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!
Wednesday, October 20, 2010
Wednesday, October 13, 2010
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 :)
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 :)
Saturday, October 9, 2010
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! :)
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! :)
Friday, October 8, 2010
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!
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!
Thursday, September 30, 2010
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....
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....
Monday, September 20, 2010
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 . . . . .
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 . . . . .
Monday, September 6, 2010
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.....
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.....
Subscribe to:
Posts (Atom)