72%
prtty good for amt of time i put in. but gotta do better than that!!
1 lecture. and literally started seeing stuff for 1st time ystrday evening.
Tuesday, March 15, 2011
Correction
I guess at least @ 60-ish%.
But I don't know what I don't know so I coulve gotten lucky and gotten a higher%age - but I'm not guessing a passing score. Like I said I have time now - a few days from now and I should be caught up....
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But I don't know what I don't know so I coulve gotten lucky and gotten a higher%age - but I'm not guessing a passing score. Like I said I have time now - a few days from now and I should be caught up....
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That dint go well
If I had to bet, I'd put my money on 60-ish%.
Well the good news is I am interested in this stuff and I have time...so ill learn it all before the final.
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Well the good news is I am interested in this stuff and I have time...so ill learn it all before the final.
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new test, same story
well at least i feel mostly rested.
what do u do when u cant stay up all night anymore?
and caffeine doesnt work anymore so u dont even bother with it anymore?
what do u do when u cant stay up all night anymore?
and caffeine doesnt work anymore so u dont even bother with it anymore?
Monday, March 14, 2011
the nursing school saga continues...
i will finish out the semester, except for the class in which i got my 2nd clinical fail. after, i will have failed out of the program. then i will start the LVN program with transferred credits. after working as an LVN for 6 months, i will be eligible to continue in the RN program. the specifics will be worked out next tuesday.
nice save, huh. plus i get to work a real job again, which is something i crave, even if its for low bucks. and depending where i work, it might be a good way to make the connections i need to get an rn job if i take that route. and it gives me time to do the rn thing when my heads into it. clearly rt now the timing is off. not just for me personally, but also in the real world new grad rn job market.
as the director put it: use this time to get your shit together!! for sure, i must enter the VN program with a different attitude. and if i go for RN, same thing. i used to have extraordinary discipline and motivation, really i did.
like i said at the meeting, "what happened there...i don't know."
now for the cram session from hell. and by cram, i really mean cram. i only went to one of the lectures. and i never reviewed the notes from that lecture. see, all my time had to shift to careplans for the other clinical. so never studied any of this stuff yet. resp, card, hemo, and f/e all by 8am tmrrw.
luckily, cramming for tests like this comes easy to me.
(way easier than spitting out careplan packets at the last minute, anyway).
it seems to be opposite for most nursing students. but then im not the typical ns.
nice save, huh. plus i get to work a real job again, which is something i crave, even if its for low bucks. and depending where i work, it might be a good way to make the connections i need to get an rn job if i take that route. and it gives me time to do the rn thing when my heads into it. clearly rt now the timing is off. not just for me personally, but also in the real world new grad rn job market.
as the director put it: use this time to get your shit together!! for sure, i must enter the VN program with a different attitude. and if i go for RN, same thing. i used to have extraordinary discipline and motivation, really i did.
like i said at the meeting, "what happened there...i don't know."
now for the cram session from hell. and by cram, i really mean cram. i only went to one of the lectures. and i never reviewed the notes from that lecture. see, all my time had to shift to careplans for the other clinical. so never studied any of this stuff yet. resp, card, hemo, and f/e all by 8am tmrrw.
luckily, cramming for tests like this comes easy to me.
(way easier than spitting out careplan packets at the last minute, anyway).
it seems to be opposite for most nursing students. but then im not the typical ns.
Sunday, March 13, 2011
im liking this lvn idea more n more...
if that route is open to me, i think its the path of least resistance.
my top choice plan b was shot down today by an expert whose opinion i value. everything else i wanna do requires completing enough prerequisites that would keep me away from being an enrolled financial aid student long enough that id have to start paying back those hefty student loans before i was ready.
plus i get to use the nursing knowledge i've been accumulating.
even careplans and paperwork and all that.
[she's making her presence known. she's smiling. i think she likes the idea. maybe she inspired it?]
unless i come up with a better idea
(or these options aren't possible),
my top 2 choices as of now are
-getting waiver to sit in on NCLEX-PN
-transferring into an LVN program with advanced standing
i could go either way. i have no preference. pros and cons to each.
my top choice plan b was shot down today by an expert whose opinion i value. everything else i wanna do requires completing enough prerequisites that would keep me away from being an enrolled financial aid student long enough that id have to start paying back those hefty student loans before i was ready.
plus i get to use the nursing knowledge i've been accumulating.
even careplans and paperwork and all that.
[she's making her presence known. she's smiling. i think she likes the idea. maybe she inspired it?]
unless i come up with a better idea
(or these options aren't possible),
my top 2 choices as of now are
-getting waiver to sit in on NCLEX-PN
-transferring into an LVN program with advanced standing
i could go either way. i have no preference. pros and cons to each.
maybe alls not lost?
...as far as getting work experience as a nurse.
i only need a year or two.
i dont have to be an rn. lvn experience will do.
i wonder if i can sit in on the NCLEX-PN???
and if not, can i make up the missing course/clinical hrs in an LVN program???
from the state lvn board website:
Method 3
Qualification Based on Equivalent Education and/or Experience
and
i only need a year or two.
i dont have to be an rn. lvn experience will do.
i wonder if i can sit in on the NCLEX-PN???
and if not, can i make up the missing course/clinical hrs in an LVN program???
from the state lvn board website:
Method 3
Qualification Based on Equivalent Education and/or Experience
Experience
Pursuant to the California Code of Regulations section 2516(b), the 51 months of paid general duty inpatient bedside nursing experience must include a minimum of each of the following:
•48 months medical/surgical nursing;
•6 weeks maternity or genitourinary nursing;
•6 weeks pediatric nursing.
The majority of the paid bedside nursing experience must have occurred in a inpatient clinical facility providing the types of patient care that will prepare the applicant for the content topics covered in the licensure examination. It is required that all experience must have occurred within the past ten years, with half of the required experience occurring in the past five years. The experience must have been recent enough that the applicant is knowledgeable regarding current types of patient care equipment, policies and procedures.
and
Equivalent Education
Applicants who have acquired additional formal nursing education from an approved/accredited vocational nursing, practical nursing or registered nursing program may submit official transcripts for evaluation for possible credit in lieu of paid bedside nursing experience. The transcripts must be submitted to the Board directly from the school where the courses were taken and must show theory and clinical hours completed, as well as the grades for each course. Applicants must achieve a C or better in the course in order to be given equivalency credit for the course. Credit will only be granted for those courses taken in approved/accredited vocational nursing, practical nursing, psychiatric technician or registered nursing programs.
Required Pharmacology Course
In addition to the required paid bedside nursing experience, the applicant must also have completed a pharmacology course of at least 54 theory hours that covers the following content:
•Knowledge of commonly used drugs and their action;
•Computation of dosages;
•Preparation of medications;
•Principles of administration.
The pharmacology requirement may be satisfied by completion of 54 theory hours of pharmacology in a Board accredited vocational nursing or psychiatric technician program or 54 theory hours of pharmacology offered as part of an approved registered nursing program. In some cases, applicants attended an accredited psychiatric technician, vocational nursing or registered nursing program but did not complete the program. In order to receive credit for pharmacology content that was offered in that program, documentation provided by the program must clearly delineate that the applicant successfully completed 54 hours of actual pharmacology content, which included the 4 content areas described above.
Many individuals and organizations offer pharmacology courses that fit the criteria listed above. The Board does not review, approve or endorse these courses. It is the responsibility of the applicant to ensure that the pharmacology course taken includes the required content topics listed above. When the applicant submits the licensure examination application, the applicant must present documentation that specifies the number of theory hours of the course, a course description and list the content presented.
A maximum total of 54 theory hours of credit may be granted for completion of any pharmacology course. If the course contains additional material that is not specific to pharmacology, credit is awarded for pharmacology content, only.
just posted on the other blog
Sunday, March 13, 2011
The quiet before the brainstorm
So here I am, back at square 1 - where I was in the early 2000s, where I was when I first started the blog - trying to figger out what the hell to do w my life. The difference is I have a little more experience under my belt, I've had exposure to some of the careers I am considering, and I understand myself a little better now, so my selection process for what to pursue next should be a little more refined.
When I woke up this morning, it occurred to me that my problem with nursing school is the emphasis on paperwork. That really is what killed me both times. The first time it was indirectly because of paperwork, the second time it was directly because of paperwork (well, technically paperwork isnt the final nail in my coffin, but it is definitely THE factor this time around).
Actually learning and understanding and connecting ideas will always be my strength. The academics, even tho I could be a jerkoff and procrastinate or avoid "studying" altogether, is pretty much a non-issue. Likewise, the clinical component, actually interacting with patients and staff, being safe and therapeutic, and having a grasp of what's going on - even though I am slow at learning or performing skills at times = also a non-issue.
