Last day of OB

Today we finished our OB rotation and I spent the day with a postpartum nurse who let me do everything. I had 4 different patients and they all needed assessments- the moms and the newborns, so I was busy all morning with that plus changing diapers, giving meds, tracking down doctors, baby photographers, lab techs, and learning about Rhogam shots (for when the mom is Rh negative and the baby is Rh positive). I did see another circumcision, which looked even more barbaric because it was done a dfferent way- this method called Plasti-bell where they put this plastic thing over the penis and tie off the foreskin, which then dies, dries up, and falls off after a few days. I think I've seen enough circumcisions in my life now. Time to move on.

Our upcoming clinicals teacher, Denise (the good one, not the sociopath) , met with us before postconference and gave us our assignments for the rest of the semester. Out of the next 9 clinicals, I only have to go back to that horrible uro-neuro floor twice. I have Four days in oncology, where I was trained as an aide, 3 weeks on orthopedics again. And better yet, we don't have to write care plans after Med Surg ends in 5 weeks. Our last four weeks are called "Leadership" and then we don't have to spend all day Monday doing care plans! Wahoo! Only 5 weeks of care plans. I can't tell you how much of a relief that is. Care plans suck. I can think of much better things to do with my Mondays than writing these stupid meaningless piles of busywork. Especially now when they make us do 2 or 3 of them each week.

I'm glad I got the most of my days on the oncology floor. It's going to be hard, but I was hoping to have a chance to get some time in there during clinicals, to see if it's an area I'm interested in. When I was first trained up there as an aide I liked it, even though the nurses are not all that great. My boss manages that floor and for some reason she can't seem to get nurses to stay. They were always a bunch of spazzes. Everyone always dreads floating there at work.

This week is the last week of the semester where we won't have some type of exam. Next Tuesday we don't have clinicals but we have our skills exam late in the day. We get to draw from a hat to find out which skill we get tested on. I'm hoping for NG tube placement. I signed up to work on Monday so I could have a couple of weeks in a row without having to work too many weekend days with midterms coming up soon. October 10th we have 2 exams.

Over the past week we got our exams back. I aced the Pharm test on cardiovascular meds. And I found out I aced the Pediatrics exam too! After she went over the exam last week I missed two, but she must have thrown those two questions out, because everyone said they got 2 more points than they thought. That's good, I need to save up my points for the end of the semester when we get the teacher everyone warned us about.

Monday I went to the main campus for lab practice time. Trach suctioning, bladder and catheter irrigation, and NG tube placement. Laura and I practiced together, we get tested next Tuesday afternoon. I didn't want to go all the way down to the VCC campus, I'm lazy about having to go anywhere outside of my little radius between Paradise Hills and the hospital. I arrived at VCC a little early thinking the parking would be a nightmare. It wasn't bad, so I decided to see if Roger was in his office and say hi. He was there, so I knocked on the door and he said, "sit down and have a chocolate eyeball." He's been teaching the block one students in assessment by using the eyeballs. He also had chocolate fingers. Hmm...I opted for the eyeball. He's doing well and is liking his new setup as a full time teacher on campus, and says he's been real busy, no time to work at the hospital. He might be teaching a Block 3 clinicals group. I'm making reservations.

We've been studying GI drugs in Pharm and it's pretty cool. Now we're getting lecture in the Nursing Process class on Labor & Delivery. This teacher we have, she's nice and she's easy to follow in her lectures but she drives us crazy. She talks about "mommy" and "baby" and the "coconut". The coconut is your head. If there's something wrong with your head, it's something wrong with your coconut. Fortunately we only have two more 3 hour mommybabycoconut lectures and then we move on. I probably shouldn't complain though, I might be missing the mommybabycoconut lady by later on this semester when we get our sociopath again. Maybe my coconut will explode. It's getting full already.

Before I forget, some trivia...

September 27 marks my one year anniversary with my employer. Dale & I were trying to figure out what special meaning that has. After much careful thought, he decided that this should be a day in honor of the many butts I've wiped over the past year. Since I work two days a week, over one year that's 104 shifts I've worked, and if you figure on the average, conservatively, I wipe 5 butts a day- some days more, some days less. If you average it out that's more than 500 butts I've wiped over the past year. Dale took it even further...if someone worked as an nursing assistant for 30 years, at that rate, they'd wipe 15,000 butts. If they worked full-time, we're talking 40,000.

Therefore, do you realize if you poop once a day on the average, assuming you lived to be roughly 100 years old, you would only wipe your own butt 36,000 times!

Which leaves me wondering...WHO has the record??? And how many *IS* the record?

I'll give a chocolate finger to the person who can tell me!

