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NRS 420 Final Entry

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Does anyone else ever find themselves thinking about how they would hypothetically medically treat someone?

 

Like, if you’re watching a movie, and someone gets hurt in the movie, and you start thinking about what you’d do to help them? Or even just a story on the news, or an experience your friend tells you about. My brain immediately starts to think about medical care that would be involved. It’s weird, but perhaps it’s a good sign.

The closest thing I can equate it to is when I took a film class in high school. We were to watch the movie Casablanca nearly frame by frame to understand the composition, camera work, setting, lighting, etc. . After finishing watching the film like that for a few days, my teacher said, “now, when you see things on TV or in the theater, try not to analyze it like you did here.” I think a similar thing is happening to me with nursing, in that I’m thinking about it constantly instead of just thinking about it when applicable.

Maybe I’m just really itching to start working. Either way, my experiences in this class and in the attached clinical have been phenomenal this semester, and I feel like they’ve really helped to get me motivated for what’s to come. Being in the critical care, DOU, emergency, and operating room settings have helped me to really apply what I’ve learned in class to my patients, and I can’t wait to start doing that as a real nurse.

 

Cheers!

-Carl

Last blog

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I am excited to see the light at the end of the tunnel! It has been three years of hard work and dedication. I can’t wait to be a nurse and start working. Nursing is such a rewarding career because you can feel good about yourself when you care for someone and make their day a good one.

In respect to this course, I enjoyed it a lot because it allowed me to think more critically. Also, I was able to see many of the medical conditions presented in the book in the actual clinical setting. This enabled me to remember the disease process better by having witnessed the disease. Also, I enjoyed the presentations of several of our guest’s speakers; they were all informative and gave real scenarios which allowed me to  learn the concepts better. For instance, the speaker on mechanical ventilation was great and I applied what he said on my clinical days. I was able to observe my patients who were on a mechanical ventilator and with a respiratory therapist I was able to review the settings of several of my patients. Moreover, this course was fun because it was structured a little different. We were able to blog homework assignments. I definitely recommend this course structure for future cohorts. Lastly, I enjoyed working on the voice thread project with my group. First time I used this format to present and I really enjoyed it and find it fun to learn this way!

Final Blog!

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Wow I can’t believe it’s the last blog post! This class has been a great learning experience. Lecture and clinical have really helped me grow in my nursing skills and critical thinking. Learning this final piece of the puzzle (critical care) has reiterated concepts that we have been learning through this whole program and solidified them. One example of a concept that I have finally understood is ABGs. In patho especially, it was hard for me to distinguish respiratory verses metabolic acidosis/alkalosis. In saying that, it surprises me, knowing how well I understand it all now. I also really enjoyed learning the different types of dysrhythmias and their treatment. ACLS is a really important class to take to reinforce the concepts of heart rhythms and how to treat a patient in a critical situation. My passion for cardiac disorders and treatment has also grown this semester. I hope to start off working on a telemetry unit and continue to learn about the heart while I grow as a nurse. I am so thankful for this program, the faculty, and the students. I truly feel blessed to have gone through this program with everyone and for everything that I experienced and learned!

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Finishing Strong

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This semester learning about critical care has been my favorite semester throughout all of nursing school! It has definitely begun to feel like everything is clicking into place in regards to truly applying all of our knowledge. I have never felt more excited to go into clinical rotations than I have this semester, knowing that I will be learning so much in the short amount of hours available in clinical. My confidence in my clinical skills has skyrocketed, my assessments have improved, and my ability to piece together the whole picture with each patient has exponentially grown. My passion for critical care has shown itself as well, and I know that one day I would love to be able to call myself a critical care nurse. The potential knowledge, wisdom, autonomy, and critical thinking skills gained are incomparable. This rotation has overall strengthened not only my nursing skills but my goals as well. My goal includes becoming a nurse on the intensive care unit, whether that happens as a new graduate or later on in my career. That being said, I honestly cannot believe that three years of nursing school have come and gone. We have all grown so much since we started and will all in turn grow to be amazing nurses when beginning our careers! I cannot wait to see how it all turns out for us, even just a  year or two from now (at the reunion we will be having…right?)

