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.

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

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).

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

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.

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

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.