Finishing Strong

I have been seriously lacking in my motivation to write.
When I last wrote, I was preparing to be evaluated on a head-to-toe assessment.  That went very well.

Now, I am trying to finish out the semester strong, so I'm living studying in the library for the four finals that I have next week.

Wish me luck!

S

P.S. - I promise, I will bring things up to speed as soon as finals are over. 

Head to Toe Assessment

• Wash hands
• Introduce self and review role for visit
• BP, PTR
• Cranium for size, contour, color, lesions
• Inspect eyebrows, eyelids, and eyelashes
• Palpate sinuses and TMJ
• CN VII (facial expression)
• CN II (confrontation test - peripheral vision)
• CN III, IV, & VI (positions of gaze)
• PERRLA
• Inspect and palpate external ear
• CN VIII (whisper test)
• Inspect and palpate external nose
• Nostril patency and CN I (fragrance test) 
• Inspect lips, buccal mucosa, gums, tongue, and palates
• CN V (clench teeth, palpate face)
• Tap teeth
• CN XII (protrude tongue - "light, tight, dynamite")
• CN IX and X (depress tongue and say "ah")
• Neck ROM
• Auscultate carotid pulses
• CN XI (shrug shoulders against resistance)
• Inspect and palpate chest and lungs - back then front
• Palpate spinous processes for paraverbal muscles for tenderness and symmetry
• Auscultate over all lung fields and verbalize normal vs abnormal breath sounds
• Percuss over all lung fields
• Palpate pericardium for pulsations, thrills, and/or heaves
• Auscultate five heart fields, sitting then lying (diaphragm & bell) 
• Auscultate heart at apex in lt. lateral position
• Inspect abdomen skin, contour, symmetry, & umbilicus
• Auscultate abdomen with diaphragm, all four quadrants
• Auscultate abdominal aorta with bell for bruit
• Percuss all four quadrants of abdomen
• Palpate abdomen; light then deep
• Inspect skin and nails; capillary refill
• Palpate skin for temperature; skin turgor
• Compare symmetrical parts
• Palpate radial, brachial, & pedal pulses, bilaterally
• Test sensations of extremities w/ cotton ball - tell pt to close eyes
• Test upper & lower extremity ROM and muscle tone using resistance
• Elicit reflexes for biceps, triceps, patellar, and achilles
• Observe gait and balance; heel-toe walk
• Romberg's sign & rapid alternating movements

Giving Thanks

The first semester of nursing school is winding down, and I couldn't be more ready for Thanksgiving break.  In fact, this year I'll be giving thanks for making it through the boring abyss that is this first semester. I'm not sure if my mid-semester slump just came late, or the effects of burnout from the previous degree took awhile to kick back in, but I am bored with the material and reluctant to study it.  

I am really looking forward to next semester, because I will study Maternal and Child Health.  I have wanted to work in obstetrics and/or neonatology ever since I can remember.   A little birdie told me that I'll be working Saturday clinicals for OB.  This is very good news because I will be placed at a "city" hospital, with higher birth rates and a NICU.  Knowing that I will work in Labor & Delivery and the NICU in just over two months is what's carrying me through the rest of this semester.

I Hate Med-Surg.

It has come to my attention that I would rather not be a nurse at all than be a med-surg nurse.  


Watching the RN's in action, I see an endless cycle of: vitals, meds, vitals, meds, procedure (if you're lucky), vitals, documentation, more meds.  It would be enough to make me puke.  No excitement, no stretching your brain, and rarely anything innovative or medically fascinating.  
Just meds, pee, poop, wounds, and moving people [who are probably obese...], all the live long day. 


I have all the respect in the world for med-surg nurses.  I don't know how they do it. 

Sailing Through the Mid-Semester Slump

The past few weeks have been a bleak attempt to avoid a mid-semester slump, something which I fell victim to quite often during my B.S. degree.  