My biggest challenge? Homework, paperwork, whatever u wanna call it. That was my problem even before nursing school, before college even. Especially, when I consider it busywork or more trouble than it's worth (w regards to learning). That's the hardest thing for me. Sitting still long enough, staying focused long enough, getting started soon enough, finishing soon enough, etc. That's the shit that kills me. And what kills me even more is I'm convinced one can be a fine nurse without having to churn out all that paperwork. I mean it's not like I have a problem with writing nurses notes or documenting the flow sheet in a timely manner. So whatever.
So no matter what I do next, I'll be best off in a program where understanding and synthesizing is valued more than regularly churning out pages and pages of homework.
Posted by (*_*) at 10:42 AM 0 comments
The quiet before the brainstorm
So here I am, back at square 1 - where I was in the early 2000s, where I was when I first started the blog - trying to figger out what the hell to do w my life. The difference is I have a little more experience under my belt, I've had exposure to some of the careers I am considering, and I understand myself a little better now, so my selection process for what to pursue next should be a little more refined.
When I woke up this morning, it occurred to me that my problem with nursing school is the emphasis on paperwork. That really is what killed me both times. The first time it was indirectly because of paperwork, the second time it was directly because of paperwork (well, technically paperwork isnt the final nail in my coffin, but it is definitely THE factor this time around).
Actually learning and understanding and connecting ideas will always be my strength. The academics, even tho I could be a jerkoff and procrastinate or avoid "studying" altogether, is pretty much a non-issue. Likewise, the clinical component, actually interacting with patients and staff, being safe and therapeutic, and having a grasp of what's going on - even though I am slow at learning or performing skills at times = also a non-issue.
My biggest challenge? Homework, paperwork, whatever u wanna call it. That was my problem even before nursing school, before college even. Especially, when I consider it busywork or more trouble than it's worth (w regards to learning). That's the hardest thing for me. Sitting still long enough, staying focused long enough, getting started soon enough, finishing soon enough, etc. That's the shit that kills me. And what kills me even more is I'm convinced one can be a fine nurse without having to churn out all that paperwork. I mean it's not like I have a problem with writing nurses notes or documenting the flow sheet in a timely manner. So whatever.
So no matter what I do next, I'll be best off in a program where understanding and synthesizing is valued more than regularly churning out pages and pages of homework.
Posted by (*_*) at 10:42 AM 0 comments
Saturday, March 12, 2011
cant think straight
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Friday, March 11, 2011
whoa thats creepy
i just checked in here to procrastinate.
but now all the hairs on my head are standing.
and im having that electricity in the brain i get when i have "religious experiences."
that post below dated march 11 (today) @ sitting in the ER was not posted by me.
i mean i wrote it and posted it a long time ago. right before my first clinical fuck up last semester. but then i changed my mind rt away and took it down. like w/in mins of posting it.
i never deleted it. i saved it as a draft, see.
oh fuck that electricity is off the charts now. fuck.
reasonable explanations: could be a blogger glitch. or someone couldve hacked my account and posted it. (but i dont see anything else funny on my blogger dashboard...so of all things, why that post?).
crazy explanation: i've been "reaching out" for help to get me thru this nursing thing lately. and lately ive been shooting myself in the foot. like today, for instance, i shot myself in the foot on the last day of clinical for the other class. and im at the moment unprepared for tomorrw clinical which is also the last clinical for this class (tho i am working on it right now). could this post, which appeared just now w/o explantion, which kind of marked the beginning of my downward spiral be the reminder i needed from a source unseen?????????????????????????????????????????????????????????????????????????????????????
no matter the explanation, its ressurection does have significance for me.
i am thankful.
---------
p.s. i notice it was dated today @ 10something am. 2 things. 1) i was at the other clinical today at that time. 2) if i had re-published that post, it would have have retained its original publish date, sometime after midnight, sometime last semester. wow.
---------
p.p.s "that image." its changed. its more "intrusive." and in some ways, more vivid. wait. intrusive not the right word. its not unwanted. more like persistent. and its more approachable. and the electricity is still there.
but now all the hairs on my head are standing.
and im having that electricity in the brain i get when i have "religious experiences."
that post below dated march 11 (today) @ sitting in the ER was not posted by me.
i mean i wrote it and posted it a long time ago. right before my first clinical fuck up last semester. but then i changed my mind rt away and took it down. like w/in mins of posting it.
i never deleted it. i saved it as a draft, see.
oh fuck that electricity is off the charts now. fuck.
reasonable explanations: could be a blogger glitch. or someone couldve hacked my account and posted it. (but i dont see anything else funny on my blogger dashboard...so of all things, why that post?).
crazy explanation: i've been "reaching out" for help to get me thru this nursing thing lately. and lately ive been shooting myself in the foot. like today, for instance, i shot myself in the foot on the last day of clinical for the other class. and im at the moment unprepared for tomorrw clinical which is also the last clinical for this class (tho i am working on it right now). could this post, which appeared just now w/o explantion, which kind of marked the beginning of my downward spiral be the reminder i needed from a source unseen?????????????????????????????????????????????????????????????????????????????????????
no matter the explanation, its ressurection does have significance for me.
i am thankful.
---------
p.s. i notice it was dated today @ 10something am. 2 things. 1) i was at the other clinical today at that time. 2) if i had re-published that post, it would have have retained its original publish date, sometime after midnight, sometime last semester. wow.
---------
p.p.s "that image." its changed. its more "intrusive." and in some ways, more vivid. wait. intrusive not the right word. its not unwanted. more like persistent. and its more approachable. and the electricity is still there.
So I'm sitting here in the fucking ER
Even tho I have clin tmrrw
cuz when I got home not long ago one of my roommates met me outside n was all serious and freaking out and shit saying I need to go inside like rt fucking now because someone needs my help. Like rt fucking now. So I walk inside and my drinking buddy roomate is pretty much bleeding to death cuz he cut himself with a ceramic knife. Not sure what that fucking means but its all I have to go with for now.
So after failing at controlling bleeding for @ 10 mins I learn he's been bleeding nonstop for the last 20 mins. And of course I say we gotta go to th ER... but of course was followed by debating which ER to go to because of pay issues or some shit. Actually was the other roomie who snapped some sense n said to worry bout pay later bc not worth it to lose a limb over this money concern.
So anyway I don't know what the fuck is going on and I still gotta write a paper for clinical tmrrw (I kno...wtf is that, right?) And haven't done all the research yet and I don't have my shit to write it with and I don't know if I'm able to miss any clinicals and I still gotta get up early to research pt and beat traffic and get decent parking and all that shit tmrrw.
So rt now I'm debating how long I should wait b4 I should just fucking bail and let him figure out how to get hold of me. I mean dude dint even go to triage, just had his vitals checked at receptionist and off he went behind the mysterious door. For all I know he's gonna be admiitted to ICU.
And he doesn't even have my new phone number. And I don't have his. Like he can still get thru to me but its all complicated.
So where was ? I dono bu am considering emailing or texting the clin instructor abt not coming in if this runs too late into the night...
Thursday, March 10, 2011
where can i learn to be a sushi chef?
i think i would like to heal others (the psychic said i have a healer theme this lifetime) through their bellies, all while mesmerizing them with flamboyant knife skills.
oh wiat. i dont think id like to make a living by slicing up poor defenseless fishies. nvm. :(
oh wiat. i dont think id like to make a living by slicing up poor defenseless fishies. nvm. :(
Wednesday, March 9, 2011
one of the things i got written up for at the last clinical...
i totally disagree with.
the other stuff - i was guilty of, and make no excuses for, and was ready to accept whatever consequences they wanted to dish out - including being kicked out of school.
but i got written up for not reading the article* - when i did in fact read the article. i mean how the fuck could you possibly know whether a guy reads an article or not?
i was called on first.
clin instr: (*_*), what was wrong with the patient? [or whatever]
me: he needed a pacemaker
clin instr: why did he need a pacemaker?
me: something was wrong with his heart
clin instr: ...
me: ??? uhhhh.... [flips through article]
clin instr: ok [other student], why did he need a pacemaker?
and that was that.
discussion of the article ensued. that "incident" would be added to my write-up.
but rly who fucking cares if i couldnt answer that question. the reason for needing the pacemaker was trivial. and honestly, even after the post conference discussion, i still dont remember the exact reason the guy needed the pacemaker. and honestly again, i could ve read the article 10 more times, and i still wouldnt have remembered why he needed the pacemaker.
that 5 page article was about the author's aging father's decline in quality of life after having it prolonged by a pacemaker that was implanted, without his understanding that it neednt be, during an unrelated surgery. THIS is what i came prepared to discuss - the main point of the article - the bigger issues of technology, informed choice, and of quality of life versus quantity of life. i mean seriously she might as well have asked me what the name of the father was or how many times the author used the word pacemaker - more trivial bullshit that would have me drawing blanks.
see this is exactly what i mean by nursing school being so fucking annoying - more punishment and more time wasted on bullshit!!
i think this is what the psychic meant about me being a deep thinker, and more likely to succeed in other pursuits. "they" can talk about "critical thinking" and whatever all day, but all i ever see is muddy thinking, inefficiency, and laser guided focus on everything that doesnt matter. and the interesting thing is they're like 100 million times better here than in that other program.
dont get me wrong tho. i was never mad about this incident.
it is just * t o o o o o o * s t o o p i d * to get upset over.
besides, ive been written up so many times already, i dont see how it could matter.
