April 11, 2012

I slept all day so I’m not feeling as tired as I have been the past few shifts. I am currently still looking for a job and have received a few responses just saying they are looking for more experience which I can understand, but if I need experience to get hired then how am I supposed to get that needed experience if no one will hire me? It is very frustrating sometimes but I am glad at least I have my CNA license so I am qualified for a job in the medical field.

Tonight the ED (emergency department) has been fairly busy. A man came in having seizures that was going to be admitted to the hospital for that reason, but the RN noticed that the patient had a fever. So before the patient was transported to the ICU, the doctor wanted to make sure he didn’t have meningitis (can cause a fever) so they intubated (placement of a flexible tube into the trachea to either assist the patient to breath or to keep the air way open) him and then did a spinal tap to be able to test for meningitis.

A lumbar puncture (also called a spinal tap) is a procedure to collect and look at the fluid (cerebrospinal fluid, or CSF) surrounding the brain and spinal cord. During a lumbar puncture, a needle is carefully inserted into the spinal canal low in the back (lumbar area). Samples of CSF are collected. The samples are studied for color, blood cell counts, protein, glucose, and other substances. Some of the sample may be put into a special culture cup to see if any infection, such as bacteria or fungi, grows. The pressure of the CSF also is measured during the procedure. (http://www.webmd.com/brain/lumbar-puncture)

I also spent some time in the Labor and Delivery department learning about a complication that can happen during a pregnancy called PIH or preeclampsia. The most common signs/symptoms or preeclampsia are hypertension (high blood pressure), high protein in the urine due to the preeclampsia affecting the kidneys, vision changes, and a headache that doesn’t go away.. In some more severe cases the liver is affected causing pain on the right side of the belly making the diagnosis change from preeclampsia to HELP syndrome (hemolysis, elevated liver enzymes, and low platelet count). The baby must be observed closely to make sure that the baby is still receiving the proper oxygen and blood flow through the uterus. Another concern is that once the mother has progressed to the point they have HELP syndrome, their platelet count is so low that their blood cant clot and if the mother was to have a c-section or a vaginal birth, there would be major concerns of how much the mother will bleed and will the doctors be able to stop it. The only cure for HELP and preeclampsia is delivery of the baby.

After having a mastectomy (the removal of partial or completely one breast, done to treat breast cancer) you will be missing some if not all of the lymph nodes on that side of your body. Lymph nodes contribute to blood return to the heart, so most times if a patient has had a mastectomy you would not try to put an I.V. in the arm on the side the mastectomy took place due to the risk of the blood/fluids being able to travel back to the heart. When the fluids and blood can’t properly travel back to the heart it causes swelling (edema) of the arm and for some mastectomy patients the edema can be permanent. A patient came in to the ED with this scenario and their veins in the arm on the side of the body that had not had the mastectomy were very fragile and would blowout before the nurses could start an I.V. The last option was to start a line in the vein of the patient’s foot which did prove to be successful. The nurses were then able to begin hydrating the patient with fluids and complete the proper blood work.

April 7, 2012

Tonight is a full moon so it has been very busy, especially in the Labor and Delivery Department. There were many women who were in labor and two women who needed to be taken to the OR (operating room). I got to go into the OR with a woman who had given two previous vaginal births and did not want a Caesarean Section for this baby but her blood pressure was too high and they needed to get the baby out ASAP, luckily the baby was full term. The patient needed to go completely under anesthesia which meant that the doctor needed to get the baby out as soon as he could before the anesthesia started to effect the baby. I was surprised of just how fast everything went because one minute they were cutting into the patient to get to the uterus and then the next the doctor was pulling the baby out. The bay came out with good skin color and didn’t show any signs of being affected by the anesthesia. I then watched the doctor and nurses begin to sew up the uterus and then stitch up the skin where the incision had been made. It was very fascinating to be able to see the different muscle and fat layers, and of course all the blood. I was also very impressed by how small the incision was and how good it looked once it was sewed and cleaned up.