Peace, love, and chocolate fingers,
Towanda, RN2B

"You know you're in nursing school when..."

You know you're in nursing school when going to the dentist is the most relaxing thing you've done all week.

I am now going into day 10 of a 13 day stretch between work and school. I worked Friday through Sunday last weekend and realized by Sunday that I need new shoes for work and school, my old ones are worn out and my hips to my ankles are one big ache. I already replaced my running shoes but I am still sore, so it must be work. Problem is, I don't have time to get any new shoes until Sunday.

This week started out Monday in the elementary school, this time doing vision and hearing screening of 5th graders. It was fairly uneventful. I did get to look in one little boy's ear who was complaining of an earache. That was nasty! I waited with him while the nurse called his parents and tried to distract him by admiring his spongebob shirt. Other than that, it was a good day, there were 6 of us from our class and we all got a chance to socialize in between throngs of 5th graders.

After the clinical at the school I had a dentist appointment. I have been meaning to get my old fillings replaced with the white ones. They are safer and look better too. I am getting one quarter of my mouth done at a time. I had 3 fillings to replace this time. As the dentist's assistant reclined the chair before they numbed my mouth, I said, this is the most relaxing thing I've done in weeks

I was numb and thick and drooling all over myself and couldn't talk or eat. I pureed my dinner so I could eat early enough to go to bed. Like baby food! Strained chicken, potatoes, carrots and red bell peppers? Mmmmm. Around 7:30 the anesthetic wore off and I started having wicked sensitivity in that part of my mouth. It felt like I was constantly rubbing my teeth on aluminum foil. Torture! I went to bed thinking I'd be able to fall asleep and by 9:00 I was in agony. I got up and took 2 ibuprofen and then miraculously fell asleep after a while. Around 2:30 am I woke up again in agony, took more ibuprofen and had to eat some yogurt to keep it down. I feel asleep for maybe a couple of hours and woke up at 5:30 and my mouth was killing me. I decided to page my instructor and beg her to let me try to get in to the dentist.

Fortunately she called back right away and said I could take an absence or call her back if I wasn't going to miss too much. I had to give my presentation on Pregnancy Induced Hypertension and was afraid if I got numb I'd be drooling as I talked to the class. The dentist got me in at 7:30 and said it was those type of fillings, they can cause some pain, but it goes away after a few days. He didn't warn me about it before that! If I had known I would have waited to do this until after school is finished! I might have to wait to get the others done. I took a bunch of ibuprofen with me and drove to the hospital and got to OB by 8:15.
Fortunately Teresa let me get by without the absence. All I needed was another paper to write.

Today I was paired with another good nurse for Labor & Delivery. I was hoping I'd get to see a normal vaginal delivery since last time I saw a C section. I lucked out, we had a patient who was 8 cm dilated and was having some contractions about 6 minutes apart when we got started. The nurse let me draw up the Pitocin and inject it into the bag and set the IV pump up. She had to connect the IV because again I'm technically not allowed to give IV meds. They use Pitocin to speed up the contractions and also to get the uterus to go back to it's normal size after the delivery. I prepped the patient and the doctor arrived, and I got to watch. It was quick- she only pushed about 3 times and the baby was out! This baby had a short umbilical cord and was also having some respiratory distress. He was grunting and had retractions-the rib cage was visible and the spaces between the ribs got sucked in when it was breathing-so they took the baby to the neonatal ICU nursery to get him stabilized. The baby should be fine after he gets some oxygen and maybe some steroids. The doctor had to do a small episiotomy on the mom so I got to see that. After that delivery things got real slow. We did have a few mothers come in late in labor and gave birth fast, so there was a lot of screaming today.

Then later I got to see a circumcision. The baby is strapped down to a little table curved to the shape of the baby's body, and given a pacifier with sugar water. They swab the whole genital area with iodine and then the doctor injects some lidocaine gel into the bottom of the foreskin. The baby screamed and wailed until it got numb, then he was quiet. Then the doctor holds the foreskin apart with a few tooks and makes an incision downward. Then he places a little metal cup on top of the baby's penis and attaches this clamp-looking vise-like thing to the penis. It was bleeding a lot. Poor baby. Then the doctor basically cuts the foreskin off in a circle like you would peel an apple. They take the tools off and then put a piece of gauze with vaseline on the penis, and continue to put a new one on with every diaper change. The doctor said it would take about 5 days to form a scab and within 2 weeks it would be healed.

Today was our last day with Teresa. We still have one more week of OB before the dreaded med-surg starts. Teresa will have a sub next week because she'll be out of town. The sub is the same nurse I was with today, so it should be good. I have postpartum again next week.