----
*technically, i was accused verbally of not reading it, but written up for not being able to answer questions about it. whatever.
the other stuff - i was guilty of, and make no excuses for, and was ready to accept whatever consequences they wanted to dish out - including being kicked out of school.
but i got written up for not reading the article* - when i did in fact read the article. i mean how the fuck could you possibly know whether a guy reads an article or not?
i was called on first.
clin instr: (*_*), what was wrong with the patient? [or whatever]
me: he needed a pacemaker
clin instr: why did he need a pacemaker?
me: something was wrong with his heart
clin instr: ...
me: ??? uhhhh.... [flips through article]
clin instr: ok [other student], why did he need a pacemaker?
and that was that.
discussion of the article ensued. that "incident" would be added to my write-up.
but rly who fucking cares if i couldnt answer that question. the reason for needing the pacemaker was trivial. and honestly, even after the post conference discussion, i still dont remember the exact reason the guy needed the pacemaker. and honestly again, i could ve read the article 10 more times, and i still wouldnt have remembered why he needed the pacemaker.
that 5 page article was about the author's aging father's decline in quality of life after having it prolonged by a pacemaker that was implanted, without his understanding that it neednt be, during an unrelated surgery. THIS is what i came prepared to discuss - the main point of the article - the bigger issues of technology, informed choice, and of quality of life versus quantity of life. i mean seriously she might as well have asked me what the name of the father was or how many times the author used the word pacemaker - more trivial bullshit that would have me drawing blanks.
see this is exactly what i mean by nursing school being so fucking annoying - more punishment and more time wasted on bullshit!!
i think this is what the psychic meant about me being a deep thinker, and more likely to succeed in other pursuits. "they" can talk about "critical thinking" and whatever all day, but all i ever see is muddy thinking, inefficiency, and laser guided focus on everything that doesnt matter. and the interesting thing is they're like 100 million times better here than in that other program.
dont get me wrong tho. i was never mad about this incident.
it is just * t o o o o o o * s t o o p i d * to get upset over.
besides, ive been written up so many times already, i dont see how it could matter.
----
*technically, i was accused verbally of not reading it, but written up for not being able to answer questions about it. whatever.
Tuesday, March 8, 2011
its still a tossup
but i'll prbly have something satisfactory to turn in if i skip lecture today.
anyway i just realized why i find nursing school to be so fucking annoying:
I
am more interested in learning about stuff like disease, labs, treatments, etc.
THEY
are more interested in monopolizing my time with busywork and rules, all of which necessarily take me away from my interest (and my free time). crap like care plan packets is the most dramatic example, but it extends to just about everything.
anyway i just realized why i find nursing school to be so fucking annoying:
I
am more interested in learning about stuff like disease, labs, treatments, etc.
THEY
are more interested in monopolizing my time with busywork and rules, all of which necessarily take me away from my interest (and my free time). crap like care plan packets is the most dramatic example, but it extends to just about everything.
Monday, March 7, 2011
typical.
so im in the position where i have to churn out a bunch of careplan packets by tmrrw afternoon or i can pretty much kiss this whole nursing thing goodbye. thing is ive been sitting here for hours and i still cant get started. i cancelled my plans for the evening so i can do this? sit here and procrastinate? its fucking stupid.
sitting here for hours, what i have accomplished is i've listened to a bunch of music i normally wouldnt listen to and ive read all kinds of blogs i normally wouldnt read. like the one by the gay guy with his unusually graphic tale of getting cockblocked by a particularly self-centered friendd or roomie or something while he was naked making out with some guy he was about to bone (lol).
i've also contemplated starting a (real) nursing school blog (again). theres a lot to consider. but theres kinda no point if im not even gonna be in nursing school 24 hours from now :( and even if i make it past tomorrow, i still have fri to deal with. then saturday. and all their paperworks. :(
heres the thing. i feel a lot more focused than i have in a while....xcept when it comes to careplan packets. they just fuck everything all up.
a long time ago i told myself i wouldnt complain about nursing school anymore (like i used to). and i havent. even in this post i havent. and wont. but fucking aye. those fucking careplan packets....
sitting here for hours, what i have accomplished is i've listened to a bunch of music i normally wouldnt listen to and ive read all kinds of blogs i normally wouldnt read. like the one by the gay guy with his unusually graphic tale of getting cockblocked by a particularly self-centered friendd or roomie or something while he was naked making out with some guy he was about to bone (lol).
i've also contemplated starting a (real) nursing school blog (again). theres a lot to consider. but theres kinda no point if im not even gonna be in nursing school 24 hours from now :( and even if i make it past tomorrow, i still have fri to deal with. then saturday. and all their paperworks. :(
heres the thing. i feel a lot more focused than i have in a while....xcept when it comes to careplan packets. they just fuck everything all up.
a long time ago i told myself i wouldnt complain about nursing school anymore (like i used to). and i havent. even in this post i havent. and wont. but fucking aye. those fucking careplan packets....
Wednesday, February 23, 2011
so this psychic says...
in a past life i was an american female nurse who died in the korean war - and thats why i got drawn (back) into nursing this time around.
ok, then i guess careplan packets must have been a recent addition to nursing education bc no way in hell i would willingly put up w that careplan crap two lifetimes in a row. f that.
---
also, nursing per se is not rly my path this lifetime as much as is expressing my healer theme through writing/teaching/touch, where i would find more success.
ok, then i guess careplan packets must have been a recent addition to nursing education bc no way in hell i would willingly put up w that careplan crap two lifetimes in a row. f that.
---
also, nursing per se is not rly my path this lifetime as much as is expressing my healer theme through writing/teaching/touch, where i would find more success.
Thursday, February 10, 2011
Friday, January 21, 2011
i just printed off 16 pages of paperwork for clinical tomorrow
really? 16 pages every single week? ms "clarafy" thinks this is necessary? wtf?
on a positive note, i dont see that ridiculous time consuming medication form (which ironically i prbly like the most out of all the paperwork (besides the systems assx form...which also is absent) even tho its more trouble than its worth imo)
on a positive note, i dont see that ridiculous time consuming medication form (which ironically i prbly like the most out of all the paperwork (besides the systems assx form...which also is absent) even tho its more trouble than its worth imo)
Wednesday, January 19, 2011
fucking aye are u srs?
all i wanted to do in the current program....was to fly under the radar and graduate just being an average joe. or a john doe. hahaha. usu i draw attn by being fucking excellent. well ive done a marvelous job of avoiding excellence. but fucking a, i still blip on the directors's (yeh theres two) radars....only for stupid shit. latest shit: having a clin instr email the dir @ me for not knowing (bc no one ever told me) there is a hospital....errrr health care facitlity orientation tmrrw. lollolololool
:(
oh and btw...rly? this inst couldnt just give me info about the orientation? instead has to mail the director to "clarafy" (lol) the issue? gimme a fucking break.
:(
oh and btw...rly? this inst couldnt just give me info about the orientation? instead has to mail the director to "clarafy" (lol) the issue? gimme a fucking break.
Tuesday, January 11, 2011
whats new, part iii
so i just did the math
i need 100/150 questions right on teh final just to pass. thats 66.666%
should be doable right? right?!!!!
i dont know. fuck.
i need 100/150 questions right on teh final just to pass. thats 66.666%
should be doable right? right?!!!!
i dont know. fuck.
whats new, part II
7.5hrs b4 the final shouldnt be the time where u go..."oh so thats what [basic terminology/concept/etc] is"
better late than never. but fuuuu... i gotta stop doing it like this.
better late than never. but fuuuu... i gotta stop doing it like this.
