Lip-Reading

Today was my first rotation at a big-city hospital. I was supposed to start yesterday, but I was given the day off to go to my aunt's memorial. I'm staying at my grandparent's house, so my drive to the hospital was just under 10 minutes, which is pretty stinking awesome!

I had a great day caring for patients, and the nurse I was assigned to looked just like my old roommate, Stephanie. She was so nice, and let me do a lot of stuff by myself.

Funny story:

I can't lip read. Here's a real-life example. After a few frustrating minutes of trying to talk to a patient who couldn't speak, they started to distinctively mouth each letter of the word. C.R.A.P

Me: crap?

Patient: looks a bit amused, and shakes their head

Me: crab? Do you want crab for dinner?

Patient: shakes head harder. Mouths C.R.A.P again, but this time I realize there's an E at the end

Me: oh, crepe? Do you want crepes?

Patient: starts to look really upset, and shakes their head (we've been at this for at least 5 minutes now)

Me: crapé? (Sounds a lot like frappé) 

Patient: forcefully mouths each word, with noticeable vocal sounds

Me: GRAPE! Do you want a grape popsicle?!

Patient: gives me a look that says "you are an idiot", but vigorously nods a yes

So they got a grape popsicle, and I felt like an idiot.

~Courtney

Labor & Delivery!!

Yesterday I spent my entire morning with 2 adorable little 1-day-old babies. One was 8 lbs, the other only 4. I got to assess them and hold them and just get wrapped up in their cuteness. Am I baby hungry now? Heck no! Do I want to go back and hold a few newborns? Yes please!

Today I was with the labor nurse, Carla, who was super fantastic and taught me so much. There was one girl in a labor room when I got there at 6 AM, and she was dilating one cm every hour. I was so worried that she wouldn't give birth until after my shift ended at 1, especially because births don't happen every day in a small hospital. Carla and I spent the morning monitoring her contractions and the baby's heart rate, and popped in on the mom to check dilation and to see if she needed anything throughout the morning. Carla showed me how to feel the stomach for the fundus (top) of the uterus, and I got to feel how hard the stomach gets during a contraction. Carla really was fantastic in teaching me things, and she promised me I would get to see and assist in the birth before I had to leave for work.

Noon rolls around, and I'm supposed to meet up for lunch with all the nursing students. Carla promises me I won't miss anything while I run to grab lunch, so I head to the cafeteria. When we get our food and sit down, our clinical teacher, Gina, rushes in and says we have to go to post conference (a meeting where we discuss what we did that day and ask questions) right away because an RN student had shown up to do his teaching assignment. So I go to the break room pretty convinced I'm going to miss the birth. I'm eating and learning about wound care (thank heavens for my strong stomach) when I hear over the hospital intercom "Courtney Brown please return to OB, Courtney Brown to OB"

I jump up and practically run back to OB. I rush in the room and get there at the same time as the doctor. Carla and I set up the bed and supplies, and the mom is ready to push. The dad and I help hold up her legs, and the doctor says to push. One nice long push later... voila! Cone-head little boy! The nursery nurse takes the baby after a few minutes to do her assessment, and Carla and I start caring for the mom. A few minutes later the placenta is delivered, and the doctor lets me put on gloves and touch it. He was great to show me the anatomy of it, and the dad was so grossed out he couldn't look away. The baby was doing just fine, and so was the mom, so we started cleaning up.Carla cut the cord into a few sections to be kept for a few days in case it was needed for testing (Did you know the umbilical cord will test positive for ALL substances the mother may have taken during the entire span of the pregnancy?) and we did a sponge count to make sure everything was accounted for.

She told me that the afternoon students had been trying to convince her not to find me, and to let them in to the delivery instead of me! Thankfully Carla responded that I had been there all morning long helping to care for the mother, and that if any student was going to see the birth, it would be me. Thank you, Carla!!! I so appreciated her when she told me that! Quality nurse right there.

The best part about watching the birth (aside from the amazing child comes out of a tiny orifice thing) was watching the mom and dad interact with each other. Such a beautiful, loving couple. Kinda made me all sniffly and wistful for the day when I have a husband as loving as he was.

Really cool rotations in L&D, but I'm pretty sure I'm not heading in that direction professionally. Only time will tell I suppose!

