my nurse gave me a great review, and I mean a great evaluation! She even told my instructor about me! AND she wants to work with me again :) (Blessing #6) All in all, I had an amazing day. Today I felt like a nurse. I felt like I knew what I was doing, and my nurse thought so as well. I was so blessed today. I can't thank God enough for these incredible experiences!!!! He is soooooooooooooo Good!!! :) It's days like these that build my confidence. It's days like these that make me feel like I'm a nurse! :)
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