Wow, sorry it's been so long since I blogged. It's just been the last thing on my mind since exams finished, LOL.
I got a few of my results back a while a go:
Acute Care:
Assignment # 1: 62%
Assignment # 2: 92%
Practical Exam (Venepuncture): 100%!!
Total grade for Acute Care: 75 (B)
Pretty happy with that.
Community Nursing:
Group Assignment: 90%
Team oral presentation: 95%
Online quiz: 85%
Assignment # 1: 55% (everyone I know got this mark or lower . . . WTF??)
Assignment # 2: don't know
Total grade for Community Nursing: 69 (C) . . . why couldn't I get just one more point??? Then it would be B instead of a C. Oh well.
I haven't completed my clinical placement or my assignment (based on the placement) yet so I don't know what my grade is for that subject is and I can't even find out what mark I got for the exam worth 50%.
I'm leaving for Canberra at the end of this week, staying there for one month to do my mental health placement. I've actually been reading up in the last week or so - drug abuse, schizophrenia, self-harm, bi-polar etc.
Also enrolled in next year's subjects. I'm already half way through my course and this time next year I'll be finished, I'll be ready to get out there and start my career as a registered nurse! How time flies. It's wonderful to set goals and slowly see yourself achieving them.
2011 THIRD YEAR NURSING SUBJECTS:
Semester 1:
Complex Care Nursing
Nursing Older People
Professional Transition in Nursing
Semester 2:
Interactions in Nursing
Clinical Practice Consolidation
Managing Chronic Conditions
That's all for now. Will definitely be blogging more often this month while I'm on my placement. No doubt I will have some very interesting stories from the psych ward!
Monday, November 22, 2010
Thursday, November 11, 2010
I got venepuncture!
Yay! I think I did pretty well, I hope so because it is worth 25%. Now just have Acute Care multiple choice exam to go. Only 30 questions and worth 15%.
Wednesday, November 10, 2010
Acute Care Practical Exam prep
Mental Health was not too bad, I think I definitely got at least three quarters of the answers right and the rest I made an educated guess. The most annoying thing about the exam was that quite a few questions were repeated and there were loads of typo and grammatical errors which they interrupted us at least 5 or 6 times during the exam to correct them. I don't think the exam was proofread until after it had been printed.
Anyway, that's out of the way now. For today's Acute Care Practical Skills exam I have to be prepared to perform and talk about these three skills: venepuncture, wound packing, and oxygen therapy. I will only do one skill in the exam but won't know which one it is until I get there.
To prepare I have done the following:
Reading:
• Oxygen therapy via nasal cannula or various masks
• Complex wounds – packing a wound
• Venipuncture
• Aseptic dressing technique
• Assessment of breathing
• Positioning a breathless patient
• Administering humidified oxygen
• Measuring peak expiratory flow rate
• Measuring pulse oximetry (oxygen saturation)
Youtube Videos:
• Oxygen therapy skills demonstration (20 minutes)
• Performing Venipuncture - taking blood (7 minutes)
• Wound Irrigation, Packing and dressing (7 minutes)
I also invited my (new) boyfriend around to practice venepuncture and wound packing procedure on him (just pretend of course, but using the actual equipment to build up my psychomotor skills), and he even gave me some constructive feedback. I hope I get to do venepuncture in the exam because of the three I think it's the most straight forward, uncomplicated and I've had quite a bit of practice doing it both in the labs with the fake arm, and on clinical placements.
Anyway, that's out of the way now. For today's Acute Care Practical Skills exam I have to be prepared to perform and talk about these three skills: venepuncture, wound packing, and oxygen therapy. I will only do one skill in the exam but won't know which one it is until I get there.
To prepare I have done the following:
Reading:
• Oxygen therapy via nasal cannula or various masks
• Complex wounds – packing a wound
• Venipuncture
• Aseptic dressing technique
• Assessment of breathing
• Positioning a breathless patient
• Administering humidified oxygen
• Measuring peak expiratory flow rate
• Measuring pulse oximetry (oxygen saturation)
Youtube Videos:
• Oxygen therapy skills demonstration (20 minutes)
• Performing Venipuncture - taking blood (7 minutes)
• Wound Irrigation, Packing and dressing (7 minutes)
I also invited my (new) boyfriend around to practice venepuncture and wound packing procedure on him (just pretend of course, but using the actual equipment to build up my psychomotor skills), and he even gave me some constructive feedback. I hope I get to do venepuncture in the exam because of the three I think it's the most straight forward, uncomplicated and I've had quite a bit of practice doing it both in the labs with the fake arm, and on clinical placements.