Monday, January 10, 2011
so whats new?
i had so many chances...
yet here i am, hanging by the skin of my teeth again.
i need a miracle.
but maybe an allnighter will do. :) and :(
yet here i am, hanging by the skin of my teeth again.
i need a miracle.
but maybe an allnighter will do. :) and :(
Sunday, December 12, 2010
natural child birth
another thing i learned is whole childbirth often(?) involves popping babies out in water.
delivery under the water!!!
dolphins optional.
delivery under the water!!!
dolphins optional.
placenta
so i learned last friday that some people eat placenta.
Cooking Up Placenta
first bite @ 2:25. "livery but nice." nice.
i wanna see this on iron chef one day: "today's secret ingredient....PLACENTA!!!"
Cooking Up Placenta
first bite @ 2:25. "livery but nice." nice.
i wanna see this on iron chef one day: "today's secret ingredient....PLACENTA!!!"
Thursday, December 9, 2010
oh one more thing
take home tests where u have to cite the rationale out the textbook are the deal. for me, theyre more helpful than any other assignments, papers, quizzes, in-class exams, and studying for those things. if i had nothing but take home tests like this from this point out, i'd be in really good shape.
oh and one other more thing...i kinda put myself in the position again where i have to cram to learn basically the whole classs before the final again. the good news is kinda know the main points and at least i gave my self several weeks this time. :)
oh and one other more thing...i kinda put myself in the position again where i have to cram to learn basically the whole classs before the final again. the good news is kinda know the main points and at least i gave my self several weeks this time. :)
cool trick
if u iron ur scrubs right out the washer while theyre still wet, you can save so much time/effort on ironing them compared to when theyre dry...esp if they dry with wrinkles. ill pbly iron again before i wear them but seems that depending on how you store em to dry while theyre damp, u might not even have to iron them again.
this may only be worth mentioning if u normally hang dry em like i do. if u let em hang and they dry w wrinkles, it sometimes takes some effort to iron the wrinkles out. i dont remember what theyre like if u put em in dryer. the only times these scrubs went in the dryer was when somebody put them in the dryer wo me knowing way back in feb or something like that.
this may only be worth mentioning if u normally hang dry em like i do. if u let em hang and they dry w wrinkles, it sometimes takes some effort to iron the wrinkles out. i dont remember what theyre like if u put em in dryer. the only times these scrubs went in the dryer was when somebody put them in the dryer wo me knowing way back in feb or something like that.
Thursday, October 28, 2010
this what i'm up against
here's my med surg clinical instructor, peter pan
i just dont get this guy.
here's peter pan ignoring yet another one of my emails
here's how the talk we had last week should have gone
peter pan: you didnt bring your paperwork. that means you will pass meds late as a nurse.
*me: rly? thats a pretty fucking stupid analogy. those things are nothing alike. in one situation, i'm already on the floor doing what i'm getting paid to do, for real life sick patients that need their meds to get better. in the other i have to slave away for hours to write some time consuming steaming pile of garbage that is 1% useful, 99% busywork that i failed to grab on my way out the door.
peter pan: i'm concerned that you are concerned with passing the course. i question your motives for being a nurse. and i need to protect the nursing profession.
*me: u fucking kidding me? you know i need to pass to move the fuck on in the program dont u? n you realize u just pulled me aside to tell me that im not passing the course, rt? if passing is not a big deal, then why did u bring it up in the first place? the whole point is so i can make some changes so that i can pass...er i'd like to think it is. cuz if you pulled me aside to just let your inner dickhead rant about how youve got something personal against me...then fuck you. and my motives? excuse me but go fuck yourself. youre seriously overstepping your boundaries there buddy. i'm here to learn nursing and youre here to teach it. you need to evaluate and teach nursing. and just nursing. my motives and my life outside of clinicals is none of your fucking business got it?
peter pan: you're obviously knowledgeable about the medical stuff when i ask you about it. but that's not everything.
*me: doooooooood. i get it. you dont like me and youre trying to downplay everything and anything that actually matters and instead want to bitch and rage inappropriately about some stupid papers like its the most important thing in the world and im a failure with no redeeming qualities because of it. ZZZzzzzzz.
* = what i should have said but didnt
-------------
to be finished/edited later.
i'm supposed to work on some presentation thing for tmrrw. uggh.
i just dont get this guy.
here's peter pan ignoring yet another one of my emails
here's how the talk we had last week should have gone
peter pan: you didnt bring your paperwork. that means you will pass meds late as a nurse.
*me: rly? thats a pretty fucking stupid analogy. those things are nothing alike. in one situation, i'm already on the floor doing what i'm getting paid to do, for real life sick patients that need their meds to get better. in the other i have to slave away for hours to write some time consuming steaming pile of garbage that is 1% useful, 99% busywork that i failed to grab on my way out the door.
peter pan: i'm concerned that you are concerned with passing the course. i question your motives for being a nurse. and i need to protect the nursing profession.
*me: u fucking kidding me? you know i need to pass to move the fuck on in the program dont u? n you realize u just pulled me aside to tell me that im not passing the course, rt? if passing is not a big deal, then why did u bring it up in the first place? the whole point is so i can make some changes so that i can pass...er i'd like to think it is. cuz if you pulled me aside to just let your inner dickhead rant about how youve got something personal against me...then fuck you. and my motives? excuse me but go fuck yourself. youre seriously overstepping your boundaries there buddy. i'm here to learn nursing and youre here to teach it. you need to evaluate and teach nursing. and just nursing. my motives and my life outside of clinicals is none of your fucking business got it?
peter pan: you're obviously knowledgeable about the medical stuff when i ask you about it. but that's not everything.
*me: doooooooood. i get it. you dont like me and youre trying to downplay everything and anything that actually matters and instead want to bitch and rage inappropriately about some stupid papers like its the most important thing in the world and im a failure with no redeeming qualities because of it. ZZZzzzzzz.
* = what i should have said but didnt
-------------
to be finished/edited later.
i'm supposed to work on some presentation thing for tmrrw. uggh.
Wednesday, October 27, 2010
i still can't believe it...
i'm still putting in more time/effort into OB than MedSurg.
why the fuck im doing this - i dont know. (i'm never gonna work in this area).
yet here i am doing it again.
and i do this wk after wk. (xcept when i slack off and dont put any time into either one).
weird.
why the fuck im doing this - i dont know. (i'm never gonna work in this area).
yet here i am doing it again.
and i do this wk after wk. (xcept when i slack off and dont put any time into either one).
weird.
Monday, July 19, 2010
vicodin
1: 2's going crazy with the drinking. did u notice?
me: 20 beers that one night. then again the next day. crazy.
1: and he's on that medicine...
me: yeah well at least the hospital's close by
1: ha but what if something happens and neither of us are here?
me: oh yeah huh. maybe i should talk to him...
with 2's super binge drinking combined with the fact that we just went over opioids at school, the timing is great to find out why he shouldnt drink while on vicodin.
ok so it's pretty simple...
Vicodin = hydrocodone + acetaminophen
1. etoh is hepatotoxic and a cns depressant
2. acetaminophen is hepatoxic. acetaminophen + etoh >> additive hepatoxoxicity
3. hydrocodone is a cns depressant. hydrocodone + etoh >> additive cns depression
the last time i asked him if he knew what might happen, he said his liver would bleed. that's a start. i suppose i could find out whether he understands how bad life would suck if he wrecks his liver.
Tuesday, July 6, 2010
clinical 7/6/10
change in c.i.
-just when i was warming up to the other, we get a new c.i. let's see how it goes...
aox2
-i think if you have any doubt, you should just go ahead and ask the questions. i was surprised at what year he thought it was.
a-fib
-rapid, irregularly irregular atrial rhythm; atria dont contract, av system bombarded with many electrical stimuli, causing insonsistent irregularly irregular ventricular rate, usu tachycardic; atrial thrombi often form >> risk of embolic stroke; one of most common arrhythmias; affects men and whites more; affects 10% of people 80+ yo; sometimes precipitates HF (bc CO decr w/o atrial contraction); the longer AF present, the less likely is spontaneous conversion, or cardioversion by any means
-most common causes: htn, cardiomyopathy, mitral valve DOs (left AV valve), hyperthyroidism, binge drinking
-sx: irregularly irregular pulse, often otherwise asymptomatic
-dx by ekg: wavy baseline, lacks discernible P waves (atria), irregular QRSs
tx: drugs to control hr, anticoagulation drugs, cardioversion
tamsulosin (Flomax)
-tx s/s bph
-moa: a1-blocker relaxes bladder sm >> urine flow improved >> decr s/s bph
-adv fx: hypotension
ezetimibe (Zetia)
-tx hypercholesterolemia
-reduces plasma cholesterol by blocking absorption of it in the small intestine
-just when i was warming up to the other, we get a new c.i. let's see how it goes...