I did hear a funny story today that I'll share with you. One of the guys in my clinical group, Ben, was at County hospital last summer in Block One clinicals and his instructor was Denise (who will be our med surg instructor in a couple of weeks). Ben is our class clown. One day Ben had to put a foley catheter in a man (that's a urinary catheter that has to go into the urethra- yes, up the penis) and the way you insert those is by gripping the penis firmly with your whole hand and shoving the catheter tube in there with your other hand until it's all the way in, about 8 or more inches of tubing. (Yes we use lubricant) . Anyway Ben was about to put the foley in but he was standing there hesitating- must have felt a little self-conscious about doing what he had to do. Denise watched him for a second as he hesitated, and finally she said, "OWN IT!"

Now I need to track down my bottle of ibuprofen so I can get some sleep. We have another Pharmacology exam on Thursday. And I have to write my Pediatrics paper from our days in the schools. And practice trach suctioning and bladder irrigation and nasogastric tube insertion. Ugh.

Good news, it's toward the end of September and nearly a third of the way done with the semester! On the big clock, 324 days to go. But who's counting?

Peace, love, and episiotomies,

Towanda, RN2B

Changing diapers

We're halfway through the 4th week of the semester already. I can hardly believe it. The long slow torture is making progress.

Last week we had no clinicals due to Labor Day and we had our first Pharm exam, which, to be perfectly honest, sucked! The teacher has no clue how to write exam questions. How can you possibly have two answers to a true-false question? And what business does she have putting true false questions on a college level exam anyway? I missed 2 out of 20 but I struggled like most of the class with her wording of the questions and I can tell that this semester, A's are not going to happen by studying, they will happen by luck. This coming week we have our first big exam on Pediatrics. We'll see!

So far this week has been fun though. Monday I had my first Pediatrics day at the public schools. Fortunately for me I switched with another student in my class so I could do my Peds days in Paradise Hills schools. That was nice to not have to drive an hour each way to way north Paradise Creek schools. I was with a group of 6 nursing students, we helped with hearing and vision screenings for kindergarten and 1st graders at one of the elementary schools in town. They were SOOOO cute! And I am not a kid person. Don’t have ‘em, don’t want ‘em, and they scare me...

The kids had to read a chart on the wall with symbols on it (umbrella, apple, house) , and cover one eye at a time, then they got to wear headphones and raise their hands when they heard the beeps, and they got stickers when they were done. And they got to color in their own personal health plans. What time to go to bed, how much to exercise, what they will eat, how to cover their mouths when they cough, etc. The difference between the kindergarten and the 1st grade was amazing, how much they develop over one year. Getting the kids to pay attention long enough to what they were doing was the biggest challenge! The school nurse thanked us for the help- she has to cover the whole district by herself and only has a few assistants. We had a blast! We didn't have to check for head lice and I didn't see any...

Today in clinicals I was in postpartum. I was paired with a great nurse and we had 4 patients, one had a C section, the others had vaginal deliveries within the past 24 hours. I got to give two intramuscular injections of Toradol, a pain medication, those were my first IM injections- and I did the Z track method they taught us last semester. Where you push the skin and subcutaneous fat out of the way before you jab the needle in. It's supposed to hurt less. I wasn't nervous and the patient told me she didn't even feel it. They were in the dorsogluteal site (the butt). I also hung plain IV fluids and got the fluids going by setting the IV pump. That was a first for me to do the whole thing with hanging the fluids using the pump. I can't hang medicated solutions or give IV medications until next semester. It's so much better to work with a nurse who takes the time to explain how to do things correctly and then lets you do it yourself.

We did assessments on the mother and newborn, and I got to see and do all kinds of cool things like changing the baby's first poopy diaper with meconium in it. Looking at how much bleeding the mom was having, checking episiotomies, incision drainage from a C-section- and checking out hemorrhoids.

The guys in our group had a good day too. They were worried about being able to get labor and delivery patients who felt comfortable with male nursing students being there, but both the guys had cooperative patients today and they were both so thrilled- it was cool to see them in postconference- BIG smiles and totally enthusiastic. Both of them said they wouldn't mind being OB nurses.

We also had some excitement on the floor today. One woman gave birth on the floor in the hallway- they couldn't get her into the room in time. And then there was another woman who was having her 2nd baby and she didn't want any medications- totally natural- and she was screaming her head off and you could hear her out in the hall- but she only screamed a few times- I think she pushed for about 30 seconds and that baby popped right out. Afterwards we were assigned to her for postpartum and when we went in to do our first assessment, she looked like nothing happened- not a hair out of place, not a bead of sweat, she looked like she woke up from an afternoon nap. No big deal. A baby machine.

Peace, love and poopy diapers,

Towanda, RN2B