So its been a while since i last posted about how work has been going. Definately still learning lots, but at the same time i have started to have confidence in myself and my abilities as a nurse. There are some things that are becoming more natural to me, chest pain for example. We have had about two a day for the past week, so im in the routine now. Take some obs, put on oxygen, get an ECG, draw bloods for Trops and then call the dr. :) Then start the admission, get set up for the dr to put in IV access and ya done. :)
Today i had a pt admitted to the hospital from the medical centre. The pt had abdo pain that started around 1300. It was just after 1500 when the pt was brought over to us. The pt not only had pain that was 9/10 but also had a distended abdomen, and nausea. I was looking after them. Once the dr came it was decided that they would be going to Adelaide so the arrangements for the transfer began. It was believed that the pt had a triple A (abdominal aortic aneurysm) which basically means the abdominal aorta dilates and causes pain and can rupture, causing the pt to bleed out in minutes. So the pt was on 5 minutely obs, coupled with IV morphine and IV maxalon. The ambulance arrived within 40 minutes of the call being placed, and then the pt began vomitting, and once the paperwork was done, he was whisked off to the RAH via the RFDS. I found out later that he didnt make it, though i am unsure what the cause was in the end. :(
Other then the chest pain, and the unfortunate event above, the week while i was at the hospital was fairly uneventful. But i have 2 weeks in the hospital before i begin my first aged care rotation. And i have my appraisal (meeting to discuss how im going) sometime in a fortnight. Fingers crossed it all goes well. :) x
Monday, March 7, 2011
Tuesday, February 22, 2011
Day Sixteen
I got to experience a section this morning!! :D I wasnt scrubbed in nor did i do anything except stand in the corner and observe but it was an amazing experience. So even tho i do not start work today until 1, i was happy to have the opportunity to be apart of this wonderful moment when the little miracle was brought into the world (getting all mushy..check). :D x
Monday, February 21, 2011
Day Fifteen
Today was another learning experience. I had another RFDS transfer, this time to the RAH and this time for a pt that we werent really sure about. The pt presented with abdo pain with unknown cause. The abdo was distended, rigid and guarding was present. Although there was discomfort present, the pt never said that they were in any pain. Normally this wasnt cause for panic and a CT scan of her abdo was booked for the following day.
Everything changed when the blood results came back. Due to dehydration, Sodium, Chloride, Bicarb, and anion gaps were all lower then the 'normal' range. Creatinine was 595 (WAY over), urea 37 (again way over) and liver enzymes were all high. White blood cell count was also high, and her CRP (indication infection, usually less then 8) was 330. Something was happening to this pt. So now the cause of the abdo pain was unknown and on top of that we had the potential for kidney failure. The pt was cathertised (the first time i had ever done this and it was successful :D) and 600mLs had drained. Urine retention was added to the list, however it wasnt too bad.
So the ambulance was contacted, RFDS organised and the forms filled out (getting the hang of these now) and the pt was taken to the RAH. I hope everything turns ok.
Finally, i found out there was a planned C-Section to happen tomorrow (22nd Feb) and so i asked if i could be there to experience it, even tho i wont be starting work until 1. I was allowed to, providing the pt says it is ok. *fingers crossed* :D x
Everything changed when the blood results came back. Due to dehydration, Sodium, Chloride, Bicarb, and anion gaps were all lower then the 'normal' range. Creatinine was 595 (WAY over), urea 37 (again way over) and liver enzymes were all high. White blood cell count was also high, and her CRP (indication infection, usually less then 8) was 330. Something was happening to this pt. So now the cause of the abdo pain was unknown and on top of that we had the potential for kidney failure. The pt was cathertised (the first time i had ever done this and it was successful :D) and 600mLs had drained. Urine retention was added to the list, however it wasnt too bad.
So the ambulance was contacted, RFDS organised and the forms filled out (getting the hang of these now) and the pt was taken to the RAH. I hope everything turns ok.
Finally, i found out there was a planned C-Section to happen tomorrow (22nd Feb) and so i asked if i could be there to experience it, even tho i wont be starting work until 1. I was allowed to, providing the pt says it is ok. *fingers crossed* :D x
Thursday, February 17, 2011
Day Fourteen
So, i had my first busy shift today. We had 6 pts in the hospital, and three people present to casualty with different conditions who ended up being transferred to larger hospitals in the city via the Royal Flying Doctor Service (RFDS). The first was an open crush fracture to his R) index finger, the second had a ? (query) bowel perferation causing them a considerable amount of pain and ? turning septic and the third, the one i was given, had had a ? MI (Myocardial Infarction).