aox2
-i think if you have any doubt, you should just go ahead and ask the questions. i was surprised at what year he thought it was.
a-fib
-rapid, irregularly irregular atrial rhythm; atria dont contract, av system bombarded with many electrical stimuli, causing insonsistent irregularly irregular ventricular rate, usu tachycardic; atrial thrombi often form >> risk of embolic stroke; one of most common arrhythmias; affects men and whites more; affects 10% of people 80+ yo; sometimes precipitates HF (bc CO decr w/o atrial contraction); the longer AF present, the less likely is spontaneous conversion, or cardioversion by any means
-most common causes: htn, cardiomyopathy, mitral valve DOs (left AV valve), hyperthyroidism, binge drinking
-sx: irregularly irregular pulse, often otherwise asymptomatic
-dx by ekg: wavy baseline, lacks discernible P waves (atria), irregular QRSs
tx: drugs to control hr, anticoagulation drugs, cardioversion
tamsulosin (Flomax)
-tx s/s bph
-moa: a1-blocker relaxes bladder sm >> urine flow improved >> decr s/s bph
-adv fx: hypotension
ezetimibe (Zetia)
-tx hypercholesterolemia
-reduces plasma cholesterol by blocking absorption of it in the small intestine
Tuesday, June 22, 2010
clinical 6/22
dextromethorphan
-otc antitussive
-dosage to tx cough = 20-30mg per dose
-been shown to alleviate pain at doses 60+mg
-no way i couldve known the pain thing unless ask provider...cuz not in drug book. cool the nurse already asked and told me. acutally she gave me full report since i missed the change of shift report. cool x2.
oxymizer (i think thats what they called it. classmate's pt)
-looks like nasal cannual xcept its high flow. 10 lpm. sounds hard on the nose?
pulse ox
-leave on for 30-45secs at least
-if low, ask pt to deep breathe. watch spo2 shoot right up.
Protonix (pantoprazole)
- tx gerd/hypersecretions
-proton pump inhibitor: inhibits gastric acid secretion.
-"prazoles" = proton pump inhibitors. eg, omeprazole, pantoprazole, etc.
hydromorphone (Dilaudid)
-was able to give, despite allergy to morphine. no x-sensitivity?
-1.5mg IV = 10mg IV morphine. >> more potent
-duration via IV = 2 hrs. pt needed it every 2 hrs.
-induces sedation. major sleepiness is sidefx everytime i've ever seen this.
-burns veins when given iv. trick learned: dilute it into 5mL NS. then administer slowly over a minute. easier to control rate of 5mL then 1mL. (used 1mg=1mL). oh yeah flush w ns b4 n after.
pancreatitis
-sx incl: epigastric pain (pt's complaint, along w diarrhea, which brought her to the er)
-acute & chronic forms
-both forms involve inappropriately activated enzymes
-will have elevated amylase and lipase
-in men: assoc w alcoholism, tauma, peptic ulcer, poor prognosis (pt was female, and not etoh abuser)
-tx includes going npo (pt was on liquid diet)
-care incl pain, n/v, etc. (pt said appetite lil bc pain, nausea, drowsy)
crohn's dz
-part of inflamm bowel dz (ibd), along with ulcerative colitis
-most common in caucasians and ashkenazi jews, appearing most frequently during teens-early30s or in the 50s (pt was mid30s...and said had some gi condition..forget which...for the last 2 yrs).
-aka regional enteritis aka granulomatous colitis
-chronic inflamm of any part of gi tract (usu terminal ileum) extending through all layers of the intestinal wall
-cause unknown
-s/s incl: steady pain RLQ, cramping, diarrhea (these r sx pt had. when i assx pain, it was sharp pain. but whoever assx the prev 2 days doc'd cramping pain. but then again pain i assx, was epigastric...prbly r/t pancreatitis).
blood transfusion, post-op knee (other pt)
-device drains blood, u empty blood from that container into iv bag, then hang that iv bag and infuse it back into pt (thru reg iv catheter, not back into the knee specifically) along with ns
compression stockings
-my pt had elastic stockings (supposedly not used much these days)...dvt prophylaxis bc recent colon resection
-blood transfusion guy had other kind that wrap around with velcro and are inflated with some sort of electric pump.
head to toe assx
-hand push/pull: if pt has iv in hand veins, gotta find another way bc it will be painful for them!!
-gotta remember to listen to apical after lung sounds! just keep steth on....listen lungs-heart-ab b4 taking it off...faster!
-make sure they know hob coming up. not just height of bed!
clinical instructors (all instructors, rly) here are so much better than at prev program. they actually use clinicals as teaching/learning opportunities...during clinicial, as well as pre- and post- conf. imagine that!!
p.s. coolest, most rebellious, punkish, stylish rn uniform ever: this dykish looking nurse wore a grayish top, grayish, nearly form-hugging, camo pants, black shoes that kinda looked like boots (but werent), black fanny pack that was nothing special but just lookd tuff w that outfit, bracelets n rubberbands on one hand, triple hoop rings in each ear, dark hair that kinda came up in a messy faux hawk type thing that was dyed blue at the top. it worked. maybe one day i will push the limits with my uniform...
-otc antitussive
-dosage to tx cough = 20-30mg per dose
-been shown to alleviate pain at doses 60+mg
-no way i couldve known the pain thing unless ask provider...cuz not in drug book. cool the nurse already asked and told me. acutally she gave me full report since i missed the change of shift report. cool x2.
oxymizer (i think thats what they called it. classmate's pt)
-looks like nasal cannual xcept its high flow. 10 lpm. sounds hard on the nose?
pulse ox
-leave on for 30-45secs at least
-if low, ask pt to deep breathe. watch spo2 shoot right up.
Protonix (pantoprazole)
- tx gerd/hypersecretions
-proton pump inhibitor: inhibits gastric acid secretion.
-"prazoles" = proton pump inhibitors. eg, omeprazole, pantoprazole, etc.
hydromorphone (Dilaudid)
-was able to give, despite allergy to morphine. no x-sensitivity?
-1.5mg IV = 10mg IV morphine. >> more potent
-duration via IV = 2 hrs. pt needed it every 2 hrs.
-induces sedation. major sleepiness is sidefx everytime i've ever seen this.
-burns veins when given iv. trick learned: dilute it into 5mL NS. then administer slowly over a minute. easier to control rate of 5mL then 1mL. (used 1mg=1mL). oh yeah flush w ns b4 n after.
pancreatitis
-sx incl: epigastric pain (pt's complaint, along w diarrhea, which brought her to the er)
-acute & chronic forms
-both forms involve inappropriately activated enzymes
-will have elevated amylase and lipase
-in men: assoc w alcoholism, tauma, peptic ulcer, poor prognosis (pt was female, and not etoh abuser)
-tx includes going npo (pt was on liquid diet)
-care incl pain, n/v, etc. (pt said appetite lil bc pain, nausea, drowsy)
crohn's dz
-part of inflamm bowel dz (ibd), along with ulcerative colitis
-most common in caucasians and ashkenazi jews, appearing most frequently during teens-early30s or in the 50s (pt was mid30s...and said had some gi condition..forget which...for the last 2 yrs).
-aka regional enteritis aka granulomatous colitis
-chronic inflamm of any part of gi tract (usu terminal ileum) extending through all layers of the intestinal wall
-cause unknown
-s/s incl: steady pain RLQ, cramping, diarrhea (these r sx pt had. when i assx pain, it was sharp pain. but whoever assx the prev 2 days doc'd cramping pain. but then again pain i assx, was epigastric...prbly r/t pancreatitis).
blood transfusion, post-op knee (other pt)
-device drains blood, u empty blood from that container into iv bag, then hang that iv bag and infuse it back into pt (thru reg iv catheter, not back into the knee specifically) along with ns
compression stockings
-my pt had elastic stockings (supposedly not used much these days)...dvt prophylaxis bc recent colon resection
-blood transfusion guy had other kind that wrap around with velcro and are inflated with some sort of electric pump.
head to toe assx
-hand push/pull: if pt has iv in hand veins, gotta find another way bc it will be painful for them!!
-gotta remember to listen to apical after lung sounds! just keep steth on....listen lungs-heart-ab b4 taking it off...faster!
-make sure they know hob coming up. not just height of bed!
clinical instructors (all instructors, rly) here are so much better than at prev program. they actually use clinicals as teaching/learning opportunities...during clinicial, as well as pre- and post- conf. imagine that!!
p.s. coolest, most rebellious, punkish, stylish rn uniform ever: this dykish looking nurse wore a grayish top, grayish, nearly form-hugging, camo pants, black shoes that kinda looked like boots (but werent), black fanny pack that was nothing special but just lookd tuff w that outfit, bracelets n rubberbands on one hand, triple hoop rings in each ear, dark hair that kinda came up in a messy faux hawk type thing that was dyed blue at the top. it worked. maybe one day i will push the limits with my uniform...
