I got my first choice of grad years! I am so happy and feel like all the hard work and time I put in these past two years has paid off. What a great way to finish the uni semester! I still have to pass all my subjects and get registered but I'm sure that will not be a problem.
My grad year will start on January 30 so until then I'm going to be doing some teaching, some aged care nursing home work, and have a bit of a holiday until then.
Handed in two more assessments and had my last day of clinical placement yesterday. Also got my mark back for the oral presentation - 12.5/15!! wow, was not expecting that.
I also got my clinical appraisal back from my nurse buddy who had to rate me in about 40 different aspects of nursing, and he rated me "independent" for EVERYTHING!! That means I'll get a perfect mark of 50/50 for the placement which is actually graded this semester, not just pass or fail, and is worth 50%. My final piece of assessment is for other 50% of that subject and is my portfolio. I have to proofread and edit what I've already done and also write up a 700 word management plan for the symptom of uncontrolled nausea. I've done the research for it and will do it when i get back from my holiday. It's not due for about another 10 days after I get back, so no stress there.
So good to have all this off my shoulders, finish a week and a half early and now going on a mini-break to europe to visit my brother and be a bridesmaid for one of my best friends! wooohoooooooo!
Tuesday, October 18, 2011
Sunday, October 16, 2011
This blog will be ending very soon
Sorry I have been so slack updating my blog . . . I don't have long to go now. I feel like I'm about 98% finished.
Tuesday is the last day of clinical placement.
Tomorrow I find out where I'm going to be working next year.
I have finished all my assignment but one, which I'll do when I get back from a one week holiday in Europe (for a friend's wedding) that I'm about to embark on this week.
The assessments I've done recently:
Got my Managing Chronic Conditions Essay about schizophrenia back and the mark was 40/50 which I am very pleased with. Recently finished the final piece of assessment for that subject which was an education pamphlet about the non-pharmacological aspects of managing schizophrenia in the community. I'm expecting to get quite a good mark in this subject, either an A or B.
For my communication subject, in the last two weeks I have done all three assessments. First was my oral presentation which was about male/female cultural socialisation and how that affects professional communication in nursing. I overprepared and planned to talk about biological differences in the communication styles (a la Men are from Mars, Women are from Venus), religion (eg Muslim and orthodox Jewish), professional boundaries, appropriate use of touch, disclosure of self, talking about sexuality with your patient and a few other topics . . but as the presentation was only 5 minutes I ran out of time quickly. I also have a tendancy to ad lib which doesn't help, but although I was disappointed in myself my teacher gave me good feedback and said she thought I seemed confident and that my presentation was really interesting. It was worth 15%
My second assessment for that subject was an online multiple choice exam of worth 30%. I did all the reading preparation and was pretty happy with it, although I didn't get to find out my score straight away. The third thing was an essay I just completed about a challenging communication encounter I've had on placement, 2500 words and worth 55%. I've just finished it, and will hand that in today. It was about a patient and the patient's full time carer who both had mental illness and drug addiction issues and were quite demanding with staff, especially about what drugs they wanted the patient to get (opioids and benzodiazepines - basically morphine and valium). The medical team restricted them and that made the patient and carer really angry. The essay isn't due for another week but I've been trying to get it done so I can hand it in before I go on my trip. So that's two subject now completed.
My final subject is my Clinial Practice Consolidation subject and the assessment is made up of how I perform on placmenent and a 4000 word folio of about ten different topics. That is 80% completed and not due for another 10 days after I get back so I'm going to finish that off then. As for my placement I think I've done well. I've had a really great buddy who is very experienced and has worked in several different countries. He's given me good feedback and taught me a lot, and there haven't been any issues. He's very cool, calm and collected, knowledgable, loved by the patients and lightning fast so it's been great to learn alongside someone like that.
One of the major things I experienced on this placement happened just last week. One of my patients died. He was palliative, so not for resuscitation and it was only a matter of time, but it was still a shock because I was the one who walked into the room and found him dead. He was an old man and had kidney failure, heart failure and a bad diarrhoea infection, but he kept in good spirits right to the end. I had been doing his care for the previous two hours and had just left the room to prepare everything to give him a wash. I told him I'd be back in 5 - 10 minutes and he cheerily said "ok". Then when I walked back in I saw he had vomited something on himself and he was very pale, and I couldn't get any response from him. I knew then that he was dead and went to find my buddy and the nurse in charge. I was upset about it for a little while and took a break to collect myself and have a cup of tea and talk to my colleague. Then when I went back I had to talk to the family and after that clean up the body and prepare it for the morgue, put in a plastic body bag and so on. Tough day.
I'll update this blog a couple more times as I finish up everything and find out my results but then it will come to an end. I've already sent off my nursing registration application and very soon, in a couple of months, I will be a registered practicing full-time nurse!
Tuesday is the last day of clinical placement.
Tomorrow I find out where I'm going to be working next year.
I have finished all my assignment but one, which I'll do when I get back from a one week holiday in Europe (for a friend's wedding) that I'm about to embark on this week.
The assessments I've done recently:
Got my Managing Chronic Conditions Essay about schizophrenia back and the mark was 40/50 which I am very pleased with. Recently finished the final piece of assessment for that subject which was an education pamphlet about the non-pharmacological aspects of managing schizophrenia in the community. I'm expecting to get quite a good mark in this subject, either an A or B.
For my communication subject, in the last two weeks I have done all three assessments. First was my oral presentation which was about male/female cultural socialisation and how that affects professional communication in nursing. I overprepared and planned to talk about biological differences in the communication styles (a la Men are from Mars, Women are from Venus), religion (eg Muslim and orthodox Jewish), professional boundaries, appropriate use of touch, disclosure of self, talking about sexuality with your patient and a few other topics . . but as the presentation was only 5 minutes I ran out of time quickly. I also have a tendancy to ad lib which doesn't help, but although I was disappointed in myself my teacher gave me good feedback and said she thought I seemed confident and that my presentation was really interesting. It was worth 15%
My second assessment for that subject was an online multiple choice exam of worth 30%. I did all the reading preparation and was pretty happy with it, although I didn't get to find out my score straight away. The third thing was an essay I just completed about a challenging communication encounter I've had on placement, 2500 words and worth 55%. I've just finished it, and will hand that in today. It was about a patient and the patient's full time carer who both had mental illness and drug addiction issues and were quite demanding with staff, especially about what drugs they wanted the patient to get (opioids and benzodiazepines - basically morphine and valium). The medical team restricted them and that made the patient and carer really angry. The essay isn't due for another week but I've been trying to get it done so I can hand it in before I go on my trip. So that's two subject now completed.
My final subject is my Clinial Practice Consolidation subject and the assessment is made up of how I perform on placmenent and a 4000 word folio of about ten different topics. That is 80% completed and not due for another 10 days after I get back so I'm going to finish that off then. As for my placement I think I've done well. I've had a really great buddy who is very experienced and has worked in several different countries. He's given me good feedback and taught me a lot, and there haven't been any issues. He's very cool, calm and collected, knowledgable, loved by the patients and lightning fast so it's been great to learn alongside someone like that.
One of the major things I experienced on this placement happened just last week. One of my patients died. He was palliative, so not for resuscitation and it was only a matter of time, but it was still a shock because I was the one who walked into the room and found him dead. He was an old man and had kidney failure, heart failure and a bad diarrhoea infection, but he kept in good spirits right to the end. I had been doing his care for the previous two hours and had just left the room to prepare everything to give him a wash. I told him I'd be back in 5 - 10 minutes and he cheerily said "ok". Then when I walked back in I saw he had vomited something on himself and he was very pale, and I couldn't get any response from him. I knew then that he was dead and went to find my buddy and the nurse in charge. I was upset about it for a little while and took a break to collect myself and have a cup of tea and talk to my colleague. Then when I went back I had to talk to the family and after that clean up the body and prepare it for the morgue, put in a plastic body bag and so on. Tough day.
I'll update this blog a couple more times as I finish up everything and find out my results but then it will come to an end. I've already sent off my nursing registration application and very soon, in a couple of months, I will be a registered practicing full-time nurse!
