Archive for month: May, 2015

BP: 92/78
HR: 98
Temp: 102
O2: 87%

WBC: 19.0
Bands: 14%
HgB: 13
HCT: 42%
PLT: 350
Glucose: 230 mg/dL
BUN: 22 mg/dL
Cr: 2.4 mg/dL

pH: 7.32
PaCO2: 66 mmHg
PaO2: 47 mmHg
HCO3: 23 mEq/L

ET tube 22cm at the lip
A/C ventilator setting
RR: 12
Peep: 5
VTE: 500
I/E: 1:2
FiO2: 1.0

Pt remains to be sedated. Based on RASS, the patient is deeply sedated with signs of delirium. Pt is NSR on the monitor with the HR around the 90s. Pt’s extremities are cold to the touch and are cyanotic in color. Pt remains on the ventilator. Respirations are 12 with an O₂ of 87% and crackles are present in the upper lung lobes and right lower lobe; and diminished lung sounds in the left lower lobe despite respiratory treatment. Bowel sounds present in all four quadrants. Pt’s abdomen is distended. Pt received an enema earlier in the morning for constipation. Pt’s Foley continues to drain 20-25mL of dark urine per hour. Skin is intact with a preventative myplex placed on the coccyx. Pt had an echocardiogram earlier today around noon. The pt ‘s echocardiogram revealed left and right side heart failure with an ejection fraction of 25%. MD and RT notified regarding O2 saturation.

It is still hard for me to believe that Pinning is only 3 days away, and I will have completed nursing school! I have worked so hard for so long to achieve this goal and now it is within my reach! It is hard for me to imagine life outside of school. If I am not working on homework or attending class or at clinical, then I can pretty much guarantee that I am still thinking about school or what assignment is due next or mapping out my time so that I can fit is all in. I am so excited to have accomplished this Everest-sized goal. Going through school has taught me that I can be successful at whatever I put my mind to. There were so many times that I felt I would never be able to complete all of the assignments or learn all of the material, but time after time, I did! So many nights I just wanted to give up, but by the grace of God, He kept me going and would remind me over and over again why I wanted to be a nurse.

Going through school I now have a much deeper appreciation for nursing as a profession. I am so proud to be entering the nursing profession on Friday and see it as a great honor! It is something I take very seriously as I have seen throughout these past 3 years the power and responsibility that nurses carry. Power, not in the sense of strength or authority (though they also have these), but in influence over the experience and outcomes of their patients. Nurses have the power to make a patient’s experience the best it can be or the worst. They have the power to make a difference in someone’s life everyday by being present with the person in their greatest time of need. They also carry great responsibility in providing safe and effective care for their patients. Patients and families entrust the care of themselves and their loved ones to nurses. The care nurses provide can mean the difference between life and death for many patients.

When I began this journey 3 years ago, I had some ideas of what type of nursing I wanted to pursue, but tried to stay open-minded each semester except for one area which I was convinced I would never like…Critical Care. I assumed that most of the patients in ICU were intubated and in extremely serious conditions that were too intimidating for me. Since I greatly value patient interaction, I thought I would dislike ICU and would have a very hard time handling the patient situations; however, I was quickly proven wrong. After rotating through the ICU and telemetry, I really enjoyed both areas of care. I loved being able to dive deeper into the situations of each patient I cared for in ICU since I cared for 1 or 2 patients at a time instead of the normal 4/5 to 1 ratio. I was also able to do a lot of nursing interventions and skills that have always intimidated me because I have not had a lot of practice with them and they feel more intense than others. I gained so much confidence in my abilities to coordinate care and assess and intervene appropriately. Overall, this semester has been one of my favorites and I have gained knowledge and experience that have prepared me to enter the nursing profession with a solid foundation that will set me up to succeed no matter what field of nursing I end up in.

I can’t believe this is the last homework assignment of my last class of nursing school. It’s so bittersweet to think that we are finally at the end. I’m more than ready to be an RN and start my nursing journey, but on the other hand, it’s so weird to think that I won’t be with the people that I have come to think of as family for the last three years. When we were told at orientation that these three years would go by fast, I didn’t believe it. And even during it, I didn’t really believe it. But now that we’re here, at the end of the road, I realize that, as much that has happened with us, it has sped by. We went from being little babies to the big sibling ready to leave and enter the world. Crazy.

I feel that our knowledge shot up this semester in critical care. We learned a great deal when we started in patho, and we continued learning in pharmacology. I feel like everything since that was based on those initial building blocks. However, this semester was where we really got to put everything into place as it was our pinnacle class. So much of what we learned was based on topics we were already knowledgeable in, and this was so beneficial to us in learning the more complicated aspects of critical care. This semester, to me, I really felt like a nurse as I took care of patients. There was much less reliance on a nurse or clinical instructor as we really took the reigns and pulled out all that we have learned in these past three years.

Additionally, it took me a while to adjust to this blogging aspect. I have run a blog in the past (now that I think about it, I wonder what happened to that blog?), but this is a new format that my previous host. And while I feel like blogging is a lot like writing a discussion board, I do find this more enjoyable than discussion boards. However, on the flip side, I wish that this would have been introduced to us sooner than our last semester. It felt like, at the beginning, we’re trying to adjust to everything that the final semester was throwing at us (graduation, job applications, critical care, NCLEX) while also finishing up our papers for Ireland, and then learning a whole new technological platform was added on top of that. It was stressful at first because of that, and I wish we had more time to work with it. I would’ve loved to have used it to it’s full potential, and I had grand pipe dreams of making this site into a virtual CV, but I didn’t want to spend all the time on it if we weren’t going to get to use it after graduation.

Overall, I think this course utilized greatly diverse learning methods which benefitted us greatly. I enjoyed the lectures with powerpoints, but I also enjoyed watching videos and acting out scenarios. I feel that, when we utilize more than one part of our brains, we really do experience greater learning that will benefit us in the long run.

So here’s the close-out to the last piece of homework. It’s been a great three years, and I’m going to miss everyone. Now, here’s on to the next big journey!