~Courtney

Operating Room Clinicals

Dear readers,

I am almost 100% sure I have found my calling in life. (a very large emphasis on almost) That calling, you may ask? It's the operating room. Oh baby, is it the operating room! Which comes as a slight surprise to me, because I was almost 100% sure I was going to pass out, or get sick to my stomach, or actually vomit during this clinical rotation. None of that happened! 

In fact, I was moving all around the room, both days, to get better looks! On Wednesday I got to see a wide variety of surgeries. I saw 3 ear tube placements, which wasn't new to me, but I got to hang out with the nurse anesthetist (CRNA) while he kept the little kids under, and ask him questions about his schooling, and the medications he used. Then I saw 2 nerve block procedures, which were less thrilling, but involved a machine that looked a lot like an MRI, which was cool to watch. Last I watched a colonoscopy with multiple biopsies. That was the first day, which was cool, but not screaming to me "This is where you're meant to be!"  Though the nice cozy blue scrubs were definitely a big plus.

Day two: a whole different experience. Oh man, I got to see a hysterectomy, and an attempt at laser prostate resection. Both were cool, but the hysterectomy wins for most awesome thing I've ever seen. WARNING: this blog post is gonna get graphic, if you are squeamish, stop reading. 

The hysterectomy was done vaginally, so this poor female's legs were suspended way up in the air. She was covered up, so the only thing showing was the vaginal area. The doctor was so wonderful to let me see what was happening, and he told me what he was doing the entire surgery. It was fun to listen to him chat with his nurses, and it was so impressive to see the camaraderie between them. It made me look forward to the time when I will have work friends to chat with, too. He showed me the Fallopian tubes and ovaries while he was doing the surgery, and after the uterus was removed, he sewed shut the opening. Then he told me to put some gloves on, which was unexpected and weird, so I do, and he proceeds to turn around and HAND ME THE UTERUS. Which was awesome, by the way, freaking awesome. Then he hands me scissors and tells me to cut the uterus open. 

I've done dissections in anatomy lab, and in high school, but to have a fresh human organ in my hands... it was incredible. Seriously ya'll, I'm meant to be in the medical field. So I cut it open, felt the tissues and whatnot, then sent it off to patho for testing.

The next surgery was a laser prostate resection on an elderly guy who's prostate was so enlarged that he had to use an indwelling catheter to urinate. The plan was to thread a laser tipped catheter up into the prostate area, then turn the laser on and pretty much disintegrate the tissue. we all had these green goggles on to protetc our eyes (which I found slightly odd because the entire procedure was completely internal), and there was the laser technician in the room, who had brought the machine from Salt Lake.
It took the surgeon almost 10 minutes to get the laser catheter up to the prostate, because the skin was completely shredded all the way up the urethra, which the surgeon assumed was from months of catheter use. The tissues were spouting blood everywhere you looked; I felt so bad for the poor guy. The catheter finally reached the prostate, and the surgeon tells the tech guy to start up the laser. He does, we all fasten our goggles on securely, and... nothing.
Yeah, after 10 minutes of work threading that laser up there... the thing doesn't work. Turns out the wire to the foot pedal had a cut in it, and during the 10 minutes of catheter threading, urine and blood had been dripping down on to the foot pedal wire... ruining the entire system and bringing the surgery to a halt. You should have seen that tech guy. He didn't bring a replacement foot pedal, and he hadn't thought to check wiring before the surgery started. He was stammering and apologizing to the surgeon, when really, he should have stuck around and apologized to the patient. The surgeon put in a new catheter so it would be easier for him to get to the prostate on the second try in a few weeks. After the laser catheter was removed, the tech guy left pretty much immediately, and left the circulating nurse to explain to the patient what had happened, and that he would have to wait another few weeks for the surgery.
While it was disappointing to not get to watch a laser disintegrate tissue, it was a great lesson for me on the importance of double checking your equipment before surgeries, and for Heaven's sake  have a replacement or two waiting in the wings!

So those were the surgeries I got to watch, and really, all of them were pretty dang cool. So we will see if operating room nursing is what ends up being my calling in life.
~Courtney

Clinical Photo Dump

I've got a nasty sore throat, so to protect the residents
of the nursing home, I wore a mask all day long

Jen and Maddi

Stephanie, AKA The Roommate

Just ordering some medication refills

Celessta and Janelle, our instructor

Stephanie and me up top,
Celessta and Brooke on bottom

Brooke passing meds

I look so cute in a surgical mask, don't I

Discussing something important it seems.
I don't know. I was taking pictures

Stephanie's turn passing meds

Counting narcotics at the end of the shift.
There were 88 pills in that bottle

We were talking about hand washing and the spread of germs.
Janelle's face says it all.

