Week 10 Check In

The speaker reflects on their recent experiences during a charge shift and three-day shifts with detailed patient care summaries. They discuss cases involving various medical conditions, such as abdominal mass, fever of unknown origin, and hyponatremia, highlighting the challenges and management strategies. Additionally, they touch on interactions with patients, family dynamics, and the learning process as a student nurse. The speaker expresses gratitude for the valuable learning opportunities and insights gained from these clinical experiences. Honestly, I shouldn't be doing these voice recordings the whole gosh darn time. Anyways, week 10 reflection, here we go. This was a shift where I got to do a charge shift, and then I had a set of three with Sarah. All of them were days, I really prefer days, home then, but Mondays can be very busy. Anyways, did a Friday shift with Nicole, and we were charged that day, or she was nurse clinician, I guess is probably the better way to say that. It was neat to see how the unit has managed from a greater picture and who comes and asks for help for what different things and what to update charge on. I guess by and large, I haven't had to do that yet in my clinical, so getting to see that communication was really interesting, and where it is that people are seeking help, and then what charge has to do. Holy crackers, that should come with so much more of a pain increase, because it just seems like at least on days, charge had to be aware of everything all at once and be doing 12 different things all at once, and the knowledge of every single patient and their overall care and their overall management, and reading charts and going back and forth between different tabs and different documents and different books. I don't know, it was just super cool. I didn't end up getting to go to rounds, because I guess they moved rounds off of Fridays, but that's okay. It worked out to be a really interesting day of getting to talk to Nicole and talk to her about what leadership looks like on the unit as a charge nurse and what the different learning lessons are, and that whole day really just allowed me to stitch together the bigger picture of things and where that fits in with me as a student. I'm really grateful to have been able to do that. Allison had been really sweet and worried that I'd be bored, and she knows that I like to keep things moving, but the time flew by, and it was fun. I think it was the second IV that I missed the entire semester through, but we had one patient that Nando came and got me, and I poked, and then I didn't end up getting it, so then somebody else poked, and somebody else poked after that, and somebody else poked after that, and finally they ended up just getting a VASC, but interesting situation and just a weird family, that shift. But yeah, it was just a really good day, and I'm super grateful for having had done it. From there, I went into a set of three-day shifts, March 23rd, 24th, 25th with Sarah. We had the same four patients. That's not true. We had five patients because we did a discharge and a NIT. I think I've done more of those that I've forgotten to comment on, but here we are. We started off with a couple on ISO and just kind of worked our way from there. Ended up having none on ISO by day three, which was lovely, but my patients were a 53-year-old male, R1, in for an abdominal mass. He was whiny. I'm just going to say that right now. It's a really interesting thing to see culturally where people come in from, and in cultures that the women do a lot of the care aspects, and it's expected. It seems that the men can be maybe not as self-competent. I don't know how to quite say that. He also is not married. Anyways, he was on contact droplet for TB and VIR rule-out. We weren't really sure with him why he had had this five-day history of worsening cough and dyspnea and then right lower quadrant pain after he returned home from a trip from India. While I was with him over the course of the three days, they had looked at potentially dengue virus and chikungunya virus, if I'm saying that right. It's the one that the mosquitoes transmit, and there's no cure for it. And then they were also looking at acute arbovirus infection, so quite the infectious disease workup. Really interesting to see what they were doing for him. Electrolyte replacement for a couple of different things, a coordination of different tests of AFBs. He kept having swabs come back with low volume. So I finally, and Sarah can attest to how ridiculous this is, but I finally put five mils of orange juice in a syringe and put that into the pea cup. So I was able to not only see what the five mils looked like, but then I was able to take that in and show him what five mils looked like because our AFBs kept coming back. They were low volume, and I had to redo a set of swabs. But, yeah, he was interesting. They also did a liver biopsy with him to try and figure out what was going on, and that's still been growing as of the end of these three days. He was NPO, so kind of managing that stuff, managing family, managing IV resites, and, yeah, sodium replaced, potassium replaced, all that good stuff. The second patient was a 36-year-old female, R1, in with fever of unknown origin. For her, she had had uterine fibroids and, like, menorrhagia, if I'm saying that right, where there's lots of bleeding with her period, with fever and, like, headache and then viral ILI symptoms, and then she also had a full-body rash. They were wondering potentially if there was a meningitis and there was muscle pain and all