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

Testing My Knowledge & Testing My Ability to Resist Temptation

I am happy to report that I'm getting a handle on my test anxiety. With so many tests back to back, you kind of get used to it...and if you did panic, it would literally consume your life.

I am also happy to report that I resisted temptation and studied for today's tests instead of watching the Grey's Anatomy and Private Practice premiers. That is truly saying something, for me.

S

You never know who's standing right next to you.

As a nursing student, you meet all types of people.  

If you didn't have a chart with patient history, you'd never know that you were standing next to a diabetic, a chain smoker (although you might smell that...), or a sex offender. 

This became apparent to me over the past week.  

While you want to treat each patient with the same level of respect, you must also err on the side of caution to protect yourself and those around you.  This becomes even more pertinent in the mental healthcare setting.  Men and women with dangerous paraphilias, poor impulse control, or a history of violence are everywhere.  It is our job as nurses to look beyond the potential danger to provide the highest level of care.  

On a lighter note, now begins crunch time - the week where the exams begin.  I am interested to see how my scores will pan out, since the format of all of our tests will mimic the NCLEX.  This week, I'll have a psych exam and a math exam.  Next week will include a health assessment lecture exam and a nursing foundations exam.  

To add one more tier to the levels of potential stress, next week will be the last nursing therapeutics lab...which means it's time for therapeutics clinical: bed baths, enemas, catheters, meds, IVs, and more.  The fact that I will have had only five "weeks" of training beforehand is unsettling.  I just keep crossing my fingers that my clinical instructor won't eat her young :) 

S

Getting Into the Swing

Well, it's week three and things have been going pretty well.


The first two weeks of nursing school were pretty uneventful, but that's probably been a good way to ease us in.  Week one was orientation and HIPAA, HIPAA, HIPAA.  Week two was a lot of review and common sense information, with the exception of Nursing Therapeutics lab.  It's amazing how many skills we're learning in so short a time!  






I've also been to two clinicals for psychiatric nursing.  So far, I have done an intake assessment on a male patient with schizoaffective disorder.  This was slightly uncomfortable because I have never dealt with mental illness firsthand.  Asking a stranger extremely personal questions upon first meeting them is uncomfortable (although I should get over that soon, considering my future career), but asking someone who is manic is entirely different!  From your average stranger, you would expect an embarrassed mumble or a blush when they're asked if they've ever experienced physical, emotional, or sexual abuse.  However, with a patient with mental illness, you never know what response you'll get.  For example, my patient was laughing one minute, sobbing the next, and laughing again thirty seconds later.  It's slightly unsettling.  


However, overall, I was lucky because my patient was quite friendly and didn't seem to be bothered by my incessant questioning.  He was really sweet!  He was a great first patient to have, because he reminded me that underneath all the lability and mania, is just a person with a disease.  There is a real stigma attached to those with mental illness.  If someone has heart disease, no one judges them; if someone has an under-active thyroid, no one judges them.  So, why is it that a person diagnosed with "dysfunction of brain chemistry" is deemed an untouchable?  What is it about our culture that creates this prejudice?  I just hope that my attitude toward my patient was enough to put him at ease while I was interviewing him, and was enough to show him that I was there to listen and not judge.  


At lunch, a different male patient brought me a sweet tea, so I must be doing something right :) 


S

Getting Ready for the Big First Day

Over the past few days, I've had to complete hospital learning modules and read through protocol manuals. Mostly, the training was for the computer systems, but some was for codes, restraints, falls, etc.  The online modules for the hospital computer system were pretty disappointing.  I don't know if this is true for most hospitals, but it seems like the charting programs are ten years behind in technology: inefficient, slow, and cluttered.  When I think of healthcare, I think of advancing technology, cutting-edge procedures, and the best of the best.  This system proved otherwise.  Although I am thankful that I won't have to do paper charting, it seems like this will be equally painful.


Nursing school begins in five days.  My anxiety has been resolved, though I really don't know why.  The whole first week of school will consist of orientations for all of the classes.  I don't expect to be terribly busy until week two.  More than anything, I'm ready to meet the girls (yes, all girls) in my clinical group.  I hope that we all have a good chemistry, because that can be so helpful!


