It's the End of the Term As We Know It

One more round of clinicals done! Although this time it's pretty bittersweet.

For the first time in all of my clinical experiences, I don't feel ready to be done but rather feel like things are just getting started and that I have so much left to learn! So that's a good sign for future career prospects at least.

The last two weeks of clinical were pretty uneventful, no super interesting cases to report. However I did administer my first intramuscular injections! Terrifying at first, but now I'm pretty pro. Although using a pediatric needle is much less intimidating than using an adult sized IM injection needle (the big fat ones that hurt). But, now at least one whole family that visited the hospital is vaccinated against the flu this year!

All in all it was probably the most inspiring and best term of clinicals. I could not have asked for a better clinical instructor, hospital staff, or peer group to work with! And, ending with a giant feast (pizza, hummus plate, two salads, two cheesecakes from the cheesecake factory, and oodles and oodles of really good candy snacks) prepared for us by our instructor didn't hurt either!

I'm just really amazed at how much doing a term of med/surg nursing really advances your skills, knowledge and confidence. I think it's mostly because it's the first time you are actually doing something as opposed to standing around and shadowing. 

Next on the docket is community health, but I can't really promise anything exciting from that session of clinicals as no one has yet even explained what we are doing. So, we shall see.

In a final note, if this hasn't been made clear already: I LOVE PEDS!

And That's How I Almost Cried During Clinical

This week I was supposed to be in the PICU (pediatric intensive care unit) for both days. The PICU has had census problems all term and usually ends up being closed because of a lack of patients. So I was incredibally stoked when they had one Monday evening who would be there both days and who had a lot of interventions that I had never seen or worked with before (wound drains, a colostomy, a PICC [Peripherally Inserted Central Catheter] line). So, Monday night I spent about 5 hours looking up all of my patients labs and medications and brushing up on my skills to make sure I would be able to provide awesome care. And I was very excited to do all these interventions too.

But then I arrived at clinicals. And was told that I could no longer be with that patient because the newly hired nurse would be working with him. Which is understandable, and I was fine with that aspect of it but what I was not fine with was the fact that I had all this pre-clinical work completed and was being switched to a patient that needed no care and was being discharged that day. ARGH!

So, we made the decision at the end of the day to have my second day take place on the regular pediatric floor. And that was an amazing decision!

My primary patient today was a 12 year old who has a BMI of 48 (over 30 is considered obese). In addition he has ashtma, COPD, gout, multiple admissions for respiratory infections including pneumonia, and arthritis. He was admitted this time due to cellulitis on his arm (a bacterial skin infection) and possible kidney failure. Unfortunately they inserted the PICC line before I got there, which was kind of a bummer, but I did get to do a heparin flush (to keep it open and free of clots) which was kind of neat and I got to play many round of connect four (a favorite board game) with him. It was really just fun being around him but also extremely heartbreaking. Many cultural and lifestyle factors are keeping him from losing weight, but unfortunately if he keeps going the way he's going his life expectancy isn't very long.

Other big news: I got to place my first NG tube today! Probably the most traumatizing thing I've ever done to an infant. Getting the tube down the nose and into the stomach was not big deal (first try I got it in the right spot, holler!) but taping down the tube to an extremely angry infant's face and needing to use scissors to trim the tape all during crying and moving on the infants part? Traumatizing. It's good that it happened at the end of my day or I would have been on edge for the rest of the day.

So that was my week! It ended on a pretty cool note I must say. And the further into this I get the more I'm pretty sure that I was created to work in pediatrics. Hooray!

Peds Clinical >>>>>> Spring Quarter Clinicals

Today was my fourth and final day in the ISCU during my Peds rotation and while it was a tad chaotic, it was also epic too. This clinical term is so much better than the spring, mainly because I'm actually doing things now instead of awkwardly standing around.

Today I took full care of two (instead of one) patients by myself. This in itself was epic and it felt like such an accomplishment on the road to working as a real live nurse. Everything went well, I've long been accomplished at time management and multi-tasking, aside from the couple of minor incidents that were baby related.

