Friday, April 30, 2010

End of week update

The last week has been finishing up labs, workshops and several assessments. My whole group did a really great job on our oral presentation which was worth 15 % for Clinical Assessment & Decisions. Go team! Also finished the drug brochure assignment for Medications. I ended up doing the editing and art decorating for the brochure and the others did the research. I also did research but just for my own knowledge to make sure it was accurate and made sense.

In labs this week we did Cardiovascular Assessment, more IV drug stuff, Wound drainage bags and more injection practice.

I still have a couple of bits of homework to do and next week I have two pre-placement clinical lab sessions at uni, and I'm also working working a couple of days. Besides that, I plan to read up on as many clinical skills as possible.

Wednesday, April 21, 2010

Nursing expo show bag haulage

Last night while watching the finale of So You Think You Can Dance I sorted through the showbags I collected at the nursing expo. I sorted stuff in 4 piles: graduate career info to read later, magazines and articles to read at my pleasure, rubbish (into the recycling of course) and free stuff. I counted 15 pens, 10 highlighters, 1 USB and 2 lipbalms! as well as a few other random things.

Press Button - Receive Pain Relief


One of the things I did for homework this week was read up on Patient Controlled Analgesia (PCA) devices, as used by our patient in our subject patient enquiry. I'm going to share this research with the rest of my group today. It 's also one of the nursing skills we've been introduced to in labs recently. This info gives a good run down of the basic aspects of this system: principles and advantages, how they work, features of the device, patient education, monitoring and other nursing duties surrounding using PCAs.
Reference:
Nicol, Bavin, Bedford-Turner, Cronin and Rawlings-Anderson [2004]. Essential Nursing Skills 2nd Edition. Mosby.

Patient Controlled Analgesia (PCA)

Principles and Advantages of PCA
Patient-controlled analgesia (PCA) has become a popular method of managing post-operative pain since the early 1990s. However, today its use is not confined to post-operative pain management. It has also been found useful in patients with burns, myocardial infarction, bone marrow transplantation, sickle cell crisis and terminal illnesses.

PCA facilitates active involvement of patients in the management of their pain. Through the use of a syringe driver and a timing device, PCA allows patients to self-administer small doses of an analgesic whenever they feel pain. It has several advantages over intermittent intramuscular or subcutaneous administration of analgesics on a PRN basis, which are:
1. PCA gives the patient a sense of control and there is no questioning of the validity of the pain.
2. It enables analgesia requirement to be individualised to a sufficiently high plasma concentration level and stable plasma concentration levels to be maintained thereafter. This prevents the peaks and troughs associated with intermittent injection.
3. Unlike the conventional system of intermittent injection, the is no delay between the request for analgesia and the provision of pain relief.
4. It saves nurses’ time.

How PCA devices work
PCA is usually administered intravenously (although epidural and subcutaneous infusions are sometimes used) via a syringe driver and time device. The patient activates the system by pressing a button that releases a small dose of the analgesic into the circulation. There is a lock-out device that prevents further doses being delivered with a specified time interval (usually between 5 and 20 minutes depending on the drug and dosage). The use of the lock-out device reduces the risk of overdose. Morphine is the most common opiate used and a dose of 1mg at 10 minute intervals will usually provide effective pain relief with minimal side effects provided the patient is carefully monitored throughout.

Features of PCA Devices
There is a variety of battery or electrically operated PCA devices available. Most include the following features:
• A facility that prevents the device delivering more than the maximum preset dose of a set period , eg 4 hours.
• Safety features that include alarms for occlusion (blockage), air in the line, low battery or empty syringe.
• A keypad lock and other locking devices that prevent unauthorised access and changes to the programme.
• An electronic microprocessor that allows the flow rate, bolus dose and lock-out interval be set. This will usually record the number of bolus doses and requested and administered, which is important when determining the effectiveness of the PCA.

Patient Education
Patient education regarding the use of PCA is vital and with surgical patients it should occur pre-operatively. The patient should be encouraged to handle the device and press the buttons etc in order to become familiar with the device and using it. It is important that the nurse notes the patient’s understanding and dexterity in handling the equipment because patients who are unable to manage the device may not receive analgesia and suffer as a result. If a patient is unable to use the system, nurse-administered analgesia will be required.