I also realized just how important wrist bands are for the safety of the staff and the patient. A CODE was called which means that a patient has no pulse and it lets the rest of the staff know there is an emergency going on and for the proper staff to respond ASAP. Once Lee and I were almost to the room, the CODE was called off. The patient had wished to be DNR (do not resuscitate), but was not wearing a DNR wrist band. The nurse in charge of the patient did know the patient was DNR but the first nurses who called the CODE were not aware. If the patient was being transported or getting an ex-ray done and all of a sudden went into CODE, the staff’s first response would be to take emergency measure to resuscitate the patient. But if the patient did not want to be resuscitated and was due to not having a DNR wrist band, it could become a big legal issue for the hospital. Always make sure that each patient has the correct wrist bands on at all times. The patient did end up passing away shortly after the code was called, and I then watched the nurses “prepare” the body so when family members came to see the patient one last time, they would look a little more presentable. This would include repositioning the patient, putting in dentures if patient had any, raising the head of the bed slightly and covering them up with blankets. I also watched the nurses put the patient in a body bag so the morgue could come pick the body up when family had left. After doing blood work they found the patient died from a heart attack.

April 3, 2012

First off, tonight is kicking my butt as far as not having any sleep and just being worn down, but I have learned a lot tonight. When I first got here, a trauma came into the ER which was a man who had been kicked in the abdomen by a horse, then proceeded to drive himself to the hospital. On the way to the hospital, the doctors believed that he passed out resulting in him driving off the side of the road and into a ditch. When he arrived by ambulance to the ER, his blood pressure was very low and they believed he had ruptured his spleen causing internal bleeding. I noticed that his skin was very gray looking and he was slightly shaking due to being in shock. After the doctors took a look at his ct scan, they decided to take him straight into the OR to remove his spleen (splenectomy), control the bleeding and look at a possible liver laceration. He had lost a lot of blood but they used an Auto Transfusion Device during surgery which took the blood from his abdomen and recycled it back into his body. Once the surgery was completed, I noticed he was talking and had color back to his skin. He was recovering very well.

About the spleen:

The spleen is located in the upper left quadrant under the ribs. There are different reasons for a splenectomy but in this case the patient had ruptured his spleen due to a blunt abdominal trauma which is common. Hypotension from hemorrhage is the most common presenting finding. (http://www.madsci.com/manu/trau_abd.htm)

A man with a blood alcohol level four times the legal limit came into the ER after falling down a few stairs and having his teeth go completely through his lower lip. Due to the severity of the laceration, he received five stitches on the inside of his mouth, four in the middle of the cut to help close it up, then fourteen on the outside of the cut to completely close the laceration. There was a good amount of blood but what made me kind of cringe was being able to see the fat on the inside of his lip, it is not a very pretty sight. But even with the open laceration and blood, I watched the careful procedure of sewing this guys lip back up and attempting to leave a minimal scar once healed.

At about four this morning a Rapid Response was called for a man who still had a pulse, but whose blood pressure was very low. When I got to the room many nurses were already pumping fluids into him, checking his heart and blood pressure. The decision was made to give him a medication that immediately reverses the effects of narcotics in the body, which makes the patient alert and sometimes agitated. His blood pressure began to increase to a safe level and the Rapid Response was stopped.

Below is a list of medical terms that I heard tonight and needed to do further research to fully understand what they mean. From this experience so far, I know that I need to take a medical terminology class ASAP!  

Medical terminology and definitions:

Source of definitions: www.dictionary.com

Pancytopenia (pan·cy·to·pe·ni·a): A pronounced reduction in all of the formed elements of the blood.

Hemoperitoneum (he·mo·per·i·to·ne·um): Blood in the peritoneal cavity.

Hematuria (hee-muh-toor-ee-uh): The presence of blood in the urine.

Thrombocytosis (throm·bo·cy·to·sis): An increase in the number of platelets in the blood. Also called thrombocythemia .

Thrombocytopenia (throm·bo·cy·to·pe·ni·a): A decrease in the number of blood platelets.

Peritoneum (per·i·to·ne·um): the serous membrane lining the abdominal cavity and investing its viscera.

Leucocytosis (loo-koh-sahy-toh-sis): a gross increase in the number of white blood cells in the blood, usually as a response to an infection

Pancreatitis (pan-kree-uh-tahy-tis): Inflammation of the pancreas.