Patient #1:
Baby Girl 1 was born at 36 weeks gestation with gastroschesis (intestines outside of the umbilicus). This was quite a fascinating pathophysiology as the surgical correction is quite simple (putting it all back in through the umbilicus) and visually the only physical difference between this baby and one not born with gastroschesis is that my patient has a very tight, very distended abdomen (it should be soft and non-distended). Baby Girl 1 is a couple days out from discharge but is having troubles holding down feedings. I kind of learned this the hard way as yesterday all her feedings went well. I thought everything was copacetic post feeding as I rocked her to sooth her fussiness. Then, out of nowhere: a contorted face and about 30cc's of formula all over herself. Luckily, none got on me and I quickly responded by laying Baby Girl 1 on her side to prevent choking or aspiration. This happened with every feeding, making it frustrating more than anything else as this usually required a new wardrobe and set of sheets. However, she's doing as well as expected and once the regurgitations are gone for sure she will get to leave and enjoy home.

Patient #2:
Baby Girl 2 was a baby born at 31 weeks gestation and really in only in the ISCU so that she can grow and develop her suck and swallow coordination so the feeding tube (NG tube) can be removed and she can either nurse on her mama or a bottle. This means I got to give her medications through her NG tube and gavage feed her. Unfortunately, as I had never set up a gavage feed on my own, it took a couple of tries to smoothly set it up on my own.

Feed #1: Everything was set up the right way (the nurse showed me how) but I didn't depress the plunger on the syringe that the food was in enough so it was awkwardly stagnant for most of the feed. Kind of embarrasing at the time, no big deal now.
Feed #2: Equipped with the knowledge of needing to give the plunger a good push, I thought I would ace this feeding effort. However, I made the mistake of not connecting the syringe to the feeding tube before putting formula in. When I took the cap off the syringe, forumla went EVERYWHERE. Awkward.
Feed #3: Success! I was pro by this point. Hooray!

All in all, it was a wonderful day and I've felt really proud of myself working in a more autonomous nursing role. Win!

Next week: Surgical Observation Day

Babies Smell Like Warm Cheese.

I blame it on the breast milk (which is all over my scrubs due to a gavage feeding mishap described alter). I never had the chance to notice this scent during my stint in L&D because most of the babies were still guzzling down colostrum (the pre-milk if you will). After my first day in the ISCU (Infant Specialty Care Unit) I had more than enough time to peg down that odor.

Here is what I find really cool so far this term during my peds rotation: I'm actually doing something for the first time. While the interventions may be simple (gavage, diaper changes, and med administration) it's the first time in my clinical experience where someones care is almost soley in my hands. And knowing what to do when and why is a pretty cool feeling.

Today my patient was a 2 week old infant born at 36 weeks. After an emergency section, the baby was hypoxic and wasn't breathing very much/well for about the first five minutes of life and about 10 hours later began having seizures. The last 2 weeks have been a time of stabilization, understanding what damage may have occured during the hypoxic period, and controlling the seizure episodes.


It's not uncommon for preterm infants to have difficulty nipple feeding as their sucking and swallowing reflexes are not properly coordinated. In addition to this, my patient isn't always the most alert baby (as in no crying or fussing what she's hungry and pretty drowsy during feeding) so the majority of her feeds are done via gavage (a fancy way of saying feeding tube + gravity). So, today I learned how to set it up, how to fortify her mom's breast milk, and how not to take it all apart in the end. Basically, the lesson of this story is don't try and unhook a feeding syringe from a feeding tube with a baby in one arm or the tube residual will likely end up all over your clothes and the floor (luckily not a great quantity but enough to be frustrating).

I also got to administer my patient's anti-seizure medications through the same  NG tube that her meals come through. Pretty simple, its just depressing a plunger slowly, but it's still a novel feeling to dispense medications almost by myself (someone still has to watch as I am still a student).

The rest of my day was spent snuggling a different patient who is a withdrawal baby and just needed some TLC and an occasional pacifier to nibble on. The only danger with this is when you are sitting in a dark room, rocking in a chair, holding a warm baby after getting up at 5:30 to get ready you find yourself nodding off occasionally. So cozy!

Tomorrow I will be with the same patient but things will go much smoother as I made the awkward mistakes today! Until next week!

In the Words of Mister Bon Jovi....Whoa, We're Halfway There

And so concludes a second term of clinicals and the first of two years of nursing school. Crazy, right? Especially since just a year and a couple of days ago I didn't even know I'd gotten into nursing school yet. My time this term in psychiatric and gerontological nursing wasn't event worthy enough to write a new post every week, so instead I will treat you with a comprehensive summary of each experience. I also don't feel like studying for finals quite this minute so this also is a good something else to do.