Friday, August 26, 2011
First assessment out of the way - only 8 to go
This week as well as being on clinical for 5 days straight, which made me very tired indeed by the end of the week, I've been focused on preparing for my first assessment task for the semester, an online multiple choice quiz made up of 30 questions based on a set of journal articles that we were given. It's worth 10% of the total mark for the Managing Chronic Conditions subject. Some of the readings I mentioned in my previous post, and these were the rest of them:
• The emotional context of self-management in chronic illness: A qualitative study of the role of health professional support in the self-management of type 2 diabetes
• Evaluation of a primary care nurse case management intervention for chronically ill community dwelling older people
• The patient’s vulnerability, dependence and exposed situation in the discharge process: experiences of district nurses, geriatric nurses and social workers
• Prioritizing Illness: Lessons in Self-Management Multiple Chronic Diseases
• From the sidelines: Coaching as a nurse practitioner strategy for improving health outcomes
• Motivational interviewing-based health coaching as a chronic care interventions
• Nurse Coach: Healthcare Resource for this millenium
• Patient empowerment: reflections on the challenge of fostering the adoption of a new paradigm
• What skills do primary health care professionals need to provide effective self-management support? Seeking consumer perspectives
• Chronic illness self-management: taking action to create order
• Nursing Science and Chronic Illness: Articulating suffering and possibility in family life
• Youth Health - sex, drugs and chronic illness: health behaviours among chronically ill youth
I didn't actually read every word of all the articles because I ran out of time. I read about half of them trying to understand the main gist of them. But the some of the questions in the quiz were quite detailed so for those ones I had to go back and find the answer. Some questions could just be answered by common sense and elimination. Anyway, I just completed the quiz and got 9.67 which means I got 29/30 right! Woo hoo!
One down, eight to go.
Other things I've got done this week:
Lectures
• Communicating around dying and grief
• Advance care planning
Also this week, I attended a 2 hour workshop for Communications in Nursing subject, then met with group to plan our topic and division of work the Managing Chronic Conditions nursing care plan assignment. There are 8 people in the group and we each have to write one nursing diagnoses and interventions. Because there are so many of us we only have to write about 300 words each. We decided to do it on Chronic heart failure, and my nursing diagnosis is activity intolerance.
Next week I need to start and complete a 2000 word essay worth 50%. I've decided to do it on schizophrenia so I can learn more about it in preparation for working as a psychiatric nurse next year. I've already done a bit of research and found some interesting articles. That will be my focus this week along with 3 more grad program interviews. Another very busy week ahead! Need to make sure I get at least 8 hours sleep as many nights as possible.
• The emotional context of self-management in chronic illness: A qualitative study of the role of health professional support in the self-management of type 2 diabetes
• Evaluation of a primary care nurse case management intervention for chronically ill community dwelling older people
• The patient’s vulnerability, dependence and exposed situation in the discharge process: experiences of district nurses, geriatric nurses and social workers
• Prioritizing Illness: Lessons in Self-Management Multiple Chronic Diseases
• From the sidelines: Coaching as a nurse practitioner strategy for improving health outcomes
• Motivational interviewing-based health coaching as a chronic care interventions
• Nurse Coach: Healthcare Resource for this millenium
• Patient empowerment: reflections on the challenge of fostering the adoption of a new paradigm
• What skills do primary health care professionals need to provide effective self-management support? Seeking consumer perspectives
• Chronic illness self-management: taking action to create order
• Nursing Science and Chronic Illness: Articulating suffering and possibility in family life
• Youth Health - sex, drugs and chronic illness: health behaviours among chronically ill youth
I didn't actually read every word of all the articles because I ran out of time. I read about half of them trying to understand the main gist of them. But the some of the questions in the quiz were quite detailed so for those ones I had to go back and find the answer. Some questions could just be answered by common sense and elimination. Anyway, I just completed the quiz and got 9.67 which means I got 29/30 right! Woo hoo!
One down, eight to go.
Other things I've got done this week:
Lectures
• Communicating around dying and grief
• Advance care planning
Also this week, I attended a 2 hour workshop for Communications in Nursing subject, then met with group to plan our topic and division of work the Managing Chronic Conditions nursing care plan assignment. There are 8 people in the group and we each have to write one nursing diagnoses and interventions. Because there are so many of us we only have to write about 300 words each. We decided to do it on Chronic heart failure, and my nursing diagnosis is activity intolerance.
Next week I need to start and complete a 2000 word essay worth 50%. I've decided to do it on schizophrenia so I can learn more about it in preparation for working as a psychiatric nurse next year. I've already done a bit of research and found some interesting articles. That will be my focus this week along with 3 more grad program interviews. Another very busy week ahead! Need to make sure I get at least 8 hours sleep as many nights as possible.
Wednesday, August 17, 2011
Group interview experience
The semester is well under way now. In the next four weeks I have 3 more job interviews (already had one this week), one online exam, one 2000 word essay and one group assignment, as well as 2 or 3 days a week of clinical placement. From Saturday to Wednesday I will have five days in a row of clinical placement and then work at my teaching job on Thursday and Friday, AND do an online exam by Friday. In that time I also have to study the material that the exam will be based on because I've only read about a quarter of it so far. I'm getting stuck into that tonight and will continue over the weekend whenever I get a chance. Hopefully get some of it done while I'm on the ward as I still only have to look after 1-2 patients at this stage in the semester.
So the grad year interview I attended earlier this week was with my current number one choice. It was a group interview and I wasn't sure what to expect with that. There were 6 of us doing the interview together and we had to introduce ourselves, interview each other a bit and handover to the rest of the group and the panel about the other person and go to a table to select cards which represent our strengths and 'things we want to work on' and then explain them to the group. I chose reliability and kindness for strengths, and capability and bravery for things I want to work on. There were a few clinical questions about time management and prioritisation of care of a newly admitted suicidal patient. Then we each were interviewed individually which wasn't too harrowing or very long. I felt good about how the whole thing went and I like the 3 people who conducted the interview. For now I will keep them as my first choice, but I still have 3 to go.
Study done so far this week (not much) . .
Lectures
• Chronic Conditions and Models of care
• Psychological aspects of chronic disease
• Culturally appropriate communication
Reading
• Assertiveness skills
• Conflict resolution
• Clinical Practice guidelines for communicating prognosis and end-of-life issues with adults in the advanced stages of a life-limiting illness, and their caregivers
So the grad year interview I attended earlier this week was with my current number one choice. It was a group interview and I wasn't sure what to expect with that. There were 6 of us doing the interview together and we had to introduce ourselves, interview each other a bit and handover to the rest of the group and the panel about the other person and go to a table to select cards which represent our strengths and 'things we want to work on' and then explain them to the group. I chose reliability and kindness for strengths, and capability and bravery for things I want to work on. There were a few clinical questions about time management and prioritisation of care of a newly admitted suicidal patient. Then we each were interviewed individually which wasn't too harrowing or very long. I felt good about how the whole thing went and I like the 3 people who conducted the interview. For now I will keep them as my first choice, but I still have 3 to go.
Study done so far this week (not much) . .
Lectures
• Chronic Conditions and Models of care
• Psychological aspects of chronic disease
• Culturally appropriate communication
Reading
• Assertiveness skills
• Conflict resolution
• Clinical Practice guidelines for communicating prognosis and end-of-life issues with adults in the advanced stages of a life-limiting illness, and their caregivers
Tuesday, August 9, 2011
Called in sick
I called in sick for my second night duty tonight. I'm not grossly unwell, just feeling rather run down with a sniffle and sore throat so I thought it would be best to stay away from the patients and try to recuperate at home. I slept from 9:30am till 5:30pm today. I heard about research that has shown that even if you are getting sufficient sleep during the day, working nights is not good for you. The body needs to be asleep during the wee hours (2am to 5am) to tap into the universal energy that assists the body to heal and recover. There is a higher incidence of diseases like heart disease, common colds, and depression amongst people who work nights or early morning shifts. Something to be aware of . . .
I've got a good chunk of study done in the last couple of days:
Lectures
• Time Management and prioritisation of care
• Delegation
• Managing Chronic Conditions: Arthritis
Reading
• Awareness of the other
• 'Other’-centred communication
• Non- verbal communication
• Ethical communication
• Assessment of Digestive and Gastrointestinal Function – upper gastrointestinal tract imaging, lower gastrointestinal tract imaging, CT scans, MRI, positron emission tomography, scintigraphy, gastrointestinal motility studies, oesophagogastroduodenoscopy (try pronouncing that one!), proctoscopy, sigmoidoscopy, fibreoptic colonoscopy, small bowel endoscopy, endoscopy through ostomy, defaecograpy, gastric analysis, gastric acid stimulation test, pH monitoring, laparoscopy, and psychological considerations.
Tonight I'm going to relax and probably watch a movie, drink lots of fluids and eat some nutritious food then get to bed by about midnight so I can back onto normal rhythm tomorrow. Tomorrow I'm planning to get a half hour massage. Hopefully that will be what I need to be fighting fit once more.