Monitoring the Patient and other Nursing Roles
Regular monitoring is essential for patients with a PCA. This includes:
1. Close monitoring of respiration rate, particularly immediately after commencement, as respiratory depression is the main side effect of opiate analgesia. Local hospital protocol should be consulted regarding the action to be taken if respirations fall below a certain level. A respiratory rate of between 8 and 10 respirations a minute usually requires intervention from the pain control nurse, the anaesthetist or doctor. Some protocols stipulate that patients should have oxygen administered while the PCA is in progress. Oxygen saturation levels should be recorded with the respiratory rate.
2. The patient’s blood pressure, pulse and sedation level should be monitored and recorded.
3. Pain should be assessed using a pain assessment tool/scale to ensure effective pain relief is being achieved.
4. The incidence and severity of any nausea and vomiting should be recorded.
5. Where possible, patients’ usage (ie how often they press the button) should be monitored to determine whether the pain control is effective.
6. The prescribed settings for the PCA system should be checked regularly to ensure proper functioning.
7. All of the above should be monitored at least hourly in the early stages.
8. The nurse should also monitor the infusion site for signs of inflammation, redness or tissue damage.
9. As with all controlled drugs, the nurse should prepare, administer and document the infusion in accordance with government policy.
10. The nurse should ensure no other opiates are administered whilst the patient is receiving PCA.

Mid-week update

Because of my busy weekend and having so many assignments to work on this week I have been too tired to update my blog for a few days.

Monday
• Subcutaneous and Intramuscular Injections - read up on this and then practised in lab. We injected into a piece of foam that has different layers for epidermis, subcutaneous layer (fat) and muscle which the 'patient' holds against their own body part. The injecting was the easy part, the difficult bit was setting up the needle, drawing up the medication and so on and keeping it all sterile.
• Edited and did layout for drug brochure group assignment

Tuesday
• Clinical Assessment Workshop at uni
• Went shopping at Target and bought two pairs of black pants, black shoes and socks to wear on clinical placement. All on special and so cheap, I love Target!
• Worked on Clinical Assessment Group Assignment which was putting together a nursing care plan for nutrition and hydration. Because I was working on this I missed most of the last episode of Blood & Guts. The bit that I saw was about the pioneers of anatomical research. They disected a dead body which was one of the grossest things I've seen so far because the skin was all hard and dehydrated and inside it looked like the flesh was all yellow and rotten. Next week a new series is starting on SBS on Tuesday nights called "Anatomy for Beginners" and each week they'll be disecting a body. I'll definitely be watching that.

Wednesday (today):
• Clinical Assessment Lab: Assessing the Gastro Intestinal System, listening for bowel sounds, palpating the abdomen and so on. Our teacher for this class has done a lot of work in liver transplants so we she gave a very interesting presentation and discussion on that topic as well.
• Acute Care Lab: Male Indwelling Catheterisation, Removing Sutures and Staples (again we used foam pads for this that had the stitches and staples already in them), setting up and using a sterile field.

Nursing Expo


I had a really busy weekend and didn't get any study done. Consequently I've been really tired the last couple of days and trying to catch up. I went to three BBQs in three days - Friday @ Dad's, Saturday @ nursing student friend's 30th birthday, and Sunday @ work friend's housewarming. As well as that I went out to dinner with an old classmate from Singapore which was heaps of fun despite having not seen or spoken to each other in 16 years, and on Sunday I went to a nursing career expo at Carlton Exhibition Centre. It's too early to be applying for jobs but a friend of mine is finishing studying nursing at TAFE this semester and she invited me along. It was good to see all the different places I'll be able to apply to when I do graduate. It was mainly Victoria but there were quite a few interstate and international stands too, even one for the NT. I heard the person there telling someone "we've got Target, Kmart, Big W . ." LOL. It doesn't look like that many in the photo but I collected at least 15 showbags full of info, pens, post it notes, lollies and so on. I'll sort through that stuff at some stage. I have way too many cloth bags already so if anyone is need of some let me know.

Friday, April 16, 2010

End of week update



This is my uniform that I'll wear on my hospital placement. I bought two tops, hopefully that will be sufficient. I'll probably have to do a mid-week wash. I still need to get a couple of pair of black tailored pants with pockets and some black shoes and socks. I'll go to Target next week for those.

