Thursday, September 30, 2010

Yesterday was my day in the newborn nursery. Here's what I did yesterday:

  • I got to give a baby a Vitamin K shot. Vitamin K is synthesized by the bacteria in your gut, but babies' guts are sterile and therefore cannot synthesize the Vitamin K by themselves. The vitamin K is important because it plays an important role in blood clotting. To recap, babies do not have bacteria in their gut. Bacteria synthesizes Vitamin K, which the babies cannot do. Vitamin K is needed to clot blood. Without it, babies can be in big trouble. So they are given a Vitamin K shot. I gave a baby a vitamin K shot.
  • I got to put the Erythromycin Eye Ointment on the baby's eyes. the ointment is used prophylactically to prevent eye infections from bacteria the baby's eyes were exposed to during childbirth, even in c-section babies (at least at this particular hospital). You basically pull the lower eyelid down and apply the ointment to the very edge of the eyelid. Then you let the eye close as normal. I got to do this.
  • I gave a baby his first bath.
  • I did a newborn assessment and an exam to assess the baby's physical maturity, called Dubowitz/Ballard Exam for Gestational Age. This is done in order to correctly meet the baby's needs if the dates of pregnancy are uncertain, or if let's say the baby is smaller but happens to be more mature than thought. Babies will need different care depending on their maturational needs, so this will closely estimate their gestational age in order to ensure the receive the appropriate care. I did one, for my clinical grade, not officially for the baby/doctor/nurse or anything, but I did one.

Yesterday we had something a little interesting. One of the babies was going to be put up for adoption. The mom already had an agency she had been in contact with. I guess she wanted to see him one last time, so after his bath, we brought him over and while I stayed out of the room, the nurse said the mom was pretty emotional (which I could guess would be the case). Mom wasn't young- over the age of 30- has 4 kids already and is, from what I heard, a single mom. I guess she just wasn't able to care for another child on her own. I can't even imagine how hard this must have been for her- what a crazy difficult decision to make. I stared over her son for quite some time yesterday, he was so cute and oh how I wanted to just bring him home with me. But I know some wonderful family, some loving mom and dad, will take this boy into their home and love him. He already has more love in his first few hours of life than some people ever receive. His mom loved him enough to bring him into the world and make an unselfish decision to give him to someone else who can better take care of him than she can. *deep breath* I will keep her in my prayers during this tremendously difficult time. I can't even begin to imagine her pain, but what love she has for this boy.

The nurse we were working with in the nursery was a nurse who usually is in the NICU but was covering for someone yesterday. She was in NICU last week when I was in there and told me that the little baby I had mentioned in my last clinical post, the one with Trisomy 18, had passed the day before. Her parents made her a DNR (do not recussitate) and she was taken off life support. I overheard one of the students saying this, so I don't have the complete story as to where the parents were exactly or anything, but apparently one of the nurses held this baby for 45 minutes until she passed. How sweet, loving and courageous of this nurse! (sorry, need a tissue break)

I hope to be a nurse like that one day.

Anyway, I am really bummed next week is my last clinical. This has been, BY FAR, my favorite rotation. We'll see what happens next week as I will be in labor and delivery once again. It seems as if every week but the first had vaginal deliveries in addition to the c-sections. I am hoping next week is a crazy busy week, or rather a crazy busy Wednesday! I'll keep you posted.

Monday, September 27, 2010

Well, exam 2 didn't go over quite as well as exam 1.

I got an 81.

It seems as if everyone either did better on this exam or stayed the same, except for me and 2 other girls. Sigh. I know that my 81 is a good score, but it just feels horrible because I know that I can do better and I don't know what happened. Anyway, I'm giving myself a pity party today and then tomorrow I will snap out of it. I can still get my B for the class if I can get a 79 or higher on the final, and historically, I haven't had anything below an 81 on a final yet, and that was for psych, which was just different as far as her testing style. In a little over 2 weeks, I will have this class behind me and then I begin, 3.5 weeks from today, the class I have been dreading since I started nursing school- Ortho/Neuro. I guess I am a little scared of Neuro and since it's not my strong suit, I am slightly worried. But I think if I can make it this far, then perhaps maybe, just maybe I can get through the next 3 classes, including Ortho/Neuro, as well.