Psychiatric Nursing
Whether it's bad or good to say it, I was pretty disappointed when I found out the majority of my psych nursing time would be spent in a substance abuse rehabilitation center with the rest of it spent in a geriatric psych. unit. However, looking back I'm really glad I got the experience I did for a couple of reasons.

I have a much deeper understanding of addiction and the road to recovery than I would ever be able to receive in my education. This is significant because the rates of addiction in the general population are relatively high, and having a better understanding of the disease and the treatment will be applicable in any unit I decide to work in and will also make me a better advocate for my patients. That's a pretty empowering feeling too, so kudos rehab.

My time in the geriatric psych. unit was pretty interesting as well. It's a mental health unit for those over the age of 65, however my patient that I spent the most time with was 52. Honestly, I think it would take a very unique personality to work in that particular setting. People are agitated very easily and when they aren't agitated they spend most of their time wandering the hallways. The nursing staff were really good in this particular unit and knew how to keep patients calm and happy with simple tasks like folding napkins or helping push carts around. One of the days I was in gero psych, I was sitting having a perfectly normal conversation with a woman about the weather and breakfast when all of a sudden she turned to me and said "I don't think the bus driver knows where he's going, this doesn't look like Pennsylvania." It caught me off guard, but also underscored the way that patients with dementia can slip in and out of reality easily.

Overall, I know that psychiatric nursing is not in the cards for me, but I did get a lot of good experience this term with therapeutic communication and exposure to different mental health problems.

Gerontological Nursing
This was the term I had been dreading the most out of my two year program because I've always known that this is not my forte. I'm don't have a fear of aging in the sense that "oh no I'll have lost my youth" but I definitely have a fear of the inability to take care of myself and the physical changes that occur as a result of age. I thought that this term would help assuage these somewhat, but it really didn't until my professor pointed out that the majority of the elderly population don't live in assisted living facilities. It really did underscore the importance of taking care of yourself now instead of waiting until later.

One of the two patients I was the closest with was a man who had a stall in the Market until October when he fell and fractured his hip. He moved into the facility to heal up and begin walking therapy. He was a very quiet man who kept to himself but as the weeks progressed, he opened up and I even got him to laugh a couple times. Once, after I shaved his face I almost forgot the aftershave. He pointed this out to me, and I replied "Of course, you've got to smell fresh for the ladies!" He was greatly amused by this and it's these little moments that I will remember with him. Once he began his walking therapy I created a poster for him to keep track of his progress once I was gone. When I told one of my peers this she replied "A poster? You are such an RA!" Yup, I still am deep down inside an RA and I'm okay with that. On the last day I was going to hang up the poster in his room but was going to check his chart before I greeted him for the day to see how his walking had progressed in the past week. I learned that the night before he had a stroke and was sent to the ICU of a nearby trauma 1 hospital. The sense of loss I felt was very great and it was hard to not start tearing up right there. It was such an abrupt end to our relationship and just was so shocking given that he had been completely fine the week before. I hung up the poster in his room with a note anyways in hopes that he 1) returns to the facility and 2) is able to start walking therapy again.

The other patient was a 93 yo woman from New Orleans. Nothing major other than she was just your classic sassy and strong southern woman who liked a good game of poker. And for 93 she's in really good shape too. Her major health problem is vascular dementia that results in delusions of maggots in her food and a man who comes in her 3rd story window every night to knock over her plants and scuff up her carpet.

All in all, it was a fairly decent term and at the very least I know two areas of nursing that I'm not particularly interested in! Next term is a different story as I am very excited to be doing pediatrics, a specialty I was set on back in the days when I wanted to go to med. school.

Enjoy the summer, I'll be back in the fall!

Placement in the Fall

Just a quick update!

I found out that next fall I will be working in a pediatric medical-surgical unit at the hospital right next to my apartment! Pretty excited!

And That's How We Got Published.

Today I was in the stabilization area of rehab and it was pretty cool for a couple reasons.

Background on the unit: After patients have completed their stay in detox, they are strongly encouraged to join an inpatient stabilization program. Many patients take this advice, however some choose other stabilization programs for various reasons (cost, closer to their home, etc). In this particular unit, patients stay for about 14 days and begin the AA or NA 12-step process. Their days are filled with a lot of different group sessions and activities to help them evaluate ways to change their life but in a group, or milieu, setting where they can bond with others and form social networks that will help in the long-term success of their recovery.

