Tuesday, March 30, 2010
Blood & Guts
Tonight's SBS viewing was Blood & Guts: A History of Surgery - The Heart, and Operation Live: Brain Surgery. Coincidently, that is an exact reversal of last week. In the live brain surgery the patient was having a tumor removed and was awake during the surgery. I've seen this before in a documentary called The English Surgeon. The reason the patient is awake during the surgery is because the surgical team need to interact with him/her to prevent permanently damaging their speech/motor/comprehension skills. They use an electric probe to stimulate the area where they want to cut before they cut it to check. In tonight's show it was the speech lobe which they suspected could be affected and they had the patient counting out loud while they prodded around the area with the probe. A couple of times he actually did suddenly stop speaking. That must have been really scary for the patient. In the other movie they carried on a conversation with the patient and had him moving his arms and legs too. There are no pain sensors in the brain itself but of course for the skull they need to use local anesthetic. The most horrific bit is that they used an electric saw and drill to open the skull and the patient can hear it and feel the vibration! I've watched a lot of medical and surgical docos in the last 12 months, partly because it's interesting but also to desenstise myself. Now I'm at the stage where I can easily eat a (meaty)dinner while watching this stuff and I don't feel any queasiness or anything.
Mid-week update
Even though it's only Tuesday, this a a mid-week update because there is no uni on Friday due to Good Friday. So far this week I've done:
• Analgesics and Anti-Inflammatories lecture
• Medications workshop
• Clinical Assessment Workshop
• Watched a movie length video on the uni website about Health Assessment and Collecting Subjective Data (it was a comedy in the sense that it more shows what not to do than what you’re meant to do, and people in it are obviously actors)
• Finished and submitted my Pre Op Patient Teaching Plan for Post-Op Wound Care. It’s not worth any marks but it’s been set as homework and I’ll get feedback on it. If you read this you'll notice that we have to provide a rationale for every single step of the care plan. When we do our skills assessment exams we also have to explain the reason for everything while we're doing it and if we don't the examiner will interrupt and ask "Why are you doing that?".
Care Plan for Pre-Operative Patient Teaching Regarding Post - Operative Wound Care
Problem
Mr Brown will have an anterior resection of his colon to remove a rectosigmoid carcinoma. He will need teaching to understand:
1. What wounds he will or may have after the surgery;
2. How the nurses will care his post-operative wounds; and
3. His own responsibilities as a patient to manage and care for his post-operative wounds.
Goals
• Establish rapport by using communication and interpersonal relationship skills. Rationale: To encourage client’s participation in the plan.
• Assess client’s learning needs related to the surgical procedure, such as how much he already knows about it and what questions he has. Rationale: To fill in knowledge gaps or correct mistaken beliefs the client may have.
• Determine clients learning style by asking how he feels he learns best, whether by reading, listening, hands-on learning, or a combination of styles. Rationale: To select appropriate teaching strategies and educational settings.
• Find out what written, visual, and audio-visual materials are available to give to the patient, such as brochures. Rationale: Different forms of learning material reinforce and clarify what you have taught the client.
• Set only one or two objectives per teaching session. Rationale: Overloading the client with information will not allow him to master the information necessary for compliance.
• Establish a specific goal at the beginning of the teaching session and stick to the plan. Rationale: Not deviating from the plan or going off on a tangent reinforces your commitment to help the client master the content, and the importance of it.
• Use professional, therapeutic, and easy to understand language. Rationale: Enhances learning. Use the following explanation to teach client about what wounds he will have or may have following the surgery:
o “For open colectomy, your surgeon will make 6-inch cut in your lower abdomen then find the part of your colon that is diseased. The surgeon will then put clamps on both ends of this part to close it off and remove the diseased part. If there is enough healthy large intestine left, your surgeon will sew or staple the healthy ends back together. Most patients have this done.
o If you do not have enough healthy large intestine to reconnect, your surgeon will make an opening called a stoma through the skin of your belly. Your large intestine will be attached to the outer wall of your belly. Stool will go through the stoma into a drainage bag outside your body. This is called a colostomy. In most cases, the colostomy is short-term. It can be closed with another operation later. But, if a large part of your bowel is removed, the colostomy may be permanent.”