sorts of stuff, but it was interesting. She had been previous alcohol use disorder, had not had A2H since immigrating from Jamaica, so super neat to just kind of talk with her about ADL. She had three kids. She's, again, super close in age to me here and quite a nice lady. Not a ton of in-depth care, but more just pain management. She had had some sciatica as well, so kind of watching that and just getting her ready for discharge. There was definitely some anxiety management with her as well and then discharge teaching when I discharged her on day three. The third patient was a 43-year-old female, R1, with hyponatremia. She is an oncology patient with stage 4 rectal cancer and an upper GI bleed and just all sorts of things. Anyway, she ended up having – she had a port, didn't touch it, assessed it. I'm still very aware of them, and it's funny because the devices have not changed since I had my own port. Like, I talked with her a little bit about how she cares for it. Things have not changed in the last 20 – God, 25 years, 24 years? She also had a left colostomy bag. She was super independent with that and then peripheral IFE. She was on monitoring, and for her, that was her sodium had been out of whack. Let me double back on that. She came in because she had an increased worth of breathing and she has a past history of PE. And then she had one of her legs had been super swollen, so they were looking for clots. She was negative on all signs of like DVPs and clots, but in the investigation, she was found to be hyponatremic, so they started correcting her, and then they overcorrected, and so we were trying to get her back on track and then deal with her nausea, and then we were going to transfer her back to medical oncology. But she was on Q4 lights, and Sarah had to collect those off the port. But then monitoring and just trying to make sure her pain was under control, and for her, it was a lot of nausea management and family management. Her mom was plus-plus anxious and was just very specific about how she wanted care done, and you could tell the patient was just like rolling her eyes at her mom the whole time. I didn't get to give Desmopressin, but the shift before us did, so it's just I was watching for like fluid restrictions because I know it can cause hyperhidrosis and patients can drink a lot, so I did have that conversation with the patient, and she did say she was quite thirsty and had been drinking more, but when we looked into fluid volumes, it wasn't anything excessive. Yeah, super neat patient. Neat to kind of see how we managed. When I was on day three with her, we ended up transferring her care. Her sodium came back into normal range, so we ended up transferring care back to med-onc. So it was neat to actually call over to the Arthur child and get to do that transfer to another unit, and the nurse hadn't done that much research on her, so I was able to kind of go into depth on the patient, and that was fun. The fourth patient was a 92-year-old male and one with seizures, and there was a clarification to the goals of care in the green sleeve, but he was a really—this was just a cruddy situation. Medically, he had been stabilized. He came in after being found altered by his wife in the house when he was en route to a hospital with EMS, had a couple of seizures, and so they had given him like loading doses of Keppra, dead in the ED, and then there was some other like electrolytes, stuff out of whack that we ended up needing to manage, and so kind of for a multitude of reasons, he came up to us for care. He'd also at home been receiving like personal care and respite care and whatnot, but his 90-something-year-old wife is the one who's managing him at home on an acreage that's in the city. So day one of him, there wasn't a ton doing. It was really more waiting for a family disco meeting, so just monitoring his care, not a ton, and it looked like we were going to be transferring care to hospitalists. He had had some nausea and just sort of managed that. Nothing to comment on day one. Day two, same thing, had been managing the nausea. There had been signs that he vomited. When I came on to shift, we got him changed. It wasn't too big a deal, and then charge said like, hey, is the family aware about this meeting, and like it didn't seem so, and the patient was also altered GCS. So I don't remember exactly why Hannah asked me to do this, but I ended up reaching out to the son to see – Hannah asked me to see what time he was available. That's what it was. So when I reached out to him, he had no clue about the family meeting, and all he said was like, I don't want my sister involved in care, but I can't talk now. Like, I'll call you back. So from there, I ended up trying to find the sister's info. There was nothing kind of in the chart, but I did find that the wife – we also didn't know if there was a wife or not at this point, but I did find a name, and so I phoned, and sure enough, the wife was at home. English was not first language, and she just seemed quite altered herself and just frail. So in asking her some of the questions that I was, like, she can't care for him. She just – she kept saying, like, his name and then come home, come home, and I was like, okay. So kind of gave him the update from there. We tried to do a little bit more digging into it, social work ended up digging into it, and we found that there was a couple of daughters, not just one, and one of them was okay to be involved in care. One of them wasn't, yada, yada, yada. Later on in the day, there was an attendant who came by, and he had asked me about the