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WIAW- A Day At Clinical

Posted Mar 27 2013 5:48am

Good Morning everyone, time to rise and shine!

*Added after last night- It’s currently around 5:45 am and I’m doing some last minute editing to this post and then hitting the publish button. But let me tell ya I am struggling this morning with this whole waking up early crapola now that break is over. It’s my own fault really, waking up 10:30/11ish almost every day last week definitely threw off my sleeping/waking schedule. I continue to be amazed about how so many of you readily wake up at the bum-crack of dawn without even an alarm clock! Impressive stuff my friends. I feel as though my eye balls are bleeding when that alarm blares at me for class. Sheese I need to stop my b*tchin.

But let’s get to the good stuff here, perhaps the reason you popped on over to my tiny corner of the blog world today, What I Ate Wednesday! You know what I am going to say next, thanks and appreciations go to Jenn at Peas and Crayons who continues this even each week. Thanks madam :)

wiawphotobutton A few weeks ago when I had the giveaway for my 2-year blogging anniversary, part of a way to enter to win was responding to my question of topics that you would like to see on the site. So many of you suggested tons of great stuff and a topic I found mentioned a few times was Nursing School! So obviously I talk about all of the negative aspects of school, how much it’s throwing me for a loop, stressing me out, blah blah blah. But I have yet to explain more about the GOOD stuff I do, the material that I am learning and then applying in the hospital setting during clinicals.

Therefore for this particular WIAW, I am doing a day in the life of me as a nursing student during my last day in the pediatric rotation! Since I am there for about 8.5 hours, food is most definitely consumed throughout the day.

5:45- wake up call! I actually shoot out of bed right when my alarm goes off on clinical days because I have a terrible fear of somehow sleeping through my alarm, shutting it off and then accidentally falling asleep…. Ahhh just no no no, so catapulting from my deep slumber is a regular occurrence. I quickly get dressed at this point, thrown on some mascara and concealer so I don’t frighten anyone, grab my already packed stuff for the day and make my way to the hospital.

Dressed in my super cool required outfit! Actually I think it’s a boot doofy looking ha, but I do feel official in it :)

IMG_9209-e1349485059614-277x550 Picture from earlier last semester… the summer glow still lingers!

6:20- arrive at hospital parking lot. This is my time to sit down and relax for a few minutes before getting in the shuttle bus that takes up to the main entrance of the hospital (parking is real weird there…basically there isn’t any). I have to be inside and waiting to get the day going before 7, so I usually meander on it at 6:50. But before this all happens, breakfast time!

I enjoyed a banana breakfast cake baked the day before but didn’t take a picture of me eating it that morning because it came out of the oven like this…

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Apparently I didn’t put a good smear of oil in, something I usually do (mm coconut oil tastes real good when used for non-sticking). So anyway, this breakfast cake was delicious but was a crumbly mess by the time I ate it… no need to show you me struggling to get the cake into my mouth while awkwardly sitting in the car. Use your imagination for such an image ;)

Banana Bread Breakfast Cake (for 1)

Ingredients:

  • 1 egg
  • 1 medium-large ripe banana
  • 3 T flour (use any kind you wish, I went with good old all-purpose, it’s all I had)
  • 1/4 tsp of baking powder
  • cinnamon
  • sweetener of choice… 1 splenda packet for me
  • 2-3 T of walnuts (or more) or any other additions you want- different kind of nuts, chocolate chips, etc.

Directions:

First make sure to mash the banana leaving as few chunks as possible, and them mix in the rest of the ingredients, stirring well to combine. Pour the mixture into an well-oiled (I learned this the hard way when you don’t) and bake at 350 degrees for 22-25 minutes.

7:00- Arrived inside the hospital in the pediatrics unit, items put away, prepared paperwork ready to be presented, and it’s time for pre-conference. This is a time when my instructor meets with me and the 4 other students that are part of this particular group, in order to chat about the various patients we will be taking care of that day. The night before the clinical, we have to go to the hospital in order to pick up or patient assignment for the next day… so you have that evening to be prepared to present their diagnosis to everyone, growth and development of that age group and any other pertinent information.

You are being graded on your level of preparation so you had better know your stuff!

