Hell Week

It's over.  I had known this week was coming for 10 weeks, but couldn't even think about it for fear I might break down crying, quit or just start screaming and pulling at my hair.  I know it seems like it's just school and school is easy right, but nursing school is unlike any other.  You can study, study, study and still NOT get it.  It is absolutely imperative you train your brain to think in a critical manner, based on the over abundant information they try to smash into your brain.  An example of a critical thinking question that I missed on my last exam was ...

The patient is having an acute myocardial infarction, which of the following would be the worst thing for him to be doing...

a. Sitting in a chair for 30 minutes
b. Getting up out of Bed
c. Eating
d. Bathing

Go ahead, post your answers (heck include your ratioionale for why if you like) and I will let ya know in my next post, or post nothing and just wait for the answer. 

Monday I had my first exam in Leadership which was fairly easy to pass.  It's not a matter of understanding the material, it's a matter of finding time to look it over.  Tuesday, I spent the morning with the crazies at Metro on the 6th floor dealing with a patient who tried to kill himself by swallowing a bottle of seroquil and a fifth of vodka because he felt he was useless and couldn't do anything right (had to laugh at the thought that he couldn't even kill himself right -- I know terrible thought, but I had it nonetheless).  Wednesday, I took my second exam in psych, which I studied the hardest for and did the worst on.  I think the class has too many instructors with different points of view and criteria and we are all just a little lost.  A prime example is a powerpoint slide in our notes looks like this...

BIOLOGICAL INTERVENTIONS FOR ANXIETY

SSRIs (Selective Serotonin Reuptake Inhibitors)
- produce anxiolytic effects by increasing the transmission of serotonin by blocking serotonin reuptake at the presynaptic cleft; take about 2-4 weeks to work
Benzodiazepines
-the most commonly used medications for panic disorder even though SSRIs are recommended for first-line treatment; they are fast acting and usually given first

THE QUESTION
Which of the following drugs is used as a first line intervention for anxiety?
a. Benzodiazepines
b. SNRIs
c. SSRIs
d. Alcohol

We find out the answer on Wednesday, and I picked SSRI's, but half the people picked Benzos because that is what is given right away and most often.  So, the real question is what the heck does "first line intervention mean?"

Thursday, I had to get to Marymount for critical care by 6:45am, so I was exhausted from only 4 hours of sleep and I had to do six medicaiton sheets on drugs and their effects and things the nurse needs to watch so she doesn't kill her patient like labs for blood, liver and kidney toxicity, urine output.  An example, lopressor is a beta-blocker, usually given to patients who have hypertension, but if at 0900 you are scheduled to give the guy his meds and his heartrate is less than 55 beats per minute and his BP is 120/80, if you give it you will probably just put the poor guy into cardiogenic shock or damn near close, so as a nurse pay attention!!  My first week my patient had coded twice, once less than 24 hours before I was assigned to her and had a transvenous pacer and a transcutaneous pacer keeping her going along with a nice little endotracheal tube and a ventilator to help her breathe with vasopressors and propafol.  The code cart was in front of my door and I can't say I wasn't scared shitless my patient was gonna punch her ticket on my shift and freak me the hell out.  Thankfully, she made it through and so did I.  This week my patient was cake compared to her.  He was even awake and could talk to me a little, so I was able to take some time to actually learn how to do central venous monitoring, using the phlebostatic axis.  The poor guy had some bad scrotal edema (BEWARE!) and kept telling me "my balls hurt!" so every 2 hours I was pushing 3 mg of morpine in  his IV and telling him to "stop touching your balls then."  He was too funny.  We managed to get out on time at 5:30 pm on the dot.  I hurried home, already exhausted and managed to force myself to listen to audio lectures and cram for my critical care exam until 2:00 am before I couldn't keep my eyes open.  I set my alarm for 6:30 am and managed to drag myself out of bed for another hour and a half of studying before heading out for the last of my three exams.  I wasn't even panicked at this point.  I was just exhasuted and knew by 10:30 am, pass or fail it would be over.  The last test I took this week consisted of 50 questions 5 med math that you must work out yourself with no choices.  There are 5 on each of the 3 exams and you can only miss 2 or you fail and you have to take the "Save My Ass Exam" immediately after the final exam which is 15 quesitons that you get 30 minutes to do.  If you fail again, you fail the class.  Two weeks ago my classmate told me how she had to take it and another girl in the traditional program sitting next to her had failed for the second time.  She just broke down crying in class, knowing she had just failed the class and would have to take it all over again because of 15 math questions.  An example question looks like this...

Your patient is in CHF (congestive heart failure) and is place on a nesiritide (Natrecor) drip.  Nesiritude 1.5 mg is mixed in 250 ml of normal saline.  A continuous infusion is ordered to run at 0.01 mcg/kg/min.  The patient weighs 185 lbs.  At what infusion rate should you set the IV pump?  Answer will be in ml/hr. 

Now, these are really just means extremes problems once you get everything into kg. or mcg. or mg. what ever you are using, but all the stress of failing builds up on you.  I never did the math to figure out how many I needed right to maintain a passing grade in a class until nursing school.  Needless to say, I passed and by 1:00 pm me and 10 of my classmates trekked to the bar to celebrate living through hell week.  I have no more exams until finals now, one big paper and about 8 small ones and then it's done.  It's really done.  I will be through the hardest academic challenge of my life.  I don't really believe graduation is only 5 weeks away, but it is.  It was way harder than any marathon I ever had to do and at times felt quite comparable to a some distorted version of hell, but my classmates and I (most of us anyway) survived it.

We did as Winston Churchill had advised..."When you are going through hell, keep going!!!"