Friday, October 23, 2009

You Give Me Fever...

Sigh. I was sent home early from clinical today - which sucks. I was in a patient's room, watching the would nurse replace a wound-vac dressing on the patient's shoulder (SUPER cool, SUPER painful for the patient and a SUPER amount of blood) when I started to feel a bit woozy. I thought it might be from the fact I was wearing gloves, a gown and a mask (I have a lingering cough that won't go away, and I didn't want to scare the patient with it's swine-flu-soundingness) - so I left the room and got some water. However, I didn't feel much better a few minutes later, so I grabbed a thermometer off the wall and took my temp - 100.0 degrees - crappers.

The night before was full of sinus pressure and sneezing, but I was hoping these symptoms were still residuals from some crappy virus I stumbled upon a few weeks ago. Apparently not. I immediately put on a mask and waited for my instructor to come out of another room, and waited, and waited. Sometimes the instructor can be in one of those rooms for a very long time, so I went to check on my patient - did a full assessment, talked to his wife about why we were putting Bactroban in his nose when he had MRSA on his penis, and helped him get to the bathroom.

When I was out in the hallway looking for new linens, I cam upon my instructor and told her about my slight temperature. "Well that's it then," she said. BOOOOOOOO!

I was upset that I had to leave. Not only did I feel like I was abandoning my patient (don't worry, I had to chart off to my instructor, my supervising nurse AND another nursing student - so the patient was in great hands) but I felt disappointed with my performance from earlier in the shift and I wanted to redeem myself. AND my patient was diabetic, so there was the chance that I would FINALLY give insulin before lunch. Sigh.

The whole disappointment thing - my current instructor is really tough when it comes to meds, which is different than any other one I've had. Sure, they have all made sure I had the correct dose and could administer the drug properly - and HEY they might have even asked me about nursing considerations or teaching - but they never really made me learn what the drug DOES. For example - Prilosec. Everyone has heard about Prilosec, and many people (me included) have taken it. So, when I was pulling it out of the med drawer for my patient and my instructor asked what it was for, I thought I was cool. When I told her it prevented acid reflux, she asked, "How?"

"By preventing excess acid?" I asked.

"How?" She countered.

I had to turn to my crappy-ass med card, which said that the drug was a proton pump inhibitor, and that it inhibited the production of gastric acid. I wasn't clear how that physiologically happened, so my instructor talked me through how the drug inhibits the hydrogen, potassium, ATP pump that churns out hydrochloric acid into your stomach. Since my patient didn't complain of any acid reflux, I asked her why my patient was on the drug. Apparently that pump goes into overdrive when the body is stressed, so doctors prescribe the Prilosec to counteract that possible overproduction from the general stress of being in the hospital. Nifty.

That was just ONE encounter with my instructor - over ONE med. I won't really get into our conversation about the propanolol my patient is on (an anti-hypertensive medication). Let's just say that NOW I know that I beta blocker relaxes the smooth muscle in the heart and vessels, lowering the blood pressure.

THE POINT, my friends, is that this instructor does not want to churn out more pill-pushing nurses who don't know what they are pushing, and don't have the knowledge to challenge a doctor's order if it seems a bit iffy. She really wants us to think everything through - which means a LOT more prep work prior to clinical, but a better nurse in the end.

K. Back to watching Mercy (my new favorite show) on the couch and drinking LOTS o' liquids.


Nikki said...

a.) so why were you giving Bactroban? just preventive since he already has mrsa?

b.) giving insulin = not exciting. although in reality, insulin kinda makes me nervous

c.) even i didnt know the exact details how Prilosec works and all of our patients (literally, every single one) is on Nexium, which is the same thing. I think one is the generic form of the other, I forget which though. I knew about the suppression of gastric juices, but I didnt know the exact physiology, so thats interesting. Now, if she can tell me the exact physiology of how a Nexium gtt treats a GI bleed, I'd appreciate it. :)

d.) if you only remember one thing about beta blockers, its to always check the HR along with BP prior to giving the med b/c it can drastically affect HR

e.) yay for learning new things!

f.) i love Mercy!

Britt said...

I always learn better in action. You'll never forget those 2 drugs now :)

Feel better soon!

Mike said...

MRSA on his WHAT? How do you just plow through that with no details like it is totally normal?