Monday, November 26, 2007

Diabetes

Its hard to believe that in less than 90 years, the treatment for diabetes has journeyed from palliative care of children in their teens from the result of keto-acidosis, to people living long and fulfilling lives with only some complications.

In my current rotation, I see the effects that long-term poorly controlled diabetes. I'm on a combined unit of orthopaedics and vascular surgery. Today I spent a day looking after people who had lost their limbs because the sugar in their blood eventually caused blockages in their arteries and veins.

I saw a woman, who at age 37 was blind, had both legs amputated, most of her fingers were gone, and was in renal failure.

I saw a man, who with type 2 diabetes, had already lost his right leg, and was on the way to losing the left.

I saw others for whom their wounds are not healing because they have poor blood flow to the area.

I see people who are fighting so hard to live. Where was this fight 20 years ago when they were first diagnosed? Is this their fault? Can we give blame to someone who is told they radically have to change their life, and be expected to comply EVERY DAY for the rest of their life? Are we not getting the word out about the complications of diabetes?

It makes you wonder.

Tuesday, November 20, 2007

Proud of myself

Every time I go to the hospital to work as a student nurse, I try and remind myself that I am there to learn and that no task is 'too small'. Yes, I want to see the cool stuff, and try to do the more complicated nursing tasks, and yes, I HATE bed baths, but I do it without complaint because, as mentioned, this is the place to learn and to build my observation skills.

I guess that has paid off. Every single placement an RN has mentioned that I should work there after graduation. And this is not an obligatory statement made to the group of us because they are short staffed, this is a nurse either pulling me aside or talking to my instructor and saying that I would be an asset to their staff. I am proud of this, and I hope in a few years time I'll actually be worthy of those statements. For now, I'm a newby student nurse that hopefully one day lands herself a job in the Emergency Department.

This day was no different. I had low expectations of Labour and Delivery because of how much time was spent sitting in a room doing nothing last time. Today it was different... it was relatively busy, and I ended up working with 2 placenta previa patients. Placenta previa is a condition for which the placenta has implanted low in the uterus, so that it actually covers the internal os, or in layman's terms, covers the cervix. If this happens, the baby cannot go out the vagina like it normally does, as the placenta is in its way. This can lead to major bleeding if the cervix tries to open, which can not only can kill the baby, but also the mother. Patients with placenta previa have c-sections to lower the risk of hemorrhage.

At first, I have to admit the nurse I was assigned to was not easy to get along with, and she seemed to not like me. She made some rude comments, and did not like that I had to follow her around. I figured it wasn't me, but that she didn't like to work with students. I think that I did a good job of interacting with the patients we were working with, and yes my nursing histories took longer then the average nurse, but that is normally the case because as a student we are not familiar with the forms, and actually ask all the questions on there.

After numerous hours of working with this nurse, I guess I must have proved to her that I was competent as a student. Perhaps it was my ability to locate some things for her on the internet, or it was the fact that I was capable of doing the tasks she required. But her annoyance for me dwindled. At the end of the day, she asked me where I wanted to work after graduation. I mentioned the ER and she said I should apply to L&D. She even mentioned it to her nurse coordinator that she should put my application at the top of the pile!

Although I am unsure of whether I would apply to L&D, I did enjoy it while I was there. I've always enjoyed the fetal development process, and the idea of helping out with labour is fascinating. Perhaps when I'm sick of traumas and older people and drug users/abusers, I'll put in an application for L&D.

Scrubbed in...

Today was a decent day, the last day of Labour and Delivery.

I saw another c-section, and they actually let me scrub in! I helped the scrub nurse make sure that all the equipment was available, and I was THISCLOSE to everything.

Bonus, I even knew the resident, she was on the emergency response team with me back about 5-6 years ago. Today she is a junior resident, but she did almost the whole c-section with the consultant right next to her. It was amazing how much responsibility residents are given so soon after medical school graduation. She did a great job, and the lady probably won't even get a big scar.

I never realized how much yanking and pulling c-sections require so that the baby can come out of the little incision they make. I realize they want to minimize the incision for scarring etc, but wowzers I've never seen skin pulled that much. It didn't tear, and I'm sure it's standard protocol to do what they did, I just was surprised. No wonder the ladies feel so sore afterward!

The baby came out screaming, which is great, and COVERED in vernix. The baby was completely white because of it. Vernix is the slimey white stuff that protects the baby from the amniotic fluid so they don't get all pruney like we do after a bath. Remember, babies live in amniotic fluid for 9 months, they need something to protect their skin.

Scrubbing in was interesting. I've never done that before, and they don't give you a crash course in scrubbing in prior to you having to do it. My instructor just told me to wash for three minutes and did a brief example. Good thing there was directions on the wall. I bet I'm not the only nursing student to need them, either. They have so many medical clerks and nursing students going through to observe that they need the directions. Overall, I think i did well as a scrub nurse assistant. I didn't do much, but I did get to see everything and help out when I could.

Saturday, November 17, 2007

Almost done!

I can't believe it, but I am almost done nursing school.

Thursday was my last exam of this degree. Friday was my last presentation. I have 6 clinic days left this term, one in labour and delivery and the rest in orthpaedics/vascular surgery.

Next term I do a practicum in the hospital. I don't know where it is just yet, but I'll let you know as soon as I do. This practicum is supposed to solidify everything we've learned in nursing school. Essentially, we're going to be working full time as nurses. When our preceptor works, we work.

I'm looking forward to this part, yet at the same time I can't believe we're done all the coursework already. LOOK OUT WORLD, HERE I COME!