• Teach client how the nurses will care his post-operative wounds. Rationale: Taking away any unpleasant surprise elements following the surgery will reduce the patient’s stress and anxiety, and promote compliance with the plan. (I have not included care for the colostomy here because it may not be necessary, just the surgical incision wound)
o You will have an incision in your abdomen which we will need to inspect regularly in the days and weeks following your surgery. It will be covered by a gauze dressing there will be drainage tubes and a drainage bag attached to the wound.
o We will check the wound for drainage amount and colour, irritation, and infection, and change the dressing as needed.
• Teach client his individual responsibilities for health behaviours regarding wound management. Rationale: Will promote wound healing.
o A small amount of oozing and drainage is normal so don’t be alarmed but you must let us know if it becomes excessive.
o The wound is likely to be painful and you should not hesitate to describe the level of pain (on a scale of 1 to 10) as well as the quality and any factors that intensify or relieve the pain such as movement or deep breathing.
o When you go home, you can have your wife do the dressing change and we will show her exactly how to do that when she is here, but it is important that you know how to do it as well, just in case she is not available to do for some reason.
o It is absolutely essential that you and whoever is changing your dressing has washed their hands very thoroughly with soap before and after, and do not touch the wound itself with your bare hands.
Evaluation:
• Request feedback during the teaching process. Rationale: Lets you know how the client is understanding the content and allows for modification as need.
• Ask client to explain the demonstration using his own words. Rationale: As above.
• After demonstrating skills, ask client to complete a return demonstration. Rationale: Allows you to observe client’s ability to perform tasks.
• Use an appropriate evaluative tool, such as a multidisciplinary teaching record used by the hospital, to record the evaluation. Rationale: Documents what teaching took place and what goals were achieved regarding patient education, which can then be placed in their file. Also can be used to avoid repeating patient teaching when it is not necessary.
• Do a self evaluation of teaching methods, teaching materials, and communication skills, by noting any problems you had, what you think went well, and questions you can look up or ask more experienced nurses. Rationale: Helps you become a better nurse.
References:
US National Library of Medicine: Medline Plus. Large Bowel Resection. http://www.nlm.nih.gov/medlineplus/ency/article/002941.htm (Accessed 30/3/10)
Smith, Duell & Martin (2008). Clinical Nursing Skills: Basic to Advanced Skills: Ch 5 Client Education and Discharge Planning. Pearson Education International, New Jersey.
Elkin, Potter & Perry (2007). Nursing Interventions & Clinical Skills 4th Edition: Ch 21 Surgical Wound Care. Mosby Elsevier, USA.
• Analgesics and Anti-Inflammatories lecture
• Medications workshop
• Clinical Assessment Workshop
• Watched a movie length video on the uni website about Health Assessment and Collecting Subjective Data (it was a comedy in the sense that it more shows what not to do than what you’re meant to do, and people in it are obviously actors)
• Finished and submitted my Pre Op Patient Teaching Plan for Post-Op Wound Care. It’s not worth any marks but it’s been set as homework and I’ll get feedback on it. If you read this you'll notice that we have to provide a rationale for every single step of the care plan. When we do our skills assessment exams we also have to explain the reason for everything while we're doing it and if we don't the examiner will interrupt and ask "Why are you doing that?".
Care Plan for Pre-Operative Patient Teaching Regarding Post - Operative Wound Care
Problem
Mr Brown will have an anterior resection of his colon to remove a rectosigmoid carcinoma. He will need teaching to understand:
1. What wounds he will or may have after the surgery;
2. How the nurses will care his post-operative wounds; and
3. His own responsibilities as a patient to manage and care for his post-operative wounds.
Goals
• Establish rapport by using communication and interpersonal relationship skills. Rationale: To encourage client’s participation in the plan.
