Day 4 - admitted two new clients, a 24 year old girl, and a 29 year old guy. Asked them about their intake for the last two weeks and what their goals are after detox. For most clients it seems their goal is to work, because they've lost their jobs due to their drinking/drug use. The guy was really struggling with withdrawal and wasn't sure if spending a week in detox was really what he wanted. The next day I he was already gone, decided he couldn't handle it. I offered the group a meditation session before bed, seeing as they seemed to like it. I advertised it as "Hardcore Relaxation", hahaha. It was a heart chakra meditation about unconditional love, followed by a discussion.
Day 5 - Found out that the guy who was admitted yesterday self-discharged, couldn't handle it, wanted to drink. Spent about an hour comforting the girl who admitted yesterday who was upset about her domestic situation (family were being evicted) and desperately wanted to leave so she could help them and also so she could drink away the worries. We convinced her the best thing she could do for her situation is stay right where she is and thankfully she did. The clients requested another guided meditation before bed, so this time I did "Detoxifying Meditation".
Weekend - spent all weekend researching and writing my final assignment for this year. It's for my Community Nursing subject and is about Secondary School Nursing. I chose that topic because I felt it was something I can relate to and write about. The essay was 1200 and I wrote it in one day. I thought I would be able to submit it electronically, but I found out late last night that it had to be handed in hard copy at uni. So today after finishing at 3:30 I came home, proof read it one more time, printed it and drove to uni just in time to hand it in at 4:55pm (due 5pm). Phew!
Monday, October 18, 2010
Tuesday, October 12, 2010
Detox Diary
Day 1: Arrived at detox centre and met the Registered nurse on duty and the Drug and Alcohol support worker. Nursing handover then I had a tour of the facility. It's two levels, boys upstairs and girls downstairs, there's a living room with a TV and library, fitness room, kitchen, ping pong table and outdoor area mainly used for smoking. It's located just near Australia's largest brewery, but luckily the clients aren't allowed to leave by themselves.
Each day they have activities to participate in including daily trip to the local pool to swim, sit in the spa or have a sauna. In the afternoon there are meetings with social workers, AA or NA meetings and housework chores to do (there's a roster). The patients get everything for free - food, accommodation, medicine - but they have to stick to the rules, participate in the activities and be respectful, otherwise they're out.
The patients have to prepare the dinners for everyone. It's good food and staff can eat it too so I've been getting free meals too. Most of them are really malnourished and need a good feed. I've been getting to know about them as much as I can and most of them are friendly and talkative.
In the evening everyone watched a short DVD about the science of relapse (how the brain works when someone is an addict) followed by a discussion.
Day 2: I started taking on more of the role of the RN. I did all the daily OBS and gave out evening and night medications. I also gave my first intra-muscular injection (a Vitamin B injection in the bum cheek). Also started assessing the patient's withdrawal symptoms. Attended my first AA meeting.
There are only about 12 patients and most of them are withdrawing from alcohol. It can actually be really dangerous (as well as very difficult) if they try to do it on their own, they can have a seizure and die, so it needs to be done under medical supervision so they can use diazepam (Valium) to manage their symptoms and also get 24 hour emotional support and reassurance when they're feeling frustrated. I've seen a few very frustrated patients already.
There are also a few who are withdrawing from opioids such as heroin and painkillers. They take a different drug that helps ease their withdrawal symptoms and reduce psychological cravings.
Most of the patients have a bed in rehab to go to after detox, but some just go back home. The patients are a mix - aged about 25 - 50 on average, a few of them are aboriginal, some of them have been in and out of detox centres, rehabs, jail and boarding houses their whole lives, and others have had more 'normal' lives that have recently fallen apart due to their drinking/drug use. One (a middle aged woman) recently relapsed "because St Kilda lost the grand final".
Day 3: Today I did two new admissions. I had to read through all the rules and get them to agree and sign a contract. Then I did an assessment of their drug and alcohol use in the last two weeks, their medical, psychological and social situation, and what their goals are. Each new patient gets a bum injection of vitamin B for the first 3 days after they arrive. I also made some calls for a patient who has Hep C, who needs to find treatment and support services in his area. In the evening there was a relaxation/meditation session which I took part in. Everyone was really enthusiastic about it and thought it was "awesome". They obviously don't do enough of that.
