While I was out

This is what a nursing diagnosis looks like:

Risk for injury related to observing surgery as evidenced by unconscious nursing student laying on floor.

Yup, it happened. 45 minutes into observing a reverse ileostomy I passed out, and not gracefully either. There was no Scarlet O'Hara-esque sigh and crumple gentley to the floor-I did my best to move away from the sterile field and fell down hitting my head. Hard. Luckily I fell backwards so the huge bump was hidden under my hair, this is opposed to last time when I fell forward, hitting my eye and spending 3 days in the hospital trying to convince the medical staff that no one hit me-I really did fall and hit my eye.

This manuver bought me a some time in the ER. For anyone planning an ER trip, for prompt service, I highly recommend being brought in in a wheelchair by an attending. Within 5 minutes I was through triage, in a bed hooked up to the monitors with 2 nurses and an aide working on me. Within 10 minutes I had seen both a resident and an attending. As impressed as I was by the efficiency of the ER, all the attention just increased my feelings of embarrassment over the whole incident.

So basically my clinical experience this week was very me focused, and let me just tell you that I am a terrible patient.

Feeling poopy

This week my assigned patient was a woman in her 70's who had been admitted to the hospital with cholecystitis, had a laparoscopic cholecystectomy followed by an endoscopic retrograde cholangiopancreatography. My speech therapist never covered words relating to gallbladder issues. Unpronounceable words aside, what I really learned about this week was stool- I discovered that nursing is just like childcare in the way that you become obsessed with someone else's bowel movements. My patient had not had a bowel movement since before she had been admitted to the hospital, which had been 8 days prior. This was obviously a problem, so she had been given an industrial strength laxative. And it worked.

Now I don't have a problem with poop-really anything below the waist I am fine with. Above the waist is another story - puking, spitting, gagging, and not to mention chewing, are all things that kind of gross me out, but poop I'm ok with. At this point I should stop to give a shout out to a certain baby in c'ville and her beloved deceased doggie who helped establish my tolerance for bodily waste.

My okness came in handy due to the fact my patient could not move quickly or easily and also did not speak english - and when I said that the laxative worked, I meant it WORKED. Through this experience I gained invaluable nursing skills; I learned how to get a patient on and off a bed pan, how to clean up a bedridden patient, and how to change and clean a bed with a very uncomfortable, very embarrassed, barely mobile patient in it. None of which are as easy as they sound. I realized that I can sit in class all day and do well on all my exams, but that will not prepare me for how to comfort an incontinent patient who is too humiliated to tell her own daughter she is lying in stool. Helping her was the most comfortable I've been so far.

Whose idea was this anyway?

Last week I was assigned my first patient as a nursing student. Without violating HIPAA I can say he was a mostly patient elderly man. He had had multiple surgeries over the last year and was currently admitted due to a complication from his most recent surgery. My first day with him was day 12 of his hospital stay and was very nice considering I was his second nursing student of the day-someone else from my class worked with him in the morning. He was very patient with me as I took his blood pressure, temperature, pulse, respiratory rate, pulse ox, pedal pulses, and checked his glucose. I also listened to his lung sounds and bowel sounds as well as palpated his abdomen. This is a routine assessment of a patient, but don't let my orderly description fool you into thinking there was anything routine about it. The whole thing took me about 2 hours and involved me going in and out of the room about 20 times as I seemed to develop the memory capacity of a goldfish. I was fumbling with the blood pressure cuff, despite the fact I have taken thousands of BPs in the last few years, I felt very relieved that I actually heard it, I couldn't get the cover to stay of the temp probe, I was paranoid I was going to trip over his chest tube and rip the whole thing out, I nodded in agreement when listening to what I thought were the lung sounds only to find out he really didn't have any on the left side, I couldn't hear any bowel sounds on the right, and my "palpating" of the abdomen was really more like me poking him in the belly and asking if it hurt. All this was repeated 2 hours later.

The next day was my patients 13th day in the hospital and he was not happy about it. One of the concerns about releasing him was that he lives alone, and by the end of the day I understood that he liked it that way. As someone who also values their alone time I could appreciate his desire to be left alone. None-the-less, the activities of the previous day were repeated-slightly more efficiently.

I felt awkward and useless. I know I am new at this and everyone keeps reminding me that we are not expected to know how to do everything, but that does not make it any easier. Right now I feel the only thing I am good at is staying out of the way, which is pretty much what I am constantly trying to do. I have a hard time standing around doing nothing while other people are working-I kept trying to be helpful, but it is difficult when you have to find a nurse to just ask if it is ok for a patient to have tea and crackers.

Right now I am having a hard time believing that in 3 years I am going to be able to care for women during pregnancy and labor. I am supposed to go from fumbling around with a stethoscope to safely guiding a new life into this world in less time that it took to pay off my car. Scary, huh?