I've got a good chunk of study done in the last couple of days:
Lectures
• Time Management and prioritisation of care
• Delegation
• Managing Chronic Conditions: Arthritis
Reading
• Awareness of the other
• 'Other’-centred communication
• Non- verbal communication
• Ethical communication
• Assessment of Digestive and Gastrointestinal Function – upper gastrointestinal tract imaging, lower gastrointestinal tract imaging, CT scans, MRI, positron emission tomography, scintigraphy, gastrointestinal motility studies, oesophagogastroduodenoscopy (try pronouncing that one!), proctoscopy, sigmoidoscopy, fibreoptic colonoscopy, small bowel endoscopy, endoscopy through ostomy, defaecograpy, gastric analysis, gastric acid stimulation test, pH monitoring, laparoscopy, and psychological considerations.
Tonight I'm going to relax and probably watch a movie, drink lots of fluids and eat some nutritious food then get to bed by about midnight so I can back onto normal rhythm tomorrow. Tomorrow I'm planning to get a half hour massage. Hopefully that will be what I need to be fighting fit once more.
Wednesday, August 3, 2011
Night shift
End of week two . . .
This week I did two night shifts on Monday and Tuesday night. They're pretty long shifts, from 9pm till 7:30am so I needed Wednesday to recover. At this stage in the semester I only have to take one patient, but it will increase gradually up to a full load as the weeks go by. One patient on a night shift is very boring! Because there's not much to do between 10:30pm and 6:00am. However, I made good use of time and got heaps of reading for uni done and got a couple of tasks out of the way for my clinical learning portfolio which will be worth 55%.
This week I also finished my job applications for next year. I've already heard back from two of them for an interview in the next couple of weeks. I've applied to four different psychiatric grad nursing programs. It was so hard to narrow it down to just four places, and also choose whether I wanted to do general medical/surgical or psychiatric, or community. In the end I chose psychiatric because it's what I'm most interested in and enjoy doing, I can increase my qualifications during the program, and there are opportunities to work in acute inpatient care, community, teenagers, emergency, drug and alcohol . . . there's a lot of choice within psych so I don't feel as though I'm limiting myself by choosing that path.
Here's a summary of what I've been studying this week:
Lectures
• The impact of chronic conditions
• Promoting comfort_and managing symptoms
Reading
• The social construction of chronicity: a key to understanding chronic care transformations
• Healthcare providers’ perspectives : estimating the impact of chronicity
• Chronicity and complexity: is what’s good for the diseases always good for the patients?
• Clinical Practice Consolidation subject guide
• Ward Orientation
• Journal article case study: An 81 year old man with massive rectal bleeding – this was related to one the patients I had on the ward.
• Journal article: Nurofen Plus misuse, an emerging cause of perforated gastric ulcer – again this is related to a patient on the ward who had been abusing a packet a day of nurofen plus, which is ibuprofen plus codeine. They abuse it for the codeine and you don’t need a prescription to get it. The problem is because it has the ibuprofen it wears away the lining of the stomach over time.
• Assessment of Digestive and Gastrointestinal Function – anatomy of the gastrointestinal tract, chewing and swallowing, gastric function, small intestine function, colonic function, waste products digestion, age related changes in the gastrointestinal system, assessing pain, indigestion, intestinal gas, nausea and vomiting, changes in bowel habits and stool characteristics, physical assessment, foods and medications that alter stool colour, stool tests, breath tests, Australian guidelines for colorectal cancer screening, abdominal ultrasonography, genetics and gastrointestinal disorders.
This week I have two more nightshifts again so I'm going to get as much reading done as I can while I've got the chance.
This week I did two night shifts on Monday and Tuesday night. They're pretty long shifts, from 9pm till 7:30am so I needed Wednesday to recover. At this stage in the semester I only have to take one patient, but it will increase gradually up to a full load as the weeks go by. One patient on a night shift is very boring! Because there's not much to do between 10:30pm and 6:00am. However, I made good use of time and got heaps of reading for uni done and got a couple of tasks out of the way for my clinical learning portfolio which will be worth 55%.
This week I also finished my job applications for next year. I've already heard back from two of them for an interview in the next couple of weeks. I've applied to four different psychiatric grad nursing programs. It was so hard to narrow it down to just four places, and also choose whether I wanted to do general medical/surgical or psychiatric, or community. In the end I chose psychiatric because it's what I'm most interested in and enjoy doing, I can increase my qualifications during the program, and there are opportunities to work in acute inpatient care, community, teenagers, emergency, drug and alcohol . . . there's a lot of choice within psych so I don't feel as though I'm limiting myself by choosing that path.
Here's a summary of what I've been studying this week:
Lectures
• The impact of chronic conditions
• Promoting comfort_and managing symptoms
Reading
• The social construction of chronicity: a key to understanding chronic care transformations
• Healthcare providers’ perspectives : estimating the impact of chronicity
• Chronicity and complexity: is what’s good for the diseases always good for the patients?
• Clinical Practice Consolidation subject guide
• Ward Orientation
• Journal article case study: An 81 year old man with massive rectal bleeding – this was related to one the patients I had on the ward.
• Journal article: Nurofen Plus misuse, an emerging cause of perforated gastric ulcer – again this is related to a patient on the ward who had been abusing a packet a day of nurofen plus, which is ibuprofen plus codeine. They abuse it for the codeine and you don’t need a prescription to get it. The problem is because it has the ibuprofen it wears away the lining of the stomach over time.
• Assessment of Digestive and Gastrointestinal Function – anatomy of the gastrointestinal tract, chewing and swallowing, gastric function, small intestine function, colonic function, waste products digestion, age related changes in the gastrointestinal system, assessing pain, indigestion, intestinal gas, nausea and vomiting, changes in bowel habits and stool characteristics, physical assessment, foods and medications that alter stool colour, stool tests, breath tests, Australian guidelines for colorectal cancer screening, abdominal ultrasonography, genetics and gastrointestinal disorders.
This week I have two more nightshifts again so I'm going to get as much reading done as I can while I've got the chance.
Friday, July 29, 2011
Final Semester!
Long time, no blog post . . . well here I am, it's my final semester already. By the end of october I will be FINISHED! I am very busy right now, with getting stuck into the lectures, reading and assignments for my new subjects, as well as working 2 - 3 days a week, and applying for graduate nursing positions.
First let me wrap up last semester. It was a stressful one but I made it through. My results weren't as high as I've gotten in the past but they were okay:
Complex Care Nursing - 60
Professional Transitions in Nursing - 69
Nursing Older People - 70
I did bang out most of the assignments at the last minute and got between 65 - 75 for most of them. I seem to get the best scores in oral presentations. All in all, I'm not too disappointed because the academic transcript that went out with my job applications had only A's, B's and C's on it, no D's.
I had to make up 2 days of my Nursing Older People clinical placement before my holiday and I did that at an aged care nursing home which was good because I got to experience the nursing side of it, rather than just the caring side.
This semester my subjects are:
Consolidation of Clinical Practice - which includes 240 hours of acute care placement. I requested another ward and this semester I'm going to be on the gastrointestinal ward.
Managing Chronic Conditions - this subject is taught completely online, even the exam. There are several assignments including group assignments and online discussion groups.
Challenging Interactions in Nursing - this subject is about communication which I find really interesting.
So far, I've mainly been listening to lectures and reading for Challenging Interactions in Nursing:
Lectures
• Awareness of Self & Others
• Conflict Resolution
• Managing aggression - De-escalation
• Managing aggression - Professional Boundaries
• Lecture notes: De-escalation strategies
• Strategies and skills for dealing with unprofessional workplace behaviour
• My Experience in Hospital: Interview with a patient who had a negative experience
• Ideal Situation for dealing with complaints
Reading
• Talking with patients
• Common communication issues
• Egan's Three Stage Helping Model: Problem clarification, setting goals, and facilitating action
• Heron's six-categories of counselling interventions – supportive, informative, cathartic, prescriptive, catalytic, and confronting
• Strategies for managing aggressive behaviour
In the workshops so far we have done some roleplaying of difficult communication situations in nursing, including asking probing questions when the patient is reluctant or unable to explain why they are noncompliant, and responding to inappropriate or threatening comments.
I'll write more about my job applications and other subjects in upcoming posts . . . stay tuned!
First let me wrap up last semester. It was a stressful one but I made it through. My results weren't as high as I've gotten in the past but they were okay:
Complex Care Nursing - 60
Professional Transitions in Nursing - 69
Nursing Older People - 70
I did bang out most of the assignments at the last minute and got between 65 - 75 for most of them. I seem to get the best scores in oral presentations. All in all, I'm not too disappointed because the academic transcript that went out with my job applications had only A's, B's and C's on it, no D's.
