Busy Bee

On Monday, I have 6 weeks left. But really the next 3-4 weeks will be the meat and potatoes of it all. I have 7 articles in which I have to read, write an abstract on and then a 1 page paper on how I feel about the article. Seven of those. Then I have a group project- a group presentation and a group paper. I still have to do 8 clinical days- 96 hrs of time. No, it's not a lot, but I do have some writing to do for those clinical days as well in my clinical journal. I also have to attend and take part in one of the local hospital's disaster drills and I have to also sit through the State Board's discipline hearings with my class (so that we can see what occurs, etc).

I am not complaining. I'm just stating I'll be a little busy.

I met today with my preceptor at the hospital. She's really nice and I'm really excited. I start my clinical on Wednesday and then my second shift is Saturday. Basically I look at my preceptor's schedule and decide when I am going to come in, which is nice. I am hoping, if all goes as planned, I will be done with my last clinical day around the 7th of April. If not, I will have a day or two to do around the 13th. the best thing is that my article project is due the 11th, my presentation will be on the 11th, my paper is due on the 18th, all of my clinicals will be done by then as well, and my kids start spring Break on the 18ths, so I will be able to enjoy the entire week off with them with no work to worry about going back to the next week. I will be officially done with school by then- in one month I will be "done".

So cool.

But for now, I will be busy. I'll try to update after Wednesday and let you know how it went.

Wow!

I sit here in my living room catching up on American Idol (since I've gotten a little behind thanks to my Cardio class), thinking about tomorrow.

Tomorrow I begin my final course in this journey. I have 7 weeks left and it just blows my mind. Its amazing to me. 7 weeks. It's gonna fly by.

Until then, I must go slumber and face tomorrow.

Cardio is

Over.

Today was my final exam. Got a 79. Not totally proud of it, but it was enough to earn me a B in the class, so I am super excited about that. More importantly, I took my last real nursing exam today. I have one more class and one exam in that class, but the class grade is made up mostly of paperwork, and the exam is mostly common sense, as the teacher put it. That takes a lot of weight off my shoulders. I have 4 assignments, one of them being a paper, one being a group presentation, one being a resume and the other assignment is where I have to find an article on 7 different topics from a list, then I have to write an abstract on each article and a reaction paper about each article (the reaction paper is basically my opinions and feelings about the information in the article). This I may start over Spring Break because I like to get things off my plate as soon as possible.

For clinical I will no longer have a clinical group, or an instructor per se. I will have an instructor who oversees me, but for the most part, I meet with a preceptor (a nurse at the hospital I am assigned to) and I basically work with her. I find out what days she is working and it is up to me to decide when I want to come in. I have 7 shifts to complete and can do them as quickly or as slowly as I want, except that I have to have at least 4 completed by midterm. I will also be assigned one ER day, but I'm not sure when that will be exactly, however, I am super excited about that. I start back to school on March 14th and by April 18th, just over a month of school, I will be done with assignments and hopefully all of my clinical assignments as well. So after Spring Break, I have just about 1 month of school left. I will have to go into school for things, but nothing will be due, and that will be very nice.

I'm really excited about this next step. I have already requested to work with a particular preceptor, so hopefully that will work out. She is a new nurse, only been working 5 months, however she has a great attitude, is very organized, really knows a lot, is easy going, and I feel like I can really learn a lot from her. The nurses at this hospital seem to be.....lax in some, or most, regards. They don't seem to enjoy their jobs or are thorough enough and sometimes its just better to have a fresh perspective from someone new. My clinical instructor really likes her, too and agrees that she is a great nurse and one we can really learn from. I hope it works out that I have her. I think it would help give me a more solid foundation to build from when its time to venture out on my own.

So for now, I am on a 10 day Spring Break. Ah. No more crazy studying. Maybe some crazy paper writing, but thats it.

And best of all, exactly 2 months from today, I will have my candle-lighting ceremony. And I will be graduating.

Wow.

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.