So i had the person who had a ? heart attack, and i jumped straight into MI mode by obtaining an ECG and drawing bloods for trops (a cardiac enzyme, troponin, which is released by cardiac muscles when damage has occured) to see whether they were positive or negative. I thought i was managing ok until a nurse way more experienced then me came in and asked about the pts vital signs, which i had forgotten to take as i had jumped straight into taking my ECG and trops. Opps, at least i will remember for next time...i hope.
Trops take 10 mins to be analysed by the little machince and it turned out they were positive. So now i was managing my first case of a MI, not just ? MIs, so i began to panic a tiny bit, i think it was expected. Anticoagualtion treatment was commenced, which involved giving the pt a Clexane injection (this just ensured that no clots could form which could potentially lead to further problems). I began to admit the pt (think a huge stack of forms that needs to be filled out) while the doctor contacted the cardiologist at the Cardiac Care Unit, located at Flinders Medical Centre (FMC) and it was decided that the patient would be transferred there for more care, since this was the pts second MI in 2 years. The transfer added a couple extra forms to the pile.
The pt presented at around 11am. By 1400(the reason it took so long was because we had already sent other pts over to Adelaide around 1230, and they needed time to refuel and everything before they came back, and the pts vitals were stable) we had been contacted by the RFDS for a handover to be conducted over the phone (which i can now say i have done :D) and so more informations, such as the pts weight and whether another person was flying with them as the pilot needed to calculate how much fuel would be required. At 1530 the ambulance arrived to take the pt to the airport, and i hope everything is going well with him and the other two people that were transfered to Adelaide.
I felt a bit stressed about the day, since not only did i have my own Emerg pt, but i was assisting with the other two emerg pts to learn a bit about the treatment for those conditions and jointly looking after the other 6 pts on the ward. It was an exciting shift and i learnt so much, but i dont think i want it to be repeated again in a hurry, i would definately like some more learning time before then. :)
So in the words of last yrs Graduate nurse.. "Its going to get easier, then a whole lot harder, before it gets easier again". Am i worried? A little, but all in all i say BRING IT ON!! :D x
Monday, February 14, 2011
Day Eleven
So, today was good. Great even. I had two patients all to myself. The other nurse had three with the student. The hospital is still fairly empty..for now.
I learnt a fair bit today. How to discharge someone, tho the paperwork is fairly straight forward (have i mentioned yet just how much paperwork there is in Nursing? i swear most of your shift is spent doing it!), and i think i did a good job. I also learnt the way to go about booking a community car to take a patient home, ring up a nursing home to discuss pt discharge arrangements and ring the medical surgery to book follow up appointments for pts prior to discharge (but yes, it all seems to be as straightforward as it sounds, so really its nothing special, just got to make sure you dot your i's and cross your t's and sign in all the right places). :)
I also learnt how to fill in pt transport forms when a pt is heading to Berri for an x-ray or CT scan, and this changes depending on whether they go by ambulance or a private car driven by a family member or friend. Again, straightforward.
Apparently there are falls protocols too, so if a patient presents to Casualty for medical treatment after a fall and they are over a certain age, well theres a form for that too. :)
Today, i learnt a fairly important lesson regarding DDA's (Drugs of Dependence). If something has 'contin' in the name its slow release (SR). i was going to give a pt Endone, 5mg, so i reached for the 'Oxycontin' - Oxycodone Hydrochloride 5mg tablets. However, Endone is quick release and last for about 4 hours (Oxycontin lasts for 12). The trick there? Well, Endone, quick release, is Oxycodone too. Just to make it confusing. So to sum it up, Oxycontin - Oxycodone is SR, and Endone - Oxycodone Hydrochloride is quick release. But even tho the brand names are different, the drug compound that makes up the medication is oxycodone in both cases. No wonder i got confused, but i've learnt this now. There are other drugs that have contin in the brand name, which also means that particular drug is SR, just to confuse us more. At least i will get it right from now on. I hope.
Since it was fairly quiet, (I only had 1 pt after 11, and they left at 1230 for a few hours to have an xray in Berri) i had the opportunity to think up and write down some learning objectives that i would like to achieve over the next 12 months. Of course there are all the usual ones, becoming competent with venopuncture and medication management, as wel as female catherterisation, if someone comes in who needs it, but the main things i am focusing on, for the next month at least, are:
- To feel able to initiate treatment for a patient who comes in with chest pain without thinking "OMG what do i do again?" and losing my knowledge to panic that might take over. Also contacting the Dr, but not before working through all the steps i need to complete so i can give the dr all the information they require.