I had to make up 2 days of my Nursing Older People clinical placement before my holiday and I did that at an aged care nursing home which was good because I got to experience the nursing side of it, rather than just the caring side.
This semester my subjects are:
Consolidation of Clinical Practice - which includes 240 hours of acute care placement. I requested another ward and this semester I'm going to be on the gastrointestinal ward.
Managing Chronic Conditions - this subject is taught completely online, even the exam. There are several assignments including group assignments and online discussion groups.
Challenging Interactions in Nursing - this subject is about communication which I find really interesting.
So far, I've mainly been listening to lectures and reading for Challenging Interactions in Nursing:
Lectures
• Awareness of Self & Others
• Conflict Resolution
• Managing aggression - De-escalation
• Managing aggression - Professional Boundaries
• Lecture notes: De-escalation strategies
• Strategies and skills for dealing with unprofessional workplace behaviour
• My Experience in Hospital: Interview with a patient who had a negative experience
• Ideal Situation for dealing with complaints
Reading
• Talking with patients
• Common communication issues
• Egan's Three Stage Helping Model: Problem clarification, setting goals, and facilitating action
• Heron's six-categories of counselling interventions – supportive, informative, cathartic, prescriptive, catalytic, and confronting
• Strategies for managing aggressive behaviour
In the workshops so far we have done some roleplaying of difficult communication situations in nursing, including asking probing questions when the patient is reluctant or unable to explain why they are noncompliant, and responding to inappropriate or threatening comments.
I'll write more about my job applications and other subjects in upcoming posts . . . stay tuned!
Thursday, June 23, 2011
Exam
Just got home from the exam - it went okay. I answered all the questions and was confident about my answers for most of them except a couple of questions about ECGs (which coronary arteries each of leads corresponds to) and underwater chest drainage. But those questions were only worth 5 points out of 50. I just guessed the answers for those.
This is the preparation I did and most of it was actually very useful.
Listened to lectures (someone them I re-watched):
• Congestive Heart Failure
• Evidence based treatments for coronary heart disease
• Exam preparation tips
• Nutrition in the Acute Care Setting
• Stroke
• Intracranial Hypertension
• Neurological Observations
• Pain in the Acute setting
Reading revision
• Cardiovascular System Anatomy, Physiology and Assessment
• Respiratory System Anatomy, Physiology and Assessment
• Neurological System Anatomy, Physiology and Assessment
• Non-invasive ventilation
• Stroke
• Intracranial pressure and hydrocephalus
• ECG interpretation
• Chest drains/underwater seal drainage management
• Central venous line management
• Enteral medication administration
• Basic life support
• Heart Failure (this topic is so complicated!)
• Acute Coronary Syndromes & Myocardial Infarction
• Nasogastric Tube Insertion
• Assessment and Care of the Tracheostomy Patient
Also, got some results back for my group's Falls Prevention presentation. We got 17.5 out of 20 (worth 20%), so that's very good.
3 weeks off uni now during which time I'll be working, doing my graduate nursing applications and spending one week in Bali. This weekend I'll be relaxing - catching up on non-uni related reading, watch a movie and go to yoga.
This is the preparation I did and most of it was actually very useful.
Listened to lectures (someone them I re-watched):
• Congestive Heart Failure
• Evidence based treatments for coronary heart disease
• Exam preparation tips
• Nutrition in the Acute Care Setting
• Stroke
• Intracranial Hypertension
• Neurological Observations
• Pain in the Acute setting
Reading revision
• Cardiovascular System Anatomy, Physiology and Assessment
• Respiratory System Anatomy, Physiology and Assessment
• Neurological System Anatomy, Physiology and Assessment
• Non-invasive ventilation
• Stroke
• Intracranial pressure and hydrocephalus
• ECG interpretation
• Chest drains/underwater seal drainage management
• Central venous line management
• Enteral medication administration
• Basic life support
• Heart Failure (this topic is so complicated!)
• Acute Coronary Syndromes & Myocardial Infarction
• Nasogastric Tube Insertion
• Assessment and Care of the Tracheostomy Patient
Also, got some results back for my group's Falls Prevention presentation. We got 17.5 out of 20 (worth 20%), so that's very good.
3 weeks off uni now during which time I'll be working, doing my graduate nursing applications and spending one week in Bali. This weekend I'll be relaxing - catching up on non-uni related reading, watch a movie and go to yoga.
Exam prep
Listened to lectures (someone them I re-watched):
• Congestive Heart Failure
• Evidence based treatments for coronary heart disease
• Exam preparation tips
• Nutrition in the Acute Care Setting
• Stroke
• Intracranial Hypertension
• Neurological Observations
• Pain in the Acute setting
Reading revision
• Cardiovascular System Anatomy, Physiology and Assessment
• Respiratory System Anatomy, Physiology and Assessment
• Neurological System Anatomy, Physiology and Assessment
• Non-invasive ventilation
• Stroke
• Intracranial pressure and hydrocephalus
• ECG interpretation
• Chest drains/underwater seal drainage management
• Central venous line management
• Enteral medication administration
• Basic life support
• Heart Failure (this topic is so complicated!)
• Acute Coronary Syndromes & Myocardial Infarction
• Nasogastric Tube Insertion
• Assessment and Care of the Tracheostomy Patient
Results
• 17.5/20 for group Falls Prevention presentation
• Congestive Heart Failure
• Evidence based treatments for coronary heart disease
• Exam preparation tips
• Nutrition in the Acute Care Setting
• Stroke
• Intracranial Hypertension
• Neurological Observations
• Pain in the Acute setting
Reading revision
• Cardiovascular System Anatomy, Physiology and Assessment
• Respiratory System Anatomy, Physiology and Assessment
• Neurological System Anatomy, Physiology and Assessment
• Non-invasive ventilation
• Stroke
• Intracranial pressure and hydrocephalus
• ECG interpretation
• Chest drains/underwater seal drainage management
• Central venous line management
• Enteral medication administration
• Basic life support
• Heart Failure (this topic is so complicated!)
• Acute Coronary Syndromes & Myocardial Infarction
• Nasogastric Tube Insertion
• Assessment and Care of the Tracheostomy Patient
Results
• 17.5/20 for group Falls Prevention presentation
Monday, June 20, 2011
Big update
Sorry for the lack of updates recently. I've been working a lot and doing assignments. I've now finished all my assignments for this semester which is a relief. In the last couple of weeks I handed in a 2000 word Clinical Case Management Review of one the patients I looked after in my geriatric nursing placement. That was worth 50% so I hope I did ok on that. Also did a 1500 word report about advances in the care of older people with depression, dementia, and end-of-life care, worth 30%. Before that I did a professional development reflective essay worth 40%. So basically one assignment a week for the last three weeks.
Other homework I've doing are a discussion board research posting about nursing care of Stroke patients, types of stroke and how they affect the patient, readings on Systematic review of treatments for depression in older people and End-of-life care and dementia.
Got some grades back for assignments I did earlier on in the semester - one worth 50% and another worth 40%. I can't remember the exact numbers but there were both in the 70s, which is "very good", so I was happy with those results.
Other than that I've also been doing a lot of research and thinking about where I want to work when I graduate. I've been attending a few career information nights with different organisations including the Royal District Nursing Service and Royal Melbourne Hospital. I need to apply for graduate positions by the end of July, and then interviews will take place in August followed by job offers in early October. So I will know before I finish my final semester where I will be working. Apparantly, most student end up getting their first preference so I have to think really carefully about my preferences and what I want. Also, I can only chose and apply to four places and I have to put those in order of preference. It's like applying to uni after year 12. So far I'm most interested in psych nursing programs at the major hospitals which have rotations in acute inpatient care, youth inpatient care and community care. There are three of these programs that I like the look of at Royal Melbourne, the Austin and the Alfred. At the Austin and the Alfred there are also programs that have two six month rotations - one in med/surg and one in psych, so you can consolidate your skills and experience both areas. However, they do not have the post graduate study included or an ongoing position. As well as all those programs, I'm also keen on community nursing with the Royal District Nursing Service which involves driving around Melbourne giving nursing care to people in their own homes for medication, wounds, dementia, diabetes and so on. I'm pretty sure I don't want to go straight to ward nursing on a busy med/surg ward. It just doesn't feel satisfying or interesting to me compared to psych or community nursing. So I have a lot to think about, and next week will start preparing my applications and making a decision about my preferences.