The first and primary reason it was awesome was that about four of the patients I had worked with previously in detox had now made their way over to stabilization. The most touching of these was the gentleman I had worked with a lot last week (giving meds, the TB injection, and general care). When I last saw him he was very groggy from all the detox medications and was not fully aware of his surroundings. This week he was much more alert and seemed to be responding well to group therapy. A sad part of his story is that as he came out of detox they realized he might have more severe memory loss than that which is expected with substance abuse, so he will be going to the gero psych unit later to be tested for dementia. Overall though it was really nice to sit in on a couple group therapy sessions and see just how much better everyone was looking than the last time I saw them.

The second reason it was awesome is that I had my first moment of realizing that even as a student, we have the power to effect institutional change. One of the sessions today covered the symptoms of acute alcohol and narcotic withdrawal. A majority of the patients in this session were not aware of the continued symptoms, such as hallucinations and tremors, and were greatly relieved to know that what they were experiencing was normal for their situation and not a sign of additional psychiatric problems. After openly confessing what they had experienced, many of them realized that they were not the only ones going through these symptoms as they had previously thought. My partner and I had a lengthy talk about how horrible it would be to not understand why or be told what to expect of your recovery until this late into the program (about a week after finishing detox). After talking it over with our clinical instructor, the both of us decided to create a simple document that either the nurses or the counselors can hand out to the patients during detox. This way they a) know what to expect and for how long and b) have a hard copy that they can reference since memory retention is a problem for recovering addicts. My partner and I will have to present this to the head of detox and what not, so its not official yet. However it's really cool to know that the two of us will be creating a document that has a very high chance of being used in a hospital for years and years, especially since it would be impacting a unit that has a lot of room for growth towards more therapeutic and positive patient care. And that's how we got published!

Until next week!

Driving That Train, High on Cocaine

Holy Cow. If you would have asked me a week ago if I would have ever considered a day working in detox "awesome" I would have laughed. Guffawed even.

I won't go too into detail as I've recounted this to many people already, but last weeks shift in detox was everything I don't want to be as a nurse. Sloppy unprofessional dress, combative language with every patient, and no interaction besides going into the room to give someone meds then leaving and returning to Farmville on facebook. Everyone hits burnout in their given profession at sometime, but I hope its never as bad as what I saw last week. Lordy.

However, today was a different set of nurses and that changed the atmosphere tremendously. Also, with a better concept of things I was able to do in detox I worked on being more vocal about things I could do, which helped so very much. The two main things I involved myself in were observing psychiatric assessments and administering medications.

What I love about psychiatric assessments is that it gives you a chance to really understand how someone became so involved in drugs and/or alcohol that they reached a point of dependency. It puts a face to notes like "drinks a fifth of vodka every day" or "has 29-36 beers a night" and humanizes addictions that can affect everyone and anyone. The assessment that struck the closest to home for me today was a young man who had spent a significant amount of time in the military and had been deployed to Iraq twice. His heavy drinking began when he entered the military and continued to get worse once he left for medical reasons and because of boredom from unemployment. None of his medical conditions were that surprising: PTSD, tinnitus from being to close to an explosion, anxiety and depression. The one that I thought was most interesting was that his chronic psoriasis, in his case tied directly to his stress levels, was only completely cleared up two times in his life: both of his tours in Iraq. He explained that while its stressful over there, and the cause of his PTSD, you don't have the same kind of stress like you do here (i.e. financial, relationships, etc). You have an assigned duty and you know where you are going to be and what you are going to be doing at all times. Anyways, I was most touched by this particular patient because of how young he was and because I am always fascinated by people who have life experiences that are so completely different from mine. I hope he is able to get his life back together and recover from his addiction.

To end on an exciting note, today was my first day EVER of administering medications!! I felt like a real nurse and am so in love with using the automated medication carts. Nothing beats flashing lights, popping drawers, and getting your fingerprint scanned! I also got to administer my first tuberculin skin test which was frightening and exciting at the same time. The patient had super thick skin which made the process difficult and extra scary, but in the end he had a bubble under his skin so my job was successful!

I am absolutely pooped now, and my time in detox is over. Next week I'll begin a two day stint in the stabilization aspect of recovery. Until next week!