Dysarthria (dis-ahr-three-uh): difficulty controlling muscles of tongue or mouth.

Dysphagia (dis-fey-juh): Difficulty swallowing.

Odynophagia (o-dyn·o-ha-gia): Severe pain on swallowing.

Volvulus (vol-vyuh-luhs): A torsion or twisting of the intestine, causing a intestinal obstruction.

Stenosis (sti-noh-sis): A narrowing or stricture of a passage or vessel.

Bradycardia (brad-i-kahr-dee-uh): A slow heartbeat rate, usually less than 60 beats per minute.

Tachycardia (tak-i-kahr-dee-uh): Excessively rapid heart rate.

Tachypnea (tak-ip-nee-uh): Excessively rapid respiration.

   

March 30, 2012

My first night shift at Littleton Hospital was on Saturday March 24, but I am just now getting around to writing down my experiences. Even though I was only running on eight hours of sleep in the forty eight hours leading up to my night shift, I made it the whole night and did not have to go home early like I thought I would have to.

 My first experience was in the ER observing a young child who had had a febrile seizure that lasted about ten minutes. I learned that febrile seizures are caused by a fever in infants and small children and can cause the child to lose consciousness and shake, moving limbs on both sides of the body. Febrile seizures can last a few second to fifteen minutes, but most commonly they last about one-two minutes. Approximately one in every 25 children will have at least one febrile seizure, and more than one-third of these children will have additional febrile seizures before they outgrow the tendency to have them(National Institutes of Health). The young child I saw come into the ER ended up being ok and went home the next day.

I then spent some time with RNs and CNAs talking about how their nursing careers took off and what they would recommend for me to do as far as getting started. I learned a lot about what schools people like and don’t like, what they would change about their career if they could, and really just gave me great advice about how to get started. I heard from many people that getting my EMT (Emergency Medical Technician) before I go for my BSN (Bachelor of Science in Nursing) because it will give me background and give me experience in the ER. I have checked into some schools this week since talking to the staff here at Littleton hospital and will hopefully be visiting Aurora Community College EMT simulation classrooms.

Tonight I am also running on a few hours of sleep but so far am keeping myself awake with some snacks and Mtn Dew. A Nursing Educator tonight was very helpful by looked over my resume and gave me a few edits to correct. I am very grateful for all the help I can get as far as advice of how to start school, how to compose a good resume and any help with terminology I may not be familiar with.

Tonight I saw a man who was assaulted and came into the ER with an Orbital Floor Fracture (Blowout) which is caused by direct trauma to the orbital bones. It is a fracture of one or more of the bones surrounding the eye which can increase pressure and bleeding around the eye and the patient may leak fluid into the sinus cavity. In worst cases when fluid is leaking into the sinus cavity, the patient may lose their eye. The patient was in a lot of pain and had swelling around his eye. Once the swelling goes down, he will be taken into the OR to hopefully reduce the pressure caused by the blood behind his eye and to stabilize the fracture to control the bleeding.

I also got to spend some time in the NICU (Neonatal Intensive Care Unit) which specializes in the care of ill or premature babies. Seeing how tiny some of the babies were made me realize just how fragile life is. Many had feeding tubes because babies under thirty four weeks tend to not have the reflexes or strength to suck/drink on their own.  The NICU nurses work with the babies to help them get to a point where they are able to feed on their own once they get old enough. I really enjoy being in the NICU but I am not sure how I would handle it if a baby became non-responsive and emergency life saving actions had to be taken.

I have never had to deal with the death of a family member, only pets, so I am curious of how I will handle the death of a patient when they are under my care. Tonight an older man passed away in the ICU (Intensive Care Unit) and it really got me thinking of how OK I am with death. I know that death is a natural thing in life, but I do think I will have a much harder time with it if the death of a patient could have been prevented. For example, a patient killed by a drunk driver is much different than an older patient who has lived a long life and is dying of natural causes. I now see the consequences of doing “dumb but fun in the moment” things such as riding a motorcycle without a helmet or heavy clothing, driving drunk/high, not taking medications when they are prescribed by your doctor and even simply smoking cigarettes/marijuana. Yes accidents happen, but many times people can prevent injury or illness by just making smarter decisions for themselves and their loved ones. I make a lot of choices to not do “dumb but fun in the moment” things just because of the fact I don’t like putting myself at risk. But I know that when I choose to not smoke, drink, drive drunk and just be stupid in general, I am possibly saving my life and maybe someone else’s that my actions could effect. Death at this point in my life scares me, and I’m not sure how to get over that. I know that my feelings towards death will change as I get more experience but for now it makes me feel very vulnerable.