On Friday this week I have my one and only exam for Complex Care Nursing which is worth 40%. I've been told there are no exams next semester so this could be my last exam for quite a while. It's an open answer exam, not multiple choice like all the others in second year so could be difficult. Over the next four days I'm going to review about 10 of the lectures, the assignment, and all aspects of the two patient scenarios we studied in workshops for this subject. Hopefully that will get me through.
Other homework I've doing are a discussion board research posting about nursing care of Stroke patients, types of stroke and how they affect the patient, readings on Systematic review of treatments for depression in older people and End-of-life care and dementia.
Got some grades back for assignments I did earlier on in the semester - one worth 50% and another worth 40%. I can't remember the exact numbers but there were both in the 70s, which is "very good", so I was happy with those results.
Other than that I've also been doing a lot of research and thinking about where I want to work when I graduate. I've been attending a few career information nights with different organisations including the Royal District Nursing Service and Royal Melbourne Hospital. I need to apply for graduate positions by the end of July, and then interviews will take place in August followed by job offers in early October. So I will know before I finish my final semester where I will be working. Apparantly, most student end up getting their first preference so I have to think really carefully about my preferences and what I want. Also, I can only chose and apply to four places and I have to put those in order of preference. It's like applying to uni after year 12. So far I'm most interested in psych nursing programs at the major hospitals which have rotations in acute inpatient care, youth inpatient care and community care. There are three of these programs that I like the look of at Royal Melbourne, the Austin and the Alfred. At the Austin and the Alfred there are also programs that have two six month rotations - one in med/surg and one in psych, so you can consolidate your skills and experience both areas. However, they do not have the post graduate study included or an ongoing position. As well as all those programs, I'm also keen on community nursing with the Royal District Nursing Service which involves driving around Melbourne giving nursing care to people in their own homes for medication, wounds, dementia, diabetes and so on. I'm pretty sure I don't want to go straight to ward nursing on a busy med/surg ward. It just doesn't feel satisfying or interesting to me compared to psych or community nursing. So I have a lot to think about, and next week will start preparing my applications and making a decision about my preferences.
On Friday this week I have my one and only exam for Complex Care Nursing which is worth 40%. I've been told there are no exams next semester so this could be my last exam for quite a while. It's an open answer exam, not multiple choice like all the others in second year so could be difficult. Over the next four days I'm going to review about 10 of the lectures, the assignment, and all aspects of the two patient scenarios we studied in workshops for this subject. Hopefully that will get me through.
Saturday, June 4, 2011
For the last two weeks I've been on my Nursing Older People Clinical placement. It was at a smaller suburban hospital in a geriatric rehab ward and I really enjoyed it. The nurses and patients were very nice and it was general medical and rehab nursing care, so the focus is on systems and functioning - renal, gastrointestinal, mobility and so on. Lots of tests like blood tests, urine tests, faecal specimens, xrays, CT scans and ultrasounds. I got to go with a patient for her CT brain scan and bladder/kidney ultrasound which was interesting. Unfortunately there was an outbreak of the Noro virus (a gastro bug) which I caught and had to stay home for two days. I had diarrhea and severe vomiting for about 18 hours but I wasn't allowed to come back until 48 hours after my last symptom. So I'll have to make up two days later on. Luckily I was better in time for my team's presentation on the last day which was worth 20% of our assessment. This weekend I'm trying to get an assignment done that's due on Monday, and then I've got another one due on Friday, and another one on the following Friday. Then it'll be time to study for the final exam and start doing grad year job applications.
Assessments:
• Team Presentation on preventing falls in acute care facilities
• Discussion board research postings (about 1000 words)- Clopidogrel (an antiplatelet drug) and Percutaneous Aortic Valve Replacement Post-procedure nursing care
Reading:
• Palliative Care Therapeutic Guidelines
• Advances in palliative care relevant to the wider delivery of healthcare
• Heart Disease – Health gums and a health heart: the perio-cardio connection
Lectures:(online)
• The Role of a Clinical Nurse Manager in ICU (Operations)
• The Role of a Clinical Nurse Manager in ICU (Quality & Risk)
• Mental Health: the state of the nation part 1
• National Legislation for Registration & Professional Development
• Preventing falls and functional decline
Assessments:
• Team Presentation on preventing falls in acute care facilities
• Discussion board research postings (about 1000 words)- Clopidogrel (an antiplatelet drug) and Percutaneous Aortic Valve Replacement Post-procedure nursing care
Reading:
• Palliative Care Therapeutic Guidelines
• Advances in palliative care relevant to the wider delivery of healthcare
• Heart Disease – Health gums and a health heart: the perio-cardio connection
Lectures:(online)
• The Role of a Clinical Nurse Manager in ICU (Operations)
• The Role of a Clinical Nurse Manager in ICU (Quality & Risk)
• Mental Health: the state of the nation part 1
• National Legislation for Registration & Professional Development
• Preventing falls and functional decline
Wednesday, May 18, 2011
Update
Sorry about the lack of updates over the past few weeks. I haven't actually had classes or placement for the last five weeks, and I've been working in aged care, doing assignments and spending time with family. Next week I'm starting my final placement for the semester, a two-week geriatric acute care placement. I think the paid work I've been doing recently is really good experience and preparation for my next placement. Today I did a shift in a secure high level dementia wing. They basically need everything done for them and are very confused. It's really sad. I also have classes during those two weeks and have two assignments to do! So I'm going to be very busy.
Here's a summary of what I've done study-wise in the last few weeks:
Assignments
• Professional Transitions in Nursing Developing a Professional Development Portfolio – I got 70% for this assignment
• Professional Transitions in Nursing Group Oral Presentation (worth 20%) – my group’s topic was the nursing implications of patient aggression, such as clinical risk management, chemical and mechanical restraint, isolation, and law. We started it off with a role play which always gets a few brownie points and reaction from the audience. Our overall score was 75%. Well done.
• Complex Nursing Care – 2500 word assignment on pulmonary oedema and non-invasive ventilation, worth 40% - still waiting for the mark on this one.
Lectures
• Introduction to the subject
• The physiology of ageing – lecture and quiz
• Geropharmacology – lecture and quiz
• Strategic planning for an ageing population
• Delerium, dementia and depression
• Nursing: Taking Care of Our Future – a lecture about managing human resources in nursing. Brought up and interesting point about the ethics of recruiting nurses from overseas to make up the numbers needed here, because it is contributing to worsening healthcare systems in developing countries where there are not nearly enough nurses either.
For the rest of this week I'm going to try to get as much of my second PTN assignment (about professional development) done as I can, and I have to do about 1200 words worth of research and discussion for the online discussion board for complex care nursing (at least 3 posts).
Here's a summary of what I've done study-wise in the last few weeks:
Assignments
• Professional Transitions in Nursing Developing a Professional Development Portfolio – I got 70% for this assignment
• Professional Transitions in Nursing Group Oral Presentation (worth 20%) – my group’s topic was the nursing implications of patient aggression, such as clinical risk management, chemical and mechanical restraint, isolation, and law. We started it off with a role play which always gets a few brownie points and reaction from the audience. Our overall score was 75%. Well done.
• Complex Nursing Care – 2500 word assignment on pulmonary oedema and non-invasive ventilation, worth 40% - still waiting for the mark on this one.
Lectures
• Introduction to the subject
• The physiology of ageing – lecture and quiz
• Geropharmacology – lecture and quiz
• Strategic planning for an ageing population
• Delerium, dementia and depression
• Nursing: Taking Care of Our Future – a lecture about managing human resources in nursing. Brought up and interesting point about the ethics of recruiting nurses from overseas to make up the numbers needed here, because it is contributing to worsening healthcare systems in developing countries where there are not nearly enough nurses either.
For the rest of this week I'm going to try to get as much of my second PTN assignment (about professional development) done as I can, and I have to do about 1200 words worth of research and discussion for the online discussion board for complex care nursing (at least 3 posts).
Monday, April 4, 2011
Brain tumors
A bit about brain tumors that I learned while on clinical placement:
Symptoms:
• headache
• vomiting
• dizziness
• strabismus (uneven eyes)
• meningismus (three symptoms occurring together - neck stiffness, sensitivity to light, and headache)
The most common type of brain tumour is a meningioma, a benign tumor that grows out of the meninges. 8/10 are treatable with surgery, steroid drugs, and/or anti-seizure drugs.