Ob final is on October 15. This week I am in the Newborn Nursery and then next week, my final clinical week, I have my beloved Labor and Delivery once again.

Thursday, September 23, 2010

So far, life has been pretty busy. I have been studying here and there, watching TV here and there (mostly here, lol) and I had to fill out 4 pages of paperwork on 2 different patients from last week in addition to doing 3 care plans and all of that was due this week. So now I must play catch up.

Last week at clinical I was assigned to the postpartum unit- one vaginal delivery patient and one c-section delivery patient. My vaginal delivery patient was a 17 year old and she was quite quiet. She didn't need much assistance, had a couple of visitors with her at all times, and for the most part, seemed very uninterested in my help. I think the most I had done with her was assist her to the restroom and teach her how to "cleanse" herself after each restroom use until her post-delivery bleeding stops, otherwise referred to as "peri-care."

My c-section patient was a lot more talkative and I feel like this was certainly a situation where I may have made a difference, even if ever so slightly. I felt like I was able to get in a good amount of patient teaching in, which is an important aspect of a nurse's job. She was a first time mom, about my age, hubby was there the whole time, other family came in, she was attempting breast feeding, etc. She had a lot she didn't know, some anxiety- I could sense- about breastfeeding, and I felt like she was very responsive to my assistance. I got her out of bed for the first time since her c-section, assisted her to the bathroom, taught her about peri-care, spoke to her about pain meds, gave her some reassurance about breastfeeding, got her to ambulate around the hallway once around, encouraged her- things like that. I really felt I did something that day. Unfortunately, the nurse to patient ratios are just insane in this unit. I believe the nurse I was working with had 7 or 8 patients. That's just ludacris. Honestly, if you are going to give good patient care in a situation like this, 4 or 5 is probably a lot. Giving meds isn't the hard part, but interacting and spending time with the patients, being their support, their teacher, their helper- it just needs more time then any of these nurses could really give. I mean, if all 8 patients were c-sections, who would have the time to assist them all to the restroom or ambulate them. This is what drives me nuts about hospitals. They cut costs at the expense of the patient and at the expense of the overworked nurse.

Ok this was a tangent I hadn't planned on. Let's move on.

This week I was in NICU. I knew that this would be a very light clinical day since we are not to do anything but observe. However, knowing myself and how I cry at anything baby related, I was really dreading this day a little. I wasn't sure how I would make it through without being a complete basket case all day. When we took the tour of the units, I had tried really hard to hold it together after seeing one baby with a picture of mom and dad in the bed. I was fighting hard. Somehow, someway, I made it. I didn't cry once. I did almost lose it at one point though. It took all I had in me to keep it together. Very sad story. This little baby, about I think around 32 weeks gestational age, (but for some reason I really can't remember exactly) was born. The mother had prenatal care, but apparently for some reason no one caught the cleft palate the baby had. The baby also had an extra finger on both hands and an extra toe on both feet. At the delivery, the parents were obviously surprised by this discovery, but were ready to take it on. Here they thought this would just be a simple (well not really so simple) cleft palate repair, but the doctor had sent the chromosomes out for karyotyping- which is where you basically examine the chromosomes- and the results come back that this poor baby has Trisomy 13. Basically, this baby was blessed to have even been born since most babies die in utero. And the prognosis is about as worse as you can have- more than 80% of children with trisomy 13 die in the first month.