Tuesday, June 15, 2010
clinical 6/15: 2.5 hour code
i'd like to write something great that captures the moment but meh i got too much shit to do. n if i put it off for later, ill never get around to writing about it. so a rambling, hurried, half-ass post will have to do...
so on the way back from the multidisciplinary meeting, er nurse c tells our clinical instructor that there is a code in the ER, send over a couple students. i was grazing behind at the back of the group, still behind the corner when he told us this. but i heard it. and quickly turned the corner rt in his line of view and practically started jumping up and down pointing at myself "pick me pick me pick me pick me pick me pick me pick me!" ok i wasnt literally jumping but i was changing levels at my knees. lol.
picked. yes!
so me and my classmate (who i wouldnt peg as the er "type") follow er nurse c down to the er.
upon getting there, there's talk at the nurses station (or whatever u call it in the er) that the pt might not make it in. i sorta felt like a jerk for being disappointed. i wasnt disappointed bc he died. or because i missed an opportunity to help save his lfie. theres nothing wrong with that. no, was disappointed bc i wouldnt get to do cpr and the code n stuff.
so we hang out for a while. saw how everyone gets ready for the code. how they position stuff in the big room to makee space. how RTs are on standby with their bags and machines and stuff. how the ekg tech and whoever else are on standy with their machines and stuff. how the nurses are on standyb with their different roles: how the one nurse is in communication with the medics, how the recorder nurse is ready with her papers and clipboard, how the med nurse and whatever other nurses are hanging out in the area where they would soon do most of there work.
how nurse c had these two cases of emergency meds ready on top of a....was it a bed it was on top of? i dont remember. (nurse c had me and the classmate open the plastic breakaway things keeping the cases shut by twisting them). one case was just like multiple compartments of epi, atropine, both prefilled in syringes built for emergency administration it seems. also there was bicarb, glucose, and some iv bags, the contents of which i didnt ever know. the other case had stuff that was in vials. the only comaprtment i rember for sure was amiodirone (sp?), because we used it.
nurse c's role was to prepare the meds that are called out and hand em to whoever. i think it was nurses actually doing the administering. nurse c was cool. she let me fumble with withdrawing the amiodarone into the syringe. she gave the classmate an opportunity to do prepare a quickdraw atropine or epi or whatevr. she took time to explain stuff and let us try stuff. she was even pretty proactive about getting me in there to do cpr. :)
in all, the drugs we used throughout the code:
*epi
*atropine
saw first hand (multiple times!!) how atropine and epi could take a pt from a 20 or 40 pulse to 120 within seconds! did similar things for bp. dont remember how low it got, but i 220/160 sounds about rt for the highs.
*bicarb (na bicarobate? i dont remember)
will have to read up why was used. but when doc called for it, it was usually around the time he wanted atropine. didnt always call for them together, but when he wanted bicarb, he wanted atropine. always insisted on bicarb b4 atropine.
*heparin.
"5000 bolus." we used it bc doc suspected ischemic MI.
*amiadrione.
used it once. im vaguely familiar with it. know its a heart med. wanna say its for arrhythmias.
-a rectal aspirin (or something). which was weird. the guy shit his pants. not sure if it was b4 or after.
finally i hear someone announce they're here outside. not long after 4 or 5 firefight paramedics come in with a fat guy covered with tubes on top of a stretcher. he kind of stays to the back rattling off the history. there was a lot of confusion and unknowns about this pt xcept this 60 yo male has a history of seizures, and prior to 911 he told his wife he had chest pain, clutched his chest, started seizing, then stopped breathing. (i think). meanwhile there was a lot of impressive teamwork going on, everyone playing out different roles, calling out this and that. everyone was playing independently, and it all worked out and had an organized feel to it. if i didnt know any better, i wouldve guessed it was all orchestrated and rehearsed. it was like an antfarm or something.
meh im getting tired of writing and spending too much time on this. so just bunch of unorganized, barebones bulletpoints now.
-nurse putting in foley set up sterile field n stuff. but didnt come close to maintaining sterility. classmate told me to watch. wonder if she knew nurse's field was contaminated in 2 places.
-i kick ass at chest compressions. sorry dude, didnt mean to break your ribs or sternum or watever. but compressions were most effective when i rotated in. doc says 2 per second. theres this monitor where you can see chest compression rate/depth/etc. i was pretty steady and had the right depth. broke the chest during my second rotation when the compressions werent as deep as they had been during my first set. see it was a big guy who had big lungs i guess, so the doc wanted the compressions deep. i think it was kinda my hand placement the second time. during my first set, i kinda didnt want to stop. i could see that i was more effective than everyone else doing compressions. but i was afraid i would get tired and lose effectiveness during future sets, so i agreed to let others rotate in after i felt kinda tired. i was winded, sweating, and started to feel my triceps burning. rt teacher dood handed me a towel. lol.
-there sure were a lot of ups/downs when it came to vitals. theyd give drugs to boost em up, then they'd drop back down.
-pts blood glucose was like almost 300 but doc said no insulin, wanted pt to keep blood glucose as high as possible. asked nurse c, she said it was to give the guy extra sugar for his brain n stuff.
-there was talk several times questioning the quality of life this guy would have if he made it. early on there was lots of pessimism about his chances. i'm glad they didnt give up. ironically, i am pessimistic about his chances travelling by ambulance to wherever it is they transferred him to. we had to do a lot of shit there in the er.
-but pt had to get transferred to a better equipped er. i'm at a pretty small hospital. when i got back to the floor, the sitter for my pt, who is a new grad nurse waiting for her new grad program to start this summer, was surprised anything like this happened in this er. she said she once had to float down there for a week and it was "pretty chill," which is fine for her since she doesnt like dramatic er stuff anywyay. on another side note, listening to her and the dialysis guy (a nurse?) talk, i got to hear their opinions for which local hospitals are good to work for.
-early on nurse c said she dint think it would end well. doc was ready to give up pretty early on. but 2nd doc didnt want to, said he'd feel bad about doing that. when family showed up, they decided to keep goin.
-classmate was amped up on adrenaline well after the scene was over and we were out of the er. surprised me for a couple reasons. one, she said she wants to do er now because of the focus she felt during all this. i can relate to the focus thing btw but i wouldnt of guessed she was like that. i wouldve guessed it would be overwhelming for her. but i was also surprised bc she didnt get the hands on that i did, right there rotating in doing cpr (she kinda just watched from afar, and in fact seemed kind of nervous when she was asked if she wanted to do it, in fact she insisted i go do it...not once but multiple times), yet for me, it was just something new and cool to be part of. not to say, i didnt care if the pt made it...bc i did want him to make it and was glad when his pulse came back after my compressions. i've spent good times in about 4 ers in my time, even been in various "situations," mosly involving 5150, psych, and drugged out pts, but this was my first cpr code and i like it. er wasnt nearly as exciting as i thought itd be except for those few "situations."
-true story: before i decided to return to nursing school, i was going to do rt school instead because i heard its exciting. and thats what i told the rt students there, who were bagging and rotating in with the chest compressions. the one guy offered to let me rotate in for bagging. pts pulse came back tho. wouldnt mind bagging rt student chick.
-the only emotionally arousing part for me was when the family showed up and i saw what mustve been the wife crying right outside the doorway after they shoo'd the nonessential peeps out of the room. actually it was more what i think mustve been the daughter that set me off. i had to look away everytime i saw her crying. (side note: the only time i came close to feeling that way was when i was in the other program following the home hospice nurse when we sat down with the early-20s-something yo daughter of a patient who the hospice nurse believed was on his way out. er daughter experience was much more intense tho).