It's okay if he bleeds, just use some toilet paper.

That was my advice as I prepared to shave my client's face today with a single blade disposable razor. I only needed two toilet paper squares, but in all honestly I probably didn't do the greatest job either as it is terrifying to shave someone's face with a blade so terribly crappy.

Today was my first day in the gerontological nursing setting. This term we have two clinical rotations, the other being in psychiatric nursing (Thursdays).

Moment of honesty: I have a strong aversion to working with elderly patients. It's nothing about them specifically, but its mostly because I don't like confronting the very real possibilities that occur as our bodies age. Luckily, medical research has made enormous strides in recent years that has shown us that a) significantly improved rehabilitation techniques following such events as falls and strokes and b) there is a ton of preventative medicine you yourself can engage in during your younger years to prevent diseases commonly associated with old age that don't need to be.

That being said, this term is my chance to begin assuaging my fears of aging and feeling more comfortable working with a population that will inevitably be in any aspect of medicine I choose to specialize in (I suppose with the exception of peds or maternity for obvious reasons).

My clinical site for gerontological nursing couldn't be more awesome: Pike's Place Market overlooking the sound. This not only enables some awesome window watching of ferries and barges floating by, but gives residents access to a plethora of walking adventures. The facility is very basic assisted living, so most of the patients are in relatively good health.

My morning started off with some basic wake-up prep work so that residents could make their way down to the cafe for breakfast (which is a popular meal among the elderly, nearly everyone I talked to said that breakfast was their favorite and that they've gained 20-30 pounds since moving in). During this wake-up prep work, I learned a couple of seemingly universal lessons:

• TED hose, or compression stockings, are terrifying to put on anybody but especially the delicate skin of the elderly. Especially if they are yelling at you that you don't know what you are doing and to get the regular nurse before you rip their skin off
• Some patients are very comfortable with their nakedness. One of the patients was just hanging out in his chair, free as you please and not a care in the world. Part of his care plan was to put lotion on his back because of dry skin and the other student nurse I worked with teased me because I lotioned him up before even putting his pants on. What a treat that must have been for him.

I spent a lot of time after this with my assigned patient who was recently admitted a couple of months ago after falling while working in his stand in the market. After he survived me showering and shaving him, we headed off to breakfast. He seems nice, but I think I was kind of driving him nuts as he is quiet and more private and I get very uncomfortable in silent situations. Oh well, I learned a lot about him and eventually let him read his paper in peace.

And that concluded my first day in gero. I survived, some of my fears have been lessened, and I think it should be an interesting term at both clinical sites!

Staples and Sheet Cake.

Today was my last day in the OB clinical rotation. Holy cow has time flown by. Every day presented new challenges and opportunities, but today was an overwhelming day of big things.

The day started out with me completing a head to toe assessment on a mother and a baby while my clinical instructor watched. I was so terrified. All term the only thing I wished for when this moment came was that I wouldn't have to palpate a woman's fundus who had undergone a cesarean. Well, guess what. I did. And I felt terrible doing it. However, I passed the test and my mother wasn't in too terribly much pain so that was a success. Win!

I was then shuttled in to the "circ room" to watch a little tiny baby boy loose a little tiny piece of skin. Luckily for the baby, he slept through the entire thing. Even the giant lidocaine shot into his pee pee. If you didn't think about what was being cut, it wasn't so bad. But every once in awhile my mind would suddenly shift to "Oh mah gawd what are they doing!" Plus, the foreskin left over on the clamp when it was all over was kinda creepy looking. In the end, it only affirmed that I personally think circumcisions are unnecessary. I surely wouldn't want anyone cutting me in the nether regions. However, no judgments shall be passed to those who have them done.

The second major highlight of the day was that I got to remove staples from a cesarean patient about to go home. At the start of the term staples grossed me out. Then I saw them removed and felt better about them. Today, I full on pulled them out. It was actually a more traumatic experience than I would have hoped for. Because of different cultural traditions, my client was very vocal about pain. It's not that the staples being pulled were traumatically painful to her, it's just the way that that particular culture tends to express pain. Even knowing this, it doesn't help when its your first time and you are terrified to have a woman wailing and crying with every staple. It especially doesn't help when it makes her husband not trust you even more. My resource nurse said I did everything fine and did a really good job. So huzzah to me!

