Term of the Day: Fall

Not the season between summer and winter, but rather what leaves do during that season.

FALL - an unintentional change in position resulting in coming to rest on the ground or a lower level

Man do I love these precise medical definitions. Absolutely correct, yet almost comically detached from everyday speech.

Falls are a big deal, especially in seniors, potentially causing serious injuries like hip breaks and concussions, or even death. So many factors can precipitate them, weakness, pain, environment, cognitive problems, medications, neuromuscular impairment, the list is long.

Prevention of falls is a huge nursing responsibility. And just as falls have many factors that increase risk, there are many preventative measures to consider. Considering just the patient's immediate environment in a hospital room requires thinking about condition of the bathroom and shower, their hospital gown, lighting, floor condition, footwear, suitability of chairs, bed height, bed wheels, and side rail position.

The standard when leaving a patient's bed is to lock the wheels, put the side rails by the head up, and lower the bed all the way down. Still, despite these precautions, tragedy can happen. Our aging teacher had our undivided attention when she showed us a couple drawings taken from photographs of patients that tried to get out of bed and died when they got tangled in their bed rails. Eeesh.

15 things I learned today

My clinical practicum teacher told us we should be learning 15 new things every week at the hospital.

15 things I learned today:

1. my computer login


2. the codes to the supply rooms


3. how to read a medical chart


4. how to take a femoral (thigh) blood pressure


5. estimating how much a patient ate of their meal


6. help a patient take a shower and they'll likely do whatever you want


7. you can never have enough towels


8. getting a patient out of bed and into a chair kills two birds with one stone, they're moving around and you can easily change their bed linens


9. the usefulness of apothecary notation


10. hospital food looks much more appealing than I had imagined


11. tracking fluid intake and output is sort of fun, I mean besides the evaluating urine for quantity, color, and odor


12. even nursing students have perceived authority


13. I'm going to be seeing a lot of backsides


14. sometimes just listening to a patient talk makes them feel much better


15. I really like this

Sigur Rós in Austin

Just got home from seeing Sigur Rós at Bass Concert Hall. Dang, they are an amazing band.

I didn't go into a trance state and "wake up" with tears on my cheeks like the last time I saw them, but the last song left my heart racing, my respiration rate way up, and the feeling of being punched in the chest. Words fail to get at just what this band can do to your head and heart.

Opening act Amina, who also play in Sigur Rós' touring incarnation, were a revelation. Incorporating string quartet, musical saw, pump organ, mbira, wine glasses, music box, pre-recorded tracks, xylophone, and more, they shifted from instrument to instrument building up a sparkling mélange of notes and texture. Really beautiful work. The EP they were selling doesn't capture how good they really are, hopefully their upcoming album will.http://www.blogger.com/img/gl.link.gif

Here's a representative sample: Amina - Hemipode

In other music news, here's a really horrible article about Austin music. I'd swear that the restaurants, clubs, and music stores paid off the reporter if I didn't know better (no way Big Dan of End of An Ear did that).

UPDATE: Mybloodyself and Spitting Tacks, my concert companions, have posted their impressions of the show as well.

Sen. Bill Frist wants my opinion?

I have no idea why, but I received a Senate Majority Leader's Survey in the mail today. That would be the REPUBLICAN Senate Majority Leader Bill Frist. To me, who lives in the only county in Texas to reject the constitutional ban on gay marriage. Me, who has held positions within the local, state, and national Green Party. Me, who has a French last name.

I cannot fathom how this came to be. I've voted in almost every election for the past 10 years or so and haven't voted in Democratic primaries in five years, but I also don't vote in the Republican primary. How did this happen? Enough fretting, on to the grim comedy.

This foul bit of marketing is really a combination "fall in line with our already-set agenda/give us some money" tool. The first survey item asks me to rank issue of importance:



"Correcting" questions became a theme for me, like changing (in red) one Value Issue question to "Do you support federal funding for research on an unlimited number of embryonic stem cell lines?" I checked Yes.

I particularly enjoyed my annotation to the first question here:



The accompanying letter is righteously indignant over the "filibusters and parliamentary gimmicks" of Senate Democrats, while completely avoiding the unethical behavior plaguing the Republican Party of late. They want 60 votes in the Senate to block Dem filibusters (institued by the "Howard Dean-Michael Moore wing their Party", you know, the actual Democrats?) and they really need money to defend themselves against those big meanies MoveOn.org. Awwwww.

