drop and give me twenty old man - i didn't say that i swear!

So today was my first day in clinicals. Because this summer is just a little "get your feet wet" clinical, we only go for about four hours for the next two weeks. We do, however, have to do a fair amount of work on our own (research on all the medications our patients are on, and all their medical diagnoses). So today we were at the nursing home which was kind of depressing- lots of elderly people half asleep in wheelchairs in one big room. It took us about three hours to wake the patients, clothe (and possibly change them) and transfer them from the bed to a wheelchair. (Each room has a built in rail on the ceiling that they hook up to a mechanical lift that lifts the patient in a sling out of bed and into a wheelchair) Then (two hours later) came breakfast. It took about an hour to feed the residents. My little lady didn't speak at all, but was a good eater. Andrew was the lucky one who got the screamer (and she was loud!).

Part of our clinical experience is also developing a nursing care plan for one of the patients at our clinical sites. To make things a little easier, we were assigned a resident at the nursing home (because the patients at the hospitals are more likely to get discharged before we get all our information). The last hour we spent at the nursing home was looking through our assigned patient's chart. Our clinical instructor said she picked patients that didn't have really advanced dementia so that we could get a good history, and get comfortable talking and interacting with patients. I was a little worried when i flipped open my chart and saw the permission form for antipsychotic meds and the severe dementia rating report. Upon closer inspection, she seems to have adjusted to life at the "villas" quite well. (a stark contrast to the information about her admission nine months ago)

All nine of the students in my clinical were sitting in the living room area going through charts and trying to translate Doctor's scribble and random abbreviations. In the middle of this, there is a patient sitting near the tv who, about every ten minutes or so, drops down and gives us twenty. yeah, push ups- it was really cute, and certainly quite random. So after getting the information i needed to do research tomorrow, i thought it would be good to go introduce myself to my patient. I walk over to her room and sort of hover by the door because it's open just a crack. Another nurse or tech walks by and asks if i want to go in. I nod and smile meekly, and she just pushes open the door and tells me to go on in. The first thing I see is that cute old man doing push ups on my patient's room floor. But the really odd thing, is that my poor little patient is on the toilet with the door open. It was really awkward, but she just smiled like there was nothing odd about meeting a new student while she's on the john with a guy doing push ups on her floor.

Vacation!!

Okay, so i didn't actually get a vacation, nor did i actually leave the city. However, right after i finished my last post, i was really upset about my dad, especially him being so far away. I was feeling really down, so Adam suggested we go on vacation. He had told me a story about a time when he was having a particularly bad, lousy, no good day, he and his friend would dress in hawaiian shirts and make margaritas to enjoy on their balcony. However, this being texas, and it being a sunday, we were not able to procure margarita making necessities. So we improvised and met some friends at Trudy's and enjoyed some margaritas (of course we were also in our tackiest hawaiian shirts - although for the record, i love my shirt (it was my dad's favorite shirt when i was a kid) and do not think it's tacky in the least. adam's, on the other hand... just kidding sweetie! so without further ado i give you some pictures Adam took while we were out (he's the artistic one, can you tell?)

Even the Joker knows the importance of hand sanitizer

Last night a group of us went to see The Dark Knight, which was, btw, fantastic. I haven't really been to the movies in awhile, and this was definitely a great one to come back for. Heath Ledger was incredible as the Joker, and the scene where he was dressed up as a female nurse was certainly priceless. My friend (and fellow student), Natasha, leaned over and said that's how she was going to dress for our last skills check off. The best part, though, is when he's walking down the hall in his old fashioned nurse uniform/dress, and turns to get some hand sanitizer off the wall as he walks out of the hospital which he proceeds to blow up. I guess you really need sterile technique for detonating dynamite...

