Category: Uncategorized (Page 167 of 212)

From our class discussion forum: For Week #4, compare the similarities and differences between pediatrics and your Adult I experience. Address the patients (diagnoses, ages, challenges), clinical sites, staff, and personal comfort you have experienced in these two settings.

The tone between my two floors is striking. I had Adult I at the **** – lots of old men. Some were depressed, some told riske jokes, some made racial comments, some were jolly, and some you could read their hard life experiences in the lines around their eyes. The staff was caring but emotionally distant. We were polite and cordial to these men who grew up in a different era.

At **** the mood is jolly and full of encouragement. We try to be pals with the kids and give them good experiences. Since they come in repeatedly they develop strong attachments to their nurses. The nurses reach out to make them comfortable, whether it’s extra stickers or special candy cane flavors, or even making custom toys out of hospital supplies.

One night at the **** a gentle man held a concert for our unit. Nurses, secretaries, janitors, and patients gathered around him in the staff lounge. He sat in his motorized wheel chair in his yellow gown (MRSA positive) and softly sang old love tunes from WWII. His voice was crackly and quiet but you could tell that he was a grand singer when he was younger.

This week a professional singer in a green velvet dress and santa hat popped onto our floor and sang Christmas carols. Her voice was smooth and honey-like, the rumor was that she was a relative of Amy Grant. Kids and staff poked their heads out of doors to get a better look at where the beautiful voice was coming from.

Both were a capella performances given for love of the patients and staff, but they were quite different experiences. Either way, everyone had a fresh smile on their face afterwards.

Thanksgiving post and pics to come, I promise. Been a crazy busy but good week at school I don’t want to write much, but don’t want to forget my experiences. Thus bullets!

• Leadership is over and I think I got 100% in the class. woot. Also didn’t pass their ATI practice test – the first time this whole program. What does that tell us about the class?
• Tuesday in outpatient dialysis. Pretty boring on the whole, but I have a better understanding of renal function and got to help set-up dialysis, blood draws, and talked about transplants.
• Wed/Thur two GREAT clinical days. Cared for two kiddos both days.
• First an 11 month old, hepatoblastoma, here for fever and neutropenia (FN). Tiny kid, was twin-twin transfusion in utero (both survived, he’s the small one). Had necrotizing enterocolitis, has a J-tube in place. Been vomiting up all his feeds until today, when he kept down a lot of PO as well as gavage overnight. Yea!
• Second a 19 year old guy with ALL (a leukemia) also in for FN. Really skinny and malnourished as well. Had him eating more by the second day and doing a lot better
• Basic care for both: give antibiotics, pain meds (dronabinol for one, or as my nurse said “the ganja pill”), get food down, measure pee and poop, vitals, and gown-up every entrance since both were on droplet isolation.
• Also got to see a lumbar puncture – it’s like maple syrup dripping out of a tree!
• Worked with the same great nurse as last time. She and my instructor are so encouraging and I had many chances to shine. I feel like I got the adult equivelent of gold star stickers all day.
• It snowed today! White out conditions made my preceptor late – she lives in the mtns and it took her 3.5 hours to get here.
• I got to work with a non-floor nurse for a couple hours (more gold stars) and do more independent care. I felt like I took the lead!
• Kids get the coolest stuff. Marshmallow shooters that act as incentive spirometers. “Beads of Courage” that they collect for a necklace – a different colored bead for each type of procedure like transfusions, chemo treatment, etc. My nurse said while I was in my clinical conference she went in the OR to help place a broviac in a teddy bear! They let the little girl scrub-in and help the surgeon place a central line in the teddy’s chest along with a bag of fluid so she can flush and draw blood from her own toy. I told my preceptor that if the do one next week to make sure I get to assist.
• The snow was swirly outside the windows. When I walked out to my car at the end of my shift I could see it was the perfect picture-book crystals that sparkle like glitter in the parking lights.
• There are Christmas decorations all over the hospital and I love it! We gave one of our kids a stocking of cherry candy canes because he hates peppermint ones. A singer came to the floor and serenaded us with carols.
• I’m dead tired after three shifts in a row (8, 12, 12) but I’m on a high from it going so well. My back is pinched and I have so much homework that tomorrow won’t be a day off at all.

• But I came home to this:

• Ben is so fantastic. He had decorations up, dinner hot on the stove, and Christmas swing music playing when I walked in the door. I love my man. I’m getting so excited for break and for the holiday. One week to go!

Remember way back when Amanda and I got fabric to make kitties? And then she made hers in a reasonable time-frame? Well I finally finished mine. Behold!

The little guy’s purple nose is hard to see. I’ll probably replace it with some peach felt. Otherwise I like them very much!

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Take 6 finally worked, originally uploaded by rachelsmason.

I had the pleasure of seeing Andy perform as Mies Gloriosous in A Funny Thing Happened on the Way to the Forum last weekend. It was a great show – the perfect part for him I think. It was a whirlwind trip but a lot of fun seeing all my mom’s side of the family. I put up some more pictures on flickr.

But then we ate them without taking pictures. So you get Demolly pictures!

That’s better.

