Yesterday was the last day of my med-surg clinical!
YAY!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
The experience wasn't all bad...in fact, with the exception of my first patient, I don't believe I had any difficult patients. And I definitely did not have any difficult family members or visitors. some things I've learned in the past five weeks:
1. How to mix and run Nexium. Would you believe that the last 4 or 5 patients I had was on Nexium IV? I've yet to see that purple pill...
2. How to get blood from what looked like a central line (but wasn't a central line...don't ask). flush both lines. Draw waste. draw blood. flush both lines.
3. How to flush a percutaneous tube.
4. How to drain a percutaneous tube.
5. How to flush a NG tube.
6. How to hang a Mag rider. This one is incredibly simple, but was particular difficult for me to understand. I saw how the old Mag rider was hanging. I then spoke to my instructor. I finally figured out that the person who last put up the mag rider did it incorrectly. The poor patient had straight mag running into his line. Ouch.
7. How to change a chest tube dressing.
8. How to look for an air leak ("cough for me please")
9. How to make sure the right IV med is running. And to make sure it is running into the patient, not onto the floor (funny story....)
10. How to separate an IV tube from an IVR (another funny story...)
11. How to use a needle-less syringe (heh...take off the cap)
12. Using a tuberculin syringe to withdraw a certain med.
13. Using a carpujack (sp) holder (hate those). (pain meds)
14. How to take an accucheck....and how to get enough blood on to the strip.
15. How to give insulin with an insulin pen.
16. How to draw insulin up in a syringe.
17. How to give lovenox.
18. How to give heparin.
19. How to give meds via IV push.
20. How to check IV compatibility.
21. How to give lopressor (monitor monitor monitor!)
22. Incentive spirometers
23. Pneumatic Compression Boots
24. Missing Doses
25. Labs
26. BP 80 something over 50 something? page doc. fluid bolus.
27. increase bands count + rhonci = possible infection
28. Diabetic gastroparesis
29. small bowel obstruction
30. NPO (nothing by mouth)
31. Diluting drugs
32. Slicing pills
33. Carry lots of red caps!
34. Ditto for Alcohol pads
35. Flush. Flush. Flush.
36. Get the patient up and out of bed!
37. Cough and deep breathe!
38. MRSA. Hypochondriac that I am, I'm convinced the car, house and I are contaminated.
39. I&Os
40. Always ask why. why why why.
41. Nurses are busy. I will have to learn that the I can start an IV when a doc is talking to a patient. Not that I would want to do this if the doc is telling the patient something awful, like they if they have cancer...My instructor said today: "Get in there from behind the patient and start the IV. You are just as important as that doctor." She probably wanted to see how I would react to a doctor yelling at me for interrupting. Fortunately neither one of us got that chance...the doc was finished by the time I walked up to the patient.
I wish I got to see or do more. A lot of my patients seem to have had the same thing wrong with them (abdominal pain). Only one or two post-ops. No major dressing changes. There was one patient with a wound which required dressing changes, but my instructor wouldn't allow me to change the dressing (the first patient, who my instructor didn't like).
My evaluation went well enough. My instructor thinks I need to go on to grad school and research. I believe that's code for: you can't do any of the practical stuff.
Last night I celebrated with a glass or two of red wine and the Woody Allen flick Manhattan. Something about red wine, Woody Allen, and Gershwin makes for a nice quiet evening. Now if I can only find the motivation to study for exam 2 or write that paper that's due Monday....
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