So far I'm really enjoying this placement. I'm the only student and there are only two staff members so I already feel like part of the team and the patients all know me by name. I don't even have to wear my uniform, it's very casual.
Each day they have activities to participate in including daily trip to the local pool to swim, sit in the spa or have a sauna. In the afternoon there are meetings with social workers, AA or NA meetings and housework chores to do (there's a roster). The patients get everything for free - food, accommodation, medicine - but they have to stick to the rules, participate in the activities and be respectful, otherwise they're out.
The patients have to prepare the dinners for everyone. It's good food and staff can eat it too so I've been getting free meals too. Most of them are really malnourished and need a good feed. I've been getting to know about them as much as I can and most of them are friendly and talkative.
In the evening everyone watched a short DVD about the science of relapse (how the brain works when someone is an addict) followed by a discussion.
Day 2: I started taking on more of the role of the RN. I did all the daily OBS and gave out evening and night medications. I also gave my first intra-muscular injection (a Vitamin B injection in the bum cheek). Also started assessing the patient's withdrawal symptoms. Attended my first AA meeting.
There are only about 12 patients and most of them are withdrawing from alcohol. It can actually be really dangerous (as well as very difficult) if they try to do it on their own, they can have a seizure and die, so it needs to be done under medical supervision so they can use diazepam (Valium) to manage their symptoms and also get 24 hour emotional support and reassurance when they're feeling frustrated. I've seen a few very frustrated patients already.
There are also a few who are withdrawing from opioids such as heroin and painkillers. They take a different drug that helps ease their withdrawal symptoms and reduce psychological cravings.
Most of the patients have a bed in rehab to go to after detox, but some just go back home. The patients are a mix - aged about 25 - 50 on average, a few of them are aboriginal, some of them have been in and out of detox centres, rehabs, jail and boarding houses their whole lives, and others have had more 'normal' lives that have recently fallen apart due to their drinking/drug use. One (a middle aged woman) recently relapsed "because St Kilda lost the grand final".
Day 3: Today I did two new admissions. I had to read through all the rules and get them to agree and sign a contract. Then I did an assessment of their drug and alcohol use in the last two weeks, their medical, psychological and social situation, and what their goals are. Each new patient gets a bum injection of vitamin B for the first 3 days after they arrive. I also made some calls for a patient who has Hep C, who needs to find treatment and support services in his area. In the evening there was a relaxation/meditation session which I took part in. Everyone was really enthusiastic about it and thought it was "awesome". They obviously don't do enough of that.
So far I'm really enjoying this placement. I'm the only student and there are only two staff members so I already feel like part of the team and the patients all know me by name. I don't even have to wear my uniform, it's very casual.
Sunday, October 3, 2010
Placement finished, two more to go
My hospital placement is over now. The last two days I looked after a patient who had a flesh eating bug that gave her massive sores on her legs that looked a lot like pressure wounds. I got to do the dressings each day for her which involved washing out the wound using sterile technique then packing it with gauze again and re-dressing it. It took about 45 minutes each time. The wounds looked a lot like this and each one was about twice the size of a tennis ball and quite deep. There was a lot of yucky yellow stuff in it as well.
Because the bug was resistant to all antibiotics and contagious she was in an isolated room and I had to wear a disposable gown every time I went in. The other patient I had had TB and anyone who went into his room had to wear a mask. He was also a drug addict and was very rude and abusive. He always asked for more morphine and said his pain was 10 out of 10 even though 5 minutes before he was walking around and going downstairs for a cigarette. He even wanted "lots of morphine to take home" when he was discharged. In those cases, I just got the doctor to speak to him about it because he was just bossing me around. It didn't bother me though. You can't take these things personally, and it's good preparation for my next placement - drug and alcohol detox.
On the last day my buddy wanted to switch roles with me, so I played the role of the RN and he was my buddy. I had to make a plan for the whole shift for 4 patients, delegate tasks to my "buddy" and decide what to do when something unexpected happened. Nothing too exciting happened but it was a good exercise to gain confidence and I had the chance to liaise directly with the allied health staff (doctors/social workers etc) to plan patient care. We all had to bring something as a gift for the staff on our ward to say thankyou. I brought strawberries and a bag of lemons (from my garden) and they were a big hit. We got to leave a bit early and our whole group went out for dinner and drinks at one of the nearby pubs on Brunswick St.
