Exam 2 Update

On Monday I had my second cardio exam. I studied just like I always do, and I did practice questions just like I always do. I took the exam and felt no better or worse than the first exam. To my surprise, I got one of the best grades I have ever received on a nursing exam. I got an 87! I was so thrilled.

More so, I have pretty much solidified the fact that I will 99.9% pass this class. Unless I don't study at all, which will not happen, or somethings happens and my pencil magically erases answers on my test, I will pass. I need a 50 to pass. I need an 80 for a B, which is what I am going to study for. I really want this B. My GPA is hurting. But at the very least, I will be moving onto to my final nursing school course.

It is still so surreal to me. We received our calendar for "Trends" my last class that begins mid-March. My graduation date, well actually it's our Candle-lighting ceremony which is what everyone attends (the actual graduation is for everyone with every type of degree for the entire campus and can include hundreds of people, which I am not really all that interested in watching graduate)- is May 4th. Two months and two weeks away.

Surreal.

I remember starting my Anatomy and Physiology I class. It seemed like such a long and daunting road ahead of me, and now it's almost all behind me.

I will stop here. There is a lot I want to say, but for now I will say this. I'm graduating very soon!

ER Day and ICU Day Updates

I had my ER day at one of the local hospitals that has a busy ER and a Trauma unit. I went 2 weeks ago, Wednesday, and was hoping for a lot of action. Unfortunately for me (and fortunately for the patients) that was not the case. The only things that were close to traumas, which were not, but were called "high index" because they did or could be hurt pretty bad, was one person who fell off of a ladder and a bicyclist who got hit by a car. They were both non-life threatening injuries.

I still enjoyed my experience. And I started my first 2 IVs ever, AND I got them perfectly on the first try. Of course the first one was with some pretty good advice from the nurse with how I should go in the vein. Also, on the patients who I started IVs, I needed to draw blood on as well, which I just used the line from which I inserted the IV catheter, but I was able to experience how to fill the tubes with blood. I had to help a nurse hold a 5 year old who needed his IV started. I was pretty impressed that I didn't cry, but I didn't!

Last week I had my ICU day. I didn't get to start any IVs or anything fun, but I took care of 2 patients with the nurse I was assigned to. One was REALLY critical. Very bad, and very sad. He was young, 50's got sick at home with what they thought was the flu. Came in after a week of being sick, having a hard time breathing and was admitted with pneumonia. He was admitted right into the ICU and needed to be put on a ventilator. He was in such bad shape, and he was fighting the intubation, he had to be heavily sedated. After some tests, he was found to be positive for Influenza A, which apparently is pretty bad. He was in Acute Respiratory Distress Syndrome (ARDS) which is also really bad. Apparently, if a person gets to the point of ARDS, it's not a good prognosis. Obviously, I am just going off what I've been told, I don't know much about ARDS yet. But at any rate, this guy was in bad shape.

Let me try to explain how bad. The ventilator has settings. There's settings where the machine breathes completely for you. Theres settings where the machine breathes a little and allows you to breathe some on your own. The machine was breathing completely for him. There is a setting for the percentage of pure oxygen you can give the patient. The air we breathe normally is 21% oxygen and that is enough to give us a good oxygen saturation (normal is 93%-100%). He was on 100% (and 100% oxygen for too long can start to become toxic, so thats not good either). Anything less than that, he would have lower oxygen saturations and his blood gases (sorry, that one is too lengthy for me to explain in one blog, ha!) would start getting bad.

Another setting, which I haven't fully learned about but will be for my Cardio final exam, is PEEP (positive end expiratory pressure). It has to do with the airway pressure needed to be maintained in order to improve gas exchange within the lungs. Any way, most patients on a ventilator are usually in the neighborhood of a PEEP of 5. Maybe 10 if things are bad. This patient was on 14. Basically, his lungs were so full of pressure and he was on the highest amount of oxygen, the only place to go from here was to get better or crash. Nothing more respiratory could be done for him. He needed to have a central line put in (so they didn't have to have 3 IV sites going and just keep this one site). However, this meant bringing the patient down to radiology to have it put in (this hospitals protocol). This guy was so critical, they could not wheel him to the department, in his bed, for fear of collapsing his lungs. It was terrible to see someone so young with no past medical problems, so sick and there wasn't much else for anyone to do.

