Thursday, February 08, 2007
Our real clinicals started this week and I'm so tired after having gotten up at 5:30 AM to get to my clinical site at 7 AM and then onto my classes all afternoon. Up until this week I thought: wow, being in nursing school is *way* easier than getting into nursing school and the prereq courses, but I'm revising that. This has been an exhausting week. Perhaps part of the exhaustion is that my two kids have been sick with some horrible coughing plague (my daughter sounds like a barking seal and my son is like an accordion with the "breathe" key pushed in.) and there's been extra juggling on everyone's part to make sure they have an adult caring for them all day. And the night waking: my daughter's little fever-y body smashed right next to me in the middle of the night barking like a seal and, me, awake counting down the hours until the alarm goes off. It's always weird to leave the house when it is still dark. There's a semi-exciting/ partially nauseating feeling and it should be dream time, but now I'm on the highway and it's still dark when I get to my clinical site.
So I picked my first patient. I thought, phew, this woman has congestive heart failure, TIAs and is on a million medications (including the drug I feared the most for nasty side effects in my first pharmacology test: amiodarone). I thought: this is going to be hard. And it was really hard. She didn't really want any help from me. The first day I "took care" of her I was panicky. She was happy to let me take her vital signs, but, while all of my fellow students were merrily bed-bathing their patients,wiping patient's butts and checking heart and lung sounds, I was chatting with my patient. She didn't really want me to check her for edema or help her with her range of motion exercises. It was...very pleasant, but I felt like I wasn't doing my job. I had a list of assessments I should have been doing. The form sat on my clipboard, ignored, until I got home. And then I realized, Hey! I did a lot of assessing in chatting with my patient. I was able to fill in information about almost every one of the body systems (cardiopulmonary, integument, etc).
Then came my first care plan. I spent more than two hours trying to write my Expected Outcomes (um, they're goal statements with a very specific language and format). Two sentences. Two hours. OK, some of that time was on the phone talking about the expected outcomes, but still. Two hours! And, here's the "funny" part. I didn't implement my plan. My patient's sister had died and she found out while I was there. I was mostly an ear today. And, even if I was able to implement my plan, it was all wrong for my patient. I was going to ask her to change her routine and I think that's what keeps her going every day: the steady regularity of her day (get up, breakfast, meds, get dressed etc) that is in contrast to her heart's dysrhythmias.
This is hard.