Yesterday I went over to my nan's house again to watch the football grand final (again, because it was a draw last week). Collingwood won so a few drinks were had and I stayed for dinner. Today I've just been cleaning my house and doing my assignment which is due tomorrow and I've just finished. It was about patient care following a blood transfusion allergic reaction.
This week I have off but I have quite a bit planned: Monday - yoga, return library books, massage; Tuesday - hairdresser, take manny to vet for vaccinations; Wednesday - Le Bop dance class; Thursday - teaching; Friday - teaching.
Because the bug was resistant to all antibiotics and contagious she was in an isolated room and I had to wear a disposable gown every time I went in. The other patient I had had TB and anyone who went into his room had to wear a mask. He was also a drug addict and was very rude and abusive. He always asked for more morphine and said his pain was 10 out of 10 even though 5 minutes before he was walking around and going downstairs for a cigarette. He even wanted "lots of morphine to take home" when he was discharged. In those cases, I just got the doctor to speak to him about it because he was just bossing me around. It didn't bother me though. You can't take these things personally, and it's good preparation for my next placement - drug and alcohol detox.
On the last day my buddy wanted to switch roles with me, so I played the role of the RN and he was my buddy. I had to make a plan for the whole shift for 4 patients, delegate tasks to my "buddy" and decide what to do when something unexpected happened. Nothing too exciting happened but it was a good exercise to gain confidence and I had the chance to liaise directly with the allied health staff (doctors/social workers etc) to plan patient care. We all had to bring something as a gift for the staff on our ward to say thankyou. I brought strawberries and a bag of lemons (from my garden) and they were a big hit. We got to leave a bit early and our whole group went out for dinner and drinks at one of the nearby pubs on Brunswick St.
Yesterday I went over to my nan's house again to watch the football grand final (again, because it was a draw last week). Collingwood won so a few drinks were had and I stayed for dinner. Today I've just been cleaning my house and doing my assignment which is due tomorrow and I've just finished. It was about patient care following a blood transfusion allergic reaction.
This week I have off but I have quite a bit planned: Monday - yoga, return library books, massage; Tuesday - hairdresser, take manny to vet for vaccinations; Wednesday - Le Bop dance class; Thursday - teaching; Friday - teaching.
Wednesday, September 29, 2010
Only 2 days left!
My clinical placement is just flying! It has been going really well, I'm enjoying it so much. All the nurses and doctors in the ward I am in are just so friendly and helpful. The patients have all been really different and I've been learning a lot about the pathophysiologies of their illnesses as well as getting the chance to practise new skills.
Goals that I've already achieved are: taking blood, giving showers/baths to patients with limited mobility (like stroke patients), taking out drainage tubes, performing an ECG, transfering a patient using a hoist, PEG tube feeding, urinary catheter removal, lots and lots of injections, nursing care planning and time management, and increasing my drug knowledge.
Every day after handover and before I give the 8:00am meds, I make a timeline plan for the whole day for the patients I am helping my buddy look after (usually 4). Then I look up all the drugs the patients are on (if I'm not familiar with the drug), and write it down in my notebook. So far I've familiarised myself with 58 new drugs!
The wide variety of patients this week have included: an Indonesian student - so got to use my language skills with him of course(actually about a quarter of the patients are international or have a low level of English), a Collingwood supporter, patient with bipolar disorder who can be really lovely one minute and abusive the next, patient with incontinance due to a stroke and who required full nursing care including spoon feeding, and young guy with dystonia. Dystonia is a neurological movement disorder, in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures. He can't swallow so is fed through a PEG tub in his stomach, and he can't talk either. Unfortunately there is no cure but his symptoms are being treated with a special drug that had to be ordered from the US and costs over $1000.
Another interesting thing that I had never heard of before but have seen a lot of on this placement is the artereovenous fistula that renal dialysis patients have on their arm for a good strong, long term, access point to their blood (for the heamodyalis). One of the nurse's jobs is to feel it and listen to it with the stethescope to make sure it's working properly. They come in different shapes and sizes but look to me like a little mountain, or range of mountains, under the skin. When you feel it, the pulse is really strong. Actually you can even see it pulsating, and when you listen with the stethescope it makes a whooshing sound.
Today was my last early shift, so tomorrow I get a sleep in - YAY! and I can stay up late and watch TV - YAY AGAIN!