Tuesday, November 9, 2010
Mental Health Exam Prep ctd
Reviewed all mental health drugs in the following categories:
• Antianxiety agents (benzodiazepines) – eg. Alprazolam a.k.a “Xanax”, Diazepam a.k.a “Valium” and Oxazepam a.k.a “Serapax”.
• Antidepressants – Tricyclic (eg. Amitriptyline a.k.a “Endep”), Monoamine oxidase inhibitors, selective serotonin reuptake inhibitors (eg. Escitalopram a.k.a “Lexapro”, Fluoxetine a.k.a “Prozac” and Sertraline a.k.a “Zoloft”), serotonin and noradrenaline reuptake inhibitors (eg. duloxetine a.k.a “Cymbalta” and Venlafaxine a.k.a “Efexor”), and atypical antidepressants (eg. Mirtazapine a.k.a “Avanza/Sol Tab”).
• Antipsychotics/Neuroleptics – eg. Carbamazepine, Chlorpromazine a.k.a “Largactil”, Clozapine, Olanzapine a.k.a “Zyprexa”, and Quetiapine a.k.a “Seroquel”.
• Sedatives – eg. Temazepam a.k.a “Normison”, Zopliclone a.k.a “Imovane”, and Zolpidem a.k.a “Stilnox / Ambien”
The examples are ones that I consider to be the most well known . . . how many have you heard of?
Read Australian Clinical Practice Guideline Summaries for:
• adult deliberate self-harm
• Suicidal thoughts and behaviours
• Depression
• Bipolar disorder
• Anorexia nervosa
• Schizophrenia
• Panic disorder and phobias
Then I did the short answer section of a past exam that a classmate emailed to me. Although this exam is open answer instead of multiple choice it’s a good indication of the types of questions that might come up in the exam.
1. List the components considered to comprise a comprehensive psychiatric assessment.
2. Name the key components of a mental status examination.
3. Name five risk factors that indicate increased risk of suicide.
4. With regard to schizophrenia name:
a. Three types of hallucination
b. Two types of delusional thinking
5. List five key signs of clinical depression.
6. List five key signs of bi-polar disorder in the acute phase of illness.
7. List four common side effects of anti-psychotic medications.
8. Name the five criteria for involuntary treatment as prescribed in the Mental Health Act:
9. What are the key elements of seclusion as described by the Mental Health Act.
10. List the forms of non medical psychological treatment used in the treatment for a person with a mental illness.
11. Name the three major themes identified by VIC HEALTH for priority action in Mental Health Promotion.
12. Within communication skills, what are the two types of questions utilised to elicit information from clients.
• Antianxiety agents (benzodiazepines) – eg. Alprazolam a.k.a “Xanax”, Diazepam a.k.a “Valium” and Oxazepam a.k.a “Serapax”.
• Antidepressants – Tricyclic (eg. Amitriptyline a.k.a “Endep”), Monoamine oxidase inhibitors, selective serotonin reuptake inhibitors (eg. Escitalopram a.k.a “Lexapro”, Fluoxetine a.k.a “Prozac” and Sertraline a.k.a “Zoloft”), serotonin and noradrenaline reuptake inhibitors (eg. duloxetine a.k.a “Cymbalta” and Venlafaxine a.k.a “Efexor”), and atypical antidepressants (eg. Mirtazapine a.k.a “Avanza/Sol Tab”).
• Antipsychotics/Neuroleptics – eg. Carbamazepine, Chlorpromazine a.k.a “Largactil”, Clozapine, Olanzapine a.k.a “Zyprexa”, and Quetiapine a.k.a “Seroquel”.
• Sedatives – eg. Temazepam a.k.a “Normison”, Zopliclone a.k.a “Imovane”, and Zolpidem a.k.a “Stilnox / Ambien”
The examples are ones that I consider to be the most well known . . . how many have you heard of?
Read Australian Clinical Practice Guideline Summaries for:
• adult deliberate self-harm
• Suicidal thoughts and behaviours
• Depression
• Bipolar disorder
• Anorexia nervosa
• Schizophrenia
• Panic disorder and phobias
Then I did the short answer section of a past exam that a classmate emailed to me. Although this exam is open answer instead of multiple choice it’s a good indication of the types of questions that might come up in the exam.