Friday, November 16, 2007

I have my reasons...

So i have been neglecting this blog recently. I have had a paediatrics exam, and my master's thesis was submitted this week. Thus, I have a right to ignore this blog. HOWEVER, I will be back in full force soon.

One thing I am grateful for is my experience with emergency response. I have been involved in prehospital emergency response for about 8 years now, and I teach advanced first aid (also known as Emergency First Response) to those wishing to be a part of pre-hospital care, such as police officers and firefighters.

Anyway, the reason I'm glad that I have this experience allows me to be better able to prioritize my nursing care. We had simulation lab this week for post-partum, and one of my classmates decided after the patient complained of cramping that he would get her some acetominaphen. I'm sorry, but when your patient who is post-partum is complaining about abdominal cramping, you need to explore this pain. You need to know if their uterus is contracting, or if it's not. If it isn't it could mean that the patient is at risk for hemorrhage. In this simulation, the patient did in fact have a non-contracting uterus, and was saturating a pad in less then an hour.

I was sitting near them (i was given the job of the 'observer'), and I wanted to scream "She is bleeding! She is bleeding! Do something about it!" but I didn't. Later the nursing instructors did talk to my classmates about their prioritizing, but I don't know if they truly understood what they did wrong.

Airway, Breathing, Circulation (and you can add a 'D' for Defibrillation). I have yet to take an ACLS course, but I'm sure that the priorities are the same. If you have someone who is bleeding, that is the priority, period.

Thursday, November 15, 2007

Friday, November 9, 2007

Thesis update

So my thesis committee was able to read my thesis in time, and has approved my thesis for defence!

YYYYYYYYYYYYYYYYYYYYYYYYYYYYEEEEEEEEEEEEEEEEEEEEEE
EEEEEEEEEEEEEEEEEESSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSSSS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Now I'm drinking wine and chatting with the bf, who I haven't really seen all week.

Have a great night.

Wednesday, November 7, 2007

Today could be called....

... a waste of time. I went to Labour and delivery today. 3 people in the rooms, only 1 more then 2 centimeters dilated. The new staff nurses recently hired got those ones. What did I do today? I stayed in the waiting room and did a bit of schoolwork. Then, I went to break. Then I went back to the room. Then I went to lunch. Then I went to an empty patient room and pretended to watch videos of "the development of your baby". And then I went home.

The only delivery of the day was right before we left, and everyone was allowed in the room EXCEPT the nursing students. The staff nurse, the training nurse, the 2 residents, the med clerk, the consultant, the family, AND the "take your kids to work day" 14 year olds were there, but the nursing students? Nope, we were in the hall.










I realize that L&D is come and go. Sometimes there are TONS of babies delivered, sometimes nothing. I wish our nursing instructor, once lunch hit, would have sent us home. We did not learn anything today. What a waste.

Tuesday, November 6, 2007

First Day in Labour and Delivery

So if you have been following my blog thus far, you know that I have been shuffled around a lot this term between paediatrics, paediatric emerg, adult emerg, mommy/baby (ok there was nothing going on the day I was there, so you probably haven't heard about that), and now, finally, I have been assigned to labour and delivery. I'll spend a measly 3 shifts there (1 for which I have already completed) but at least it's an experience, or so they tell me.

I didn't tell you that I have completed my last content course of my nursing degree. I have some seminars later this week and next, but overall, I'm pretty much done most of my nursing degree! Now only if I can survive the next few weeks of exams and assignments, I'm free!

Ok back to labour and delivery. Today seemed like it would shape into a pretty boring day. On the board there were three women delivering. One was at 2cm dilated, 1 was almost there at 9cm (but one of my group-mates would get that experience as he was going to PACU instead of labour and delivery the next day), and the other was just there for a ?labour. The one nurse with the 9cm dilated woman had to train new staff, so we lost out on watching that one. So, with 6 of us needing to get some experience with L&D, it didn't look so good. However, there was a scheduled c-section that day, so things were looking up.

It turned out that most of us were able to assist with this delivery. One of my classmates scrubbed in and helped the scrub nurse with the section and tubal ligation. Another classmate followed the circulating nurse. Yet another classmate stood back and also followed the circulating nurse. THEN, there were two of us assigned to the baby assessment area, plus our instructor who would guide us through the assessment.

It was my job to do the initial assessment on the newborn baby. Essentially, the baby would be taken out of utero, given to the circulating nurse, who then would take the baby into another, smaller room to get it ready to see mom again. During this time you need to do 2 apgar* scales, one within 1 minute after birth, and one 5 minutes later. You also need to clean the baby off, to get it dry, put the hat on him/her, assess breathing and heart rates (and quality), give erythromycin to the eyes, and a vitamin K injection into the thigh. THEN you need to shorten the cord (if need be), diaper the kid, and swaddle him/her. All of this should be done fairly quickly, so that baby can get back to mom.

*the Apgar scale was developed to assess the health of a newborn. The scores range from 0-10, with each of the 5 categories having a maximum score of 2. It involves appearance, pulse, grimace, activity and respiration.

Of course with a student doing the assessment, I think it took twice as long as it probably should have taken, but I must say that it was a very interesting experience! Good thing there was no problem with the baby, as even with all the first responder training I have completed, if something went wrong I think I still would have freaked a bit. Of course my instructor was there (she's an RN and a midwife so she looks after babies all the time), but still, it was a tense situation.

I enjoyed it today... I would have got to see another c-section but I had to leave for an appointment. I'll update you further how tomorrow goes.

Thursday, November 1, 2007