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Sunday, October 29, 2006

 

immersion

All I can think about right now is nursey stuff. If it's not the papers I have to write, the procedures I have to do in clinical, or the drugs I have to memorize, it's the nursing care of Elderly Kitty. Who is hanging in there, but still needs lots of attention.

This week in clinical I pulled a drain from a surgical incision, removed a Foley catheter, and passed meds. My clinical group also went to a flu shot clinic at the hospital and gave injections. I was super nervous but it went just fine. Although the first person I injected was this very skinny old man and I felt the needle bump into his bone. He didn't flinch, though, and I just eased the needle back a little bit and aspirated (no blood) and injected the vaccine. Aaaugh. The other shots I did went picture-perfect, and in fact the last patient told me "I didn't feel a thing!".

Tomorrow morning I've got an exam for which I need to know a metric assload of drugs. I'm hoping I don't just blank out - I've done my best to learn them in a short amount of time. If only there was a way to pipe stuff directly inside my head!

Friday was a super-long day - got up at 5:30, went to clinical, went to flu clinic, dropped off M* at the park & ride, took J* back to his car by my house, changed out of my scrubs, shot up Elderly Diabetic Kitty, went to R*'s gig on Capitol Hill, had a beer (hallelujah!), hung out with some friends of friends who all turned out to be nurses, talked shop, balanced my caffeine level with Diet Cokes, ate dinner, drove home because R* had a lovely cocktail with dinner, passed PM meds for Elderly Kitty, and collapsed into bed.

Since then I've basically just studied. And ran a couple errands. And had a nice breakfast out with R* today. Time to do it all again tomorrow.

The little boy I babysit for is nearly two, and is talking but mostly in one-word declaratives. When he's finished with something (eating, playing with a particular toy, swinging on the swings, etc), he announces "all done!" and moves on to the next thing. Last week he'd had a rough night and on the way home from playtime he sniffled and said, "....aaaaallll dooonnnne...." in this very sad voice. He was just worn out. I told my carpoolmates about it, and on Friday while we were driving M* back to the park & ride, J* shut his eyes and announced, "All. done." M* and I just cracked up because we so knew what he meant.

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Tuesday, October 24, 2006

 

Happy fall.

Pumpkin beer? Check.
Eggnog latte? Check.
Hot apple cider? Check.
Fire in the fireplace? Check.
Fuzzy socks? Check.
90 days of rain? Uh... in progress.

The first 5 almost make up for the last one.

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Tuesday, October 17, 2006

 

kitty update and a brainstorm

Mr. Black Cat is doing much better. He's not back to 100%, but he seems much more like his old self. Just like any elderly patient, he's up to 4 different meds administered at 3 different times of day. And yes, I have to wipe his butt on occasion. Although at least this IBS flare-up has not been nearly as disgusting as the last one. I'm not expecting that he's going to live years longer or anything, but I do think he'll be with us for a few more months. Today he wanted to sit on my lap and sniff every single bite of my lunch before I put it into my mouth. This is a good sign.

Okay, as for the brainstorm - I didn't have one, I'm asking for your help with one! I have to present an article to my clinical group at post-conference on Friday. I'm totally fine with the article and the speaking part, but I'm supposed to use a "visual aid" and I'm drawing a blank. The topic of the article is prescribing a "range order" for painkillers and why it's important for nurses to advocate for range orders for their patients, and how to use these orders to keep patients as comfortable as possible. In case you are as clueless as me (I just learned this today!), a range order is a prescription, typically for pain medication, that allows the nurse to use her judgement about how much to administer based on the patient's status and the situation. For example, the doctor might write an order for morphine, 1-4 mg/hour by IV, as needed for pain. This would give the nurse the leeway to crank up the patient's dose to 4 mg/hour if the patient was in terrible pain, or to crank down the dose to 1 mg/hour if the patient was getting groggy and the pain was long gone.

So yeah, I don't need to recap the whole article for you - just tell me what you think I could do VISUALLY to help with this presentation! I don't have access to a computer or overhead, so it's gotta be something I can just hold up, pass around the table, or tape to the blackboard. The only idea I've had so far is to bring some kind of tiny candy, like smarties or jellybeans, and use them as "units" to demonstrate how I could dose 2 different patients with the same range order...?

Any ideas would be appreciated!

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Sunday, October 15, 2006

 

kitty hospital

Mr. Black Cat gave us a scare this weekend... Friday night we were out late because R* had a gig, and we went out for dinner after he played. When we came home, I gave Booshka his usual nighttime pill and we went to bed. Then he woke us 3 times in the night because he was throwing up. Saturday morning he refused to eat and was very weak. We were really worried about him and took him to the vet, where we saw our very favorite doctor... and she examined him and said it is most likely a flare-up of his irritable bowel disease, and that extra steroids and antacids should make him feel a lot better. They gave him some fluids and took blood and urine samples just to make sure that nothing else is going on. When we got home from the vet, Booshka ate a little bit and then went to sleep. But he wouldn't eat in the evening when he normally gets his insulin, and he just ate a tiny bit at bedtime.

This morning, though, he hopped out of bed at 6:00 and asked for breakfast. So I fed him and gave him his insulin injection, and an extra steroid/antacid dose to keep his tummy from hurting. So far, he seems like he's bouncing back.

Last time this happened, about a week later he had an explosion from the hind end that necessitated daily baths for a few days. We're hoping to avoid that this time around with the extra steroids before the explosion. Keep your fingers crossed, because that was just gross, even for an experienced butt-wiper like me.