1. List the components considered to comprise a comprehensive psychiatric assessment.
2. Name the key components of a mental status examination.
3. Name five risk factors that indicate increased risk of suicide.
4. With regard to schizophrenia name:
a. Three types of hallucination
b. Two types of delusional thinking
5. List five key signs of clinical depression.
6. List five key signs of bi-polar disorder in the acute phase of illness.
7. List four common side effects of anti-psychotic medications.
8. Name the five criteria for involuntary treatment as prescribed in the Mental Health Act:
9. What are the key elements of seclusion as described by the Mental Health Act.
10. List the forms of non medical psychological treatment used in the treatment for a person with a mental illness.
11. Name the three major themes identified by VIC HEALTH for priority action in Mental Health Promotion.
12. Within communication skills, what are the two types of questions utilised to elicit information from clients.
Sunday, November 7, 2010
Mental Health Exam Prep
My first exam is for Mental Health Nursing at 9am this Wednesday. It's going to be 100 multiple choice questions and worth 50% of the total grade for the subject, so basically I'm just reviewing everything they've thrown at us in the form of lectures and reading. This is what I've covered in the last few days:
Lectures:
• The Nursing Considerations of a Patient with Mental Illness in the General Ward.
• Therapeutic Relationships
• Psychopharmacology
• Mental Status Examination
• Mini mental examination
• Mental Health Assessment
Reading:
• Procedure for making a request and recommendation for involuntary treatment as an inpatient or in the community under the Mental Health Act.
• Mental Health Assessment and Care Planning`
• Applying the recovery model of intervention
• Recovering from Chronic Mental Illness Guidelines
• National Practice Standards for the Mental Health Workforce
• National Aboriginal and Torres Straight Islander Health Survey Summary of Findings
• Cultural Considerations and Communication Techniques Guidelines for Providing Mental Health First Aid to an Aboriginal or Torres Strait Islander Person
• Anthropology in the Clinic: The Problem with Cultural Competency
• Metabolic Syndrome
Lectures:
• The Nursing Considerations of a Patient with Mental Illness in the General Ward.
• Therapeutic Relationships
• Psychopharmacology
• Mental Status Examination
• Mini mental examination
• Mental Health Assessment
Reading:
• Procedure for making a request and recommendation for involuntary treatment as an inpatient or in the community under the Mental Health Act.
• Mental Health Assessment and Care Planning`
• Applying the recovery model of intervention
• Recovering from Chronic Mental Illness Guidelines
• National Practice Standards for the Mental Health Workforce
• National Aboriginal and Torres Straight Islander Health Survey Summary of Findings
• Cultural Considerations and Communication Techniques Guidelines for Providing Mental Health First Aid to an Aboriginal or Torres Strait Islander Person
• Anthropology in the Clinic: The Problem with Cultural Competency
• Metabolic Syndrome
Wednesday, November 3, 2010
Reading – Drug Use in Australia: Preventing Harm
I started reading this book just before I had my clinical placement in the detox centre and have found it really interesting and well-written. These are the chapters that I've read through so far:
• Psychological theories of drug use and dependence
• The Social Context of Drug Use
• Alcohol and Aboriginal Society Heavy Drinking and Allied Responses
• Women and Drugs
• Adolescent Substance Abuse
• Addressing Drug Problems: the case for harm minimisation
• The problem with grand theories of drug use – this chapter was about how society tends to villainise and stereotype drug users as sinners, sick people and social victims. Furthermore, a drug user’s socioeconomic status and physical appearance will determine how society and the justice system view them. For example, users who come from poor families, are unemployed, need to commit crimes to pay for drugs, or have sores on their skin get labelled as “junkies”, whereas users who are well-heeled (think Matthew Newton, Kate Moss, Lindsey Lohan and Ben Cousins) are merely people who “have some issues with drugs/alcohol” or are “troubled” and “need some time off to get help and deal with their demons”. Because of their beautiful appearances, high profile jobs and bank balances they can avoid criminal convictions and harsh labels, and instead they go to rehab centres which are extremely expensive and inaccessible to the average person. Similarly, kids from the poor side of town who drink and take drugs in the park or at the train station get called “nuisances” and “delinquents” wasting their lives, whereas rich kids who drink and take drugs at parties in posh homes are “party animals” just having a good time and letting off steam at the weekend (after studying so hard during the week). The reality is that drug users come from all walks of life, and have different reasons for using drugs. Some are addicted or use excessively which seriously affects their lives and those around them in a negative way, while others are social users who do not have any problems. Some are physically addicted, while others are only psychologically addicted (ie. Their mind really wants it but they’re not getting the shakes or feeling sick if they don’t have it). Some use every day while others wait till the weekend then binge, and even those people are not necessarily addicts, just like people who go out drinking every weekend, or who have a glass of wine or two with dinner every night are not necessarily alcoholics. All in all, broad generalisations and being quick to judge is dangerous and counter-effective to fixing the problem.