This poor thing was on a ventilator- a machine which breathes for the patient. At one point, while the nurse was inserting a PICC line (peripherally inserted central catheter, used for meds and feedings), the baby's respirations went completely down to 0 (not she was on a med so that the PICC line could be inserted which was causing the decreased respirations). The other student and I looked at each other and would have been freaked out had it not been the fact that the machine was doing the breathing for this baby. Still, it was weird to see someone not registering respirations. Another baby was having chest retractions, which was scary to me and the other student, but apparently, it wasn't quite enough to warrant the attention of the NICU nurse. There are 3 levels of chest retractions, which the retractions are a usual sign of respiratory distress. I could never picture them in my head because no matter how hard I tried to breathe in, my chest did not retract. It just amazed my mind that our bodies were even capable of doing that, but boy, can those ribs sink in deep. Anyway, there are R1 retractions, which are pretty minor, R2 retractions, which are a little more serious, and R3 retractions, which are very serious. The baby had been retracting at R1 for most of the day, but later on, he started to work really hard to breathe, and his retractions got worse- up to R2.

The neonatologist ordered a chest xray to rule out pneumothorax-collapsed lung, and atelectasis (I love saying this word, its a fun word to say), which is a collapse of the alveoli, little sacs in the lungs that exchange the oxygen for carbon dioxide. The baby, almost immediately after the xray, started breathing better, and he ended up not having either of those things going on with him, which was good.

The NICU amazes me. The nurses are a real team. The doctor treats the nurses with respect. The nurses were all very informative, they answered a ton of questions and showed us so much, and even the doctor called us over to show us things on the xray. Everyone on the unit has this tremendous wealth of knowledge. I just can't wrap my brain around how much these nurses know- it is really mind blowing, well, for me at least. I feel where I am at now, I could never know that much information. But I know in reality, that I could know that much info after I have had as many years of experience as they have. It's just hard to see that end of the tunnel way over here at the beginning of the tunnel.

That's just the way it is in nursing. There always seems to be a tunnel to travel through. It's a never-ending journey somewhere, a never-ending learning experience. As I exit one tunnel, I will venture into another. In May, my journey in this tunnel is over and I still have yet to figure out where I will end up. Labor and Delivery is still high on my list. NICU is growing on me. ER might be a contender, but I'm not even sure I will experience an ER before I graduate.

We'll see how things go along the way. For now, I have an exam on Monday and I will be in the newborn nursery on Wednesday. I will post the results of my exam on Monday afternoon!

Friday, September 10, 2010

I got an 89 on my exam. My second highest grade in nursing school so far. This is a solid B, so solid in fact that I was only 3 pts shy of an A. So solid that I can essentially get an 80 on the next two exams and get a B in the class. And so solid that I can get a 65 on the next two exams to pass. I do need an average of a 94 on the next two exams for an A, which may be a little difficult, but hey, I'll still try.
Yay, I am so excited :)
OB Exam 1.

I think I am ready. But there is always so much I don't know that it's hard to tell.

Tune in later for the results.

I feel good so we'll see :)

Thursday, September 9, 2010

Labor and delivery. For as long as I can remember, this area has been number one in areas of nursing I am interested in. A close second is ER/Trauma and Peds as third. Maybe it's because I feel like I am making more of a difference in people's lives in these departments. Maybe it's because I find these areas so intriguing. Maybe it's neither of those things and something entirely different, but those areas have always remained on the forefront of my mind.

When I first started nursing school, I told myself I would keep an open mind, that I wouldn't close myself off to just L&D, or ER, or anything else. I would go through the rotations and see if maybe something else would surprise me. I went through three rotations on med surg floors so far. This is the area where everyone tells you to work a year or two in order to hone your skills as a nurse and then transfer to wherever you like after. My first two of the three med surg floors I was on I absolutely HATED. I'm not a big fan of adult poop or adult urine. I'm not a big fan of 1:6-8 patient ratios. I'm not a fan of doing nothing but passing meds all day. Or being yelled at by older patients. Or anything else really med surg-like. I don't feel like I am making a difference, I don't feel like I am helping anyone. The third of those three med surg floors I had a better experience, and ended up feeling a little more like what I was doing mattered. But still. It didn't feel like home.