- To feel more competent when assessing a pt that presents to casualty, even if its just to the point of finding out their personal details, what made them come to the hospital, a set of complete vital signs and any specific questions that relate to that particular scenario, AND
- To be able to adequately and appropriately manage a pt who has been involuntarily detained under the mental health act and arrange safe and case appropriate transport to Adelaide where they can gain a better range of health. Mental health is interesting to me, probably because i don't understand it very well, so i think to be able to successfully handle a situation, i will need to have gained some basic knowledge in this area, which i hope to do over the next 12 months.
Finally, i spoke to the TPPP/GNP facilitator today about how she felt i was going. She told me i was on par with where is was meant to be at this stage in my training. So, with a big sigh of relief and a new wave of determination, im ready to face the next stage of increasing my knowledge and independence that little bit more. :D x
I learnt a fair bit today. How to discharge someone, tho the paperwork is fairly straight forward (have i mentioned yet just how much paperwork there is in Nursing? i swear most of your shift is spent doing it!), and i think i did a good job. I also learnt the way to go about booking a community car to take a patient home, ring up a nursing home to discuss pt discharge arrangements and ring the medical surgery to book follow up appointments for pts prior to discharge (but yes, it all seems to be as straightforward as it sounds, so really its nothing special, just got to make sure you dot your i's and cross your t's and sign in all the right places). :)
I also learnt how to fill in pt transport forms when a pt is heading to Berri for an x-ray or CT scan, and this changes depending on whether they go by ambulance or a private car driven by a family member or friend. Again, straightforward.
Apparently there are falls protocols too, so if a patient presents to Casualty for medical treatment after a fall and they are over a certain age, well theres a form for that too. :)
Today, i learnt a fairly important lesson regarding DDA's (Drugs of Dependence). If something has 'contin' in the name its slow release (SR). i was going to give a pt Endone, 5mg, so i reached for the 'Oxycontin' - Oxycodone Hydrochloride 5mg tablets. However, Endone is quick release and last for about 4 hours (Oxycontin lasts for 12). The trick there? Well, Endone, quick release, is Oxycodone too. Just to make it confusing. So to sum it up, Oxycontin - Oxycodone is SR, and Endone - Oxycodone Hydrochloride is quick release. But even tho the brand names are different, the drug compound that makes up the medication is oxycodone in both cases. No wonder i got confused, but i've learnt this now. There are other drugs that have contin in the brand name, which also means that particular drug is SR, just to confuse us more. At least i will get it right from now on. I hope.
Since it was fairly quiet, (I only had 1 pt after 11, and they left at 1230 for a few hours to have an xray in Berri) i had the opportunity to think up and write down some learning objectives that i would like to achieve over the next 12 months. Of course there are all the usual ones, becoming competent with venopuncture and medication management, as wel as female catherterisation, if someone comes in who needs it, but the main things i am focusing on, for the next month at least, are:
- To feel able to initiate treatment for a patient who comes in with chest pain without thinking "OMG what do i do again?" and losing my knowledge to panic that might take over. Also contacting the Dr, but not before working through all the steps i need to complete so i can give the dr all the information they require.
- To feel more competent when assessing a pt that presents to casualty, even if its just to the point of finding out their personal details, what made them come to the hospital, a set of complete vital signs and any specific questions that relate to that particular scenario, AND
- To be able to adequately and appropriately manage a pt who has been involuntarily detained under the mental health act and arrange safe and case appropriate transport to Adelaide where they can gain a better range of health. Mental health is interesting to me, probably because i don't understand it very well, so i think to be able to successfully handle a situation, i will need to have gained some basic knowledge in this area, which i hope to do over the next 12 months.
Finally, i spoke to the TPPP/GNP facilitator today about how she felt i was going. She told me i was on par with where is was meant to be at this stage in my training. So, with a big sigh of relief and a new wave of determination, im ready to face the next stage of increasing my knowledge and independence that little bit more. :D x
Wednesday, February 9, 2011
Day Eight
Today was the first day that i felt i can do this. I mean actually do this. I had an amazing EN student with me who is so willing to learn. And i was thinking independently, instead of forever asking for clarification on something. I've learnt basic things now, some routines, where things are, the way certain things are carried out. It feels good.
Of course, i'm still making small mistakes. Like forgetting we needed a faecal sample from a pt (patient) until after he had used his bowels. But nothing life threatening, nothing even really harmful (this shift anyway). I know i've still probably got that expectation bar set way to high (i'm learning, i need to give myself time to do that and not just expect to know it all) but i'm slowly lowering it a little bit, as well as rising up to meet it. :)
Today i rang the doctor for the first time regarding a pt and pain management issues that they were having. I needed to explain the situation and what i was after. I also made a suggestion of what i thought, with the help of my very knowledgeable GNP coordinator, would be a possible drug to try (even tho i wrote it on the stat med chart, and spelt it incorrectly...at least today i can say i now know how to correctly spell it. Its buscopan..not buscapam. :P). The doctor then came over to review the patient and i found that i was able to appropriately and professionally liase with him regarding the pts care and what i was needing to do to help with their pain management. A very helpful skill to pick up early on in this industry. Although i do believe that i will still need quite a bit of practice at it before i am truely competent in this area. Just got to remember baby steps..as long as im learning and increasing my abilities i am doing ok.