I also read two books that I found in my school library:
• The Truth about Heroin Addiction and Treatment
• Alcoholism and the Family
• Psychological theories of drug use and dependence
• The Social Context of Drug Use
• Alcohol and Aboriginal Society Heavy Drinking and Allied Responses
• Women and Drugs
• Adolescent Substance Abuse
• Addressing Drug Problems: the case for harm minimisation
• The problem with grand theories of drug use – this chapter was about how society tends to villainise and stereotype drug users as sinners, sick people and social victims. Furthermore, a drug user’s socioeconomic status and physical appearance will determine how society and the justice system view them. For example, users who come from poor families, are unemployed, need to commit crimes to pay for drugs, or have sores on their skin get labelled as “junkies”, whereas users who are well-heeled (think Matthew Newton, Kate Moss, Lindsey Lohan and Ben Cousins) are merely people who “have some issues with drugs/alcohol” or are “troubled” and “need some time off to get help and deal with their demons”. Because of their beautiful appearances, high profile jobs and bank balances they can avoid criminal convictions and harsh labels, and instead they go to rehab centres which are extremely expensive and inaccessible to the average person. Similarly, kids from the poor side of town who drink and take drugs in the park or at the train station get called “nuisances” and “delinquents” wasting their lives, whereas rich kids who drink and take drugs at parties in posh homes are “party animals” just having a good time and letting off steam at the weekend (after studying so hard during the week). The reality is that drug users come from all walks of life, and have different reasons for using drugs. Some are addicted or use excessively which seriously affects their lives and those around them in a negative way, while others are social users who do not have any problems. Some are physically addicted, while others are only psychologically addicted (ie. Their mind really wants it but they’re not getting the shakes or feeling sick if they don’t have it). Some use every day while others wait till the weekend then binge, and even those people are not necessarily addicts, just like people who go out drinking every weekend, or who have a glass of wine or two with dinner every night are not necessarily alcoholics. All in all, broad generalisations and being quick to judge is dangerous and counter-effective to fixing the problem.
I also read two books that I found in my school library:
• The Truth about Heroin Addiction and Treatment
• Alcoholism and the Family
Friday, October 22, 2010
Detox Diary - Week 2
Day 6 - A client self-discharged after 3 days. We talked to her and tried to convince her to stay but she kept saying "I can't do it", and "I feel like I'm going crazy". Because she had already bonded with the other clients, we had a meeting with them after she left so they could talk about how they felt about her leaving.
Day 7 - A new client was admitted and he was clearly high on heroin but denied that he had just had some. It's not unusual for them to have one last hit before to ease their anxiety. Some tell you straight out that that's what they did, while others are ashamed or think they'll be judged negatively for doing that. Actually the reason the nursing staff need to know is because we need to monitor their withdrawal symptoms and planning their medication accordingly. He had no withdrawal symptoms, speech very slurred, very flat affect, about a 5 second delay when you ask him a question and pupils were not reacting to light (we shine a torch in their eyes). When someone has had narcotics, whether it's heroin, morphine or general anaesthesia, their pupils are very small and do not reacted to light. When we did his bag search (I get to live my border security fantasy or being a customs officer by doing bag searches when the clients come in), we found two used syringes in his backpack. It was a difficult and awkward admission, he seemed very negative and not sure about being in detox, and had no plans for when he got out.
Day 8 - slept through my alarm and was two hours late today . . . oops! luckily they said it was no problem. I offered to stay back to make up the hours but they said not to worry about it.
Day 9 - Led an afternoon discussion group on "mindfullness" - being mindful of your thoughts, words, behaviour and the effects they have on those around you, especially in this environment right now. The client who was admitted two days previously who was high on heroin when he came in, is now coming out of his shell, we are seeing more of his personality, sense of humour and other good qualities he has. He says he feels "straight" and really good, and that he is really enjoying being here . . what a turnaround! Actually it is very heartwarming to see that by the end of their stay, most clients don't want to leave because they are so happy with where they are at, in a safe, supportive, happy, healthy, drug free environment. However, they have to move on and start rebuilding their life. Most go to assited living/rehab facilities with a plan to stay for three months or more. The places they go to have activities to keep them busy, regular/daily AA and NA meetings, meditation, housework and other life skills they have to do, and counselling. They are allowed to leave, but they get random urine testing and if they have been drinking or using drugs they're out.
