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Advanced MedSurg: Round 2

Today I find myself in the same spot I was a few months back. Tomorrow I take the final exam in Advanced MedSurg for the second time, and for the second time it all comes down to this test. It’s very simple: pass the final, pass the class. No other way around it.

Everything is riding in this exam. It’s not just the class, but also my continued attendance at MDC School of Nursing, since I can only retake a class one time and that’s it.

Better not to think about it.

One exam. Sink or swim.

I’m swimming. Here’s hoping I reach the shore.

Tired

I cannot properly convey how tired I am.

It’s just about the end of the first half of the semester, the end of Advanced MedSurg, and I am wiped. You may see me up and about doing stuff (I try to do my best around the house even if it isn’t a lot) and studying (not today Friday, but seriously, I’ve never studied this hard ever before) and working out (I’ve been running regularly for the past three weeks), but I am beyond depleted. If I had a little battery icon like my phone, I would be in the red.

The sad thing is that I’ll get to sleep tonight and tomorrow during Shabbat, but it won’t really help. Yes, I’ll feel somewhat refreshed and renewed, but in light of the two days after, during which I need to finish studying an entire semester of Advanced MedSurg for my final on Tuesday and ATI (standardized) test on Wednesday, it will simply be a like bandage on an arterial bleed.

Still, I have no option but to continue ahead and hope copious amounts of coffee will be enough to give me energy and focus.

Sword of Damocles, Thy Name is Advanced MedSurg

October 26, 2012 Leave a comment

I haven’t written about what’s going on in my nursing classes since the end of the Spring semester. I’ll have to do that at some other point, though in short, it was an interesting mix of Nursing specialties and I did fairly well.

Right now, however, I find myself in the same spot I did back in Spring in relation to the first part of Medical-Surgical Nursing: I am on the very edge between passing and not passing (I got an F on the first exam [long story], and a C on the second exam), and all rests on the final exam.

It would suck to fail Adv MedSurg at this point, since it is the next-to-last class in my year-long program; it isn’t something I want, nor want to think about too much, but it is something I have already considered. It isn’t the foremost thought in my mind, however. I am still in the game, and with a really good grade it is possible for me to pass this class and move on to Leadership, the last class before graduation.

That message in the meme picture above? That is my mantra for the next week.

Bring it, Adv MedSurg.

Putting It All Together (or Holy Carp, It All Makes Sense!)

I’m studying for my MedSurg final and I remembered this incident that happened last week during clinicals.

My patient was very stable and compliant that day, so after doing my assessment and morning care I went to check with my assigned nurse to see how else I could help her. We saw all her other patients and then I tagged along while she gave meds, which gave me a chance to review desired and side effects as we went along.

One of her patients was a middle-aged man with severe wrist swelling. As she prepped his meds, I would tell him what he was taking and some side effects to watch out for. For one of the meds we had to check his sodium level, which at the time of his last labs was 131, slightly under normal (135-145 mEq/L). As I applied a topical gel to his wrists to help with the pain, he asked us if he was scheduled for a brain scan that day. The nurse and I looked at each other, a bit confused by his question. She said that there was nothing in his chart about a brain scan. I asked him why would he have a brain scan and he said he’d been having extremely vivid dreams for a while, the type where you don’t know if you’re awake or asleep. The nurse said she’d check again to be sure and I filed away this information.

As I went on about my duties, I kept thinking about this patient and his question. Something in his case was triggering memories in my head but I quite couldn’t put my finger on it. It hit me about an hour later, while I was helping my patient back to bed after she had eaten her breakfast and I saw the slip on her tray that said “Cardiac Diet” (which means no more than 2g of sodium a day).

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Resolving Personal Issues

Nurses care for patients. That is our primary and overriding duty. But in order to care for our patients, we also need to take care of ourselves.

During my Death & Dying lecture in Fundamentals, one of the key lessons we learned is that in order to effectively help patients and their family deal with such issues, we need to have our own issues with the subject resolved. The rationale being that one who has unresolved issues with the topic of death and dying won’t be able to properly offer the help and care the patient will need at such juncture. It makes perfect sense, actually. The greater truth is, however, that this same lesson applies to pretty much every type of care we offer our patients.

