Tuesday, April 25, 2006

Yep yep yep yep yep, cow. Mooooo!

I really should be studying or sleeping right now, but a friend posted up some links to Sesame Street bits on YouTube. Man that site is a timesucker.

I got tears in my eyes from laughing at this Yep Yep aliens sketch. My sister used to talk like them all the time. I think I know what I'm going as for Halloween.

Saturday, April 22, 2006

Having trouble peeing? Yeah, we got something for that.

Catheter lab

Thursday's skill lab was devoted to learning how to insert urinary catheters. Wheee. Doing it on the mannequin was fairly simple. Of course, they don't wince when you shove a tube up their urethra. And unlike some real women, the mannequin's urethral opening is easy to find. I did learn a trick though. When cleansing the inner labia with the betadine swabs, the urethral opening often winks when stroked. So there's that.

Test that balloon

The demonstration video we watched to prep for the day had live models in it. Some friends and I were wondering how much they got paid for it. First, there's the irritation factor, and second, your junk is out there preserved on video for posterity.

Ready for action

We took home foley kits to practice on our own and I briefly considered trying it out on myself, just to see how much it hurt. I didn't do it, but the next day I told a small group of students that I had. No one batted an eye, and a few people said that they had considered it as well. I fessed up to the lie, but was somewhat concerned that my fellow students so readily believed me.

Someone told a story about a female student who was assisting a nurse with a catheterization on a male patient. The student was holding the penis and the nurse was just about to insert the catheter when she was called out of the room. So the student is left holding this guy, who is 17 years old. Annnnnd he gets an unintentional hard-on. She drops it and hastily exits the room. Embarrassment all around.

Wednesday, April 19, 2006

Cigarettes or fingers, your choice

I'm in my adult health lecture class right now learning about peripheral vascular disease. My instructor just went over the danger of tobacco use when patients have other predisposing factors to obstructions in their blood vessels. Tobacco use causes vasoconstriction (arterial muscles constrict the vessels), increased platelet aggregation (and therefore blood clot formation), increased levels of epinephrine & norepinephrine which cause further vasoconstriction and increased heart rate, and the introduction of carbon monoxide which interferes with oxygenation.

Severe peripheral vascular disease can result in tissue death and may require amputation of the affected extremity (arms and legs). All of that is just background to what the instructor said next:

"Physicians will often tell their patients, 'You can choose cigarettes, or your extremities, but not both.'"

To which I added, "And remember, it’s hard to smoke without hands, so..."

Sunday, April 16, 2006

Rather nasty experience

*Not for the squeamish*

Turn back now if you know what's good for you.

I'm in a confessional mood, so I'll share. When I got home tonight, I ate some mint chocolate ice cream while watching Arrested Development episodes. I'd finished my ice cream and was washing it down with some water when some funny bit happened on the show. As everyone knows, swallowing and laughing at the same time is not well-tolerated in the body. It's pretty much a war between the two. In my case the battle was settled thusly:

1) Swallowed water went into my trachea instead of esophagus
2) Coughing ensued
3) A small quantity of mint chocolate ice cream came back up my esophagus
4) Regurgitated ice cream entered my mouth (still mostly full of water) and nose
5) Watery ice cream fell out of my mouth into my glass
6) Into a paper towel, I blew a mixture of ice cream and mucous out of my nose
7) Coughing continued while I contemplated how vile it all was

Saturday, April 15, 2006

Calexico at Emo's

I saw Calexico play a free show acoustic show tonight. It was pretty good. I've seen them play better, but you can't argue with a free show. I was surprised that they didn't play more songs from their new album as this and the scattering of other US dates they're playing are to promote Garden Ruin.

More out of focus pics here. I didn't squeeze up front because I was with someone, and where we were standing was not conducive to picture-taking.

Thursday, April 13, 2006

Day surgery

Once during our first semester of upper-division classwork, every nursing student at UT has a chance to observe day surgery.

I saw:

1) Three colonoscopies

The first was routine. The doctor was cool and pointed out anatomy like the entrance to the appendix, the liver (blue patch on the colon wall), and the prostate. The second one was interesting because the patient chose not to be sedated. He was a trooper, breathed well through the painful parts, and didn't make a peep. The third guy was well-sedated and yet still groaned loudly throughout it. Poor guy, it was a rough go for him. Thankfully we won't remember it because of the amnesiac effects of the sedation.

2) Uterine and cervical tissue sampling

Just what it says. It requires a lot of prep for a procedure that's over quickly. Sterile drapes all over the place.