-one of nurse c's responsibilities was to talk to the family. i asked if she did it bc was a responsibility or just thats the kind of thing that she gravitates to. she said both. but yes, is responsibility.
k, ill just wrap it up cuz im writing like crap now.
will just say my pt on the floor was pretty interesting too. 91 yo who looks 50. his secret is scotch and water almost daily. haha. dialysis. edema. pacemaker. defibrillator. cataracts returning after lasiks. interesting skins. low ass bp. like 70/50, but denies dizziness. hx crf, pna, hyperlipidemia, diverticulosis, and a bunch of stuff. if i had time to learn all his issues, tx, and meds, i'd learn alot. too bad i dont.
cool clinical day.
so on the way back from the multidisciplinary meeting, er nurse c tells our clinical instructor that there is a code in the ER, send over a couple students. i was grazing behind at the back of the group, still behind the corner when he told us this. but i heard it. and quickly turned the corner rt in his line of view and practically started jumping up and down pointing at myself "pick me pick me pick me pick me pick me pick me pick me!" ok i wasnt literally jumping but i was changing levels at my knees. lol.
picked. yes!
so me and my classmate (who i wouldnt peg as the er "type") follow er nurse c down to the er.
upon getting there, there's talk at the nurses station (or whatever u call it in the er) that the pt might not make it in. i sorta felt like a jerk for being disappointed. i wasnt disappointed bc he died. or because i missed an opportunity to help save his lfie. theres nothing wrong with that. no, was disappointed bc i wouldnt get to do cpr and the code n stuff.
so we hang out for a while. saw how everyone gets ready for the code. how they position stuff in the big room to makee space. how RTs are on standby with their bags and machines and stuff. how the ekg tech and whoever else are on standy with their machines and stuff. how the nurses are on standyb with their different roles: how the one nurse is in communication with the medics, how the recorder nurse is ready with her papers and clipboard, how the med nurse and whatever other nurses are hanging out in the area where they would soon do most of there work.
how nurse c had these two cases of emergency meds ready on top of a....was it a bed it was on top of? i dont remember. (nurse c had me and the classmate open the plastic breakaway things keeping the cases shut by twisting them). one case was just like multiple compartments of epi, atropine, both prefilled in syringes built for emergency administration it seems. also there was bicarb, glucose, and some iv bags, the contents of which i didnt ever know. the other case had stuff that was in vials. the only comaprtment i rember for sure was amiodirone (sp?), because we used it.
nurse c's role was to prepare the meds that are called out and hand em to whoever. i think it was nurses actually doing the administering. nurse c was cool. she let me fumble with withdrawing the amiodarone into the syringe. she gave the classmate an opportunity to do prepare a quickdraw atropine or epi or whatevr. she took time to explain stuff and let us try stuff. she was even pretty proactive about getting me in there to do cpr. :)
in all, the drugs we used throughout the code:
*epi
*atropine
saw first hand (multiple times!!) how atropine and epi could take a pt from a 20 or 40 pulse to 120 within seconds! did similar things for bp. dont remember how low it got, but i 220/160 sounds about rt for the highs.
*bicarb (na bicarobate? i dont remember)
will have to read up why was used. but when doc called for it, it was usually around the time he wanted atropine. didnt always call for them together, but when he wanted bicarb, he wanted atropine. always insisted on bicarb b4 atropine.
*heparin.
"5000 bolus." we used it bc doc suspected ischemic MI.
*amiadrione.
used it once. im vaguely familiar with it. know its a heart med. wanna say its for arrhythmias.
-a rectal aspirin (or something). which was weird. the guy shit his pants. not sure if it was b4 or after.
finally i hear someone announce they're here outside. not long after 4 or 5 firefight paramedics come in with a fat guy covered with tubes on top of a stretcher. he kind of stays to the back rattling off the history. there was a lot of confusion and unknowns about this pt xcept this 60 yo male has a history of seizures, and prior to 911 he told his wife he had chest pain, clutched his chest, started seizing, then stopped breathing. (i think). meanwhile there was a lot of impressive teamwork going on, everyone playing out different roles, calling out this and that. everyone was playing independently, and it all worked out and had an organized feel to it. if i didnt know any better, i wouldve guessed it was all orchestrated and rehearsed. it was like an antfarm or something.
meh im getting tired of writing and spending too much time on this. so just bunch of unorganized, barebones bulletpoints now.
-nurse putting in foley set up sterile field n stuff. but didnt come close to maintaining sterility. classmate told me to watch. wonder if she knew nurse's field was contaminated in 2 places.
-i kick ass at chest compressions. sorry dude, didnt mean to break your ribs or sternum or watever. but compressions were most effective when i rotated in. doc says 2 per second. theres this monitor where you can see chest compression rate/depth/etc. i was pretty steady and had the right depth. broke the chest during my second rotation when the compressions werent as deep as they had been during my first set. see it was a big guy who had big lungs i guess, so the doc wanted the compressions deep. i think it was kinda my hand placement the second time. during my first set, i kinda didnt want to stop. i could see that i was more effective than everyone else doing compressions. but i was afraid i would get tired and lose effectiveness during future sets, so i agreed to let others rotate in after i felt kinda tired. i was winded, sweating, and started to feel my triceps burning. rt teacher dood handed me a towel. lol.
-there sure were a lot of ups/downs when it came to vitals. theyd give drugs to boost em up, then they'd drop back down.
-pts blood glucose was like almost 300 but doc said no insulin, wanted pt to keep blood glucose as high as possible. asked nurse c, she said it was to give the guy extra sugar for his brain n stuff.
-there was talk several times questioning the quality of life this guy would have if he made it. early on there was lots of pessimism about his chances. i'm glad they didnt give up. ironically, i am pessimistic about his chances travelling by ambulance to wherever it is they transferred him to. we had to do a lot of shit there in the er.
-but pt had to get transferred to a better equipped er. i'm at a pretty small hospital. when i got back to the floor, the sitter for my pt, who is a new grad nurse waiting for her new grad program to start this summer, was surprised anything like this happened in this er. she said she once had to float down there for a week and it was "pretty chill," which is fine for her since she doesnt like dramatic er stuff anywyay. on another side note, listening to her and the dialysis guy (a nurse?) talk, i got to hear their opinions for which local hospitals are good to work for.
-early on nurse c said she dint think it would end well. doc was ready to give up pretty early on. but 2nd doc didnt want to, said he'd feel bad about doing that. when family showed up, they decided to keep goin.
-classmate was amped up on adrenaline well after the scene was over and we were out of the er. surprised me for a couple reasons. one, she said she wants to do er now because of the focus she felt during all this. i can relate to the focus thing btw but i wouldnt of guessed she was like that. i wouldve guessed it would be overwhelming for her. but i was also surprised bc she didnt get the hands on that i did, right there rotating in doing cpr (she kinda just watched from afar, and in fact seemed kind of nervous when she was asked if she wanted to do it, in fact she insisted i go do it...not once but multiple times), yet for me, it was just something new and cool to be part of. not to say, i didnt care if the pt made it...bc i did want him to make it and was glad when his pulse came back after my compressions. i've spent good times in about 4 ers in my time, even been in various "situations," mosly involving 5150, psych, and drugged out pts, but this was my first cpr code and i like it. er wasnt nearly as exciting as i thought itd be except for those few "situations."
-true story: before i decided to return to nursing school, i was going to do rt school instead because i heard its exciting. and thats what i told the rt students there, who were bagging and rotating in with the chest compressions. the one guy offered to let me rotate in for bagging. pts pulse came back tho. wouldnt mind bagging rt student chick.
-the only emotionally arousing part for me was when the family showed up and i saw what mustve been the wife crying right outside the doorway after they shoo'd the nonessential peeps out of the room. actually it was more what i think mustve been the daughter that set me off. i had to look away everytime i saw her crying. (side note: the only time i came close to feeling that way was when i was in the other program following the home hospice nurse when we sat down with the early-20s-something yo daughter of a patient who the hospice nurse believed was on his way out. er daughter experience was much more intense tho).
-one of nurse c's responsibilities was to talk to the family. i asked if she did it bc was a responsibility or just thats the kind of thing that she gravitates to. she said both. but yes, is responsibility.
k, ill just wrap it up cuz im writing like crap now.
will just say my pt on the floor was pretty interesting too. 91 yo who looks 50. his secret is scotch and water almost daily. haha. dialysis. edema. pacemaker. defibrillator. cataracts returning after lasiks. interesting skins. low ass bp. like 70/50, but denies dizziness. hx crf, pna, hyperlipidemia, diverticulosis, and a bunch of stuff. if i had time to learn all his issues, tx, and meds, i'd learn alot. too bad i dont.
cool clinical day.
Tuesday, June 1, 2010
clinical 6/1/10
random observation. dont feel like elaborating. or writing clearly. ill just cross my fingers and hope i understand what it all means if i ever look over these notes again.
1. around here, u dont get xtra pay for being fluent in a 2nd language. in fact, it's almost expected. weird. must be a wage theory 101 oversupply thing. ie, enought potential applicants with this ability (or few enough positions available), that a premium doesn't have to be paid. im interested in learning a bunch of extra languages, but only at the most non-intesive, non-rushed pace. a financial incentve would prbly be just the thing to push me to take it from an on-off hobby into striving for fluency. oh well.
2. intermittent pain for medical pts. if its not getting progressively worse, sometimes all u can do is wait and see.