I finished the survey and mailed it off. Not that it will do any good. Still, it made me feel warm and fuzzy to oppose their agenda on practically every question.

Term of the day: Auscultation

Last week in Assessment class, we learned how to use our stethoscopes to listen for various heart sounds. The week before, we did lung sounds.

AUSCULTATION - the act of listening to sounds occuring within the body

We're not expected to be able to hear faint sounds like heart murmurs this early on in our careers, just the basic abnormal sounds like crackles and wheezes in the lungs. Crackles (like Rice Crispies in milk or the sound made when you rub your hair between your fingers) indicate fluid in the lungs and point to things like pneumonia. Wheezes (a continuous, musical whistling) can be heard in people with pneumonia, but usually occur with things like asthma or bronchitis.

One of our instructors was reminding us of these and accidentally said "crackles and weasels". I busted out laughing. No disrespect to the instructor - it could happen to anyone - but the vision of carefully listening for the sound of tiny weasels romping about inside a person's lungs was too much.

Especially when I took it one step further, "Hmm. On the lower right side I'm hearing the distinctive sounds of crackheads and weasels."

A great first day

It was a sea of burnt orange at the hospital today, my clinical group's first day of caring for patients. Where before our clients had been elderly people in an assisted living facility, now we are at a hospital for the rest of the semester. Our instructor eased us into it; all we were supposed to do was pick up breakfast trays, assess how much the patients ate, keep a running count of their fluid intake, change linens, and take vital signs. Fairly easy stuff at this stage, and yet exciting to do.

My partner and I had a much better day than the rest of our class though. One of our patients was a little out of sorts. She didn't touch her breakfast and didn't want to wear her nasal cannula (tube that delivers oxygen). Our instructor convinced her to get out of bed into a chair, as much to get her ambulating as it was to allow me to change her sheets. Once in the chair with her nasal cannula in, she almost immediately became more alert and pink-cheeked.

Now more awake, she apologized for being dirty. She wasn't really, but being in a hospital bed for two days can make you feel more than a little grungy. Our instructor suggested a shower, and so my partner and I gave her one. Remember when I talked about the relationship-building aspect of bathing a patient? Even more true than I had guessed.

Bathing a stranger wasn't weird or scary or gross or any of the things you might think. It was just, caring. She thanked us profusely during and after the shower, then called her daughter to say how much better she felt and how nice we were. She was glowing and we were thrilled.

It's inevitable that caring for patients will become routine and even tedious at time, but I'm determined to always hang on to what it can mean to them and me.

My sense of humor might make me an outcast

A couple weeks ago, I was in Skills class and our instructors were demonstrating sitting mobility-impaired patient up and moving them in and out of bed. One of my fellow students asked what you would do with very large patients. Short answer is get help from other staff. The longer answer involved bigger beds and a friend of mine misheard our instructor as saying "big boy beds".

I immediately thought of a great endorsement deal for one-half of Outkast. Big Boi Hospital Beds, "I like the way you move."

My friend laughed, other people just stared. I thought it was clever.

It is now my duty to completely, uh bathe you*

Because some fellow students and I are going to the Texas Nursing Student Association conference in San Antonio on Thursday, we had our Skills lab this afternoon. Lab topic this week: Bathing and Hygiene.

The slight embarrassment began with the pre-lab videos we watched over the weekend. As the nurse on the tape demonstrated perineal care (washing the lovely bits and asscrack) on the "actors", I kept thinking, "I wonder how much these people are getting paid?" I heard secondhand about a girl that was nervous about the Potential For Erections. Helpfully, our book covers this. "Wash shaft of penis with gentle but firm downward strokes. Vigorous massage of penis can lead to erection, which can embarrass client and nurse." Uh, yeah.

I'm not so concerned about the guys, it's the lady parts that make me nervous. It's not that I'm scared of labias majora and minora, I just don't want to be too rough. Err, I don't have a lot of, let's say experience, with washing the peesh.