Goals of brain tumour treatment:
• decompression to relieve intracranial pressure (surgery)
• diagnose the type of tumour (histopathology)
• management plan (radiotherapy, rehab or palliative care)
• peritoneal shunt (if there is hydrocephalus)
This week I did two aged care shifts (paid work) and have been going to class three days a week. Next week I have a group presentation worth 20% and an assignment worth 40% to do.
Videos
• Nurse TV: Nursing Makes a Difference http://www.youtube.com/watch?v=TOiK5Cbz97U&feature=related
• Nurse TV: No lift policy http://www.youtube.com/watch?v=xQTJd_-QSXE
• Safe Needles Save Lives
Reading
• Reflective Practice: A Guide for Nurses and Midwives
• Neurologic Assessment Skills for the Acute Medical Surgical Nurse
• Neurovascular Observation
Lectures
• Adverse events and root cause analysis
• Quality and risk management
• Implementing Change
• Leadership in nursing
• Clinical leadership and management
Symptoms:
• headache
• vomiting
• dizziness
• strabismus (uneven eyes)
• meningismus (three symptoms occurring together - neck stiffness, sensitivity to light, and headache)
The most common type of brain tumour is a meningioma, a benign tumor that grows out of the meninges. 8/10 are treatable with surgery, steroid drugs, and/or anti-seizure drugs.
Goals of brain tumour treatment:
• decompression to relieve intracranial pressure (surgery)
• diagnose the type of tumour (histopathology)
• management plan (radiotherapy, rehab or palliative care)
• peritoneal shunt (if there is hydrocephalus)
This week I did two aged care shifts (paid work) and have been going to class three days a week. Next week I have a group presentation worth 20% and an assignment worth 40% to do.
Videos
• Nurse TV: Nursing Makes a Difference http://www.youtube.com/watch?v=TOiK5Cbz97U&feature=related
• Nurse TV: No lift policy http://www.youtube.com/watch?v=xQTJd_-QSXE
• Safe Needles Save Lives
Reading
• Reflective Practice: A Guide for Nurses and Midwives
• Neurologic Assessment Skills for the Acute Medical Surgical Nurse
• Neurovascular Observation
Lectures
• Adverse events and root cause analysis
• Quality and risk management
• Implementing Change
• Leadership in nursing
• Clinical leadership and management
Sunday, April 3, 2011
Third and final week of placement
Had six shifts in a row this week and most of them were earlies so I've been very sleep deprived and tired. But the placement has been great. I have one more day to go (tomorrow). Also starting tomorrow I have two weeks of classes for my Professional Transitions in Nursing subject.
Here are some of the things I did this week:
• Had the flu vaccine (for free)
• Observed and assisted with the fitting of a halo brace. Involves full spinal care manual handling (five people) and the doctor put the brace on, screwing it into the skull (with local anaesthetic). My role besides the manual handling was to hold the patient’s hand and tell her she is being so brave. They needed her to stay really still and she squeezed my hand really hard when they were injecting all around her head with the anaesthetic. I put a picture of a halo brace a couple of blog posts ago.
• Administered intravenous drugs via a PICC line (directly into the heart), using sterile technique.
• Looked after five separate patients that were IV drug users and had head injuries due to either a fall or a car accident while intoxicated. Two of them were in nappies and had to be spoon fed all their meals. Another had to be shackled to his bed because he was non compliant and would put his head drains out IV lines if his hands weren’t tied up.
• Planned and carried out all the care and documentation for two patients each shift. Some things, like give drugs, I had to do under supervision but everything else I did myself.
• Got a really good final assessment and feedback from my clinical educator and successfully passed the placement.
Here are some of the things I did this week:
• Had the flu vaccine (for free)
• Observed and assisted with the fitting of a halo brace. Involves full spinal care manual handling (five people) and the doctor put the brace on, screwing it into the skull (with local anaesthetic). My role besides the manual handling was to hold the patient’s hand and tell her she is being so brave. They needed her to stay really still and she squeezed my hand really hard when they were injecting all around her head with the anaesthetic. I put a picture of a halo brace a couple of blog posts ago.
• Administered intravenous drugs via a PICC line (directly into the heart), using sterile technique.
• Looked after five separate patients that were IV drug users and had head injuries due to either a fall or a car accident while intoxicated. Two of them were in nappies and had to be spoon fed all their meals. Another had to be shackled to his bed because he was non compliant and would put his head drains out IV lines if his hands weren’t tied up.
• Planned and carried out all the care and documentation for two patients each shift. Some things, like give drugs, I had to do under supervision but everything else I did myself.
• Got a really good final assessment and feedback from my clinical educator and successfully passed the placement.
Friday, April 1, 2011
Understanding the nursing handover and patient notes
Acronyms from ONE SHIFT:
ABX - antibiotics
NAD - nil abnormalities
CP - chest pain
THR - total hip replacement
OSA - obstructive sleep apnoea
HOB - head of bed
BOS - base of skull
TTE - trans thoracic echogram
AXR - abdominal xray
TOV - trial of void
VSS - vital signs stable
IVDU - intravenous drug user
ORIF - open reduction internal fixation
MVA - motor vehicle accident
ABX - antibiotics
NAD - nil abnormalities
CP - chest pain
THR - total hip replacement
OSA - obstructive sleep apnoea
HOB - head of bed
BOS - base of skull
TTE - trans thoracic echogram
AXR - abdominal xray
TOV - trial of void
VSS - vital signs stable
IVDU - intravenous drug user
ORIF - open reduction internal fixation
MVA - motor vehicle accident
Sunday, March 27, 2011
Cardiovascular System Review
The three body systems I am revising and expanding my knowledge on this semester are cardiovascular, respiratory and neurological. These are the systems that are most relevant to what we're learning in classes and on placement. I'm reading three different textbooks for each, and then doing the review questions at the end of the chapter in one of the textbooks. I recently completed Cardiovascular System Anatomy, Physiology, Diseases and Disorders. Here's a summary:
1. Which of the following risk factors are controllable or modifiable?
a. Heredity b. Diet c. Age d. Stress
e. Smoking f. Exercise
2. Which of the following statements are correct in relation to coronary artery disease?
a. It is often called coronary heart disease.
b. Slow, progressive occlusion of arteries often leads to development of collateral arteries that extend into ischaemic tissue, providing some protection against infarction.
c. It will always lead to a myocardial infarction.
d. Diagnosis of CAD is made by evaluating the history, ECG, and angiograms.
e. The disease is commonly due to atherosclerosis.
3. Define the following terms related to haemorrhage:
a. Petechiae – small pinpoint haemorrhages (like varicose veins)
b. Ecchymosis – larger area of purplish colour commonly called a bruise
c. Purpura – spontaneous bleeding into the tissues related to a haemorrhagic disease that may be characterised by both petechiae and ecchymosis.
4. What are the functions of the cardiovascular system?
The most basic function is to pump blood around the body and supply all organs and tissues with freshly oxygenated, nutrient rich blood. Waste products of cell function are removed with the blood as it leaves . The cardiovascular system also transports other vital substances, such as hormones and immune cells.
5. Which signs and symptoms are associated with common cardiovascular system disorders?
Dyspnea (difficulty breathing), fatigue, tachycardia (rapid heart rate), chest pain, pain in the left arm and/or jaw, heart palpitations, sweating, edema in the extremities, nausea, vomiting, cyanosis.
6. Which diagnostic tests are most commonly used to determine the type and/or cause of cardiovascular system disorders?
Auscultation of the chest, blood pressure measurement, ECG, angiogram, blood test, cardiac catheterisation.
7. What symptoms are usually seen in congestive heart failure?
Gradual increase in dyspnea, tachycardia, tachypnea (rapid breathing), neck vein distension, edema in the ankles and lower legs.
8. What is the difference between phlebitis and thrombophlebitis?
Phlebitis is the inflammation of superficial veins and may be caused by injury, obesity, poor circulation, prolonged bed rest, and infection. Thrombophlebitis is the development of a clot in an inflamed vessel. Clots in superficial veins rarely embolise (break loose and travel), but clots in deep veins often do and are a serious concern (deep vein thrombosis).
9. What are the most common signs and symptoms of shock?
Extremely low blood pressure, facial pallor, cool and clammy skin, cyanosis, tachycardia, tachypnea, altered mental status, syncope (fainting), unconsciousness, oliguria (lack of urine).
10. What are some of the changes occurring in the cardiovascular system with age?
The heart muscle loses some of its contractility, causing decreased cardiac output and/or increased heart rate to compensate. Vessels lose elasticity and become more rigid and narrowed. Valves become thick and sclerotic and lose some functioning. Decreased peripheral circulation results in cool and pale extremeties, improper healing, and edema in the legs and feet.