Yesterday I had a long day at uni. First I met up with my Clinical Assessment and Decision group to plan our group project which is a 1200 word nursing care plan and a 15 minute oral presentation. I am going to do the Nutrition and Hydration part of the care plan and for the oral presentation we decided to do a role play which I am going to write, direct and organise props and the other 5 members will play the parts.

Then had a two hour Acute Care workshop which was very boring and I struggled to keep my eyes open. Got my first assessment back which was my oral presentation and report on informed consent. I got 9 out of 10 which I'm satisfied with. That was worth 10% of my mark for the entire subject. After that it was Clinical Assessment Lab and we covered a lot:
• Using an opthalmascope and otoscope to examine inside eyes and ears
• Check blood sugar level
• Examining the neck for injury and swollen lymph nodes
• Doing an ECG (Electrocardiogram)

My blood sugar was the lowest out of everybody's! The normal range is 4 - 8 and everyone was in that range, except me - mine was 3.0. Everyone was like "Kate you have to eat!" I'm sure they all think I'm anorexic now, lol. I guess that's why I was falling asleep in the previous class. I did eat in between classes, I had 3 onigiri (homemade seaweed riceballs with tuna inside) and some dates, but I guess that wasn't enough. I'm definitely someone who needs to eat every 2-3 hours and I am going to make an effort to eat a bigger lunch/breakfast before I head to uni and if I don't have time I'll just buy something to eat when I get there. The range of food on campus is actually really good and not too expensive. The other day I got a really yummy lamb curry for $5.80 and took it home and made my own rice. It was a good size and lasted me two meals. If I bought that from a local Indian takeaway it would cost twice that much.

Tuesday, April 13, 2010

Wednesday 14th

In today's labs we covered:
• Female Indewelling Catheterisation (using a plastic manequin of a female groin area, without any legs or upper body)
• Setting up a Patient Controlled Analgesia Machine (usually for morphine)
• Operating a Gemini Intravenous Pump
• Mental Health Assessment

My homework that I did today was to research foods that won't exacerbate nausea and vomiting, to share with my group tomorrow. This is what I found out:

Nausea with or without vomiting is a common side effect of surgery. Nausea can prevent you from eating enough food and maintaining your nutritional intake and weight.
Dietary strategies to manage nausea include:
• Avoid foods that:
o are fatty/greasy/fried;
o are spicy or hot;
o have strong odours.
• Eat small amounts more frequently and eat slowly.
• Eat before you get hungry, because hunger can make feelings of nausea stronger.
• Avoid eating in a room that is stuffy, too warm, or has cooking odors that might disagree with you.
• Sip cold clear fluids (e.g. cordial, flat gingerale, lemonade, diluted fruit juices, icy poles and jelly). This is particularly important if you are vomiting to prevent dehydration.
• Have foods and drinks at room temperature or cooler; hot foods may add to nausea.
• Rest after meals, because activity may slow digestion. It's best to rest sitting up for about an hour after meals.
• Choose stomach-friendly foods, such as toast, crackers, yoghurt, creamed rice, oatmeal, boiled potatoes, rice, noodles, steamed/baked skinned chicken, canned peaches or other soft, bland fruits and vegetables, carbonated drinks that have gone flat.

Source: http://www.virtualmedicalcentre.com
Article reviewed by:
The DAA WA Oncology Interest Group

Tonight I went to a Le Bop dance class with my friend from work. We've been to this class 3 or 4 times now and it's heaps of fun. It's a type of partner social dancing which originated in France in the 1950s. It is also known as Ceroc.

I haven't quite mastered this move yet because I'm still a beginner.

Tuesday April 13th

Uni:
• Clinical Assessment & Decisions workshop
• Met with Medications group to plan group assignment. We decided to do a drug brochure about Panadeine Forte.