Goals that I've already achieved are: taking blood, giving showers/baths to patients with limited mobility (like stroke patients), taking out drainage tubes, performing an ECG, transfering a patient using a hoist, PEG tube feeding, urinary catheter removal, lots and lots of injections, nursing care planning and time management, and increasing my drug knowledge.
Every day after handover and before I give the 8:00am meds, I make a timeline plan for the whole day for the patients I am helping my buddy look after (usually 4). Then I look up all the drugs the patients are on (if I'm not familiar with the drug), and write it down in my notebook. So far I've familiarised myself with 58 new drugs!
The wide variety of patients this week have included: an Indonesian student - so got to use my language skills with him of course(actually about a quarter of the patients are international or have a low level of English), a Collingwood supporter, patient with bipolar disorder who can be really lovely one minute and abusive the next, patient with incontinance due to a stroke and who required full nursing care including spoon feeding, and young guy with dystonia. Dystonia is a neurological movement disorder, in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures. He can't swallow so is fed through a PEG tub in his stomach, and he can't talk either. Unfortunately there is no cure but his symptoms are being treated with a special drug that had to be ordered from the US and costs over $1000.
Another interesting thing that I had never heard of before but have seen a lot of on this placement is the artereovenous fistula that renal dialysis patients have on their arm for a good strong, long term, access point to their blood (for the heamodyalis). One of the nurse's jobs is to feel it and listen to it with the stethescope to make sure it's working properly. They come in different shapes and sizes but look to me like a little mountain, or range of mountains, under the skin. When you feel it, the pulse is really strong. Actually you can even see it pulsating, and when you listen with the stethescope it makes a whooshing sound.
Today was my last early shift, so tomorrow I get a sleep in - YAY! and I can stay up late and watch TV - YAY AGAIN!
Friday, September 24, 2010
Fantastic first week!
My first week of placement has flown fast and been really good. I've had a different nurse buddy everyday and they have all been so nice and good teachers and gave excellent feedback about me to my clinical educator, so I passed the first week assessment with flying colours.
I've had a really interesting mix of patients including: 3 different kidney transplant patients at different stages, an HIV positive African refugee, alcohol and drug addicts who are going through withdrawal, suicide risk patients, and stroke patients.
Some of skills I've had a chance to practise are: lots of injections (including morphine), removing drainage tubes and urinary cathether (on a male), bed baths and showers, and sterile wound dressings.
Looking forward to next week but nice to have a break this weekend. Today I'm going over to my nan's house to watch the AFL grand final with her - GO PIES! Tomorrow I'll do yoga in the morning and then going to a baby shower for a friend from work in the afternoon.
I've had a really interesting mix of patients including: 3 different kidney transplant patients at different stages, an HIV positive African refugee, alcohol and drug addicts who are going through withdrawal, suicide risk patients, and stroke patients.
Some of skills I've had a chance to practise are: lots of injections (including morphine), removing drainage tubes and urinary cathether (on a male), bed baths and showers, and sterile wound dressings.
Looking forward to next week but nice to have a break this weekend. Today I'm going over to my nan's house to watch the AFL grand final with her - GO PIES! Tomorrow I'll do yoga in the morning and then going to a baby shower for a friend from work in the afternoon.
Tuesday, September 21, 2010
Time to update my blog
I have been pretty absent from this blog for the past month, so apologies if you have been checking it for updates . . . but this week I started my clinical placement! so now I have things to write about. I am at the same hospital as last semester but this time I'm on a different ward and as far as I know I'll be on the same ward for the whole two weeks. It's the renal, neurology and stroke ward so very different patients from my last placement.
Yesterday we just had orientation and because I've been at this hospital before I knew most of the stuff already. Luckily in my group there are two other girls that I'm already friends with and our clinical educator is really really nice.
Today with my buddy nurse (who was also really really nice, so hopefully I will get to work with her again) I looked after 3 patients who have had strokes and one who has just had a kidney transplant after being on dialysis for three years. I think stroke patients are quite interesting because the stroke can affect people in different parts of their brain or body. For example, for some it is more their psychomotor skills that are reduced, while others could be affected in the language part of their brain which makes having a conversation with them confusing, for both parties.