I got to talk with his daughter, a recent medical student graduate who hasn't yet started her residency. She and her brother basically camped out in the ICU waiting room, day and night. She was thinking of changing her career to nursing because she saw how little time the doctors spent with the patient and family and how much the nurses did. I thought that was, and unfortunately, true. I do think there are a lot of GREAT doctors that do take the time for the patients and families and kind of get the short end of the stick with being stereotyped with all the others. I encouraged her to keep going and make a difference in the field.

Yesterday, after lunch, my clinical group went into the ICU. Every week we do this and whoever was in the ICU that week presents a patient to the group. My patient was still there. But now he was awake. I saw the daughter in the waiting room and we stopped to say hello. She told me how well her father is doing and that he has improved SO much. It made me so happy to see that it seems he's going to be alright that I kind of teared up a little leaving the waiting room. It just made me so happy to see them full of hope. I asked my friend to get his vent settings. He is now on 35% oxygen and his PEEP is 5. Even if you don't understand the numbers, you can see that 35% down from 100% and 5 down from 15 is a big improvement.

So there's my ER and ICU updates.

Passed!

I passed my first cardio exam with an 82 (1 point away from a B). I was hoping for at least an 80 so I was really thrilled to get higher than that. I sometimes still feel like for the amount of time I put in studying, I should get a higher grade, but I am really thankful because I was starting to get a little worried while waiting for the grades to be posted.

Clinical is going ok. We only had one day so far and it was not a full day. This week I have clinical on Tuesday and then I have to be in the ER on Wednesday, so 2 back to back 12's will be interesting. But I am SUPER excited about being in the ER. Next week I go to the ICU, so that will also be exciting. As always, I'll keep you posted.

Stay tuned!

Tomorrow is

my first big Cardio exam. Yikes! Say a prayer for me! There is A LOT of info swirling around in my head. I have to know about Coronary Artery Disease, Acute Coronary syndrome (which encompasses unstable Angina and MIs aka heart attacks), Chronic Stable Angina, Heart Failure (right-sided and left-sided), cardiomyopathies (there are different types), shock (there are different types of this, too), critical care nursing, hemodynamic monitoring (oy vey- too much to explain), assessment of the cardiovascular system and I have to read EKG's and by read I mean interpret the rhythm, rate, determine the duration of the different intervals, figure out what's causing that particular rhythm and know how to treat it. Oh yeah, I have to know how to treat EVERYTHING I already mentioned above.

And this is all just for this first exam.

Phew. It's overwhelming just writing what I need to know for tomorrow. Well, I mean, I already have studied this and am supposed to "know" it already, but I still need to review because there's just so much I learned in the last 3 weeks.

I'll keep you posted tomorrow on how it went. For now, I must continue studying.

Realizing

I think I am realizing.............where I want to "specialize" in.

Going in, I had a good indication I would see myself in either Peds, L&D (Labor and Delivery) or ER. As I've gone through my rotations, I've kept my mind open to new things, just in case. I went through my OB rotation and felt a connection, just like I had thought. Lately, however, I have been feeling this pull towards critical care- mostly ER/Trauma.

Actually, more than a pull. I REALLY feel like this is me. When I think of the words "ER" and "Trauma" I just feel such a passionate need to be there. Thing is, I haven't even had my ER day yet.

So I suppose that I cannot yet be 100% certain that is where I see myself ending up, but it is a strong opinion that my heart has been right all along.

As I think back on L&D- it is still an awesome field and I really do love seeing babies! I'm just not really sure why I feel more of a pull to ER/Trauma than L&D.

