Clinicals

I'm not even going to comment on the big timeframe that I have gone MIA, other than to explain the second semester nursing is whooping my behind. So freakin hard. I'm just hoping to get B's in every class.
The past two days I have been in clinical in the Medical ICU. I loved it, probably due to the fact that I had an awesome preceptor named Jen. She was always asking what more she could explain. I changed a central line dressing, gave shots, hung IV bags, and even questioned a pharmaceutical order. My instructor was very impressed with my knowledge. I questioned why my patient was receiving sildenafil (Viagra) and Isosorbide dinitride (a nitrate). Viagra was used to dilate his lungs, and nitrates do essentially the same thing, which has been widely accepted for years as a potentially fatal combination because a person's blood pressure would bottom out. Apparently, the group of doctors sitting next me are testing it at the VA to see its affects and it will be published in a medical journal soon. I felt smart.

One of my patient's had a subdural hematoma a couple years back with a subsequent craniotomy, so half of his skull was caved in and you could see it pulse every once and awhile. COOL. My other patient was life flighted from Grand Junction because he was hyponatremic= low blood sodium. You are supposed to have a sodium of 135-145 mg/dL, but his was 110. He was placed in the ICU because of the huge seizure risk with your electrolyte being so low, and alas, he went into a status epilepticus. This is a medical emergency and led into a code blue. I wasn't here at this point, but when I came into clinical the next morning, we were pushing Ativan and Dilantin all the time. He was unresponsive at this point. So when my nurse asked, "hey, do you want to be an NG tube down?" I was thrilled. An NG tube is a nasogastric tube that is used to inject meds or food directly into the stomach. So I take a plastic tube that is about half an inch wide and about 12-15 inches long, lube it up, and place a towel underneath his mouth in case he vomits. I stick it into his nose, it hits the back of his nasal cavity but you just got to keep pushing. 15 inches later, I believe it is in the stomach. How do I make sure? Puff air into the tube and listen with my stethoscope at his xyphoid process to hear if there is gurgling. I hear nothing, which means it's in the lungs. Greatttttttt. Jen assures me that there really is no way to prevent that, especially when they are unresponsive and have no gag reflex. I pull out the tube, which is now coated with blood, and reinsert. A success! The rest of the day went smoothly, but he's still unresponsive.

There have been many interesting stories at the VA hospital in the last month. First off, it's Springtime, and do you know what that means? It's suicide season. Apparently, springtime is big for suicides because people are depressed in the winter and Spring signifies new beginnings and happiness, and these depressed people don't feel that excitement and decide it's time to take their life. So there are many people coming into the ER with attempts. Second, I think people just get crazier at this time. One guy showed up in the ER not knowing where he was. After investigation, they found $75,000 cash on him and his apartment IN SAN DIEGO kicked open. He doesn't know how or why he got to Salt Lake City, but he's here. Needless to say, he has dementia.

Another guy, who was actually my friend's patient escaped. He was crazy as well and homeless, and when my instructor was trying to get a burger at 10 pm on a Friday, she saw him rolling down 4th South in a wheelchair, his gown billowing in the wind, racing at top speed down that mountain.

The other places I have gone in the last couple weeks is to the Emergency Department, where I successfully placed an IV with a broken arm, and back to Dialysis, which was actually really fun. On Monday, I will be in the cath lab, where they do all sorts of cool stuff like placing central lines or angios where they go into the femoral artery and inject dye through the body to see if there is an occlusion or clot that they need to clear out. That will be my last day of clinical for the year!

As for next semester, get this: Ashley and I are in the same clinical group again!! It's unheard of!!! We will be in the Infant Unit at Primary Children's and then I will be in Maternity at the U Hospital. I will also have a Community health rotation, as well as 'special days' where I will go somewhere unrelated to Maternity/Peds. I have loved this semester for all the knowledge I've gained-I'm actually starting to feel like a nurse. But also hated it for the fact that each time Ashley and I study harder, we get worse on tests and are barely hanging in there! I'm looking forward to a relaxing summer, with the prospects of another interesting semester in the fall!