Small side notes:
-I got to remove a Foley catheter, no big deal but a first time is a first time
-I got to do discharge teaching which made me feel official but it was also awkward because it mostly felt like I was talking to myself.
-The closest I ever came to seeing a vaginal delivery is watching 16 and Pregnant on MTV. Damn. So, if you know anyone delivering vaginally hook me up. Cause it would be nice to know what it looks like.

The day ended with a surprise fiesta hosted by our faculty nurse. She bought a Costco cake. I got the corner piece with the most frosting. Today was a good day.

And so concludes my first term of clinical rotations. No more crowning head, next term is all about psych patients and "pits and pubes" with the elderly, as my faculty nurse so tenderly put it.

Stay tuned....

A Crowning Head...of sorts.

I can now officially say that I have witnessed a c/s. While I think that its amazing that they can do it as quickly as they can based on years of perfecting techniques, I kind of hope that I myself don't have to get any. It was still a very moving experience and I had to fight back tears, but it also felt sterile and impersonal. With vaginal deliveries there is more of a tension built up through all the pushing and it feels more intimate. But it was kind of weird to just be like "snip snip pop! baby here!" Ideally, I would like to have vaginal deliveries with no epidural so that I can be fully present in the moment and to not risk endangering my babies, but given the track record of women in my family I'm won't be allowed to delivery vaginally. Anyways, aside from the smell of burning, it was still a neat experience and Baby Boy did very well!

The rest of my day was spent working in the neonatal intensive care unit, or NICU. It was a fairly slow day as my set of twins were stable as was the baby girl I was also assigned to. The parents were there most of the time so that limited my ability to really interact with the babies, but it was educational nonetheless.

I got to see what a 28 week baby looks like as one had recently been delivered in the L+D unit. It's scary how underdeveloped 28 week babies are. Just for reference, a baby is considered at term when it has completed 37 weeks, or the start of the 38th week. That's ten weeks pre-term. That's 2 and a half months. That's not supposed to happen. But, so far baby was doing just fine. It was kind of cool because they had a catheter an artery in the umbilical cord because they can get blood samples this way without continually having to poke the baby with needles. Since this little bebe had a long stay ahead of her I thought this was neat!

Aside from the c/s, the highlight of my day was getting to take vitals, change a poopy diaper, and feed and snuggle an at term baby who was in the NICU because of high bilirubin levels. He was absolutely adorable and the sweetest little boy in the world. He was even more adorable because when the bili bed was turned on (light therapy to help rid him of excess bilirubin) he had to wear these foam sunglasses to protect his eyes. Baby's first stunner shades. I like snuggling and I like babies, but I know I won't be ready for quite some time!

Well, I'm super wiped. These days take so much energy out of me! Next week I'm in L+D again so maybe I'll get to see some more babies being birthed!

¿Comprende?

Day 3 was so ridiculously overwhelming, but it was also really good too.

I was assigned to the mother-baby unit which is where mother's go after they have delivered but before they are discharged from the hospital. It's a recovery unit of sorts. I was paired up with a really good resource nurse who had been working int he field for about 7 years or so, so that was helpful because I was tres nervous about my first day in Mother-Baby.

I worked with three families all together, but really only interacted with two of them. The first of these two was one of those "if you had waited one second longer the baby would have been born in the hallway" situations. Mama and baby were super comfortable and mostly healthy. The baby was really jittery, which we first thought was because of low glucose. But, we later found out that the mother had smoked some during her pregnancy and so baby girl was going through some minor withdrawals. It was sad to see both a mother who didn't fully realize what the consequences of her actions would be as well as seeing this tiny, helpless infant who was in pain and had no idea why or what was going on. Fact: The placenta doesn't protect the baby from really anything other than holding in all the amniotic fluid the baby pees out. Everything you do to yourself you are also doing to your baby!!

The family that I worked the most with and felt like I bonded with was a Mexican mother who spoke little English. Although I took five years of Spanish in middle/high school and one year at UO, I am super insecure about my abilities, even though they are way more there than I would like to admit. So, no, I never spoke Spanish to her but I regret it now. There were a lot of times where I almost felt myself slip naturally into conversation but because of insecurity, I held myself back.

