Pulmonary Medicine Experience?

missnurse01, MSN, RN · May 31, 2012

goodness it could be anything...pulm edema, asthma, pulm htn. lots of flu, resp infections etc. if your place does lung transplant pts could also end up here before going home or to rehab...

good luck!

cbrite · May 31, 2012

Thank you missnurse01!

I know it's quite a broad area, that's interesting I hadn't thought of people who are post-transplant!

classicdame, MSN, EdD · May 31, 2012

be prepared to deal with grouchy people. Being low on oxygen takes a toll on attitude - and who can blame them? Be sure to listen to chest before and after treatments to tell the difference, if any.

cbrite · May 31, 2012

Good tips, thank you classicdame!

nurseprnRN, BSN, RN · May 31, 2012

remember that if you count up all the metabolic energy you use, for everything-- growing hair, digestion, pumping blood, working substances through your liver for detox, walking around, mentation, healing paper cuts, shunting calcium in and out of your bones, all of it-- if you are normally healthy, about 5% of that total body energy goes into the work of breathing and gas exchange.

if you are a bad copd'r, that percentage can approach 30%. imagine, almost a third of all the work your body does going into just ...breathing.

this is why many people hate copd patients, because they have a reputation for being rude and demanding. well, honey, if that much of your metabolic energy is going into breathing, you really don't have any extra for social chit chat, you really do need someone to move that kleenex box or glass of water three inches closer, and you won't have the breath to say please and thank you. so if you can bear that in mind, these are people who really need a nurse.

cndn_grl08 · Jun 1, 2012

Definitely will see a lot of COPD, pneumonia, possibly chest tubes but that depends on the type of unit (this is medicine, not surgery so some places will not). Know different chest sounds and what they mean, know interventions for dyspnea, know about oxygen (when to use it, how much, what method of administration, etc.), different nebulizer medications may be helpful to look up ahead of time. Also may help to know a little bit about heart failure and conditions like that as it often goes hand in hand with respiratory complications as well. Hope that helps!

Double-Helix, BSN, RN · Jun 1, 2012

I did my partnership on a pulmonary unit too. I loved it! I got such great experience and saw a huge variety of patients.

A lot of our patients came from ICU. Many were vented for long periods and still had tracheostomies. Some still required supplemental oxygen. Occasionally we would get a patient who was on a ventilator long term. I got lots of experience doing trach care and suctioning- a skill that many of my fellow nursing students were still quite uncomfortable with. (You'll learn to handle sputum, too.)

A fair number of our patients were also post-op thoracic surgery- primarily lung resections. These patients usually have chest tubes in the immediate post-op period, so expect to learn a lot about chest tubes (on suction and water seal), how to change the dressings, check for air leak, and assist the doctor with removal. Chest tubes were another area where I had gotten little exposure in my other clinicals.

You're right that you'll also get patients with COPD exacerbations, asthma exacerbations, pneumonia and other respiratory infections. You'll probably also care for some patients with newly diagnosed lung cancers, Cystic Fibrosis, pneumothorax and chronic lung disease. These patients often have multiple co-morbidities, so you'll also have to manage wounds, diabetes, heart conditions, certain types of cancer, and physical deficits.

Also expect that the pulmonary floor will probably take overflow from the medical floors too. So be prepared for anything. I once had a patient on my pulmonary unit that had a continuous bladder irrigation following bladder surgery.

By the end of your clinical experience, you'll be a pro at listening to lung sounds. On a pulmonary floor, being able to differentiate between sounds and pick up on changes is imperative, so it's a good idea to brush up on your lung sounds before you start. Also read up on management of chest tubes. It's always good to have an idea of what to expect with these. Review different types of O2 delivery systems, as well as how much O2 you can give through each type (When do you need a simple face mask instead of a nasal cannula? What's the difference between a venti-mask and a non-rebreather?). It would probably also be a good idea to review your steps for proper trach care and suctioning. Practice in your skills lab if you can.

Good luck! I know you'll learn so much! My partnership experience really prepared me to take a full assignment as an RN.

cbrite · Jun 1, 2012

I totally agree GrnTea, that's a great way of looking at things- I'll definitely keep that in mind! One of my teachers once told us to try plugging our noses and to breathe through a straw for as long as we can to understand how frightening it is to not be able to breathe, and man was she right it's a horrible feeling.

It's good to hear you liked your experience on a pulmonary unit Ashley, I was told by the placement co-ordinator that it's a very challenging unit and I'm going to learn a lot.

All this information is very helpful, thank you guys! I'm planning on doing a little research package for my own benefit so all of this gets me off to a great start!