Clinical was good today, pretty average experience, until I got picked to assist a resident with a phone call. Pretty much I sat and held a phone up to her ear so she could talk to her brother in England. But as I sat there, with burning arms hanging in mid air, and a stuffy mask on my face, all I could think about was how that moment right there is the epitome of being a nurse. Putting others ahead of you, so they can heal in whatever way possible. It was a gratifying feeling. Not to mention as she chatted with her brother, she said "this sweet young lady is holding the phone to my ear for me". That's all it took to make all that pain and stuffiness worth it. Made my day, actually.

Over and out
~Courtney

{the weirdest things make me happy}

I've had this mental 'to accomplish in nursing school' list. It's not numbered or anything, and things get added and taken off all the time.

Today, I catheterized a patient.

Check that right off the list!

I was standing in the nurses station when Celessta walked by and mentioned she was going to do a straight cath, so I immediately asked if I could watch. It's stuff like this that's going to give me vital knowledge, so I jumped at the chance to watch an actual catheterization. The nurse walks by and asks which student nurse is doing the cath, and I look at Celessta expectantly. She doesn't say anything, so I shoot my hand in the air.
"Me! I'm doing it!"
So I did.

And I got it on the first try.

Oh, and BTW, the urine was the most concentrated, sediment-filled stuff I've ever seen. It. Was. Awesome.

Sorry guys. This is a medical blog after all.

~Courtney

The Nursing Home

Last semester, I spent about 10 hours spread out over at least 6 weeks with a resident at the nursing home I do my clinicals at. I did my NANDA and care plans on her, and got to know her pretty well.

This semester I have been at the same nursing home, but I hadn't noticed her scooting around the facility in her wheelchair. Granted, I was busy talking to other residents or following around the director of nursing. But this week was my 'med pass' week, where I handed out medications to the residents all day long. The 200 hall at this nursing home is called The Unit, and the Alzheimer, dementia and high-skilled nursing patients live there, behind a locked door. So I'm beginning my morning at 6:waytooearly A.M and I hear the characteristic nasally deep breathing M.C. has. So I flip to the room the breathing is coming from and I see her picture tucked into the folder. I started pulling out her medications, and noticed a lot more dementia medications than the previous semester, but didn't think much of it. I walked in to her room and cheerily said "Good morning!". I pretty much stopped dead in my tracks as I stared, horrified, at this... body, that resembled the M.C. I knew and loved.

She had that characteristic look of someone who's here, but not really 'here'. Her eyes were unfocused, and she Made no sense when speaking. I watched her choke down her pills and walked out of the room feeling stunned and a little empty.

I can't work in nursing homes. I can't watch patients deteriorate. I can't do that. Obviously patients deteriorate in hospitals, I'm not naive, but patients at nursing homes... you learn so much about them: their quirks, dislikes, funny habits, their sense of humor. And then you watch them completely change. And it kills me.

So nope. Nursing homes are definitely not the place for me.

~Courtney

Public Health

In an effort to make this blog a titch more... medical, I'm going to post about my weekly experience in my clinical rotations. This past week was the public health side of nursing; I got to play with little preschoolers on Wednesday and with mentally handicapped elementary schoolers and middle schoolers on Thursday.

Wednesday was so much fun. I played with the kids, and watched how the program Head Start works. I was very impressed with the structure of the class, and how the teachers have taught the kids excellent manners and hand washing skills. I got to play with dolls, blocks and puzzles with the kids during free play, and I got at least 5 of the most precious leg hugs of my life. Seriously, how cute is the leg hug?! I don't get them very often, so naturally my heart melted every time it happened.
While I had a really great, fun time with the kids... I couldn't really see the purpose of me being there. These kids were healthy and active, with no apparent disabilities. So while it was fun, it kind of seemed, well, pointless. Though I did get to see how normal, happy, healthy young kids act when they aren't sick, so hopefully that will help me be able to recognize when something isn't quite right with my future patients.