It was cool though over the course of 8 hours to see how we bonded and how much more comfortable she became with me. I felt like we understood each other well even though we weren't speaking the same language. At times it was almost like I understood her better than the RN which was kinda neat. She had two grown sons who served as translators (MAJOR RED FLAG. YOU NEVER HAVE FAMILY MEMBERS TRANSLATE!!!) because she didn't want to use the translator services as reported by her night nurse. It worked out just fine, but it really wasn't an ideal situation in that sense.

I got to watch a woman's c/s staples being taken out today, which was good because staples freak the heck out of me. This helped me get over my fear of looking at them. Staples should be in paper, not in people. Blech. No me gusta.

I also got to feel a fundus (the top of the uterus) for the first time today. It was nice and firm and in the midline, but it's also weird to be like "I am touching someone's uterus through skin" Just surreal, but also neato!

Pretty slow week as far as cool stories to tell, but it was a big week for me in realizing my style of acclimating to new situations.

Future Goals:
-Get over the nastiness of staples
-Speak Spanish even if minimally
-Make sure to buy those cute mitten things for my babies. So stinkin' adorable!

Have a good week!

Vitals...Hearing Test...Weigh...Latch...Weigh...Repeat.

Today's clinical experience was rather uneventful but educational nonetheless! I was assigned to work in a clinic that Overlake has for recently discharged mother's to come to for wellness checks and lactation support.

First off, breast feeding has got to be one of the most complicated yet natural things ever. It was interesting to see that all the moms I worked with today needed the same basic lesson. I could sum it up for you in three simple points:

• Mother's breast:baby::Red Robin Hamburger:you. No joke, they compared the boob to a big hamburger. Effective tool, kinda gross.
• Don't you dare try and put your nipple in that baby's mouth until they've got a big, wide open mouth or it won't latch properly.
• Breast milk solves any and all of life's problems. Sore nipples? Squeeze out some breast milk and watch the magic happen. Sore incision site from a c/s? Squeeze, rub, enjoy. Miraculous!

Overall, I really enjoyed my time in the clinical setting. I don't think that this particular one is necessarily for me because of the repetition of it all (hence the title. It's seriously what we did for all 6, 1 hour-long appointments today) but I really do enjoy the one-on-one patient interaction that this type of setting provides so my interest in pursuing a Doctor of  Nursing in Women's Health. There is something very fascinating about the different stages and health changes a women goes through that I don't want to limit myself to just the OB experience, although I do love it. But, then I'm torn because I really like meticulous procedure things (such as maintaining sterile fields or catheter insertion) so I think that I would also enjoy becoming a Certified Nurse Anesthetist. Oh drat, life's little choices. I suppose I shall figure it out in time!

The other thing I learned today is that I definitely want to have children someday. NOT ANYTIME SOON! But someday. Sometimes I wonder if I really want kids or if I've always assumed I would have them because that is what you are "supposed to do." But after interacting with lots 'o babies and seeing the family development and bonding I realized that I really want to experience that in my life and help a tiny, adorable, human being progress through a healthy and comfortable childhood. And baby girls are too much fun to dress, so there's that whole thing.

I also learned this week that unless Portland can make me a better offer, I would consider re-locating to Seattle to have a baby if life takes me elsewhere. First off, the clinic that I worked in today is not standard procedure but really should be since the average time for hospital stays for vaginal births is 24 hours and 48 hours for c/s. You can't possibly educate your patients in that short of time! I just like the follow-up aspect of it and when I'm an exhausted, emotional wreck after birthing large footballs I would like that kind of support. Also, there is a pediatrics office that is open everyday of the year, even holidays! That's pretty amazing and convenient. Especially if my children are fated to the never ending string of strep throat incidents that I was subject to. Me and chewable banana-cherry flavored Amoxicillin are pretty much best friends now.

That's pretty much it for this week! Because I was in a different building I couldn't follow up on the family I worked with last week so I'll never know what time their baby was born, which is kind of disappointing because I think my time prediction was really close. Drat.

Next Week: A Day in the Mother Baby Unit (The next step after labor and delivery)

No Crowning Babies....Yet.

Every omen prior to clinical today pointed to bad, horrible, terrible things in my future.