• Assess client’s learning needs related to the surgical procedure, such as how much he already knows about it and what questions he has. Rationale: To fill in knowledge gaps or correct mistaken beliefs the client may have.
• Determine clients learning style by asking how he feels he learns best, whether by reading, listening, hands-on learning, or a combination of styles. Rationale: To select appropriate teaching strategies and educational settings.
• Find out what written, visual, and audio-visual materials are available to give to the patient, such as brochures. Rationale: Different forms of learning material reinforce and clarify what you have taught the client.
• Set only one or two objectives per teaching session. Rationale: Overloading the client with information will not allow him to master the information necessary for compliance.
• Establish a specific goal at the beginning of the teaching session and stick to the plan. Rationale: Not deviating from the plan or going off on a tangent reinforces your commitment to help the client master the content, and the importance of it.
• Use professional, therapeutic, and easy to understand language. Rationale: Enhances learning. Use the following explanation to teach client about what wounds he will have or may have following the surgery:
o “For open colectomy, your surgeon will make 6-inch cut in your lower abdomen then find the part of your colon that is diseased. The surgeon will then put clamps on both ends of this part to close it off and remove the diseased part. If there is enough healthy large intestine left, your surgeon will sew or staple the healthy ends back together. Most patients have this done.
o If you do not have enough healthy large intestine to reconnect, your surgeon will make an opening called a stoma through the skin of your belly. Your large intestine will be attached to the outer wall of your belly. Stool will go through the stoma into a drainage bag outside your body. This is called a colostomy. In most cases, the colostomy is short-term. It can be closed with another operation later. But, if a large part of your bowel is removed, the colostomy may be permanent.”
• Teach client how the nurses will care his post-operative wounds. Rationale: Taking away any unpleasant surprise elements following the surgery will reduce the patient’s stress and anxiety, and promote compliance with the plan. (I have not included care for the colostomy here because it may not be necessary, just the surgical incision wound)
o You will have an incision in your abdomen which we will need to inspect regularly in the days and weeks following your surgery. It will be covered by a gauze dressing there will be drainage tubes and a drainage bag attached to the wound.
o We will check the wound for drainage amount and colour, irritation, and infection, and change the dressing as needed.
• Teach client his individual responsibilities for health behaviours regarding wound management. Rationale: Will promote wound healing.
o A small amount of oozing and drainage is normal so don’t be alarmed but you must let us know if it becomes excessive.
o The wound is likely to be painful and you should not hesitate to describe the level of pain (on a scale of 1 to 10) as well as the quality and any factors that intensify or relieve the pain such as movement or deep breathing.
o When you go home, you can have your wife do the dressing change and we will show her exactly how to do that when she is here, but it is important that you know how to do it as well, just in case she is not available to do for some reason.
o It is absolutely essential that you and whoever is changing your dressing has washed their hands very thoroughly with soap before and after, and do not touch the wound itself with your bare hands.
Evaluation:
• Request feedback during the teaching process. Rationale: Lets you know how the client is understanding the content and allows for modification as need.
• Ask client to explain the demonstration using his own words. Rationale: As above.
• After demonstrating skills, ask client to complete a return demonstration. Rationale: Allows you to observe client’s ability to perform tasks.
• Use an appropriate evaluative tool, such as a multidisciplinary teaching record used by the hospital, to record the evaluation. Rationale: Documents what teaching took place and what goals were achieved regarding patient education, which can then be placed in their file. Also can be used to avoid repeating patient teaching when it is not necessary.
• Do a self evaluation of teaching methods, teaching materials, and communication skills, by noting any problems you had, what you think went well, and questions you can look up or ask more experienced nurses. Rationale: Helps you become a better nurse.
References:
US National Library of Medicine: Medline Plus. Large Bowel Resection. http://www.nlm.nih.gov/medlineplus/ency/article/002941.htm (Accessed 30/3/10)
Smith, Duell & Martin (2008). Clinical Nursing Skills: Basic to Advanced Skills: Ch 5 Client Education and Discharge Planning. Pearson Education International, New Jersey.