So far I have received a lot of great information of how I should start my career as a nurse, how to apply for jobs, as well as a lot of medical terminology. To say the least I am so far enjoying my time at Littleton and hope I will be able to see more “action” before my time is up. I also have to say that having one of the most knowledgeable nurses I have ever met by my side each shift has helped me tremendously.

March 24, 2012

My grandmother had surgery yesterday to remove a button sized tumor from her bladder. The procedure took just about half an hour and everything came out the way they were hoping. The doctor explained everything to me and even brought me pictures so I could understand what he was talking about. Once my grandmother was in recovery, I was able to go back and visit her. For anyone who doesn’t know my grandma, she LOVES to talk. My grandma had obviously been talking about me before I visited her because all of her nurses knew I was a CNA and would then explain everything to me in detail and pretty much let me observe their every move. I learned a lot about what needs to be documented on the computer and how to do that, very confusing to say the least. I also learned a lot about medications and what to give in certain situations, especially when patients are coming out of being under an anesthetic. To say the least at the hospital I learned a lot more than I expected.

When I brought her home, it was challenging to get her settled and get her as comfortable as possible. The nurses at the hospital had showed me how to change the catheter and take care of it, which was a review from what I learned in my CNA classes. So my first task was to change the catheter to a larger bag and make sure it was comfortable for her. I found that when I’m the only caregiver, my role switches from being her granddaughter to being her CNA. I woke up multiple times throughout the night to help her get comfortable and to take care of anything else she needed. As of right now, I’m running on about seven hours of sleep since Thursday. I’m find it a lot harder to care for a “patient” in a home environment compared to a nursing home/professional environment just because it is more relaxed, especially since I’m in my own grandmother’s house. I was a little disappointed that I was not able to start my night shifts at Littleton Hospital last night, but I have learned quite a lot just caring for my grandma and she has needed my help. I’m hoping to get some rest today and start at the hospital tonight. (I apologize if this post is a little choppy, my mind is SUPER tired. But I hope I have conveyed most of what the past few days have looked like for me.)

March 21, 2012

Looking for a job is no longer just about the money, I am learning a lot about what it takes to make a good resume and how to apply for a job in person. I can easily fill out an application online, but by going in to a facility to apply in person the employer can put a face to my application. I have also learned that being shy when it comes to applying for a job does not work, so calling them and checking on the status of my application shows that I’m proactive and determined.

The past few days I have continued to apply to facilities in the Denver area, and also applied to the facility that I did my clinical hours at for my CNA classes I took last October. I will be calling them again tomorrow to check on my application. I have not heard back from any facilities but I’m keeping ym hopes up.

A family member of mine will be having surgery this week, and this will be my first opportunity to put my CNA skills to work while taking care of a family member. I’m curious to see how different it will be having to take care of someone I know opposed to someone I don’t. I think it will be easier emotionally to take care of someone that I don’t know just because I don’t have much of an emotional connection right away with any other patients that I would be caring for in a facility. During my clinical hours, I heard a saying that really changed the way think about the quality of care that I give to my patients, “Take care of your patients as though they are your grandparents.” Of course I would always give the best care that I could, but by thinking of them as your grandparents it really puts it into perspective of how important quality care is to your patients and why EVERYONE deserves the best.

March 16, 2012

Working in a nursing home is not just a job, it’s a chance everyday to make someone happy and give them the care they deserve. Too often the elderly are put into nursing homes and seem to be “forgotten”. This is where CNAs can have a huge impact in someone’s life. Since CNA’s give most of the direct care to the patients, they have the opportunity to get to know each patient and understand what they need as an individual. I am choosing to work in a nursing home because each day I know that my work will make a difference.