The other thing that is new to me is bedside handover, a new initiative brought in by Health SA to help involve the patients in their own care. Basically it involves the morning staff member responsible for the patients care and the afternoon staff members to talk to and with the pt at handover time. You get the patient to introduce themselves and why they are in hospital, explain what we are providing for them in terms of care, check they are wearing correct wrist bands with their personal information on them (red for those with alerts) and give the pt a chance to ask any questions or raise any concerns they have with their care. i felt that today i had a slight grasp on this, still a long way from perfect, but definately heading in the right direction. :)
So i found that today i felt better about everything. I felt competent and like i will actually survive this year without too many mistakes, because lets face it, they will happen. But i feel like i will cope with anything that is thrown at me, and if i can't, i feel that i will be able to ask the appropriate questions to the right people to get the answers i need. Fingers crossed i continue to feel this way. :) x
Of course, i'm still making small mistakes. Like forgetting we needed a faecal sample from a pt (patient) until after he had used his bowels. But nothing life threatening, nothing even really harmful (this shift anyway). I know i've still probably got that expectation bar set way to high (i'm learning, i need to give myself time to do that and not just expect to know it all) but i'm slowly lowering it a little bit, as well as rising up to meet it. :)
Today i rang the doctor for the first time regarding a pt and pain management issues that they were having. I needed to explain the situation and what i was after. I also made a suggestion of what i thought, with the help of my very knowledgeable GNP coordinator, would be a possible drug to try (even tho i wrote it on the stat med chart, and spelt it incorrectly...at least today i can say i now know how to correctly spell it. Its buscopan..not buscapam. :P). The doctor then came over to review the patient and i found that i was able to appropriately and professionally liase with him regarding the pts care and what i was needing to do to help with their pain management. A very helpful skill to pick up early on in this industry. Although i do believe that i will still need quite a bit of practice at it before i am truely competent in this area. Just got to remember baby steps..as long as im learning and increasing my abilities i am doing ok.
The other thing that is new to me is bedside handover, a new initiative brought in by Health SA to help involve the patients in their own care. Basically it involves the morning staff member responsible for the patients care and the afternoon staff members to talk to and with the pt at handover time. You get the patient to introduce themselves and why they are in hospital, explain what we are providing for them in terms of care, check they are wearing correct wrist bands with their personal information on them (red for those with alerts) and give the pt a chance to ask any questions or raise any concerns they have with their care. i felt that today i had a slight grasp on this, still a long way from perfect, but definately heading in the right direction. :)
So i found that today i felt better about everything. I felt competent and like i will actually survive this year without too many mistakes, because lets face it, they will happen. But i feel like i will cope with anything that is thrown at me, and if i can't, i feel that i will be able to ask the appropriate questions to the right people to get the answers i need. Fingers crossed i continue to feel this way. :) x
Friday, February 4, 2011
Day Five
Today i was excited because it was 0815 and i was on track! Well, i was until a patient came into emerg and i was lucky enough to assist with their care. It was a great learning experience of what to do when a person came in with chest pain, and the patient turned out to be ok. Although it had kinda thrown me out of whack, i had caught up again by 1230 (losing and finding a bottle of calcium supplements and successfully taking blood with a vacuette (YAY!!!) in the meantime).
*For those who don't know, a vacuette is a small green tube that has a special needle screwed into the bottom of it that allows the small containers used to collect the blood in to be filled while only having to stick the patient once with a needle (probably not the most accurate way to describe them, but my brain is mush at the moment)*
I got to count the DDA drugs at shift change and i thought i had successfully completed my shift without forgetting anything for the first time...until i realised i had forgotten to write a patients note. :/
So, feeling guilty and bad about this, theres another mistake to add to the list. But, i think i will get the hang of this....eventually! :) x
*For those who don't know, a vacuette is a small green tube that has a special needle screwed into the bottom of it that allows the small containers used to collect the blood in to be filled while only having to stick the patient once with a needle (probably not the most accurate way to describe them, but my brain is mush at the moment)*
I got to count the DDA drugs at shift change and i thought i had successfully completed my shift without forgetting anything for the first time...until i realised i had forgotten to write a patients note. :/
So, feeling guilty and bad about this, theres another mistake to add to the list. But, i think i will get the hang of this....eventually! :) x
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