Elkin, Potter & Perry (2007). Nursing Interventions & Clinical Skills 4th Edition: Ch 21 Surgical Wound Care. Mosby Elsevier, USA.
Monday, March 29, 2010
Stress
Over the weekend I was feeling pretty stressed out. Not so much mentally as physically. For me, being a uni student is more stressful than working because the work never ends, it just seems to keep piling up. When I was working I rarely took any work home, maybe just once every couple of months to mark essays or something but other than that I did all my work at work and home was for relaxing and non-work activities. Also, not having much money is a little bit stressful but it's mainly the amount of learning there is to do.
Stress is really bad for your health, both physical and mental, but it affects different people in different ways. Some people get headaches, some get bad skin - like breakouts or exzema. For me, I get a hard lumps in my back that hurt and feel really tight and it's really hard to get rid of them once they're there. The best way I've found is by massage. Before I started getting regular massages I just carried these things around with me everywhere I went and it felt like crap. My massage therapist couldn't believe how bad my back was when I first came in to see her. Anyway, I had a massage on Saturday and there was one particular 'mound' in my upper back that was especially bad and she basically spent the entire appointment working on this one spot because it was so hard to break down. Besides massage she also used some needles and cupping. Afterwards I was SO SORE. I put heat pads on the spot and took pain killers it was that bad.
I had planned to do a lot of uni work this weekend, but because of that I didn't end up doing much at all, I tried but it was too hard to concentrate. So I ended up doing the usual things I do every weekend which is watch some DVDs (I watched an Indonesian movie called Rahasia Bintang which had very bad acting and lots of blood that looked too much like tomato sauce to be believable, and Ramen Girl - a Japanese movie starring the late Brittany Murphy which was also really terrible - when I lived in Tokyo one of my friends who worked occasionally as a model was an extra in this movie which is why I was interested in watching it), planned my meals for the week and did a grocery shop, cleaned the whole house - vacuum, clean kitchen, bathroom, change and wash sheets, all laundry and ironing - caught up with a couple of friends, but nothing special, just for a chat and a cuppa.
On Sunday I felt fantastic! All the pain and tension was gone! I did all my internet research for my assignment and presentation that is due this week and I went to yoga. Even though I only do Bikram once a week I've noticed that I keep getting better at it and more flexible. That really motivates me, otherwise I'd probably get bored because it's exactly the same series of postures in the same order every time. I'm also addicted to the sweat factor. I feel really clean after about sweating about 2 litres (literally). I also went to the gym twice last week to do an hour of cardio each time. I think a minimum three times a week for exercise is a good idea.
The homework I've been working on is:
• Looking up lots of different drugs for my medications workshop – the drug use, form, action, adverse effects and nursing considerations for each one
• A plan for teaching a patient post operative wound care for colorectal cancer surgery
• A report on informed consent for medical procedures (and I also have to do a 5 minute oral presentation for this on Thursday which is worth 15% of my mark for my Acute Care subject)
In Clinical Assessment Lab last week we did Neurological Assessment which was a lot of fun because as patients we could pretend we had amnesia or drifting in and out of consciousness.
Wednesday, March 24, 2010
Mid-week update
This week I have been attending uni a lot more because my workshops and labs have started. In workshops we review and discuss what we've learned in lectures and work through problems in small groups. In labs we practice clinical skills. Here's what I did this week:
Monday - Medications workshop (3 hours)
Tuesday - no labs or workshops so stayed home to do online lectures and reading. As soon as I started the first lecture the power went out! It stayed out for at least 3 hours and this was the first time that's ever happened in this house from what I can remember. So I was going to do some reading but unfortunately I fell asleep within 15 minutes because I was doing the reading in bed (bad idea). I ended up napping for about 3 hours and consequently felt a bit sluggish when I woke up. I did not really get anything done on this day and had trouble concentrating. However that night there were two very interesting documentaries on SBS. The first was called "Blood & Guts: The History of Surgery" and this was part 1 in a series. This episode was about brain surgery. Gruesome stuff. The second show showed open heart surgery in real time with commentary. The patient's mitral valve was damaged and needed repairing. The mitral valve is supposed to be one-way. If it is damaged by trauma or wear and tear due to high blood pressure the person fitness is greatly reduced and they cough up blood constantly. So even though I didn't do any uni work on Tuesday I still learned a lot from these two programs.
