Thursday, July 29, 2010

Blood Work

I had quite a headache all day at clinicals, but managed to not let it distract me from one of the most hands-on clinicals I have had thus far.  It started off rough with my grandma dying in the first week and having 3 case studies, a nursing profile for a client having a pulmonary embolism and a concept map on a patient with lymphangitis cellulitis and 2 quizzes to make-up, but it all worked out. 

Our rotation was only 6 weeks.  I missed week one, but week two had my first patient refuse medication and got to pull out a central line.  The central line is just insane.  Its basically an IV that runs directly into your subclavian vein, which feeds directly into the vena cave, which feeds into the right atrium of the heart!  Crazy to be that clos to it! The patient had been unable to eat due to stomach cancer and we were running total parenteral nutrition (TPN) right into his blood vessels.  Removing it is quite simple, the patient turns his ahead away from the line, he holds his breath and you just pull it out -- it's a rush for a nursing student.

**This is not my patient, just a pic I found**

Week 2, they sent me off to "convenient care" which is like outpatient oncology, but that day all my patients were anything but.  My first two patients had kidney failure and needed bi-weekly injections of procrit or aricept, which is just two different brands of erythropoetin.  The kidney also have the responsibility of making RBCs and obviously when they quit working RBC production becomes inhibited.  I was able to give both shots in the deltoid -- thankfully, most IM's are given in the deltoid or the vastus lateralis.  The butt is usually a last resort (whewww!).  Then I had 2 patients with peripherally inserted central lines (PICC), which start somewhere in the upper arm and are threaded up and through to the subclavian again and into the heart.

These people had IV antibiotics for a few months, so they needed to be cleaned and have a dressing change.  A peripheral IV is only good for 72 hours and having to be re-stuck every couple days would just suck.  These were much more realistic.  A patient with an insanely low blood count came in for 2 units of PRBC and so I watched a blood draw (or 3 for that matter as this patient's veins just ran away from the needle every time it seemed).  We finally got it and it was cross-typed and matched and for the next couple hours I monitored her VS (specifically for hypertension) as that is a common side effect of the transfusions, not to mention she was hypertensive anyway.  After that, a patient managed to rip a saline locked IV out of his upper arm while eating and got blood everywhere before we finally managed to re-dressed and cleaned it up. 

Week 3, was dealing with all the other bodily fluids as my patient was end-stage alzheimer's and had lost the ability to swallow.  Eating had become impossible and with a hiatal hernia, successful placement of a g-tube or peg tube was impossible, so she ended up with a j-tube, which I found out you do NOT check the residual on.  I was worried about running too much isosource as the pump was 35ml/hour continuous, but was told I would know if it wasn't being tolerated because, well everyone knows what happens when you eat too many oreos or corn right? 

Needless to say, I will never be a GI nurse of any kind.  I spend half my time trying not to vomit and the other half of the time holding my breath when dealing with patients who are inconinent, but I know I am a super hero because I willingly do that stuff!!  I had also willingly volunteered to take on a second patient that was MRDD and had to take about 8 oral meds.  I ended up doing one at a time hidden in small bites of his breakfast tray, starting with the smallest and working my way up to the horse pill sized ones.  My instructor actually gave me 4's for the day, which is above satisfactory, so YEAH!!!  She even stated she only gives \3's (satisfactory) unless something very exceptional occurs, so BOOOOYAAAHHHH for me!! 

Today, was my last day there on the floor and we were told it was exceptionally, slow and there weren't enough patients for all of us.  I volunteered to go back to convenient care and work and as a result she told me since I worked with two patients last week to go on down to the heart failure clinic.  SWEET!!!  I hate standing around at clinicals, even if there is absolutely nothing to do, I still feel guilty.  Heart failure was definitely different.  My first patient needed Lasix IV push (4ml over 2 minutes) and then 2ml and hour for 4 hours on an IV pump.  It was nothing knew, but each pump is different and it's always nice to brush up on skills to clear the lines and access the ports correctly.  They were having a slow day too, but it was still more action packed than upstairs as I had 4 patients coming in needing blood draws for BMPs, PTs, BNPs you name it.  I had only started an IV and accessed a med-port one time, so using a butterfly needle and finding veins, followed by doing a blood draw was exciting and new!  It may not seem like it, but sticking a needle in a teeny-tiny vein, without missing and miniminzing the discomfort of the patient is very nerve racking for me.  Not to mention when every patient you have says "I have really hard veins to get blood out of" it definitely makes me a little doubtful of my skills.  My first patient I was told to go for a little vein on the dorsal side of the hand.  I know I hit the damn thing, but it ran away from me and I got no flash.  I was disappointed, but my instructor told me not to worry that patient was indeed a hard stick.  None of my patients had pretty veins just popping up in there antecubes for me, but I successfully nailed the rest on the first try.  My confidence with blood and needles was definitely boosted after today's handy work. 

Now, I have 4 more days of school and the "Dog Days" of summer finally begin for me after 7 long, intense months of school.  I only need a 59 on my final exam to pass, so you can only imagine how confident I am.  I feel like a senior in high school again, just itching for the end of school.  Although, it's only 3 weeks off.  I plan on enjoying every minute before I start my last semester of school.  It's so crazy I am almost 3/4 done.  It seemed like just yesterday, I was sitting in orientation wondering what I was getting myself into.  I know the hardest is yet to come, but hopefully, these few weeks off will allow me to re-charge and hang in there until December 17th.


Julia said...

I am excited for you just reading this. I know how interesting physiology is and you are taking one more step towards it - - 3/4 done, YAY!!!

If ever I need a nurse...I am coming your way.

Janet Edwards said...

I am so excited for you to get done and for now, 3 weeks off! When can we play?