1. Which of the following risk factors are controllable or modifiable?
a. Heredity b. Diet c. Age d. Stress
e. Smoking f. Exercise
2. Which of the following statements are correct in relation to coronary artery disease?
a. It is often called coronary heart disease.
b. Slow, progressive occlusion of arteries often leads to development of collateral arteries that extend into ischaemic tissue, providing some protection against infarction.
c. It will always lead to a myocardial infarction.
d. Diagnosis of CAD is made by evaluating the history, ECG, and angiograms.
e. The disease is commonly due to atherosclerosis.
3. Define the following terms related to haemorrhage:
a. Petechiae – small pinpoint haemorrhages (like varicose veins)
b. Ecchymosis – larger area of purplish colour commonly called a bruise
c. Purpura – spontaneous bleeding into the tissues related to a haemorrhagic disease that may be characterised by both petechiae and ecchymosis.
4. What are the functions of the cardiovascular system?
The most basic function is to pump blood around the body and supply all organs and tissues with freshly oxygenated, nutrient rich blood. Waste products of cell function are removed with the blood as it leaves . The cardiovascular system also transports other vital substances, such as hormones and immune cells.
5. Which signs and symptoms are associated with common cardiovascular system disorders?
Dyspnea (difficulty breathing), fatigue, tachycardia (rapid heart rate), chest pain, pain in the left arm and/or jaw, heart palpitations, sweating, edema in the extremities, nausea, vomiting, cyanosis.
6. Which diagnostic tests are most commonly used to determine the type and/or cause of cardiovascular system disorders?
Auscultation of the chest, blood pressure measurement, ECG, angiogram, blood test, cardiac catheterisation.
7. What symptoms are usually seen in congestive heart failure?
Gradual increase in dyspnea, tachycardia, tachypnea (rapid breathing), neck vein distension, edema in the ankles and lower legs.
8. What is the difference between phlebitis and thrombophlebitis?
Phlebitis is the inflammation of superficial veins and may be caused by injury, obesity, poor circulation, prolonged bed rest, and infection. Thrombophlebitis is the development of a clot in an inflamed vessel. Clots in superficial veins rarely embolise (break loose and travel), but clots in deep veins often do and are a serious concern (deep vein thrombosis).
9. What are the most common signs and symptoms of shock?
Extremely low blood pressure, facial pallor, cool and clammy skin, cyanosis, tachycardia, tachypnea, altered mental status, syncope (fainting), unconsciousness, oliguria (lack of urine).
10. What are some of the changes occurring in the cardiovascular system with age?
The heart muscle loses some of its contractility, causing decreased cardiac output and/or increased heart rate to compensate. Vessels lose elasticity and become more rigid and narrowed. Valves become thick and sclerotic and lose some functioning. Decreased peripheral circulation results in cool and pale extremeties, improper healing, and edema in the legs and feet.
Homework summary
In addition to my placement I've also being doing a lot of study recently. I have to, because it's relevant to what I'm doing on placement, so will help me get more out the experience, and I have assignments and homework tasks due.
Here is everything I've got done in the last 1 - 2 weeks:
Lectures
• Psychiatric Complexities in Acute care settings
• Pain management in the acute care setting
Reading
• Excellence in practice: technology and the registered nurse
• Establishing and maintaining a professional profile
• The theory-practice gap in clinical practice
• Reflective practice for the graduate nurse
• Anatomic and physiologic overview of neurological system – neurons, neurotransmitters, the brain (cerebrum, brain stem, cerebellum), structures protecting the brain, cerebrospinal fluid, cerebral circulation (arteries and veins), blood-brain barrier,
• Neurological Observation
• Professional Learning Outcomes Assignment (1600 words)- this assignment included a cover letter, curriculum vitae, and essay about my learning needs in order to transition confidently from student to graduate nurse. I finished it over the weekend and am handing it in today.
Here is everything I've got done in the last 1 - 2 weeks:
Lectures
• Psychiatric Complexities in Acute care settings
• Pain management in the acute care setting
Reading
• Excellence in practice: technology and the registered nurse
• Establishing and maintaining a professional profile
• The theory-practice gap in clinical practice
• Reflective practice for the graduate nurse
• Anatomic and physiologic overview of neurological system – neurons, neurotransmitters, the brain (cerebrum, brain stem, cerebellum), structures protecting the brain, cerebrospinal fluid, cerebral circulation (arteries and veins), blood-brain barrier,
• Neurological Observation
• Professional Learning Outcomes Assignment (1600 words)- this assignment included a cover letter, curriculum vitae, and essay about my learning needs in order to transition confidently from student to graduate nurse. I finished it over the weekend and am handing it in today.
Friday, March 25, 2011
Neuro placement - week 2
I'm about half way through my placement, still have 8 days to go, and am loving it.
This week I've been doing nursing care for an elderly Russian man who speaks very limited English and had come into the ED after having increasing headaches over the last 12 months, and then had some kind of seizure while driving. The did a CT Brain scan and found something looking like this:
Then they did a craniotomy to take a biopsy and it turned out to be Gliobastoma Multiforme, one of the worst kind of brain tumors which has a very grim prognosis - 6 months to a year. After the surgery. A few days after the surgery he went into a coma for about 24 hours. As part of the neurological observations we had to do sternal rubs and press hard on the nail beds to inflict pain (to assess whether the brain is responding to painful stimulus). It leaves a pretty nasty bruise when it is done over and over.
I accompanied him to get an EEG done which measures the electrical activity of the brain. His brain function was normal and they did some other test where they lift up an arm and it flops back down to the bed quickly when let go. However when the arm was lifted and let go close to the face, the arm stopped falling a couple of centimetres from the face, which showed that there was some kind of consciousness there because otherwise they would have hit themselves in the face. The findings were consistent with a psychogenic pseudo coma which is a state mimicking acute unconsciousness with intact self-awareness, due to severe depression, inability to cope, near death experience and a number of other factors. They become 'locked-in' to this state.
As soon as the patient's family left, I decided to check on him and he started waking up! Since then he has been awake and fully conscious and has also said he can remember everything his family were saying to him while he "was asleep" and complained that people kept "pinching and punching" him. So bizaare.
Another patient I had this week had epididmo-orchitis which is inflammation of the testicles, causes by trauma or STD infection. He said he was hit in the balls by a soccer ball. It make the testicle that is inflamed change shape and become really large so they are in a lot of pain and have difficulty walking. He was given IV antibiotics and pain relief.
If you want to see what it actually looks like you can do a google image search. Decided not to put a picture of someone's inflammed testicles on my blog, lol.
Yesterday two males in their 20s were admitted after a single vehicle car crash. Lots of lacerations to the face and body from smashing the windscreen, but no seat belt bruises on either of them. They both said the other one had been driving and they both had illicit drugs in their system. They had neck braces on and were supposed to be lying straight and avoid moving their spine until it could be confirmed that they didn't have any spinal fractures, but they were both completely non compliant and insisted on getting out of bed and taking their neck brace off because it's too tight. Idiots!
Had my first formal feedback from my clinical educator and she thinks I'm doing really well. She said my strengths are: performing nursing care in accordance with recognised standards of practice, seeking additional knowledge when presented with unfamiliar situations, demonstrating increased responsibility and accountability, approaching patient assessments in and organised and structured way, and ensuring my nursing practice is sensitive and supportive to cultural, social and psychological issues. The things I need to develop are my drug knowledge and interpreting supplementary data such as blood test results to help me plan care and interventions for my patients.
Last night I slept for 12 hours to catch up on sleep debt. Today I'm working on an assignment that's worth 40% and due Monday.
This week I've been doing nursing care for an elderly Russian man who speaks very limited English and had come into the ED after having increasing headaches over the last 12 months, and then had some kind of seizure while driving. The did a CT Brain scan and found something looking like this:
Then they did a craniotomy to take a biopsy and it turned out to be Gliobastoma Multiforme, one of the worst kind of brain tumors which has a very grim prognosis - 6 months to a year. After the surgery. A few days after the surgery he went into a coma for about 24 hours. As part of the neurological observations we had to do sternal rubs and press hard on the nail beds to inflict pain (to assess whether the brain is responding to painful stimulus). It leaves a pretty nasty bruise when it is done over and over.