3. 2/3 of pts i worked with today were RNs orfamily members of pts here today.
4. observed the whole pre-op checklist thing. wonder why i never witnessed this after a whole semester of medsurg1 at the other program even though i was 1. at a much larger hospital and 2. got to watch actual procedures. we were even taught this checklist pre-procedure thing during the fundamentals class here....but never once at the other program even after a handful of clinicals class.
1. around here, u dont get xtra pay for being fluent in a 2nd language. in fact, it's almost expected. weird. must be a wage theory 101 oversupply thing. ie, enought potential applicants with this ability (or few enough positions available), that a premium doesn't have to be paid. im interested in learning a bunch of extra languages, but only at the most non-intesive, non-rushed pace. a financial incentve would prbly be just the thing to push me to take it from an on-off hobby into striving for fluency. oh well.
2. intermittent pain for medical pts. if its not getting progressively worse, sometimes all u can do is wait and see.
3. 2/3 of pts i worked with today were RNs orfamily members of pts here today.
4. observed the whole pre-op checklist thing. wonder why i never witnessed this after a whole semester of medsurg1 at the other program even though i was 1. at a much larger hospital and 2. got to watch actual procedures. we were even taught this checklist pre-procedure thing during the fundamentals class here....but never once at the other program even after a handful of clinicals class.
Wednesday, April 21, 2010
Teaching Incentive Spirometer & Turn, Cough, Deep Breathe
Deep breathing and coughing exercises
-improve (or maintain) ventilation and pulmonary gas exchange
(especially after prolonged immobility or general anesthesia)
-work by clearing mucus and allowing moisturized air to enter the bronchi/bronchioles/alveoli
-prevent or treat respiratory complications from immobility & illness
-inflates alveoli, removes secretion that may become reservoir for microbial growth, which may in turn interfere with gas exchange
-
Saturday, April 17, 2010
Clinical 4/17/10
Just a few random things.
1. If O2 sat unexpectedly low: have pt deep breathe & recheck.
2. Crackles in elderly recovering from cold: deep breath & cough bc risk infx.
3. Macular degeneration: "I can only see outlines....it's dark in the center...it's especially difficult when eating....I can't recognize faces only voices....I don't want to go to exercise because I can't see the demonstration"
4. HIPPA. That is all. Pt's got a cool story tho. Cool enough to have been basis for a book, movie, tv shows, tv appearances, magazine articles....
1. If O2 sat unexpectedly low: have pt deep breathe & recheck.
2. Crackles in elderly recovering from cold: deep breath & cough bc risk infx.
3. Macular degeneration: "I can only see outlines....it's dark in the center...it's especially difficult when eating....I can't recognize faces only voices....I don't want to go to exercise because I can't see the demonstration"
4. HIPPA. That is all. Pt's got a cool story tho. Cool enough to have been basis for a book, movie, tv shows, tv appearances, magazine articles....
Thursday, April 1, 2010
piaget's stages of cognitive development
bc teach said is on test but dint lecture on it bec nurses dont teach u everything u need to know in nsg schl. something like that.
why nsg instructors, who are responsible for educating future nurses, hold this philosophy is beyond me. just thankful he doesnt take it to the xtreme my "instructors" (LOL) in the other program did. no comparison actually. that's a good thing. :)
notes from interwebs (not the text bc i dont have it w/me atm)...
*SENSORIMOTOR STAGE 0-2yrs
most in tune with sensorimotor stimuli; simple reflexes; circular reactions; beginning of mental/symbolic thought; understanding by coordinating sensory experience w/ motor action; knowledge of world via interacting with environment; problems with object permanence resolved by end of this stage
*PRE-OPERATIONAL STAGE 2-7yrs
begin grasping language, prone to fantasy, perspective is self-oriented, substitutes objects with symbols, able to think about things not happening now, thinks outside world, play pretend, think operantions through but only in one direction; difficulty seeing POV of others;
-SUBSTAGES
-----SYMBOLIC FUNCTION SUBSTAGE: egocentric thinking (only understands own POV), can formulate designs of objects not present, language, pretend play
-----INTUITIVE THOUGHT SUBSTAGE: primitive reasoning, knowledge but only know it intuitively, fails at conservation-of-liquid tasks*
*CONCRETE OPERATIONAL STAGE 7-12yrs
begins abstract reasoning; able to mentally manipulate info; begins solving hands-on prolems in logical manner; understands laws of conservation, working backwards; appropriate use of logic;
-IMPORTANT PROCESSES: seriation (pattern gradients), transitivity (if a>b, and b>c, then a>c), classification, decentering (multiple aspects taken into account..eg, not just height of container), reversibility, conservation, elimination of egocentrism (can take other's POV)
*FORMAL OPERATIONAL STAGE 12 to adult
full comprehension; can make decisions w/o concrete objects; can consider multiple POV, can solve abstract problems; more scientific thinking (devising solutions and systematically test them); finds identity; begins to deal with social issues; can transcend beyond concrete experiences into abstracts/hypotheticals to solve problems and draw conclusions; can think about the future
related
wikipedia
kinda creepy. but interesting illustration of the stages. sensorimotor was best. then it becomes less relevant with each stage thereafter imo.
why nsg instructors, who are responsible for educating future nurses, hold this philosophy is beyond me. just thankful he doesnt take it to the xtreme my "instructors" (LOL) in the other program did. no comparison actually. that's a good thing. :)
notes from interwebs (not the text bc i dont have it w/me atm)...
*SENSORIMOTOR STAGE 0-2yrs
most in tune with sensorimotor stimuli; simple reflexes; circular reactions; beginning of mental/symbolic thought; understanding by coordinating sensory experience w/ motor action; knowledge of world via interacting with environment; problems with object permanence resolved by end of this stage
*PRE-OPERATIONAL STAGE 2-7yrs
begin grasping language, prone to fantasy, perspective is self-oriented, substitutes objects with symbols, able to think about things not happening now, thinks outside world, play pretend, think operantions through but only in one direction; difficulty seeing POV of others;
-SUBSTAGES
-----SYMBOLIC FUNCTION SUBSTAGE: egocentric thinking (only understands own POV), can formulate designs of objects not present, language, pretend play
-----INTUITIVE THOUGHT SUBSTAGE: primitive reasoning, knowledge but only know it intuitively, fails at conservation-of-liquid tasks*
*CONCRETE OPERATIONAL STAGE 7-12yrs
begins abstract reasoning; able to mentally manipulate info; begins solving hands-on prolems in logical manner; understands laws of conservation, working backwards; appropriate use of logic;
-IMPORTANT PROCESSES: seriation (pattern gradients), transitivity (if a>b, and b>c, then a>c), classification, decentering (multiple aspects taken into account..eg, not just height of container), reversibility, conservation, elimination of egocentrism (can take other's POV)
*FORMAL OPERATIONAL STAGE 12 to adult
full comprehension; can make decisions w/o concrete objects; can consider multiple POV, can solve abstract problems; more scientific thinking (devising solutions and systematically test them); finds identity; begins to deal with social issues; can transcend beyond concrete experiences into abstracts/hypotheticals to solve problems and draw conclusions; can think about the future
related
wikipedia
kinda creepy. but interesting illustration of the stages. sensorimotor was best. then it becomes less relevant with each stage thereafter imo.
Sunday, March 28, 2010
Gordon's Functional Health Patterns
Why bother looking up Gordon?
CI said careplans based off Gordon. From what I've seen so far (not much), it's only loosely based on Gordon. But it's relevant so why not learn more.
Btw...
Ask an experienced nurse about care plan, and she can definitely help. Ask about nursing diagnosis...and maybe not. LOL.
Marjorie Gordon (1987)
11 categories, systematic approach to database
1. Health perception and Health management
2. Nutrition & Metabolism
3. Elimination
4. Activitiy & Exercise
5. Cognition & Perception
6. Sleep & Rest
7. Self-perception & Self-concept
8. Roles & Relationships
9. Sexuality & Reproduction
10. Coping & Stress Tolerance
11. Values & Beliefs
CI said careplans based off Gordon. From what I've seen so far (not much), it's only loosely based on Gordon. But it's relevant so why not learn more.
Btw...
Ask an experienced nurse about care plan, and she can definitely help. Ask about nursing diagnosis...and maybe not. LOL.
Marjorie Gordon (1987)
11 categories, systematic approach to database
1. Health perception and Health management
2. Nutrition & Metabolism
3. Elimination
4. Activitiy & Exercise
5. Cognition & Perception
6. Sleep & Rest
7. Self-perception & Self-concept
8. Roles & Relationships
9. Sexuality & Reproduction
10. Coping & Stress Tolerance
11. Values & Beliefs
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