Within the first hour, I gave one patient a shower and did an injection, as well as doing the standard morning vital signs obs, medications, blood sugar level testing and so on. Most of the patients have an indwelling urinary catheter and their fluid intake and output needs to be measured. For the kidney transplantee that needs to be done hourly. Also, looked up lots of medications that I didn't know (that the patients are on)
In the afternoon, there was an education session for graduate (first year) nurses about tracheostomy care and I went along to that which was very interesting. We haven't studied that at uni yet but it's a good opportunity to learn because the teaching is a lot better and easier to absorb in the clinical setting than at uni.
My big blunder today (well, not that big but stressful at the time) was that I failed to get up early. I was so organised, went to bed at 9:30 (after taking a sleeping tablet at 8:30), set two alarms for 5am with the plan of having a full shower (ie, including hair wash), making my lunch and being at the hospital by 6:45am for 7:00am start. But no, I completely slept through the alarm and woke up at 6:30!!! I literally put on my uniform, quickly fed manny, ran out the door and to the train station. I arrived 7:10 which is pretty fast but I didn't feel very 'fresh' when I arrived. Ended up spending $20 throughout the day on expensive coffee and food. Oh well. Hopefully will do better tomorrow.
Yesterday we just had orientation and because I've been at this hospital before I knew most of the stuff already. Luckily in my group there are two other girls that I'm already friends with and our clinical educator is really really nice.
Today with my buddy nurse (who was also really really nice, so hopefully I will get to work with her again) I looked after 3 patients who have had strokes and one who has just had a kidney transplant after being on dialysis for three years. I think stroke patients are quite interesting because the stroke can affect people in different parts of their brain or body. For example, for some it is more their psychomotor skills that are reduced, while others could be affected in the language part of their brain which makes having a conversation with them confusing, for both parties.
Within the first hour, I gave one patient a shower and did an injection, as well as doing the standard morning vital signs obs, medications, blood sugar level testing and so on. Most of the patients have an indwelling urinary catheter and their fluid intake and output needs to be measured. For the kidney transplantee that needs to be done hourly. Also, looked up lots of medications that I didn't know (that the patients are on)
In the afternoon, there was an education session for graduate (first year) nurses about tracheostomy care and I went along to that which was very interesting. We haven't studied that at uni yet but it's a good opportunity to learn because the teaching is a lot better and easier to absorb in the clinical setting than at uni.
My big blunder today (well, not that big but stressful at the time) was that I failed to get up early. I was so organised, went to bed at 9:30 (after taking a sleeping tablet at 8:30), set two alarms for 5am with the plan of having a full shower (ie, including hair wash), making my lunch and being at the hospital by 6:45am for 7:00am start. But no, I completely slept through the alarm and woke up at 6:30!!! I literally put on my uniform, quickly fed manny, ran out the door and to the train station. I arrived 7:10 which is pretty fast but I didn't feel very 'fresh' when I arrived. Ended up spending $20 throughout the day on expensive coffee and food. Oh well. Hopefully will do better tomorrow.
Thursday, September 2, 2010
2 assignments down, 2 to go
Finally finished the two assignments I have been working on this week. I had forgotten how long it can take to write an essay and how many times it needs to be re-checked and edited.
The first one was a 1000 word scenario for Acute Care about a patient having an adverse reaction to a blood transfusion. That one is due today and I just submitted it online. The second one is a 2000 word essay about community health needs assessment. I've managed to get it down to the right amount of words, and now I just need to read over it again a couple of times over the weekend to check for errors. It's worth 40% so I hope I do well on it. I'll hand that in next week on the due date.
Now I have just one more week "off" before my acute hospital placement. I've got two more assignments of 1000 words each that I haven't even looked at yet. Next week I'll try to get as much of those done as possible so I don't have to do them while I'm on placement. If I don't get them finished though there's no need to stress as they're not due for another month or so.
The first one was a 1000 word scenario for Acute Care about a patient having an adverse reaction to a blood transfusion. That one is due today and I just submitted it online. The second one is a 2000 word essay about community health needs assessment. I've managed to get it down to the right amount of words, and now I just need to read over it again a couple of times over the weekend to check for errors. It's worth 40% so I hope I do well on it. I'll hand that in next week on the due date.
Now I have just one more week "off" before my acute hospital placement. I've got two more assignments of 1000 words each that I haven't even looked at yet. Next week I'll try to get as much of those done as possible so I don't have to do them while I'm on placement. If I don't get them finished though there's no need to stress as they're not due for another month or so.
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