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Once the meeting has finished, 30-45 minutes later, it’s time for all of us to take morning assessments and vital signs on our individual patients. These include:

  • Temperature
  • Blood pressure
  • Oxygen stats- we like at least above 96%, especially with children
  • Respiratory rate- the range varies depending on how old the child is
  • Heart, lung and bowel sounds- listening for anything unusual such as absent bowel sounds (no good), wheezing when breathing, or a heart murmur of any sort, skipping beats, etc.
  • Assess the child’s IV if they have one, making sure there is no swelling at the insertion sight, the fluid is running at the right rate, that there is still fluid/meds in the bag, how much has infused and if there are blocks of any kind in the line.

Those are the basic ones, although if a patient has some kind of situation that requires more checks, including a wound of some kind, any breathing mechanisms, post-surgery care… then those will be attended to at this time as well. If a child has a routine medication while in the hospital, this will be assigned for 8am, at which time the nurse will administer them… though of course in this case, we get to do this! With the professor present :)

On this day, my patient had a pretty serious condition that did require several daily medications, so I was involved in this process for a long time. Under the scrutiny and watchful eye of the professor/clinical instructor, I looked up each med that I had (hopefully) previous researched, explained a bit about it, then went through the electronic system to obtain each one. Calculations then must occur in order to make sure the dosages written by the doctor are correct… this part if always SO stressful for me… it’s already been established that I suck at math. Plus with the professor putting me on the spot, well let’s just say I am quite shaky but get through it!

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9:00-10:00- Once the morning assessments are all completed (following introducing yourself, talking with the family, asking if they need anything), then next task is recording what you observed, and noting anything of great importance. These are noted on the patient’s individuals progress notes, also we jot down their total input and output thus far for the shift, vitals, and results of diagnostic tests the child might have received from the previous day.

10:30- Some downtown between note-taking, 10:30 rolls around and coffee break time. A time where me and my fellow students take 20 minutes to go to the caf, brab a snack, coffee, whatever. To save some money, I brought a protein bar with me, but did feel the strong “need” to suck down an ice coffee. Like a weirdo trying to be discreet about taking pictures of food, I snapped one here at the table REAL FAST before the rest of the group sat down.

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Let’s get real about this Quest Bar flavor, the Chocolate Chip Cookie Dough. Oh.my.word. my new favorite for sure! It honest to goodness tastes like cookie dough and that is not coming from a place of deprivation, where I previously had a very sorry view of what a legit sugary, buttery cookie tasted like. I ordered a 12 bars in this flavor and am averaging 2 per day… yeah, time for some more.

11:00-12:15- Return from break and check in with patient. Talk to them, interact, play if appropriate as these are little kids, well most of them, and while yes they are sick, they do like to have fun too! If they are well enough to get out of bed, we can join them in the cool play room available or provide them with coloring books, activities such as playing cards, various toys, painting and so on. Around noon we take vital signs (the same as before) once again in order to make sure they are continuing to progress toward health. Oh and I forgot to mention, checking the IV is something we do at least every hour, so this will occur for the 4 or 5th time at noon.

On this particular day, all of our patients were under the age of 5, except mine who I will be talking about in a hot second. Because of this, she wanted privacy with her mom and I helped one of the other students with changing a child and bed who had gotten sick on himself, poor guy!

12:15-1:00- lunch time! I have no complaints about the food at this hospital, it’s fresh and fairly cheap, plus there is a ton of variety, from healthy to artery-clogging (ironically enough). For my time there I went with either soup + 1/2 sandwich, salad from the extensive salad bar, a full sandwich with chips… some kind of combination of those listed. That day I was feeling the salad bar and piled on anything that caught my eye.

photo(3)

Meal picture taken quickly again before everyone sat down (I am speedy getting my food apparently), and dug right into this concoction as I was starvin’ marvin by this time! In the salad- spinach, mixed greens, grilled chicken, whole egg + egg whites, I think there was some tuna in there, cucumbers, tomatoes, almond slices and olive oil for a dressing. I also enjoyed a pear with a handful of walnuts I had tucked in my pocket, but didn’t get the chance to document this, sorray!

1:00-2:30- Once again we check on our patients, give medications if applicable, interact, and also help out the other nurses there whenever we can… such as with restocking supplies in rooms, aiding in care for those other than your patients, putting together charts/various paperwork.. basically act and look busy. The professor is always watching…. If it’s slow that day, or your patient is all set, then we can start our paperwork that is due for the next week- a completed data collection sheet, a nursing care plan (talk more about this later), Growth and Development for the specific age of your patient, and a weekly evaluation of our performance.

Deluxe Trail Mix Handful of trail mix before the day wrapped up

2:30-3:15- the next group arrives, the evening clinical group and during this time we hand off our patients to our fellow students and brief them on how the day went. This post-conference is also the time to discuss any questions we have, mistakes we might have made, what we could have done better, what we did well, and overall how we felt about the day.