patient, and I was able to give him a pretty extensive report into the social and, like, everything from cardiac bowel to bowel all the way down, and he was very cute. He's like, do you have a preceptor? Like, I could let them know that was a really good report. I was like, no, it's okay. I'll call Sarah, but thank you. And, yeah, it was kind of funny to have that happen. Oh, stop. Sorry, I'm going to pause this and deal with my cat. Anyways, we ended up getting an order to come in about, like, ensure patient gets fed because the meal tray had been sitting at bedside and I had already been kind of struggling to get the patient to swallow meds. I crushed them and put them in apple sauce just to try and get them in, but there was one that couldn't be crushed, and he, like, chewed on it and there was no redirecting him for it. So trying to get him fed. And at that point in the day, I was a little bit busier. I ended up asking a health care aide to help me with that, and he did. And then that kind of was that. I left for shift, and that was sort of our day at that point. Day three, came in, took a look at the notes for this patient, and sure enough, overnight, he had likely vomited, aspirated, and then had a desetting episode and ended up just becoming quite gurgly, like audible crackles and, like, full-on drowning in his lung sounds from the hallway and desatted. And then they had got our T.F. to do sectioning. They ended up putting in, like, an NPA and suctioned through that, and he was, like, noncompliant and just not a great situation. So all of a sudden we had this patient go from transfer of care to hospitalist, and he did get transferred to needing to have him put back to an MTU team. So day three was just kind of managing him. He also had a bowel movement, so we did a tap water enema with him, and then we had the old suppository when we did that tap water enema. It's my second time having seen one. This was the first time doing an in-bed one, so just a little bit more learning with that one. In terms of what we put down in the bed to redirect the output and kind of the bowel contents, yeah, definitely interesting. I've unfortunately had to do them on myself before, and they're just not pleasant. So, yeah, a little bit more learning there, and kind of how we go from that stuff. I'm just, like, shaking my head, just the whole situation. It's so awful to have to do those for people. But man, oh, man, if you don't, manual disinfection is that much worse. So, finally, the last patient that I had was a – we didn't know if we were going to get her on day two. We didn't end up getting her day three, a 55-year-old female. She had had syncope episodes that were, like, prodromal in her presentation, but they had been the same as how she presented with kidney stones. So it was interesting as we moved through the day. I end up – Sarah was not around. She had to, like, go take people to tests and do other stuff, which is – it's good because this two-hour, I was totally independent, and it really – I needed her for a couple of things, like the drawing lights off that port. But other than that, it wasn't really – didn't really need her a ton in the nicest way possible. I mean, I always need you, Sarah, but, like, it was nice to be a lot more independent in my operation and time management. I think that's been going on for a while, but, like, I really noticed it this tour. I actually sat there going, like, can I do anything for anybody? Day three, I checked everybody a number of times. But, yeah, it was cool because also this patient was cardiac monitored, and we got to go through that stuff and managing BGL because they were checking, like, hemoglobin A1C and, like, the sepsis care flag, I guess. The connector thing was active, so just checking for that. And then she was going for, like, a CT chest, an MRI brain, a 24-hour roll term monitor, a TTE, an EEG. So learning about that stuff, trying to coordinate her being on the stretcher and moving about. She also had a 22-gauge fineting to put in. I put in an 18, actually, for her. And, again, just, I don't know, it was a really good tour, this tour. It felt so much more independent in terms of managing social issues, managing patients, like going off to get to different tests and, like, a busy Monday to a Wednesday shift. So all in all, it just felt a little bit more like a real nurse, not a little bit more. I definitely felt like a lot more of a real nurse. Obviously, I'm not at Sarah Nelson's level, but it feels really good. My confidence is growing in myself. I know I sound like I'm going to cry right now, but it's because I'm sad that this is all coming to an end. Sorry. Sorry, getting mixed up in a group there. I'm really sad this is all coming to an end. I've had such an amazing experience with both of these strong, intelligent women and amazing nurses and kind humans and just great people to be around and to learn from. And Sarah Nelson definitely has different styles in how they do things, and I think that has been one of the biggest blessings of being able to see how they do it differently and see how both of them do it right, but the different interpretations and different ways to get to the same end. So, yeah, I am so incredibly grateful for this clinical experience. I know I still have more shifts to go, but I'm going to be writing my final here. I've done discharges. I've done new admits. I've done all sorts of skills, and holy crow, it's been a really cool three months. And I promise I don't cry this much normally. I'm probably just hormonal because my period is coming up, so I'm really sorry.