So, until orientation begins, I'll be working on getting back into an early morning routine. This will be payback for my puppy - he has woken me up early on many occasions...this will be the first time that I'll have woken HIM up...we'll see how he likes it! ;)


S

All That Is to Come

For months, I have been waiting for my first semester clinical assignments.  I've wondered who will be in my group?  How far I will have to drive each day (...meaning how early I'll have to drag my sorry butt out of bed)?  Who will my instructor be - the sweet little lady, or the one who will eat you alive so that you truly learn?  The questions have been in the back of my mind since March.  Finally, I decided to stop wondering (and worrying, just a little bit) and to just let it all happen. 

Well, as soon as I stopped wondering, I received an email with ALL of the answers.  Last night, I spent two hours reading over all of the PDFs for groups, schedules, locations, etc.  My iCal was probably excited to be used again - I've been neglecting it since I graduated in May - and in the name of a new semester and a new degree, a little micro-management never hurt anyone.  


I thought that knowing my schedule would put all chances of possible anxiety to rest.  But, I was wrong.  I'm starting to get a little nervous.   I've already gone through all the BS to get a B.S in Biology.  You'd think that the degree under my belt would put my mind at ease...what's two more years?  I can do this!  I'm used to upper level coursework, and I have always dreamed of working in healthcare.  Why so nervous all of a sudden?  I guess I'll never really know; but it was enough to keep me up all last night! 

I'm sure I'm not the only one who feels this way.  And, that is why I decided to write about my experience as a nursing student.  I plan to write in this blog:

1. To channel my feelings into something productive/creative in order to get everything off of my chest. I have made a vow to myself that I will not internalize my feelings in my career as a nurse.
2. To have something to look back on to see how far I've come; 
3. And, to help anyone else who is considering the nursing field.  

Let the journey begin. 

S

I'm Dreaming of a White...Dutch Oven?

What do chemists call a benzene ring with iron atoms replacing the carbon atoms?

A ferrous wheel!

Now that the embarrassment of my background in science is behind us, let's get to the topic of the day. I have had enameled cast iron on the brain for over a week now.

• It's the dead of winter which always makes me crave homemade soups, stews, and casseroles.
• I've been seeing enameled cast-iron Dutch Ovens in my dreams...
• And to top it off, my friend Hillary over at The Gleam of Rose Tea, is doing a cast iron teapot giveaway this week!

But first, I wanted to learn what makes enameled cast-iron such great cookware! According to Real Simple, "Cast iron retains a relatively even temperature over a long period, so it's perfect for making soups and stews." Another benefit is the no-fuss stove-to-oven transition that most cookware does not allow. However, it is important to be sure that your lid does not have a plastic handle - the plastic cannot withstand high oven temperatures.

After drooling over Le Creuset 'French' Ovens in vain, (due to my full-time student status/lack of a real income) my mission was to find myself a Dutch oven of comparable size and quality.

I looked for white enameled cast-iron Dutch ovens, because I have this unavoidable obsession with making sure things match. I have black (round) and white (square) dishes, and on the off chance that one day, in the near future or in the far future, I have open shelving in my kitchen, I don't want to run the risk of having a mismatched, cluttered look.

I know, I have a problem.

SEARCH & COMPARISON RESULTS:

Le Creuset Round French Oven

3.5 qt

$184.99

Mario Batali Dutch Oven

4 qt

$89.95

Breakdown:

Le Creuset: price per quart - $52.84

Mario Batali: price per quart - $22.49

That's a $30.35 difference per quart!

Now, I'm no mathematician, but considering my budget (or lack thereof...), I am going to have to go with the Batali. And, considering that they look damn near the same, I am fully satisfied with (and super excited about!!!) what I've found!

Keeping in mind that a piece like this is an investment, I'll just have to get over myself and buy it so that I stop thinking/dreaming about and obsessing over Dutch ovens. And I'm sure the good ole boyfriend will be thrilled to stop hearing me talk about it, too!

What about you? What are your experiences with enameled cast-iron? Do you have a favorite Dutch oven recipe? I'd love to hear about them!