Special Delivery

Today I got a chance to visit the Labor and Delivery Dept. I was able to see a live birth!!! YAY!

This woman was laying partially on her side with the help of her husband and the nurse. As this was her second child, she knew what to expect. She has an Epideral to manage her pain, but she still could feel pressure and enough feeling to push. Upon every contraction of the uterus, she pushed, and immediately the baby was crowning. They had to call the midwife in fast. When the midwife got there, the baby was nearly out. They put on some oily lubricant to soften the tissue which help to ease the baby out. Within no time at all, the baby came out and immediately she began to cry.

It's a GIRL!!! Here she was all purply-pink. Those little toes and fingers! She was given to her mom right away and the family was filled with incredible joy. All her labor pain was gone in an instant.

"A woman giving birth to a child has pain because her time has come; but when her baby is born she forgets the anguish because of her joy that a child is born into the world." (John 16:21)

What a blessing to witness such an incredible miracle; God's gift of life.

Fall Risk

My second day of clinical at the Woman's care unit.....

I was assigned to a nurse who I couldn't find half the time. It's like she disappeared on me. So along with my patient assignments, I helped out another nurse with her patients. I was everywhere; answering call lights, checking vitals, teaching, providing snacks, blankets, and assessing the patients. It was a busy busy day. I'm just glad I was able to help out.

My nurse handed me a bowl of soup and asked me to deliver it to a patient. So I did, and I met the most incredible woman of God. She told me about her surgery, her family, church, and her cooking! She was a talker and I loved it. I hope that I will get to have time with my patients to hear more about their life stories. Then I helped her take a shower and clean up for bed. And she talked and talked and talked. Loved it!

So my patient was recovering from a Hysterectomy (removal of uterus). She was on Post Op day #2. Then the scary thing happened....She asked to use the bathroom. So I helped her out of bed. She usually ambulates on her own in her room without assistance. As she was standing up, she started balancing on one foot, and I told her not to do that. I had one arm and she was stable....until.....she decided to reach for the shower curtain. She started to fall. Without injuring myself (Thank God!) I helped ease the fall by lowering her in the shower. She was okay!!! I reported it to the nurse and I had to file an incident report. I nearly had a heart attack. My second day in this unit and a patient falls. Let me tell ya....it sure was a learning experience. It wasn't my fault, but I have my eyes wide open now.

I spent over an hour in her room just listening to her life story and making sure that she was okay, especially emotionally. My nurse came in and and posted "fall risk" signs on the door and bathroom. My patient just looked at me and started laughing, "Oh no....I'm a fall risk....I can't go anywhere by myself now." I told her that she was right. I will be with her the whole time. And she just laughed at me, "That won't be so bad." :) What a cute pie!

Thank God for saving my patient!! The thought of a patient falling and hurting herself during her recovery freaks me out! I would have cried...well I did a little. I'm such a softy. That's probably why God put me there.....to care and cry.....and prevent falls :)

"Bad Things Come In Threes"

My clinical day started out with me locking my keys in the car......this is the second time in like 2 months. Annnnd I left my spare in there too! I'm going to have to give my boyfriend a key so he can let me in next time a screw up haha :p

Clinical Day #1 was an interesting experience at Women/Newborn Care Unit. I started out the shift waiting for the charge nurse to get off of lunch. An hour passes by and I was sent on a scavenger hunt to look around the unit and find things in the supply room. That was good. I needed to do that. There are so many different supplies! It's craziness; bili bags, breast pumps, newborn masks, formula, photo equipment, diapers (of course), baby warmers, bili warmers, pacifiers, baby glucometers, etc. A lot of the equipment was doubled adult and newborn. I'm glad I got to look around. I was already sent to get things during procedures.

I didn't see much today. It was a 'shadowing' day so I followed a nurse around. I got to see a fundal assessment which was cool. I ended up just watching the whole process. I got to get my patient information for tomorrow which was good. I felt like I shouldn't have been there though; like I was in the way.

At lunch I had really nothing to say to my clinical group. They all had amazing things happen today. I didn't have much for them. Sadly, I then spilled my soup all over the floor. I hate making messes for people, so I tried to clean it up myself.....I just wanted to go back to my unit....

Back on the unit, my nurse came to me and straight up told me "Don't ever let any nurse tell you to change your practice or how you do things when you graduate." At first I thought she was upset with me. But apparently our patient (who was a nurse) was giving her a hard time. I loved my nurse. She wants me to work with her next week :)

Then at about 7:30pm, I started seeing spots of color in my sight of vision; most people call it an aura. I don't think I get them quite that bad. But yes, a migraine was coming. I didn't have an excedrin with me :/ The nurses all started searching their bags for meds. They drugged me up with 400mg of ibuprofen. Wowza! But that didn't work......the light was killing me...then my instructor came up and sent me home like 2hrs early. I felt bad leaving clinical early, but with that migraine, I wouldn't have been able to focus, and the nausea would just have worsened over time. My instructor told me to get home as soon as possible because I have a history of tunnel-vision when I get migraines. Obviously when I get a migraine, it's God telling me to slow down and breathe... you'll be fine. I worry toooooooo much! :/

As I was leaving, my nurse said "bad things come in threes....what else did you do?" Well I locked my keys in the car as soon as i got here, with my spare in it, and I spilled my soup all over the floor in the cafeteria at lunch. She just laughed at me and told me that I should work with her next week :)

I got home and crashed til it was gone. Yay for migraines! I was stressed and nervous today and that mostly caused it. But now I'm ready to start a new day! I'm ready to begin patient care on mommies!

Winter Term Begins....

Happy New Year!

Hallelujah! It's finally 2011. Time for a new clinical rotation! Sadly, I won't be on my med-surg floor that I wanted to be on again. That floor was great :)

So God wants me somewhere else! I got assigned to the woman's floor which involves Gynecology, Postpartum, and Family Birth. Maybe this is my focus or maybe I'm supposed to help someone....who knows? I'm really nervous because I don't know what I'm up against. It's a new unit with a total different side of nursing. I haven't had much experience in this department. I know I will like it because this was the department I wanted to be in when I first started nursing school. Let's just say....I will have a variety of blog diagnoses compared to the last term :) I'm excited and nervous at the same time. Hopefully I get to hold some babies!!! :)

So here I begin the next 10-12 clinical days in the Women's Health Unit/Birth Center. . . .

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!