I just know that wherever I am, I want to help others and make a difference.

And I like adrenaline, just a little bit. :)

Back to the Grind

I sit here the night before I begin my final semester of nursing school and a wave of emotions invade my mind. My final semester. Where exactly did the time go?

I'm excited. I've wanted this for such a long time, it's hard to believe I'm almost there.

I'm stressed. So much reading to do and I'm already behind. Time management has never been my forte.

I'm nervous. I know that I can do this, but there's always a small part of me that worries, "What if I don't pass?" (I have to say, though, after that last class I took, passing that helps me believe that I can just about do anything)

I'm relieved. The end is finally in sight.

I'm apprehensive. What if I don't do well as a nurse? What if I don't like it? I still feel as if I have barely scratched the surface with all there is to know, even though I know a lot more than I ever did before I started school. There's a lot of responsibility with the title....am I really ready?

I'm a little sad/scared mix. I have been a stay-at-home-mom for over 8 years now. Eight years of freedom to do what I want, when I want. When I graduate, I will have to go back to work for the first time in, by that time, 9 years. Nearly a decade. That's a BIG change. I will miss being able to jump at the drop of a hat to do whatever. I think this hit me hard realizing that this last Christmas could be my last Christmas off with family in a while. This is something that will take a while to get used to.

I'm enthusiastic. To finally have steady income and health insurance. Good health insurance.

I'm optimistic. I am hoping for the best job. One where I love to work, so that it's as if I am not working at all. I know for some, that seems like a dream, but in reality, I am just hoping I love what I do so much, more so than just having a "great job." I have hope that it will be everything I have looked forward to all these years.

I'm ready. I think.

Wrapping up Ortho/Neuro

This class is done, and has been done since last Monday- thank goodness! I'm not sure how much longer I could tolerate the teacher.

Unfortunately, she is the worst professor (if I should even call her "professor") that I have ever encountered. She is rude, she would never admit she is wrong, she confuses herself during lecture, she doesn't know what she's teaching, she often contradicts the book during her lectures, her exams are just ridiculous and she is just overall mean, unless she likes you.

I am so glad to be out of her class. It was by far the most difficult and I am so thankful I did so well on the first exam and decent enough on the second exam to where I only needed to get 57 on the final to pass the class. I ended up getting a 72 on the final. That actually was a failing grade- C is 73-82. But it was enough to pass me and that's all that matters.

There was a lot of people who needed grades in the 70's on the final to pass. Some did it, some did not. A lot did not actually. If I had to guess, about 1/3 of the class failed. Even my clinical instructor said that if so many people are failing her class, semester after semester, doesn't that tell you it's not the students? I counted at least 25 students that took this class last semester that were retaking it now with me and I would say about that failed the course this time. Very sad. And makes me VERY grateful I was able to come out of this class alive and kicking. I can't even imagine having to sit through this lady's lectures and exams for another semester. Talk about torture.

My clinical instructor on the other hand was amazing. She really got us to think but in a non-intimidating environment. She was gentle and kind but didn't hold our hands- which is what we don't need. We need to be able to handle things on our own and think about things ourselves, but she never made us feel stupid or scared or imcompetent if we didn't know the answer.

I think all instructors need to take a course from her in how to handle students. Like I said, we don't need someone to hold our hands, we just need someone to believe in us. She did that, and it made a difference.

So next up- Cardio. This is a mixture of cardiology and respiratory problems, and a few endocrine issues. This is basically the last "stressful" course I will be taking, and once I am out of this course, the next one is just writing papers and doing projects and pretty much it is unheard of to fail that course. I will have 3 exams in the Cardio class and 1 exam in the last class, and then I am done.

Done.

Wow. Never thought I would reach that point. It seemed like such a far off goal, but now it's so close. I can finally see the light at the end of the tunnel.

Four months and 11ish days left. Wow.