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
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