Our lab instructor told us that most patients won't need help with perineal care and prefer to take care this themselves. As our course packet helpfully suggests, "Most patients understand what is meant is the nurse simply says, 'I'll give you a washcloth to finish your bath.'" Later I was saying that suggested phrasing is helpful. Of course someone was going to hear that as suggestive phrasing. Hilarity ensued.

The lab instructor went over the material, quizzed us a bit, and then it was time for us to bathe each other. Un-com-fort-a-ble. It really wasn't that bad, we just did face, arms, chest, and back wearing swimsuits the whole time. It was, an experience.

Last week when we were talking about this lab coming up, a fellow student was saying that bathing is a task that can and is often delegated to nursing assistants. Nurses had better things to do. Our Skills instructor gently called him on it. She explained that bathing a patient allowed a nurse to assess their skin for any potential problems and allowed a time to talk in a setting that tends to allow patients to open up. It really turned me around from thinking of bathing as a necessary but undesirable part of the job, to seeing it as an opportunity to provide care for a patient. A little mushy, sure, but true.

*All apologies to Nirvana for mangling their lyrics in this post's title.

My typical week of first semester nursing school

It's been awhile, sorry. I had a busy week, first round of tests. They went okay, one great score and one disappointing-but-not-terrible score. I was going to go into a little detail about a class when I realized that I never explained my schedule. So...

SUNDAY

Preparation for Monday's clinical. Starting in a couple weeks, I'll go to the hospital on Sunday afternoon, copy down data from the patient's chart, write brief summaries of their medical diagnoses and treatments, note what medications they're taking and possible side effects, construct a list of things they are at risk for, and possible nursing interventions I can perform. I'll explain the profession jargon in a future post. I'll be quizzed on some of this material tomorrow morning first thing.

MONDAY

6:30 AM - 3:15 PM Adult Health Clinical

This is where I go to a facility and care for a patient. As we learn more in my Thursday classes (see below), we do more for the clients. In addition, I read the medical chart, gather data, and come up with nursing diagnoses that may require interventions. All the information I gather and things I do for clients are recorded in a big database that takes anywhere from 5-10 hours to prepare and is due every Wednesday afternoon.

TUESDAY

My "day off". I can squeeze in some errands, but mostly I finish my client database and study for my Wed-Fri classes. I also have to read and watch videos up at school to prepare for an online quiz we have to take before attending Thursday Skills class. If you fail the quiz, you have to write out a long explanation of everything we're going to do on Thursday. I usually take the quiz on Wednesday afternoon.

WEDNESDAY

8 - 11 AM Adult Health

A lecture class on body systems, disease and wellness, etc. We take breaks, but I'm sure glad the instructor is lively or my classmates and I would be glazed over. Coffee is a lovely thing.

11:30 AM -1:30 PM Mental Health

Just like the name says, but this is a "what is going on?" class. We're never quite sure. There's lecture, handouts, and somewhat irrevalent videos that aren't coming together so far. I'm also beginning to think that either the profession of psychiatric nursing causes one to become odd, or that odd people become psychiatric nurses. It's a "Chicken or the Egg?"-style dilemma.

4 PM - 7 PM Spanish for Healthcare Professionals

Thank goodness fluency is not the goal. I have to be careful not to blow it off. It's a three hour class and I'd hate to get a B in what is fairly simple course. I'm surprised at how much I remember from my Spanish classes ten years ago.

Some time today I also have to finish reading and complete workbook exercises for Assessment class first thing Thursday morning.

THURSDAY

8 AM - 10:30 Health Assessment

This is a practical class where we learn head-to-toe assessment in a mock hospital setting. I'll take some photos and post them soon. This is a fun class because it's hands-on. Lecture classes are fine, but psychomotor learning is welcome relief. To date, I can now take a health history, assess nutrition, measure vital signs, and assess lung sounds and function. I'll be learning about the heart and major vessels this coming week.

1 PM - 2 PM Office hours

I staff the UT Nursing Student Association office and work on any projects I have going as Breakthrough to Nursing coordinator. The position is about encouraging and retaining nursing students of color, guys, and the older-than-average, as well as learning about transcultural nursing. I'm the first person in the job and I'm enjoying defining the role.