I accompanied him to get an EEG done which measures the electrical activity of the brain. His brain function was normal and they did some other test where they lift up an arm and it flops back down to the bed quickly when let go. However when the arm was lifted and let go close to the face, the arm stopped falling a couple of centimetres from the face, which showed that there was some kind of consciousness there because otherwise they would have hit themselves in the face. The findings were consistent with a psychogenic pseudo coma which is a state mimicking acute unconsciousness with intact self-awareness, due to severe depression, inability to cope, near death experience and a number of other factors. They become 'locked-in' to this state.
As soon as the patient's family left, I decided to check on him and he started waking up! Since then he has been awake and fully conscious and has also said he can remember everything his family were saying to him while he "was asleep" and complained that people kept "pinching and punching" him. So bizaare.
Another patient I had this week had epididmo-orchitis which is inflammation of the testicles, causes by trauma or STD infection. He said he was hit in the balls by a soccer ball. It make the testicle that is inflamed change shape and become really large so they are in a lot of pain and have difficulty walking. He was given IV antibiotics and pain relief.
If you want to see what it actually looks like you can do a google image search. Decided not to put a picture of someone's inflammed testicles on my blog, lol.
Yesterday two males in their 20s were admitted after a single vehicle car crash. Lots of lacerations to the face and body from smashing the windscreen, but no seat belt bruises on either of them. They both said the other one had been driving and they both had illicit drugs in their system. They had neck braces on and were supposed to be lying straight and avoid moving their spine until it could be confirmed that they didn't have any spinal fractures, but they were both completely non compliant and insisted on getting out of bed and taking their neck brace off because it's too tight. Idiots!
Had my first formal feedback from my clinical educator and she thinks I'm doing really well. She said my strengths are: performing nursing care in accordance with recognised standards of practice, seeking additional knowledge when presented with unfamiliar situations, demonstrating increased responsibility and accountability, approaching patient assessments in and organised and structured way, and ensuring my nursing practice is sensitive and supportive to cultural, social and psychological issues. The things I need to develop are my drug knowledge and interpreting supplementary data such as blood test results to help me plan care and interventions for my patients.
Last night I slept for 12 hours to catch up on sleep debt. Today I'm working on an assignment that's worth 40% and due Monday.
Monday, March 21, 2011
Neurosurgery clinical - Day 2
Very long and productive day today. From 9 - 11am I had a lab class in which we did Basic Life Support (CPR) practice and refresher, nasogastric tube insertion, and epidural management. Not all nurses can insert and remove epidurals, you have a gain specific accreditation at least a couple of years into practice. But we will be expected to assist, assess and document.
Then I had a break and spent some time in the library researching for my assignment that I'm currently working on. Reading I did today:
• Australian Nursing and Midwifery Council National Competency Standards for the Registered Nurse
• Continuing Competency Framework
• Managing the Transition from Student to Graduate Nurse
• Becoming a competent, confident, professional practitioner
• Becoming part of a Team
• Managing approaches to nursing care delivery
Following that I had a very interesting shift with some new experiences:
• Neurological observations on a patient with Post Traumatic Amnesia (he was assaulted to the head in a nightclub)
• Neurological observations, full nursing care (hygiene), pressure area care, and drug administration via PEG (directly to the stomach) on an unconscious patient.
• Care of a patient with halo brace, accompanied him to his x-rays and helped him sit up and get out of bed for the first time since his accident.
I didn't get home till 10:30pm. Luckily tomorrow I am on afternoon shift again. But then on Wednesday I have an early start. I don't like late finish then early start because it is impossible to get 8 hours sleep in between. The most I could get would be six hours. If I get home at 10:30 there's no time to wind down afterwards, and I have to be up again at 5:00am to shower, have breakfast, catch the tram and be there again by 6:45. I'm not complaining but I wouldn't like to have to do that on a regular basis. It really messes with your body clock.
Then I had a break and spent some time in the library researching for my assignment that I'm currently working on. Reading I did today:
• Australian Nursing and Midwifery Council National Competency Standards for the Registered Nurse
• Continuing Competency Framework
• Managing the Transition from Student to Graduate Nurse
• Becoming a competent, confident, professional practitioner
• Becoming part of a Team
• Managing approaches to nursing care delivery
Following that I had a very interesting shift with some new experiences:
• Neurological observations on a patient with Post Traumatic Amnesia (he was assaulted to the head in a nightclub)
• Neurological observations, full nursing care (hygiene), pressure area care, and drug administration via PEG (directly to the stomach) on an unconscious patient.
• Care of a patient with halo brace, accompanied him to his x-rays and helped him sit up and get out of bed for the first time since his accident.
I didn't get home till 10:30pm. Luckily tomorrow I am on afternoon shift again. But then on Wednesday I have an early start. I don't like late finish then early start because it is impossible to get 8 hours sleep in between. The most I could get would be six hours. If I get home at 10:30 there's no time to wind down afterwards, and I have to be up again at 5:00am to shower, have breakfast, catch the tram and be there again by 6:45. I'm not complaining but I wouldn't like to have to do that on a regular basis. It really messes with your body clock.
Saturday, March 19, 2011
3rd year clinical - first shift
I did my shift on Friday even though I'm not 100% better. My clinical educator said it was ok. I was still coughing a bit and felt guilty but I made sure I did hand hygeine all the time and I made it through the shift, and there were actually a few other staff members with what sounded like the same cough as me, so I didn't feel so bad.
I am on the neurotrauma and neurosurgery ward, which has some overflow from the orthopedic ward too. The patient I was mainly looking after was an orthopedic patient - an 80 year old Greek lady with the broken femur who was day 4 post surgery and needed full nursing care for everything. She had a 'pad' which is actually an adult nappy, but they call it a pad because I guess it doesn't sound as bad, and was having diarrhoea. The pad needed changing 3 times during my shift and because even rolling to her side caused a lot of pain, 2 nurses were needed to change it. The smell was so bad. I don't know if I'll ever get used to dealing with faeces, but it's part of the job. I feel sorry for people who are incontinent and it makes me never want to get to that state. All the more reason to keep up my yoga and pilates and try to keep my bowels healthy.
Did my first blood transfusion on her as well (her haemoglobin levels were low after the surgery) which was good after learning all about it last year but not having had a chance to do it yet. Had to educate her first about the reasons using simple language because her English was a bit limited, then get consent, do the baseline assessment and monitor for adverse reactions, as well as set up and start the actual transfusion.
Also did my first drug administration per vagina. Not as bad as it sounds. The tablet comes in a disposable applicator. Just like inserting a Tampax tampon. It was an oestrogen tablet that absorbs at the site of the cervix.
Also removed an IV catheter for the first time. My nurse buddy was very nice and I think we worked well together. She's young and only a couple of years out. I'll be working alongside her for all of next week too. I'm glad I wasn't asked to come in this weekend to make up the shifts I missed, better to have the weekend to recuperate and make up the shifts when I'm fighting fit.
Currently working on my Professional Transitions in Nursing Assignment which is due next Monday. I also have two 2 hour classes next week as well as 5 x 8 hour shifts of clinical, so very very busy this week.
I am on the neurotrauma and neurosurgery ward, which has some overflow from the orthopedic ward too. The patient I was mainly looking after was an orthopedic patient - an 80 year old Greek lady with the broken femur who was day 4 post surgery and needed full nursing care for everything. She had a 'pad' which is actually an adult nappy, but they call it a pad because I guess it doesn't sound as bad, and was having diarrhoea. The pad needed changing 3 times during my shift and because even rolling to her side caused a lot of pain, 2 nurses were needed to change it. The smell was so bad. I don't know if I'll ever get used to dealing with faeces, but it's part of the job. I feel sorry for people who are incontinent and it makes me never want to get to that state. All the more reason to keep up my yoga and pilates and try to keep my bowels healthy.
Did my first blood transfusion on her as well (her haemoglobin levels were low after the surgery) which was good after learning all about it last year but not having had a chance to do it yet. Had to educate her first about the reasons using simple language because her English was a bit limited, then get consent, do the baseline assessment and monitor for adverse reactions, as well as set up and start the actual transfusion.
Also did my first drug administration per vagina. Not as bad as it sounds. The tablet comes in a disposable applicator. Just like inserting a Tampax tampon. It was an oestrogen tablet that absorbs at the site of the cervix.
Also removed an IV catheter for the first time. My nurse buddy was very nice and I think we worked well together. She's young and only a couple of years out. I'll be working alongside her for all of next week too. I'm glad I wasn't asked to come in this weekend to make up the shifts I missed, better to have the weekend to recuperate and make up the shifts when I'm fighting fit.
Currently working on my Professional Transitions in Nursing Assignment which is due next Monday. I also have two 2 hour classes next week as well as 5 x 8 hour shifts of clinical, so very very busy this week.
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