Wednesday - 4 hours of labs and one lecture at uni. In the labs we practised taking vital signs (blood pressure, respiration, pulse, temperature, pain assessment), interviewing the patient on admission to hospital, pre-operative checklist and questionaire, and setting up an IV. I was told I have a very good bedside manner :-D
Lectures this week so far:
• Promoting Normal Kidney & Bladder Function in a Post-operative patient (catheterisation)
• Nutrition Before & After GI Surgery
• Loss & Grief –(not only death but patients dealing with their diagnoses such as losing a limb, a breast, cancer, or an STD)
• Respiratory Assessment
• Endocrine system & metabolic assessment (glucose monitoring & thyroid examination)
• Performing an ECG (Electrocardiogram)
Fitness Challenge Update - On Saturday I had a complete day off from both studying and exercising. I'm not going to lie and say I completed the 7 day challenge because that would be . . . lying. But, it doesn't matter because the point of it was to fit regular exercise back into my schedule which is what I did. I did Bikram yoga on Sunday as usual and last night I did one hour of cardio at the gym while I watched SYTYCD. I love watching these amazing athletes while I work out because it inspires me to be fitter, faster, stronger! (and more flexible)
Monday - Medications workshop (3 hours)
Tuesday - no labs or workshops so stayed home to do online lectures and reading. As soon as I started the first lecture the power went out! It stayed out for at least 3 hours and this was the first time that's ever happened in this house from what I can remember. So I was going to do some reading but unfortunately I fell asleep within 15 minutes because I was doing the reading in bed (bad idea). I ended up napping for about 3 hours and consequently felt a bit sluggish when I woke up. I did not really get anything done on this day and had trouble concentrating. However that night there were two very interesting documentaries on SBS. The first was called "Blood & Guts: The History of Surgery" and this was part 1 in a series. This episode was about brain surgery. Gruesome stuff. The second show showed open heart surgery in real time with commentary. The patient's mitral valve was damaged and needed repairing. The mitral valve is supposed to be one-way. If it is damaged by trauma or wear and tear due to high blood pressure the person fitness is greatly reduced and they cough up blood constantly. So even though I didn't do any uni work on Tuesday I still learned a lot from these two programs.
Wednesday - 4 hours of labs and one lecture at uni. In the labs we practised taking vital signs (blood pressure, respiration, pulse, temperature, pain assessment), interviewing the patient on admission to hospital, pre-operative checklist and questionaire, and setting up an IV. I was told I have a very good bedside manner :-D
Lectures this week so far:
• Promoting Normal Kidney & Bladder Function in a Post-operative patient (catheterisation)
• Nutrition Before & After GI Surgery
• Loss & Grief –(not only death but patients dealing with their diagnoses such as losing a limb, a breast, cancer, or an STD)
• Respiratory Assessment
• Endocrine system & metabolic assessment (glucose monitoring & thyroid examination)
• Performing an ECG (Electrocardiogram)
Fitness Challenge Update - On Saturday I had a complete day off from both studying and exercising. I'm not going to lie and say I completed the 7 day challenge because that would be . . . lying. But, it doesn't matter because the point of it was to fit regular exercise back into my schedule which is what I did. I did Bikram yoga on Sunday as usual and last night I did one hour of cardio at the gym while I watched SYTYCD. I love watching these amazing athletes while I work out because it inspires me to be fitter, faster, stronger! (and more flexible)
Friday, March 19, 2010
Friday 19th
Today I didn't get that much study done at all. I slept in till about 10 and only listened to one lecture which was Risk Management, Law and Ethics in Drug Administration. Even though it was an easy lecture I had trouble concentrating so I just faffed around doing other stuff. I'll do a half day of study this weekend to make up for it, probably on Sunday but I don't feel too bad about it because I've gotten a lot done this week. One other thing I did was listen to the Cardiac and Pulmonary Auscultation CD that came with my Littman stethescope. It has 20 tracks on it containing examples of normal and abnormal heart and lung sounds and what they indicate, then I listened to my own heartbeat and lung sounds - everything was ok.