Anyways, on a more serious note, i've been having a sort of crummy day. My mom called this morning and as soon as she said hello, i knew something bad was going on. Trying to hold back tears, she told me that my dad was going to have to be in the hospital longer than expected, and that he would be having surgery tomorrow. It turns out the cellulitis he was in the hospital for, was not responding to the triple antibiotic IV drip. After debriding the wounds and seeing more blisters pop up, they have diagnosed it as MRSA (Methicillin resistant Staphylococcus aureus). So they changed the antibiotics, and since cleaning the wounds is so painful (even with 2 doses of 5g of morphine, he's still screaming in agony) they are just going to put him under general anesthesia so they can do a thorough cleansing. It's kind of scary, and my sisters and i feel so helpless because my parents are all the way up in Ohio. In the back of my mind i can't help remembering that the last time he was under general anesthesia (i'm pretty sure it was just for a colonoscopy) they had a really hard time getting him to wake up. But i'm sure that everything is going to be fine. I just wish i could be there with them, and i worry because my mom doesn't have much of a support system up there, because they just moved there a year ago.

no more skills pretests!!!!

sorry, but if you've taken any of these seemingly wimpy, but then kicks you in the face pretests, you would understand the need for all four of those exclamation points. seriously. I could not be happier that they all behind me now. I even got an A on this last one. (we won't talk about the second to last test- not as pretty) The pretests may be over, but here comes the skills "check-offs" where we have to perform specific skills (i.e. inserting a catheter or administering injections or medications) under the watchful eye of a scrutinizing professor. Mostly for the first check off we just have to be meticulous about not breaking sterility. Tricky but obviously a very important skill to master.

Today in class, we practiced hygiene and restraints. I'm still not exactly sure how the two fit together, maybe if the patient won't let you bathe them, you're supposed to put them in restraints and show them who's boss? Probably not. That was a joke. I promise; in fact we learned that the restraints are only used as an absolute last resort after all other interventions have failed. So we were supposed to fully bathe our partners, or we could work in groups. I was really sleepy, so i volunteered to be the patient getting bathed. (we were told to wear tank tops and shorts) As it worked out, i only got an arm wash, but we had a fun time doing it. My partner brought some luxurious body scrubs and lotions, so it was more of a spa treatment than a bed bath. but when i asked for my pedicure, i was turned down.

This time next week, i'll be preparing for my first day of clinicals! We talked a little about the preparations we'll need to do for each clinical, and the big paper we have due at the end of clinicals... it doesn't look pretty. The clinicals, although scary, i think will actually be really interesting. (and hopefully fun)

So a group of us were going to go to the free concert in the park, Blues on the Green, but it looks like it's going to be a stormy night. I guess we'll have to wait another two weeks for the next one. A few of my friends still had to study for the last pretest that they have to take by tomorrow morning. Part of our last exam was learning all these abbreviations they use for documentation, some of which were really random and wacky. (KVO- keep vein open, or BRP- bathroom privileges, or SWV -sisters with voices) okay, that last one was a joke mindy threw in this morning while she was quizzing me. on that note, i'm going to go have to go have a celebratory beer!

Put that knitting down, and get back to work katie!

I started a new knitting project yesterday, something i haven't done since i started school. I got a little ahead last week, so i have a little less work to do this weekend. (notice i said a "little" less) I taught Adam how to knit, and we are both working on making his niece a wool soaker (diaper cover for cloth diapers). It's turning out really well, in fact i'm nearly done with mine (Adam is a little bit slower- he's still learning and doing really well!). But i had to force myself to put it down for the evening, so i could get some studying done. I will say for the record, though, i was a very good girl, and stayed home tonight while some friends went out for a beer. I have to finish most of my studying for tuesday's pre-test because i have a meeting with financial aid at 3pm tomorrow. (gotta love livin off loans) Speaking of studying, i need to get back to that, my brief study break turned into an hour of goofing off on the internet.

i've got mad skills!