2 PM - 4 PM Clinical Nursing Skills

Another practical class that's more about procedures performed on or for patients rather than as a way of gathering data. I can exhibit standard precautions (handwashing, gloving, use of mask and gown), check blood glucose with a finger stick, move a patient in bed or transfer them from bed into a chair, and make a bed while a client is in it. This week is bathing and hygiene. We have to wear bathing suits and "Prepare to get wet!" Nervous giggling will surely commence.

FRIDAY

11 AM - 1 PM Aging

A lecture class on the social, psychological, and physiological changes that occur with aging. This is my most interesting lecture class, mostly due to our lecturer's engaging stories and examples.

That's my normal week. Whoo-hoo.

Term of the day: Cerebrovascular Accident

I thought that a stroke, a sudden interruption of blood to a part of the brain, was still called a stroke by medical professionals. Nope. For some time now it's been called a:

CEREBROVASCULAR ACCIDENT (CVA)

The cerebrovascular part is much more descriptive, but the accident part is a bit odd. "Whoopsie, you had an accident. Errr, a chunk of your brain is dying."

In recent years, many professionals and support organizations have starting using a new term to emphasize the seriousness of CVAs. Despite their good intentions, I think brain attack is goofy. It sounds like a bad '50s science fiction film.

BRAIN ATTACK! I imagine a flock of pulsating, green brains buzzing a terrified small town while teenage girls scream, a brave policeman gets off a couple of pistol shops before being vaporized, and a radio station DJ begs for, "Someone! Anyone! For the love of God, help us!!". At some point, a city councilman would say something like, "They've destroyed City Hall! The nerve of them." Wocka-wocka.

My first day in burnt orange scrubs

Monday was my first day of "caring" for a elderly resident of an assisted living facility. I put caring in quotes because I did nothing for her, just asked questions and took notes. She was very sweet and patient with me. We got a lot of talking done; a couple other students have residents with moderate dementia and it was a bit more of a challenge.

My resident has decided to adopt me. I thought I would blush when she announced this to a couple of other women residents in the dining room. My capillaries really got a workout though when one of the other women complimented me on my eyes, then my chest hair, then began batting her eyes at me and swishing her hips. She's 76. So basically I'm having better luck with the golden girls than the gay guys. Depressingly hilarious.

Putting all my resident's information into the required client database took me 10 hours. The fact that 10 hours was about average for my class did not raise my spirits much. Hopefully I'll get faster with more practice because we have to do one almost every week for the next two years. Urk.

I'll see the same resident next Monday except this time I'll know how to check her vital signs with a blood pressure cuff and stethoscope. Here's what mine looks like:

Term of the day: Nectar thick liquids

Patients who have trouble swallowing and an impaired coughing mechanism (dysphagia) are at risk for food and liquids getting into their lungs, which can result in pneumonia. Because of this, patients with dysphagia are often prescribed special diets. Pureed food is pretty obvious, but how about thick water? Thickening agents are often added to fluids to reduce the chance of it getting into the lungs.

NECTAR THICK LIQUIDS - the consistency of fruit syrup or V8

There's also honey thick and pudding thick. My instructor brought some Thick N Easy for my class to try. Suffice to say, thick water is weird and thick Diet Coke is vile.

A walk with pictures

I went for a walk yesteray and took some pictures. Click a picture for more.

Term of the Day: Nursing

You would think I'd have been able to rattle off a good definition of this months before now. I never had a handle on it til now though.

NURSING - the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of illness and suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities and populations.

That's the official policy statement of the American Nursing Association. It really comes down to this, medicine focuses on diagnosis and treatment of a health problem. Nursing focuses on diagnosis and treatment of the response to that health problem.

Cool.

A shock to the chest

I was flipping through my CPR manual today when I came across a wince-inducing, yet funny-in-a-Steve-Carell-kind-of-way notation in the Automated External Defibrillation chapter. AEDs are widely available now so that non-professionals can shock people in ventricular fibrillation (ER fans will recognize this as "V fib") back to a normal heart rhythm.

Sometimes the user can run into a problem though, I mean besides the dying person lying the ground. To whit:

Foundation Facts: The Hairy Chest Problem

If the victim has a hairy chest, the adhesive electrode pads may stick to the hair of the chest, preventing solid contact with the skin. This will lead to a "check electrodes" or "check electrode pads" message from the AED. If you receive such a message, try the following:

• Press down firmly on each pad. This may produce sufficient adhesion between the pad and the skin to solve the problem.