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Saturday, October 14, 2006

 

clinical

This was the first week where we actually went to clinical at the hospital. Last Thursday we had clinical orientation but that was just a tour - this week we actually got assigned a patient and had to assess them, come up with care plan, etc. I was terrified of the whole thing since I don't have any hospital experience at all - I hate doing new stuff, even though it's good for me blah blah blah. But it went pretty well and I at least know where to find a couple of things on this unit at the hospital... if nothing else I can get a patient a clean gown and measure their oxygen saturation or blood sugar! By the end of the week I started to think that I might actually have fun by the end of the quarter.

However, I also started to think that I need to quit my job. I was supposed to work this morning but called in. I'm just too tired and stressed out, and R* says it's more important to him that I do well in school and that we have some semblence of a home life than that I bring home a few hundred dollars a month. Also, an unexpected variable is that my classes run a lot longer than they are scheduled - for example, I chose to work Wednesdays 2-10 PM because I was supposed to get out of skills lab at 12:30. In reality, I don't get out of skills lab until 1:30 or later, which makes it impossible to even get to work on time. I've already been in touch with the mom of the little boy I babysit occasionally, and I'm going to pick up some babysitting hours a few afternoons a week. While I don't have tons of free time, I think I can make that work, and it will be way less stressful than trying to cram in an 8 hour shift at work! Now I need to call my boss and explain that I'm leaving. I feel guilty about it - but I know I've gotta do what's right for me and R*.

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Monday, October 09, 2006

 

assessment, the first step

(If you're a nurse or nursing student, you know why that title is funny. If you're not, suffice to say that the brainwashing is working... I mean, I am being socialized into the nurse role.)

Last week I didn't do so hot in terms of following the schedule that I set for myself. I didn't completely fail, either - I did get up and do yoga a couple of times before class, I packed my breakfast and/or lunch most days, and I completed all my assignments on time. I managed to keep food on the table and clean clothes in our laundry baskets - but the rest of the house sort of went to hell. And I didn't get in any cardio.

Today is going according to plan thus far - I got up and did yoga this morning, went to class, ate my pre-packed lunch on campus, came home and studied for a while, went for a jog, came back and showered, and now I'm sitting down to study again. If I manage to fix dinner and clean the catbox tonight, I will have managed to do everything I set out for myself today!

It helped that Sunday was catch-up day. I caught up on sleep by sleeping until 11:30. I caught up on cleaning the house. I caught up on lots of reading for school. I'm so, so happy not to be working on Sundays anymore. Not that working on Saturday is loads of fun, but at least I get one day of down time to get ready for the week ahead and spend time with my sweetie.

Okay, time to hit the books.

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Sunday, October 08, 2006

 

gingko

I'm reading in my pharmacology book that gingko extract can improve short-term memory in healthy adults as well as in elderly patients with mild to moderate memory impairment. I wonder if I should stock up on gingko tea to counteract the dementia caregiver effect? Apparently I am suffering from the dementia caregiver effect because I can't find the article that I read about it a few weeks ago.

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passed

Hospice Lady passed away on Tuesday morning. I'm sad she's gone but happy that she's able to rest now. For privacy reasons I won't link to her obituary, but it was very very sweet and talked about how she spread love everywhere she went, which I saw whenever I cared for her. Goodbye, sweet lady!

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Tuesday, October 03, 2006

 

hospice redux

I worked on Saturday morning. I really didn't want to. I had been up late Friday night, first at J*'s bachelorette party and then at R*'s jazz gig. I considered calling in sick when I got home but didn't. The alarm went off at 5:00, I sat up and felt queasy and considered calling in sick but didn't. I stumbled into the shower, threw on my work clothes, and drove to work. I told myself that I would just go in, get my residents up and ready for breakfast, and if I still felt awful I could go home.

Then I got to work and found out why I needed to be there that day. My sweet lady hospice patient had gone rapidly downhill since I had seen her the week before, and I was her caregiver that day. Her family was on their way from out of town. And Hospice Lady didn't want to be alone. She wasn't speaking but I knew she recognized me when I spoke to her and leaned over to hug her and she put her arm around me to hug me back (she felt so fragile). I sat with her for most of 5 hours, until her family arrived. I held her hands and stroked her forehead and swabbed her mouth and talked to her and gave her spoonfuls of water and massaged her neck. Whenever I got up, she reached out for my hands. She was on oxygen but her breathing was still labored. Her pulse was fast and weak. Her skin was crinkly from dehydration and her fingernails were turning blueish. I asked the other nursing assistants who I knew were fond of her to come see her - and everyone did. All the CNAs and the nurse on duty dropped by and told her they loved her. Her closest friend at the Old People Hotel sent a CNA to tell Hospice Lady she loved her - and even in her state, Hospice Lady nodded to show she understood.

When her family arrived, they obviously wanted some alone time. So I gave them their privacy but dropped by every 30 minutes or so to check in. Before my shift ended, I changed Hospice Lady's brief (she was so dehydrated there wasn't much there) and got her resettled in bed. And then I sat down and told her that I loved her and that it was a privilege to take care of her and that I would be so glad for her when she was able to rest. I told her I would be thinking of her and her family and said goodbye and kissed her cheek.

When I got up to leave the room, her family members thanked me deeply, and hugged me a lot, even though I hadn't met them before today. I talked with them for a little while and told them they would be in my thoughts, and that I was honored to take care of their relative. One of them cried on my shoulder for a minute.

I really felt like a nurse that day. I cared for a patient, I cared for her family, and I held it together emotionally without suppressing all my feelings and becoming a robot. It was a really good experience.

I haven't been back to work since then and don't know for sure if Hospice Lady has passed away. I don't think she could have gone on for more than another day but I don't know for sure. I work tomorrow evening and will find out then.

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