Here is my 2 ounces of yarn spun on my drop spindle. I counted roughly 76 to 78 yards of single ply yarn. It is recommended that you unwind your yarn onto a chair back if you don’t own a niddy-noddy. They don’t mention that you should choose a chair back which is not wider at the top than in the middle. Luckily I was able to stretch my yarn over the upper corners after I discovered my error. That’s Jem cowering all guilty-like because I caught her on the table, licking my bowl of chicken soup while I was away from the table. She knows that was wrong, but she can’t stop herself!

After two soaks in the sink I hung my skein to dry. The wash and dry is supposed to set the twist. Sadly there isn’t much I can do with 78 yards. Next time I’m at Fancy Tiger I’ll check for more roving from this sheep.

Bestest. phone call. ever. I won 4 free burritos from Chipotle in their weekly drawing. YEA!!!! No cooking tonight!!

(I’m cheating on this post. We have to respond to questions in an online discussion group for class. Instead of writing a post about my week here, I’m just copying my response to the group. Mwa haha, I’m so clever).

* Describe your patient assignment this week. What was the child’s diagnosis, treatment, nursing challenges?
I cared for a three year old girl with neuroblastoma. She was here for a 4 day course of chemotherapy, I cared for her on the third and fourth day. The first day she was very quiet, sleeping a lot, not feeling well. Her father was at the bedside and I get the feeling he wasn’t thrilled about that. Not involved in care. The second day her mother came in the afternoon and the girl perked up immensely. Suddenly she was all about playing and talking. Very fun and sweet.
With her chemotherapy her I&O’s are extremely important. her kidneys get blasted so you want to keep fluids going through her. We had her on D5W + ½ NS + 20 mEq KCL round the clock. We weighed her diapers and measured emesis to make sure her output was at least 45 m/hr per orders. Otherwise you replace ml per ml. She also has a strict regimen of fluids and electrolytes after her chemo, which was during the night shift so I didn’t really get to see that.

* What was your most significant thing learned during week #2? (In other words, an “aha” moment!)
First to answer some of the group’s questions, the oncology patients are here for various amounts of time. Like I said, my girl was here for a specific course and many are like that. In for a week at a time every month or two. Another child I cared for was here since he was diagnosed 9 days ago. My nurse also had a patient in the BMT (bone marrow transplant) unit so I got to shadow the care there. It was an 11 year old girl with aplastic anemia (her marrow stopped making all types of cells). She had a 10 day course of chemo, then go a transplant of stem cells from cord blood, and now was waiting for her body to respond. It can take just a week or two to work, but she’s been here in isolation for 34 days now with no response. They talked another a kid who took 120 days for his body to start producing. They also had a 18 month old kid who had been the hospital since birth. So the length of stay on our unit can vary quite a bit.
I’m not sure I had an aha moment, but obviously I’m already learning a lot about oncology care. I got tons of practice giving IV medications (working with the tubes, doing calculations). I also had some variety with my little 3 year old – getting assessments while she sleeps and getting assessments while she’s talking and jumping and playing with my steth (including banging the bell with it in my ears – OUCH!). You have to make special accommodations to get the information you need. You have to be creative and flexible.

I’ll try to keep this short because I’m very tired and I need to get to bed early, say by 9:30.

Despite going to bed at 9 pm last night it was not restful. I had just finished my prep sheet for my first patient the next day and I was in a state of panic. How do I measure input and output for a three year old? How do you get a UA dip each time she pees? How I will know when she needs to pee? How do I get into their omnicell? What counts as hypotension for a kid on chemo? What does chemo look like? And these are in addition to all my normal anxieties about new clinical, such as will I get a good nurse? Will she like me? Will I be bored? Will I get to do anything good? And what if I screw it up? What if I get sick tomorrow? What if I’m late? How early do I need to leave? How will I meet my clinical instructor? Like I said, I’ll stop there to keep it short.

So I slept from about 10 pm to midnight, then woke up every 45 minutes until 5 am. As usual breakfast (oatmeal, banana, OJ) did not taste good that early. I felt like throwing up and had diarrhea – my usual anxiety woes. They usually dissipate by the time I get to my clinical/first rehearsal/performance, but they make the getting there part fairly awful.
I was nearly late and had trouble with my badge access to parking.

Luckily my nurse Anna was in no hurry and set me up for a great day. She worked with me at my pace and let me do all the things I wanted, without pushing or assuming I knew a lot. Of course I fumbled and felt flustered and slow throughout the day, but she was a great cheerleader and teacher. I even dropped an open port of tubing on the floor TWICE in one hour and she showed no disappointment in me. I worked with all three of her patients including the one who I prepped to care for, a 3 year old girl with a stage 4 neuroblastoma. She was a cute little girl who liked The Little Mermaid and wanted to play with the empty syringes and bags after we changed her fluids.

I felt like I mostly shadowed today, which is what I wanted. They had set me up to believe I would be doing total patient care, and indeed I heard some horror stories from other students who were at the hospital last weekend. Nothing like that for me. It’s a top of the line hospital with the cheeriest staff ever.

My biggest complaints with my rotations so far have been 1) It’s too slow and 2) I don’t get to do enough procedures. Well today was anything but slow with NO downtime and I worked with more IV meds/tubes today than I have in all my schooling combined.
I don’t know how I feel about peds. I don’t have any spark of “Oh yes! Working with kids is the best/my calling/all I ever dreamed of. ” But I don’t dread it or have any trouble getting over the fact that we have to do things to the kids that hurt. I’m dead neutral. I wonder how I’ll feel in four weeks.