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!
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!
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