This was our first week of "skills" labs. We all thought it was going to be slightly less labor-intensive, but we were so very wrong. We have skills lab every morning for three hours monday thru thursday, but before every lab (actually it has to be taken by 5 o'clock the day before), we have to pass a pre-test about the material we would be covering. Sounds easy enough, but in actuality, the quizes are computerized and extremely specific. Imagine fifty over-achievers getting 75s on multiple quizzes- some even failing! Needless to say everyone was constantly complaining about the workload (preparation for the quizzes usually took about three or four hours) and about the specificity of the quizzes. As the week went on, though, i think we had a better understanding of how to prepare for the pretests (i actually got A's on the last two!). The end of the week still left us completely exhausted (i love weekends!).

The actual time we spent in the skills lab, though, was really fun. We learned more about handwashing and sterile technique (in the sterile world, clean is dirty!), and then on wednesday, we learned how to put in catheters (on dummies, not our lab partners). The whole process is made a little more difficult because you have to maintain surgical sterility. I'm really good at donning sterile gloves, though, and i can spot a break in sterility from a mile away. Friday, we had open lab, where we could come in and practice catheterization (it's going to be one of our check-off skills tests). I went through the whole process twice, and i'm pretty sure i've got it down. Setting up the sterile field is a little tricky, though. You can either put down the sterile drape (rectangular sized sheet put between the legs in front of the perineal area) without sterile gloves, by only touching the corners within 1 inch from the edges (and be able to brush against the legs- but not being able to reach across the sheet), or you could don sterile gloves and touch any part of the sterile sheet, but you have to be extra careful not to touch the bedsheets, the patient, or any other non-sterile object. like i said, it's tricky.

I really like my skills teacher, because she really forces us to think things through instead of just telling us the "right" way to do something. Some people in my group don't like that, but it's kind of fun to have to "think critically" about a specific situation. Really, it's just good practice, because in reality, when we come across new situations, there will never be an omnitient person sitting on our shoulder telling us the "correct" way to do something. Monday, we worked on body mechanics (being able to safely move a patient, or helping them move/walk). We had to be able to move an immobile patient from the bed to a chair and then back again. My partner was a 5 foot petite asian woman, (maybe a hundred pounds soaking wet) but when she went limp, it was really tough to move her. I eventually got it down (without letting her go down), but then we added in the extra challenges of IV and catheter tubes. You could really see the wheels turning when you watched someone try to figure out which side to put the chair on so you don't smoosh the tubes (yes, that is the technical term, thank you). Next week, we get to practice giving injections and taking blood pressure readings. (adam said he would only volunteer for one of those - but he wouldn't let me pick which one) And yes, one of these days i will actually get some pictures up here. i promise...

it's july, you know

well, my boyfriend subtly reminded me that we are in fact, in the midst of july, and my last post was mid-late june. Many things have transpired since then. First, i turned a delightful 29 last weekend, and celebrated with some kayaking on town lake and a bbq at a friend's apt. Secondly (and also sort of a birthday present) my good friend/roommate got promoted to boyfriend, but that's all a little more personal than this blog is meant for, so we'll just leave it at that. (picture katie smiling ear to ear) so back to school...

I think we've had two more tests since i finally purchased all my remaining books. I did well enough on the tests, although i wasn't terribly excited about my lower scores, but i still have a solid A average, so i'm not going to complain. This next week we start our "skills" portion of this course. So our lecture portion is completed, which seems like a relief, but i think the workload will not be going down at all. Also, in the skills section we are all separated into smaller groups, some of which meet at different times of day. So i'm kind of bummed that some of my closer friends aren't in my group, but it just gives me an opportunity to get to know more of my classmates. Afterall, once we finish our foundation year, we will all be separated by our specialties anyway. Monday's skills lesson is on infection control and body mechanics. I worked for a hospital system for two and a half years, and we had infection control meetings every other month, so i'm pretty comfortable with the material. The body mechanics information will be really helpful, because i'm worried about hurting my back even more (i have a slipped disc and have to be really careful about injuring it further). We also bought a "gait belt" that we will put around patients so we can help them ambulate down the halls. and pull them up from a sitting position. Then, in another few weeks, we start our small clinical rotation! i'm excited to get out of the classroom and get more hands-on experience.