I'm going out tonight to a concert (The Dead Weather from the US) and I didn't want to exercise and get all sweaty again and have to wash my hair again (it's very hot and humid at the moment) so for my daily exercise I did my Rodney Yee Advanced Pranayama DVD. Pranayama is breath meditation. This still counts as exercise to me because it's very good for the lungs, mind and nervous system, which is very, very important and often gets neglected. For example, I've owned this DVD for about a year and never used it until now. However, now that I've done I'm sure I'll use it again because it is very good, like all of Rodney's DVDs. Rodney Yee has a Buddha-like face, a perfect yoga body and a very soothing voice. Now I feel very relaxed, yet energised and ready to go out and have a good time. Thanks Rodney!
I'm going out tonight to a concert (The Dead Weather from the US) and I didn't want to exercise and get all sweaty again and have to wash my hair again (it's very hot and humid at the moment) so for my daily exercise I did my Rodney Yee Advanced Pranayama DVD. Pranayama is breath meditation. This still counts as exercise to me because it's very good for the lungs, mind and nervous system, which is very, very important and often gets neglected. For example, I've owned this DVD for about a year and never used it until now. However, now that I've done I'm sure I'll use it again because it is very good, like all of Rodney's DVDs. Rodney Yee has a Buddha-like face, a perfect yoga body and a very soothing voice. Now I feel very relaxed, yet energised and ready to go out and have a good time. Thanks Rodney!
Wednesday, March 17, 2010
Thursday 18th
Today's Lectures:
• Pharmacodynamics
• Cardiac Drugs – Autonomic Nervous System
• Cardiac Drugs – Hypertension & High Cholesterol
• Promoting Sleep, Rest & Comfort (this lecture was very easy as I’m already a bit of an expert on this topic)
Videos:
• Monitoring Blood Sugar
• Types of Insulin and their uses
• Mixing Insulin
• Injecting Insulin
• Insulin Pens
I also did some pre-reading for next week’s workshops and labs.
For my exercise today I did one of my Dance DVDs. This time it was Contemporary with Travis. I didn't think the choreography was particularly good, but I gave it my best shot and that's all that matters, lol.
• Pharmacodynamics
• Cardiac Drugs – Autonomic Nervous System
• Cardiac Drugs – Hypertension & High Cholesterol
• Promoting Sleep, Rest & Comfort (this lecture was very easy as I’m already a bit of an expert on this topic)
Videos:
• Monitoring Blood Sugar
• Types of Insulin and their uses
• Mixing Insulin
• Injecting Insulin
• Insulin Pens
I also did some pre-reading for next week’s workshops and labs.
For my exercise today I did one of my Dance DVDs. This time it was Contemporary with Travis. I didn't think the choreography was particularly good, but I gave it my best shot and that's all that matters, lol.
Clinical Placement
I got an email this morning notifying me that I'll be doing my clinical placement this semester at a large well known hospital near the CBD where some really major surgeries are done by Melbourne's top doctors. I think it will be good to have on my CV when I graduate and apply for jobs, and hopefully I'll make a few good contacts. I'll be there for two weeks in May which is after all my uni classes finish but before my exams. I'm so glad I don't have to do my clinical during the uni holidays like some do. That means I'll have AT LEAST a month off between semesters. Awesome!
Subscribe to:
Posts (Atom)