Clinicals

I should be making up medication cards instead of writing this, but that's the way that procrastination goes when I don't have the energy to bake something.

I've now done a whopping 5 clinical days in two locations. My clinical group consists of 8 students and 1 instructor. The way it works is we invade a unit of some kind, get an assigned patient (only one) to take care of for the day/week/whatever, and then are let loose on the floor. Kinda scary, huh? We work W,Th,F from 7-3 every week with a post-conference from 3-4. We do some shadowing of the RN's, and we follow instructions when given, but mostly we're left to manage whatever parts of our patients' care we can (either limited by legality or our learned skills) completely independently. That includes bathing, oral care, feeding, dressing, changing, repositioning, dressing changes, range of motion exercises, and whatever special sorts of things they may need. Like emptying ileostomy bags. As we learn more skills in class and lab, we get to practice them on our patients. For example, I'll be giving heparin and insulin injections for the first time tomorrow.

So, my first unit was in a long term care facility. Also called a nursing home, but that's less PC nowadays. My patient was the only one that was lucid enough to hold a conversation, but needed plenty of care because a stroke had paralyzed half her body. So I did whatever I needed to do for her, and let her husband do whatever he could, and then spent the rest of the day just sitting around. The pace in that kind of facility is not particularly fast, so there was never really a lot to do. I spent most of my time bathing and changing people. I also got my first real exposure to tracheostomy tubes. They tend to fill with phlegm almost constantly, not something that is usually seen on TV. The other thing that I got to use a lot was the Hoyer lift (A less swanky version of this. The soundtrack to that video just makes me laugh). Hoyer's are fabulous for patients that can't get up on their own for whatever reason and are too heavy to be lifted easily or safely.

My second clinical unit is a lot more exciting. We're on the ENT (ear, nose, throat) floor, which also happens to serve as a regular medical floor too. There are a lot more staff, the patients are a lot sicker, and everything moves quite quickly. I was running around most of the day today without any real downtime until about 2pm. I was mostly taking care of my patient, but did a lot of assisting with other stuff too. My patient is nonverbal and mostly immobile, but alert and aware of his surroundings. He had a trach for a while, but it was removed. He's the one with the ileostomy, and he also has a feeding tube and gets nothing by mouth. His medical diagnoses are numerous and complicated, but the prognosis is not great. He'll probably survive a long time, but is unlikely to regain mobility or speech. The only reason he's still in the hospital is that they haven't been able to find him a placement in a nursing home yet. It's a very sad situation.

I've only got two more weeks before the end of my first semester of nursing school. Wow, this is going by fast.