Weeks 7 & 8.
I realize it’s been a while… and I’m even starting to wonder what happened over the past two weeks… I believe the patient I cared for last week was another “no right bone flap,” which means that the neurosurgery team has taken off the right half of his skull so that his brain can swell and have more space to swell… this allows for better healing. He was a very passive patient, but I realized that family can be both a blessing and a nightmare. The family is able to notice little changes in personality that we, as nurses, do not detect. However, they also detect little changes that we do not detect…
It was amazing that my patient was just regaining his ability to speech as he was experiencing pain, which made our job a lot easier… he could indicate exactly what he needed/wanted. That was pretty cool. However, the thing that I struggled with the most was putting his “helmet” on when he was being discharged. Patients without bone flaps wear these padded helmets to protect them from any falls, etc. they are close fitting… and just a reminder, when they don’t have a bone flap, the skull is the ONLY thing protecting their brain. I was now putting this big padded, tightly-fitting skull-cap on him. All worked out well, but I didn’t enjoy the increased level of stress…
We also had a very scary incident involving a patient, who went downstairs/outside with an attendant, striking a match while he was receiving oxygen through his nose… Needless to say it caused an incredible stir and I took one major lesson from it. EXPLAIN WHAT THE REAL CONSECUENCES ARE… “Patient X, You are on oxygen, so you can’t smoke or light a match because the oxygen will ignite and cause ……” not just the “patient x, you can’t smoke or light a match.” The full explanation, if the patient is not struggling with altered mental status, might make a lot of difference.
Last week, I also had two exams in Clinical Skills and Pharmacology. They went ok. Nothing too big.
This week, I took care of a patient, who had aortic dissection & mitral valve regurgitation.
Listening to his heart beat was incredible… He was a really wonderful, patient, good patient, but that almost made it harder. His prognosis is not great. As a relatively young man – 42, the prognosis for the aortic dissection is pretty grim and that is before considering that he blew his mitral valve. (Side note: the patient had had a previous aortic dissection when he was 39. I’m not sure if this was the same injury or if it was a new dissection.)
I also completed two tasks that had been plaguing me.. I completed the last of my assessments and, for the first time, Jane, my clinical instructor, showed me how she does it. The rest of the assessment she had just let me do my thing. She explained that she did that so that I would develop my own style. This time, she showed me another way of doing things, that would give me more information and allow me to do multiple assessments simultaneously – without letting the patient know that I’m doing anything… So, I’d be able to minimize the time I interrupt the patient’s day.
And, the second task that I crossed off was that I GAVE MEDICINE! I gave 6 medications at one time – PO and IV push. PO is Latin for by mouth and IV push is just what it says. I take a syringe and push the drug directly into a patient’s IV access point. Giving PO medications is not a difficult process as it’s really just getting medications out of a machine and then giving it to the patient. However, before we are allowed to do this, we have to understand how the drugs work and how they will work within our patient. As a result, we need to know the adverse affects that might develop so that we can watch for them and respond quickly if we note any of these affects. After I have explained these things to Jane, I then need to be able to explain it to my patient. And, no, we don’t usually speak with the patient the way we speak to Jane. We prefer to use terminology that makes sense to the patient. So, instead of explaining that the drug is an Angiotensin Converting Enzyme Inhibitor (ACE-I), we would say that the drug will reduce blood pressure, which will reduce the workload of the heart. Depending on the patient, we may also continue to explain some of the things we are looking for – the dehydration, the potential that the patient might get dizzy if they get up too quickly, etc. Teaching is a HUGE part of my role and by teaching the patients about their care, this can also help when/if they are discharged and are responsible for their care at home.
This week we had our last exam before our finals week. Shockingly, I have one week without any exams… it’s a bizarre feeling. Hopefully, the study group that I have found will be able to do a lot of review this week after lectures so that next week will be a bit less stressful.
And, my exciting plans for break… I will be going home to see mom & dad for several days at the beginning of September. And almost immediately after my trip home, I head south to visit Matt & Shaari. I’m very excited to see Mom & Dad and maybe enjoy some nice weather. We have had beautiful weather in SF lately, as it’s sunny and clear, but it’s not warm. It feels like early fall, but without the bite in the air… “Bite in the air” is saved for later in the year or it is “fog” and it smacks you upside the head. Anyway, I’m also looking forward to seeing Matt & Shaari’s new home and meeting the kitties!