Lectures:

• Gastro-Intestinal Tract Medications
• Inflammatory Bowel Disease
• Assessing Cardiovascular System

Nursing Skills Videos:

• Using a Gemini Automatic Intravenous Infusion Pump
• Establishing and Maintaining a Sterile Field
• Reconstituting Powdered Medication – Rubber Capped Vials (for injection)
• Bathing a Client in Bed

TV:
• Blood & Guts: A History of Surgery - Fixing Faces. This episode was about reconstructive surgery - noses, face transplants, cleft lip and so on. Definitely the most horrific episode so far in this series, especially all the soldiers who suffered burns to their faces in world war 1 & 2. It was really sad.
• Operation Live: A neurosurgeon removed a tumor from a woman's pituitary glad, accessing it through her nose and using an endoscope to look inside. Although the tumor was only small it was causing excessive amounts of growth hormone to be secreted from the gland and consequently she had enlarge feet and hands. This was the last episode in this series.

Monday, April 12, 2010

Back to School

Morning Reading:
• Central Nervous System
• Depression
• Anxiety
• Angina
• Atrial Fibrillation
• Reviewed Circulatory System Anatomy
• Storage of Medicines
• Medication - Oral Routes
• Instillation of Nose, Ear & Eye drops
• Topical application
• Respiratory Route - metered dose inhaler

All of this was to prepare for my afternoon medications workshop and lab. In the lab we practised reading drug charts and performing patient assessment and safe administration of oral drugs, eye drops, transdermal patch and nebuliser.

Saturday, April 10, 2010

Friday, April 9, 2010

Friday 9th

Lecture Half-Marathon:
• Hospital in the Home (24 service for post-op patients)
• Information about Clinical Placement
• Drugs used to treat Central Nervous System Disorders
• Endocrine Medications (Diabetes)

Also did some homework for Medications and Clinical Assessment group work and emailed it to my group members, and went to the Hawthorn library to borrow drug books, anatomy books and medical dictionary.

Tuesday, April 6, 2010

Tuesday April 3rd

Mid Semester Break Lecture Marathon # 1:
• Anatomy, Physiology & Pathophysiology of the Lymphatic System
• Anatomy, Physiology & Pathophysiology of the Immune System
• Care of the Infected Surgical Wound
• Intravenous Antibiotics

Videos:
• Measuring Oxygen Saturation with Pulse Oximetry
• Administering Oxygen via a Nasal Canulae

Tuesday Night SBS Viewing:
• The Operation: Surgery Live – Hiatus Hernia (Keyhole Surgery)
• Blood & Guts: A History of Surgery – Spare Parts (Organ Transplants) - the most interesting part of this was comparing the two patients who received the first and second hand transplants. The first man hated his new hand from the get go. He thought it was ugly and too big and his immune system rejected the hand. He carrying around a dead hand which looked horrific and he felt more handicapped than before he had the transplant, and really depressed. Eventually, about 5 years later, he had the hand removed. The second patient had lost his hand over 30 years earlier. His new hand looked completely different to his other hand, it was fair skinned, only light blonde hairs and it was clearly a female hand. However he totally adopted the hand as his own, it healed beautifully and he did all the physiotherapy enthusiastically and gained 80% of the functions that he had in his other hand. He started doing all the things he couldn't do before like pick up his grandchildren, learn carpentry, played tennis and musical instruments. It was a good example of how important patient compliance and positive psychology are so important for successful outcomes, no matter how good the surgeons are.

Thursday, April 1, 2010

Thursday April 1st

Yay! Finished for the week. Now I'm going to enjoy a three day weekend and have a complete break from studying. Next week is mid-semester break. I plan do some catch up study and homework on Monday and Tuesday and then I'm working on Wednesday.

I got great feedback on my Post Op wound care patient teaching plan, both positive and constructive but nothing bad. The teacher made a booklet for each of us which had copies of everyone's care plans with the teacher's comments. This allows us to read each other's research (we all had a different topic) to share knowledge but it also allows you to see the standard of other student's work, how they organise it and so on. I think that's useful.

Today I handed in my first assessment (about informed consent) and gave an oral presentation about it in class which seemed to go down well. Because of the two things I had to hand in this week, I haven't exercised this week (since Sunday) because I've been doing the homework in the evening, and by the time I'm done it's too late for the gym and time for dinner. Next week I'll be more active in my week off.

In labs this week I learned:
• Administration of 0xygen
• Inserting a Nasogastric tube for feeding or suctioning the stomach
• Musculoskeletal Assessment
• Integumentary Assessment (Hair, Skin & Nails)
• Respiratory Assessment

This weekend, Manny and I are going down to Dromana for Easter. I'm looking forward to some really hearty food.