• If unsuccessful, briskly pull off the electrode pads. This will remove much of the chest hair.


• Wipe the area and if a lot of hair remains, shave the area for electrode pad placement with a few strokes of the prep razor in the AED carrying case. Open and apply a new set of electrode pads.

That whole "briskly pull off the electrode pads" is the ugly part. Though to be fair, the victim is unlikely to care too much what with the severe internal chest pain.

Still, sucks to be Alec Baldwin.

Term of the day: Xiphoid Process

Sounds like a band doesn't it?

XIPHOID PROCESS (Say it a couple times out loud. Fun huh?)

It's actually a pointy thing at the bottom of your sternum where the last ribs meet. While it is made of cartilage, the xiphoid process ossifies (becomes bony) in adults. When performing CPR, it is used to help locate proper hand placement for chest compressions. Care should be taken to avoid pressing on the xiphoid process itself during compressions as that can cause the pointy end to pierce the diaphragm. Which is super bad.

Oh wait, it is the name of a band.

"Money (That's What I Want)"

Originally a Motown song (co-written by label founder Berry Gordon), it was later elevated to new heights by the scorching Beatles version. Confident, sexy, and trashy-sounding, it's fantastic. To my ears though, the best version is by The Flying Lizards. Their take exhibits the same characteristics, but in a completely different way. The instrumentation is primitive, robotic, and groovy in that Kraftwerkian German way. And then there's the vocals. Backed by muffled, strained invocations of "That's, what I want," singer Deborah Lizard exudes contempt and self-assurance when she declares, "I want money." She will totally step on your face with her stilleto heel and you will pay her to do it. I mean, if you're into that sort of thing.

I was just pointed to a live performance The Flying Lizards did for the BBC back in the '80s. Like many other "live" BBC performances, they're just miming the song, but the totally fake way they go about it made me laugh. Watch especially for the guy on the left who ends up reading the repetitive "that's what I want" lyric off successive sheets of paper.

(for those reading this through an RSS feed aggregator, there's a video to click on here, just go to my actual blog site and you'll see it)

Also? YouTube is really, really cool.


This post dedicated to Carole, the only person I know who loves this song as much as me.

Pain, see Requirements for Graduation

Yesterday in Skills lab we practiced checking blood glucose on each other. It's a standard procedure for patients, especially for those with diabetes. If you've ever donated blood, you know how it goes: alcohol wipe, lancet to pierce the side of your finger tip, drop of blood on the strip, beep beep, blood glucose.

One of my fellow students noted, "This must be the only major where you sign agreements that it's okay for another student to purposely hurt you."

Gorgeous models (for medical procedures)

BoingBoing really came through for me yesterday. Two posts there directed me to medical simulation model supply websites. What a treasure trove of delights.

Maybe you'd like to practice diagnosing facial lesions? Limbs & Things has the perfect item.



Perhaps you need to improve your cut-down skills on something that will actually bleed, but won't sue?



My personal favorite, just for the sheer morbid humor of it, is the adorably-named Lumps & Bumps set "to be used in conjunction with the 'Strap-on' Breasts when performing breast examination." Cause breast lumps are so cute and totally fun.

The phone number for Limbs & Things? 866-GOLIMBS. Of course I've ordered the catalog.

Kyoto Kagaku has a amazing selection of models as well.

Love the creepy Whole Body Phantom.



Though, if you really want to scare the kids at Halloween, I recommend the Digital Rectal Examination simulator.



As expensive as these items are, I just know there's some perv out there who's tired of his Real Doll and is willing to drop a three thousand bucks for a Clinical Female Pelvic Trainer w/ Interchangeable Uteri.

Term of the day: Sleep

This may seem obvious, and it is. I just love the definition given in one of my textbooks.

SLEEP - sustained natural, periodic suspension of relative consciousness

Wow.

Seeing as I'm getting a sore throat, it’s time for me to get a lot of it starting about 20 minutes from now. Though, slugging generic Nyquil and sacking out for 12 hours isn't all that natural.