3) Two hand surgeries

First was removal of a benign tumor from a woman's hand. The surgeon specializes in hands and was happy to tell me all about what she was doing and why. The second surgery wasn't as cool, but still interesting. I got to fetch the nurse a sterile finger nail cleaner and open up a sterile gown for the doctor.

So nothing too bloody for me. A fellow student got to see a nose job where they pulled out a guy's middle nasal turbinate.

That was really bloody as the tissue is well-perfused by capillaries which you'd expect because one of the functions of the turbinates is to warm inhaled air.

I'd never been interested in surgery before, but after this experience, I can see myself possibly working in day surgery at some point. The high turnover and variety would keep it interesting.

Of honkers, hoo-hoos, and hornpipes

Today in class we learned assessment of the breasts and genitalia. Usually we assess each other, but since assessment includes inspection and palpation, today we just watched videos and looked at medical models. Even that made some people anxious.

The breast exam video played without controversy. During the male genital asessment video though, there was a bit of an uproar. The "patient" in the video was uncircumcised and the narrator explained that with such patients, the examiner asks them to retract their foreskin. The guy in the video did and you'd think there was mouse in there or something. Gasps and actual muffled screams from the ladies in the audience (I didn't hear any of the five other guys, but maybe they freaked too). I'm not sure exactly why they were so surprised and/or horrified. Once he pulled it back it looked like a circumsized penis, something I assume they'd seen before. Maybe they were shocked by the amount of foreskin? Cause he did have a lot. Whatever the reason, it cracked me up to see and hear such an extreme reaction.

Later, our instructor asked the teaching assistant to start handing out medical models so that the students could palpate the testicles for lumps. What she said, in a completely casual tone, was "S____ is handing out the testicles as we speak." Priceless.

Tuesday, April 11, 2006

On the the subject of infants' level of cool

From last Wednesday to Sunday, I was at the National Student Nursing Association convention in Baltimore. I’ll write more about that later, but I just remembered something.

One of my guy nursing student friends calls things “gay” all the time, like in the 5th grade sense. “That test was gay,” and so forth. He used to apologize to me when he did it, until I convinced him that I knew what he meant, it didn’t offend me, and that it actually made me laugh because it was so childish.

During the convention we were at dinner one night and someone started talking about her experience on the maternity floor at the hospital. Several other people joined in, cooing about how precious the babies can be. In a lull in the conversation, both as a rebuke to all the goo-goo talk and a crack at my guy friend, I said in my most contemptuous surfer dude voice, “Babies are gay.”

Tuesday, April 04, 2006

What happens in skills lab, stays in skills lab

I had an assessment performance exam yesterday. In front of our instructor, my lab partner and I had to assess each other’s skin, gastrointestinal, and neuromuscular systems. In the real world, we wouldn’t be doing large parts of the exam, but it’s useful to learn. While we perform the exam, we talked out loud so the instructor knew that we knew what we were doing.

It was my turn and I was about to assess my partner for sensation in the face and extremities (arms and legs). To do this, you have the patient close their eyes and tell them that you will lightly brush their skin with different stimuli (in this case either a cotton wisp, the blunt end of a tongue depressor, or the end of a unwound paperclip). The patient is to tell the examiner where they feel the sensation and whether is was the soft, blunt, or sharp stimulus.

I never practiced exactly how I was going to say it out loud. What came out was, “OK, close you eyes and I’m going to touch you in various places.”

There was a pause in the exam as my instructor and lab partner laughed heartily. Yeah, that was fairly inappropriate.

Monday, April 03, 2006

The pointy end is the patient end

I gave my first injection today, and I wasn’t nervous at all. I think I was so focused on proper technique, that anxiety couldn’t take hold. It was a subcutaneous injection (into the layer of fat between skin and muscle) of insulin into the back of the patient’s upper arm, which is a preferred site for insulin. The patient’s been getting insulin injections for a long time now, I don’t think I hurt him.

I didn’t tell him it was my first time with a real person, but he didn’t really need to know that. Why create unnecessary anxiety? Or have him flat turn me down? When we practice injections in lab, our teachers actually address this. The hypothetical conversation between student nurse and patient would go something like this (with the parts said only in our heads in brackets):

Student nurse: OK, time for your medication.
Patient: Nursing student huh. Have you done this before?
SN: Yes [on a mannequin].
Patient: Who?
SN: I just gave an injection to Mr. O’Dell [which is the name of our mannequin].

I didn't have that conversation with my patient. He seemed at ease with me and I was ready to go. Prep site, dart in, stabilize, inject slowly, withdraw. No problem.