This is a lesson that was driven home today for me in my skills lab when we learned how to insert a nasogastric tube. An NG Tube is a type of catheter inserted into the stomach through the nasal passage. It is used to decompress (get stuff out) the stomach, as well as for feeding and delivery of meds in some cases. In most cases, it is a treatment done for only a few days, except in rare cases. My mom was one of those rare cases.

Mom developed a duodenal tumor that shut down her gastrointestinal tract cold. In early February of 2009, I had to take her to the ER when she started feeling unwell. By the time we got there, she began to vomit violently and continuously, some eight times in a one-hour period with no signs of stopping. By the time she was finally taken into the treatment room, she was almost unconscious from all the fluid lost. She was immediately given an IV for rehydration, and when they detected very little bowel sounds, the doctor ordered an NG Tube be placed to decompress her stomach.

Imagine for a moment having a 15-inch plastic tube stuck into your nose and down your throat. Now imagine that while having an almost uncontrollable urge to vomit because you have three-days’ worth of food, liquids, and body fluids stuck in your stomach.

I saw the nurse put the NG Tube in Mom and it wasn’t pretty, even though we all knew it was for her benefit. It did its job, though. For the next 100 or so days of hospitalization over the following six months, Mom would not be without an NG Tube for more than 10-20 days. Towards the end it stayed in permanently; she took it to hospice home care and had it on the night she died.

I have unresolved issues with NG Tubes. Every time I see one a shiver runs down my spine as I recall that moment when it was inserted into her as an emergency procedure, and I remember how long she had it. I knew today we would be learning this skill and I steeled myself as best as I could before even leaving the house. The moment the professor pulled out the equipment, I lost my resolve. I withdrew, physically and emotionally. I hid in the back of the room. I fought back tears. I did not want my classmates or professors to see me this way. When I couldn’t take it any more, when the mannequin looked like Mom to my eyes, when I felt the world collapsing around me, I got out of the skills lab and hid in the bathroom.

I am a nurse student, and part of my training is going through situations like this so that I can face my own demons, fight them, vanquish them, and in the process gain the wisdom necessary to serve others who will be where I was back in 2009, or today for that matter. Putting in an NG Tube is a skill I need to be able to perform to pass this class, so you can bet that I will go back to the lab during practice hours and learn how to properly do it. And for that I need to resolve my personal issues, because ultimately there’s nothing I want more than to be a nurse.

Categories: The Literary Nurse Tags: ,

End of First Semester

Just so you get an idea of the speed at which my program moves: I am writing this on March 11, a Sunday, and already I am one week into the second semester and one week away from my first exam. No time to breathe!

Anyway, on Friday, March 2, I finished my first semester of Nursing School and I did really well!

  • Nursing Fundamentals: A
  • Adult Health Assessment: B
  • Introduction to Pharmacology (Math): A
  • Nursing Fundamentals Skills: A
  • Nursing Fundamentals Clinical: Pass

It feels like I’ve been in school forever, but it’s only been two months. Two really hard, challenging months. I’ve gone from being a naive enthusiastic student with absolutely no practical knowledge of nursing, to an apprentice, enthusiastic student with the fundamental skills and knowledge of nursing. I’ve already helped patients on the floor at a nursing home and at the hospital, not to mention at an accident and during a potential emergency. I’ve given medications, I’ve redressed wounds, given bed baths, changed beds, cleaned whatever needs to be cleaned, been yelled at by a hooped-up-on-narcotics patient, gotten to know patients well enough for their families to recognize me out on the street and for me to wonder about them and their status in the days in between clinical rotations.

I’ve already studied far more than I ever thought I would, and realized it’s not enough; I’ve already felt like I have learned nothing and I’ve wasted time and money because I’ll never be able to do this right; I’ve already cried for no particular reason simply because of stress; I’ve lost so many hours of sleep that I simply don’t think I will ever catch up. And I’m only two months into my education.

And I friggin love it.

I had one weekend of freedom, and already the second semester has started. I am now taking Medical-Surgical (Med-Surg for short) Nursing Lecture, Skills and Clinicals, and Pharmacology. Bring it on.