3:15 comes around and we get the heck out of there! I am always EXHAUSTED when the day ends.. makes sense with all of the standing/walking around, but also the mental pressure makes me tired as well. I am on constant alert during clinicals, so very afraid of messing up in some way, making a major mistake, disappointing my professor or looking like an incompetent dumb-dumb in front of her… I’m pretty sure that by the time we are unleashed, my blood pressure is at a rather high place. Eventually I calm down though, uhh 2 hours or so after haha.

When I arrived home that day, I was once again feeling those oh-so-lovely hunger pang and went with an assortment of items that ended up meeting all the important food groups. Totes did not mean to do this, but mmm a choice snack plate if I do say so myself. Rolled up turkey with 1/2 an avocado (+ salt, necessary with an avocado) and pretzel twists for a delightful, even saltier crunch. Can’t say that amount of sodium helped my blood pressure in anyway at all. Ahh well.

photo(4)

I thought it might be interesting for you to hear a bit about some of the diagnosis we treated, so allow me to take a few lines to discuss my patient on that last day. ** I am of course not revealing any private information AT ALL, just making that clear. This young teen was admitted the day before with an admitting diagnosis of a Sickle-Cell Crisis, secondary to a primary diagnosis of Sickle Cell Anemia, diagnosed with this when she was 4-years old.

This is what I wrote down for my Data Collection Sheet:

Sickle Cell Anemia is a disease that is passed down through families in which red blood cells form an abnormal sickle or crescent shape. This decreases the cell’s flexibility and results in a number of complications. When the red blood cells are shaped in such a way, they are very fragile, deliver less oxygen to the body’s tissues, and tend to clump and get stuck in the small blood vessels, interrupting healthy blood flow. In children, a major concern is called Acute Chest Syndrome, which is associated with fever, chest pain, difficult breathing and pulmonary infiltration (fluid/foreign substances in the lungs) can be seen with an x-ray. If this crisis is not treated readily, it could progress leading to increasing work of breathing and eventual death due to lack of oxygen.

230px-Sickle_cell_01

When a child with Sickle Cell is in such a crisis, fluids are essential to help them recover, along with plenty of rest, and medicines are used to alleviate an illness that might be associated (i.e. a respiratory infection). Basically the child comes to the hospital in such a condition because both the parents and patient are terrified of the potential such a crisis could escalate to.

Yay for learning about new diseases!

After consuming that snack, I did eventually move my butt to the gym where I completed a simple, yet effective upper body/core strength workout followed up with easy cardio on the elliptical. An enjoyable time for me, as that is when I get my reading on from a pleasure book of choice.

Hefty, voluminous bowl of oatmeal was my dinner of choice that night… mixed with a sliced banana, 1 egg + 2 egg whites, vanilla soy milk, flax seed, blueberries and nut butter later on… I like to enjoy it with those last few bites :)

IMG_9437

Various other snacks were consumed later on, honestly I can’t remember it all, nothing special. I am a major picker/snacker after dinner which I continue to be weary of (and debate if it helps or not), but whatever, I am doing what works and what I believe both my mind and body want.

There you have it, my usual clinical days in pediatrics! I am officially done with that though, and it’s time for MATERNITY (which I think I already mentioned in another post?) Anyway, psyched to see some real live births, C-sections, other surgeries, postpartum care, taking care of newborns… ahh I can’t wait and I will of course talk about my experience there when things get going.

-If you were to pursue some kind of medical career (or already have one!), do you think you would prefer to work with children or adults? While I truly love to be with kids, it can be plain sad at times, and also the parents… well they are a whole different scenario to consider!

-What are your favorite quick, on-the-go breakfasts? Oh and filling too! It’s hard to eat before the coffee break but I am haaaangry by that time, so I am hoping to think of another option that holds me over a tad longer.

-Have you ever heard of Sickle Cell Anemia or know anything about it? Before researching this patient, I only knew that it was common in parts of Africa and that it gave immunity against Malaria.. I didn’t realize how common it is in the U.S.

-Have you tried the cookie dough Quest Bar flavor or perhaps discovered a new product that’s worth mentioning?

-Please tell me what is the best thing you ate/cooked/baked/ordered in the last week!

Phewww this post took me so so much longer than I anticipated, though I liked talking about all of this and sharing my experiences! I’m thinking more posts like these will make an appearance. Have a great rest of your Wednesday :)

 

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