Day 1 – E.R.

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BP: 100/58
HR: 120
O2: 78%
Temp: 102.4
Resp: 9

WBC: 18.0
Bands: 14%
HgB: 14
HCT: 50%
PLT: 350
Glucose: 250 mg/dL
BUN: 20 mg/dL
Cr: 2.4 mg/dL

pH: 7.30
PaCO2: 68 mmHg
PaO2: 45 mmHg
HCO3: 26 mEq/L

Sputum and blood sample positive with S. pneumoniae

 

JA is a 68 yo male pt who came into the ED via ambulance this morning. JA was found to be SOB and difficult to arouse by his wife prior to coming to the ED. His wife reported JA has been complaining of fatigue, chest pain, SOB and fevers for the last 2 weeks. VS are as follows: BP: 100/58; HR: 120; RR: 9; O2: 78%; T: 102.4. Pt is difficult to arouse; responds to painful stimuli. Pt is sinus tachy on the monitor with HR in the 120s. S1S2 is present. Cap refill is 3 seconds. Skin is tenting. Upon auscultation, crackles are present in the upper lung lobes and the right lower lobe. Lung sounds in the left lower lobe are diminished. Respirations are labored and nasal flaring is present. RR is 9-10 with sats at 78% on RA. Pt put on 2L nasal cannula, which increased the pt’s sats to 85-87%. Venturi mask 4L applied; the pt’s sats increased to 89-90%. Pt has a productive cough with thick, yellow sputum. Chest x-ray taken. Abdomen is soft and non-tender. Bowel sounds are hypoactive. Wife reports that pt’s last BM was 2 days ago. Pt’s wife reports he is continent of urine and voided last night before bed. Pt’s skin is intact, warm and dry. Awaiting lab results and chest x-ray results.

Day 1 – ICU

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Patient transferred from E.D. at 1200. Pt’s diagnosis is pneumonia/sepsis and acute respiratory failure. Zosyn IV has been initiated in the ED. Pt’s VS are as follows: BP: 107/61; HR: 105; RR: 13; O2: 90%; T: 102.0. Patient is intubated with vent settings on A/C: Peep: 5; VTE: 500; I/E: 1.2; and FiO2: 1.0. The pt is sedated with midazolam 3 mg/hr. The pt is sinus tach on the monitor with a HR in the 120s. S1S2 is present. Pulses are weak in all extremities. Skin is hot and dry to the touch. Cap refill is 3 seconds. Crackles are present in the upper lung fields and right lower lobe. Lung sounds are diminished in the left lower lobe. Bowel sounds are present in all four quadrants and the abdomen is soft and non-tender. The pt has a Foley with 50 mL of dark urine draining to gravity. Skin is intact. The pt has an arterial line in his left arm. Site is clean, dry, and intact. Pt has a triple lumen PICC line present on his right upper arm that is patent. The site is clean, dry, and intact.

Day 3 – ICU

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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.

Day 5 – ICU

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BP: 88/44
HR: 102
Temp: 103
O2: 90%

WBC: 18.0
Bands: 16%
HgB: 13
HCT: 42%
PLT: 350
Glucose: 230 mg/dL
BUN: 24 mg/dL
Cr: 2.3 mg/dL

pH: 7.24
PaCO2: 68 mmHg
PaO2: 44 mmHg
HCO3: 20 mEq/L

ET tube 22cm at the lip
A/C ventilator setting
RR: 10
Peep: 5
VTE: 500
I/E: 1:2
FiO2: 1.0

At 1500, levophed 10 mcg/min IV was initiated due to pt’s declining BP. Throughout the day, pt’s levophed dosage increased to 81.8 mcg/min IV based on sepsis rate (0.01-3mcg/kg/min). Pt’s current VS on levophed 81.8 mcg/min IV: BP: 88/44; HR: 102; RR: 10; O2: 90%; T: 103. Pt’s physician notified about pt’s condition, labs, and VS.

 

This is only the Beginning…

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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.