Thursday was a completely different experience: these kids were mentally and physically disabled. I spent my day with a class of various mental disabilities, and various ages. The youngest kid was 8, and the oldest was 18. None of them had Down Syndrome, and some had such slight disabilities it took me a while to figure out exactly why they were at the school. Eventually I noticed that most the kids had interpersonal issues, which eventually lead me to Autism and Asperger's syndrome. I talked about lime Cheetoes (did you know they exist?) and answered a lot of personal questions with the kids. We played board games and did math problems together (I know, Courtney? Doing math? Willingly?).
This clinical was more medically associated, though I did not get any medical hands on experience. It was good to see the normal functioning level of these kids though, and I'm sure it will help me know how to help care for special needs patients in the future.

So there you have it. Clinical week one, semester two!
~Courtney

Finally

Finally, I'm actually learning things in lab. I've been waiting oh so patiently impatiently to learn new stuff for 6 weeks now. We have been taught basic certified nursing assistant skills, which was boring and seemed such a waste of my time. That's terrible to say, and i'm sure the program knows what they are doing... but I've had my cna for 2 years now, and my medical assistant for 3.
I suppose a bright side is that lab and clinical weren't stressful at all. While other students were all freaked out to take a blood glucose on a patient, I had no worry at all, considering I've taken hundreds of blood glucoses working as a M.A.
So now, finally, we're being taught new stuff. This week we learned to catheterize patients. On Tuesday we will be learning colostomy and tracheotomy care. I am so excited for Tuesday! Not particularly excited for tomorrow, I feel like we spend too much time at the nursing home. Especially considering my 18 (I kid not) page assignment is completed, while other students still have a few pages to complete from their patient tomorrow. So I'm going to be wandering around the building, looking for stuff to do. I hate the feeling of wasting my time. I can't stand it when i'm at work with nothing to do, and I really hate it in clinical.
But in other news, we start hospital clinicals in 3 weeks! I am so looking forward to it! I was under the impression that we would spend every Monday at the same place, but apparently we get to go all over! I'm so excited to have different experiences at different places.
Also, bonus, I have afternoon clinicals, which means I don't have to wake up at 4:30 am to get ready for 5 am clinicals. Huzzah!

~Courtney

The Snugly Duckling

Today was clinical #2. I forgot my watch, and had the hardest time getting out of bed.

On the way over I realized in a few months, my clinicals will be at 5:45 A.M. Shudder.

But after getting there, and standing around for a half hour, we were released to do the

stuff we needed to get done, and for me, that was interview one of the residents there.

I was worried she wouldn't give me good answers to the dozens of questions I had to 

ask for my assignment. She was great, and I easily answered all the questions, and then

some. It was a lot of fun to listen to all her stories, she even made me cry a bit, and of 

course we laughed together too. The paper's written and turned in, hopefully I get full 

points on it. After that assessment was finished, I didn't really know what else to do,

there weren't any call lights to take care of, and all the residents were at lunch, or just

about at lunch. So thus began the duckling parade. We all wear blue scrub tops (that 

button up, how weird is that) and khaki pants, and I've noticed all six of us students will

stand in the same position, feet together, hands in front, with one hand grasping the other

wrist. It's like we all subconsciously know to stand the same way, one of the nurses saw

it today, she looked at all of us, turned back to her patient, then turned back to us with

this look like, 'are you all seriously standing the same way?' I find it sort of numerous.

Not only do we all stand the same, we also follow each other around during the dull

moments, and we look like a sea of blue and khaki. The CNA's there giggle sometimes

when we walk by in that group. Overall, clinicals have been slightly frustrating thus far.

Today our clinical instructor encouraged us to use our blood pressure cuffs as much

as possible to get used to reading them accurately. Later when the nurse pulled out a 

glucometer and asked which one of us wanted to get a blood glucose reading, almost

all of my fellow students got this look like, 'you want me to poke a patient and draw 

BLOOD?' I had to laugh internally, then volunteered, and did the procedure while they

all watched (and took notes). I am so grateful for the experience I had working as a 

medical assistant, yet at the same time, it's made clinicals less exciting and a little on

the tedious side sometimes. I'm so looking forward to when we start learning new-to

-me information.That's when this will become challenging and a lot more fun, I love a 

good challenge. I'm grateful every single day to finally be in nursing school, working

towards the goal I've had all my life. R.N, here I come! Finding joy in the journey. 

~Courtney