This semester, I have managed to avoid an academic slump (yay), but my nutrition, exercise/dog walking, and blogging have suffered.  However, I think that I'm back on track now; my fridge and dog thank me, I'm sure. 

Review of the past few weeks: 

1) I've had a several tests in my classes over the past few weeks - I'm happy with my scores, so my motivation is at an all time high. 

2) I've recently finished my Psych clinical.  This is bittersweet.  While it will be really great not to have to drive the distance each week, I'll miss being in the hospital setting on a weekly basis.  I much prefer that to the classroom setting.  

I've also grown to love working there, and have "made friends with" some of the patients.  I have seen some at their worst, and watched them progress to discharge.  I feel their frustrations as they battle their illness, and I am proud of them when they leave.  I get very involved with my patients, and I tend to wonder about them once I get home.  I know that this is detrimental to my own emotional wellbeing, so I'm working on it.  I need to find a balance.  Growing up in the North, I learned not to wear my heart on my sleeve - which is why Southerners may have thought of me as cold, uncaring, and bitchy.  So, when I made my trek below the Mason-Dixon line, I had to modify the way I carry myself, and seriously tone down the sarcasm.  Now, I'm thinking that I've gone soft!  It's time to even the scales so that I'm not an emotional wreck by the fifth year of my nursing career!

3)  I've started a Nursing Therapeutics clinical in a Medical Care Unit.  I feel at home in a hospital.  

I feel like the act of putting on a pair of scrubs is part of my own process of self-actualization.  

In short, I LOVE it.  

I have taken it upon myself to dive right in.  I offer my service to virtually every nurse on the floor, and when there's nothing left for me to do, I observe an NP or MD.  Spending time with advanced care practitioners makes me realize how much more I want out of nursing.  I like the mystery of medical diagnosis; I like to dig around for clues in diagnostic tests.  I like the idea of tackling symptoms and systems, rather than focusing entirely on the human response.  I would like to think that in becoming a nurse practitioner, no matter which specialty I choose, I will be able to find the balance between treating the patient and treating the disease. 

4)  I am in love with my clinical group. They are the best. The end. 

S

Nursing Parts of Speech

Who knew that "toilet" was a verb?
Toileting, an activity of daily living. 
A person can toilet, or a nurse can assist with toileting.  


Lesson learned.  Nurses change parts of speech on a whim. 


S

A Brief Comparison

Words from one of my most recent patients:
"I am a ninja jedi ... George Jetson invented electricity ... I can count colors on my fingers"


This week, I've been thinking a lot about how this degree, the BSN, is different from my previously earned degree, the B.S. (letters which comprise my favorite double entendre).

1. My test grades are significantly better.  That's always a plus.  I think this is because of the style, modeled after the NCLEX.  It's much easier for me to choose the "best possible answer" or "top nursing priority" than it is for me to remember the mechanism of an organic chemical reaction.   
2. I really like my schedule.  I have lecture on Mondays and Fridays, clinical on Tuesdays,  and labs on Wednesdays and Thursdays.  Sure, most people don't like to sit in one classroom for six hours, but I'd personally rather just get it out of the way for the rest of the week.  
3. The nursing program is significantly less cut-throat than the biology program is.  I have made more friends in four weeks of nursing than I did in four years of biology. 

So far, so good!

The only downside I've found up to this point, is that I am not used to having all of these group projects. This would be fine in a group of four or five.  But, these projects are in groups of ten (my clinical group).  It's really hard to get everyone's input, and I am a bit of a control freak.  But, what can I say? When it's for a grade, someone has to be the one to keep the assignment organized and the group on track!  

I also need to keep in mind that since I have already taken two years of upper level classes, my pace is a little fast with some of the assignments.  Note to self*:  the people in your clinical are juniors in college.  Take a breath, and slow down.  

Overall, I am really enjoying the BSN program!  I am looking forward to the upcoming semesters, when the topics are more focused and the material is a little more challenging (I'm sure I'll want to kick myself later for wishing that upon myself...oh well!) 

S