Then came Peds. I felt more comfortable, but it wasn't how I envisioned it at all. I thought I would go in there and be super nurse, and make all these sick kids magically smile and feel better. I was naive, and my expectations caused me to be disappointed. My Peds rotation was just yet another med surg floor, this time the patients were smaller, and I had to deal with moms and dads on top of it, which can be intimidating. I know that there is a whole lot more to the Peds world than what I experienced and I did like it more than the other rotations, but it still just didn't feel quite.........right.

Then there was Psych. Definitely NOT for me. Charting non-stop all day in the nursing station, and passing out meds- not my cup of tea. I can be a secretary any day of the week if I want right now without a license. Nurses chart- sure, but not like this. This was just insane (no pun intended).

Then came OB.

The excitement of it alone almost overwhelms me.

I've only had one day on the floor and while I didn't experience much, something just feels......right. It's hard, because I am an emotional person, so I don't know how long it will take me to stop crying after every birth, after every loss. I fought back tears several times yesterday. Most happy ones, but there was a sad set of tears in there, too. In talking to the nurse I was working with, I was told it's OK to cry. We're human. If there's a loss, just be there for the patient, cry with them, and if I need to step out, then do it. I will be able to find a way to block things when I need to. I can do it. It might take some practice, but I think I can.

I really feel like this might be my home. And the realization of that kind of overwhelms me as well.

There are so many awesomely fascinating aspects of OB. It is really such a specialized area and I feel like while there is a lot that I know, and a lot that I am still learning, there is still SO much more to learn. There's also other aspects of OB, too- like postpartum nurses, baby nurses, NICU. I will be experiencing all of these during this rotation. Maybe I will like those, too.

There's just something about L&D.

So for my first day, I had a patient, who just so happened to be an RN herself. First time mom, didn't know the sex of the baby yet. I was so excited to be able to experience this time with her and her husband. Unfortunately, she didn't deliver before I left. In fact there was not one vaginal delivery then entire time were we there, yet the floor was crazy busy. By the time we left, all 12 beds were full and all 3 triage beds as well. There was about 4 c-sections earlier in the day, and I was able to see one of them. It was pretty cool to be able to see things from the other side of the table for once, and holy cow, the stitching involved is amazing! Way cool. So many layers......which I am sure I knew in the back of my head but just didn't realize until it was there in my face to see. Doctors and nurses all seemed very nice. My nurse even told me about the new grad program their L&D has about once a year.

I saw two epidurals given, I saw one spinal given (for the c-section I watched), I watched a foley cath being done, which I had asked to do myself because I know how to do them and can do, them, but my nurse thought it would be a better idea for me not to do it since my patient was a nurse. I saw the baby nurse and the pediatrician doing their thing with the newborn, suctioning out the mucous the c-section babies often have, doing the gestational age tests, APGAR scores, foot prints, etc. I saw everything BUT a vaginal delivery.

Right before we went home, a young lady came in who was 21 weeks pregnant with her water broken and in a lot of pain. The nurses were saying she was probably going to deliver soon. This was tough for me, because as I learned, with a baby that small, there is nothing that can be done. Nothing. Too small. Usually after 24 weeks there is a chance, and at 22 weeks they may evaluate to see if there is a shot but 21 is not enough. Sad, very sad. Apparently, the patient was a drug mom in a drug program at the hospital. Even sadder.

But not all the cases are like this. I can't express the coolness of witnessing the birth of a little life into the world. Watching them take their first breath and seeing the happy moms and dads, so proud. I got to take a picture of a dad cutting the cord off his little girl (was a c-section baby and they were doing it in the little newborn room, oh and the picture was for the dad with his camera, not mine!). So cool. So very, very cool.

There's just something about L&D.
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