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...