Anyone who has ever spent the night with me knows how anal I am about checking, re-checking, and checking once more to make sure that my alarm clock is set and ready to go. Well, much to my surprise last night I realized that the reason why I had missed three alarms in the last two weeks was due to the fact that my phone no longer makes sound. At all. But, never fear my friends. I'm basically like MacGyver Part Two because not only did I set the alarm on my stove for six hours of "bake time" but I put my vibrate-capable phone in a pint glass so that when my mom called at 5:00 to try and wake me up, an audible ringing would drift through my apartment. It was pretty epic. Turns out the stove woke me up just fine and my pint glass 'o magic was not necessary. So that was bad.

Then, I forgot my stethoscope. Seriously, it's got to be the most basic thing in the world but I was without it. So my faculty instructor lent me hers. Which was wonderful because it came in very handy with my first assignment...

My first patient had just delivered a baby cesarean (c/s from here on out ever in the history of this blog) two hours prior to my arrival. So, I got to do lots of cute new baby things like taking vitals, swaddling, and giving Baby Girl her first bath ever! The experience was wonderful, adorable, and a little emotional. Perhaps it was all of the anxiety of the last three weeks culminating to my teary eyed moments. Perhaps it was the always incredible sight of a grown man telling his mom for the first time over the phone that he is the father of a healthy baby girl and uncontrollably crying (it's powerful if you have yet to witness it). Whatever the cause, it was hard not to cry as I interacted with this tiny infant and I got emotional. Prediction: I'm going to be a wreck with my own future (underscore future) babies.

On that note of future babies, working in OB is the best contraception ever. Every teenage girl and boy should have to see some of these things. Teen pregnancy rates would drop dramatically, I am for certain.

I was supposed to get to scrub in for a schedule cesarean but for reasons unknown, the mother never showed up. She re-scheduled for tomorrow but I was disappointed that I didn't get to see a live surgical birth. Le boo.

My second, and main patient, of the day was a woman in labor with her first child. It was pretty exciting because she was excited and her husband was adorably anxious. For most of the morning we monitored her contractions and the coinciding fetal heart rate, which was exciting and grand. Then she decided the pain was too much and needed an epidural, pretty standard. But, the cool part was that I got to watch! It wasn't weird, the anesthesiologist was hilariously over-dramatic (remind me and I'll re-enact his swishing of vials motion), and the needle was a lot smaller than I imagined. Smaller in the sense that it's still a pretty damn big needle to go into such a sensitive space, but in my fantastical brain I had visualized a needle slightly smaller than a thumb. I don't know why, it's just how my brain thinks.

About an hour after her legs became all numbly and full of tingles, I got to insert her catheter. Lordy bee was I nervous for this one! I've practiced on mannequins and I'm a pro at maintaining a sterile field, but actually doing one on a real person is totally different. And stinky. No unexpected smells for a laboring woman, but sometimes it was hard not to make a face and for that I feel bad. Anywho, the procedure went swimmingly and luckily for me she couldn't feel anything because of las drogas. But, I feel cool and accomplished because I got to do something pretty neat-o.

From here on out it was pretty standard procedure of checking in with mom and family. She was dilating about 1cm every hour until...BAM. She jumped from 5cm to 9 cm. It was exciting, scary, and just bizarre and my little hopes got all raised up that I would get to see a birth. I even held a leg as she pushed and tried to make Little Baby work his/her way down the birthing canal. However, sad day when we realized Little Baby wasn't going anywhere yet and I had to go home for the day.

All in all, it was a very good first day of clinicals! So much fun, lots of downtime, but mostly lots of fun! Also, as a side note, we took bets to see what time my patient was going to give birth and I called 2:30 PM. When I left it was 2:15 so there is a relatively good chance that I won, but I could have also been way off.

On next weeks episode:
-Did I call the birthing time right?
-Will I wake up on time?
-How many mother/baby post-partum assessments will I complete in 8 hours?

Stay tuned.

Bring on the Crowning Heads

Tomorrow is my first day in the clinical setting as a nursing student. Am I starting off with something relatively calm and stable like gero? Nope. We're are cutting right to the action packed world of labor and delivery. Terrified? Definitely. Anxious? Most certainly. Confident in my abilities after a two week intensive "Baby Bootcamp"? We'll see about that.

I mainly decided to start a blog to share my experiences during nursing school with friends, family, and random strangers on the internet because it seemed like a neat and simple idea. No patient stories will be shared (Gotta stay cool with HIPAA!) but thoughts, feelings, perspectives, and learned lessons will be. So, sit back and enjoy watching the magic unfold as I work my way through my life as a nursing student!