Day 10 - watched a documentary about recovering heroin addicts on the methadone program. After watching this I am totally for this program. Not everyone realises this but being on the methadone (or suboxone) program means these addicts have to go to the same pharmacy every day for their dose, and it does not make them feel 'high' or like they have had 'free heroin'. The drug does affect the same opiate receptors but it just makes them feel 'normal' or 'straight' and not craving heroin. Some addicts do use heroin on top of their methadone because psychologically they want the 'rush', however physically they do not need it. Being on methadone is expensive, about $150 per month, and it is not covered by PBS. However, it is a lot cheaper than having a daily heroin addiction which can cost up to $100 a day for long-term users, and most of them would have to commit crimes such as burglary or prostitution to find this kind of money.
Also took a couple of clients clothes shopping at the Salvation Army store. Some clients are homeless or come to detox with just the clothes they are wearing. If they have no money they can get a voucher.
The last thing that happened today is I am going to be a Salvation Army volunteer! I will be doing a one hour meditation and relaxation techniques instruction and discussion group every week in the next month's activities program. I will most probably doing it on a week night. How exciting! I am really happy about this.
Day 7 - A new client was admitted and he was clearly high on heroin but denied that he had just had some. It's not unusual for them to have one last hit before to ease their anxiety. Some tell you straight out that that's what they did, while others are ashamed or think they'll be judged negatively for doing that. Actually the reason the nursing staff need to know is because we need to monitor their withdrawal symptoms and planning their medication accordingly. He had no withdrawal symptoms, speech very slurred, very flat affect, about a 5 second delay when you ask him a question and pupils were not reacting to light (we shine a torch in their eyes). When someone has had narcotics, whether it's heroin, morphine or general anaesthesia, their pupils are very small and do not reacted to light. When we did his bag search (I get to live my border security fantasy or being a customs officer by doing bag searches when the clients come in), we found two used syringes in his backpack. It was a difficult and awkward admission, he seemed very negative and not sure about being in detox, and had no plans for when he got out.
Day 8 - slept through my alarm and was two hours late today . . . oops! luckily they said it was no problem. I offered to stay back to make up the hours but they said not to worry about it.
Day 9 - Led an afternoon discussion group on "mindfullness" - being mindful of your thoughts, words, behaviour and the effects they have on those around you, especially in this environment right now. The client who was admitted two days previously who was high on heroin when he came in, is now coming out of his shell, we are seeing more of his personality, sense of humour and other good qualities he has. He says he feels "straight" and really good, and that he is really enjoying being here . . what a turnaround! Actually it is very heartwarming to see that by the end of their stay, most clients don't want to leave because they are so happy with where they are at, in a safe, supportive, happy, healthy, drug free environment. However, they have to move on and start rebuilding their life. Most go to assited living/rehab facilities with a plan to stay for three months or more. The places they go to have activities to keep them busy, regular/daily AA and NA meetings, meditation, housework and other life skills they have to do, and counselling. They are allowed to leave, but they get random urine testing and if they have been drinking or using drugs they're out.
Day 10 - watched a documentary about recovering heroin addicts on the methadone program. After watching this I am totally for this program. Not everyone realises this but being on the methadone (or suboxone) program means these addicts have to go to the same pharmacy every day for their dose, and it does not make them feel 'high' or like they have had 'free heroin'. The drug does affect the same opiate receptors but it just makes them feel 'normal' or 'straight' and not craving heroin. Some addicts do use heroin on top of their methadone because psychologically they want the 'rush', however physically they do not need it. Being on methadone is expensive, about $150 per month, and it is not covered by PBS. However, it is a lot cheaper than having a daily heroin addiction which can cost up to $100 a day for long-term users, and most of them would have to commit crimes such as burglary or prostitution to find this kind of money.
Also took a couple of clients clothes shopping at the Salvation Army store. Some clients are homeless or come to detox with just the clothes they are wearing. If they have no money they can get a voucher.
The last thing that happened today is I am going to be a Salvation Army volunteer! I will be doing a one hour meditation and relaxation techniques instruction and discussion group every week in the next month's activities program. I will most probably doing it on a week night. How exciting! I am really happy about this.
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