1st clinical medication

[mirasmommy]

I had my first clinical rotation in medication and found myself completely overwhelmed. Up till now I have done well with my pre research ( which includes an explantation of results for all labs on the pt I am assigned) for the medication rotation I was assigned three pts, I had to research all the meds, the labs the night before and needless to say it turned out to be an all night process. I wanted to be prepared but still found myself really nervous and unsure of pretty much everything. I thought I was prepared but things were just so hectic. I did my first UA cath and put it in the wrong place ( my teacher was very sympathetic about this but I felt like a complete moron) the IVPB, drips, tubes, connections, diluents, pump settings, was so confusing. I really hope practice makes perfect with all of this. The other two students were about as confused As I was. One of the hardest things for me is getting a routine down, especially with timing. Checking the medications with the Dr. new orders is a biggie. The hospital I was at had just switched to a computer system, the nurses were dealing with learning that and dealing with us students around and they were kinda rude. Any tips on establishing a routine would be very helpful. I really hope I can get through this, I graduate LPN school in June ( possibly) thank you Shannon

[Daytonite, BSN, RN]

Sounds like you started out just fine the night before. You knew all the labs and meds that patient was going to be getting and researched those.

I'm assuming that you have already checked the Kardex the day before since you already know the meds and labs. Otherwise, the very first thing you want to do is check the Kardex and get pertinent information about your patient: diet, activity, labs, test, or x-rays scheduled for that day, treatments that need to be done. Next, check the med sheet to see what has to be given and pay particular attention to the times they are to be given. Then, check the chart and look at any doctors orders written since you last looked at the chart. Since you've already checked the Kardex and med sheet you should be able to recognize immediately if there was something that didn't get noted and transcribed properly. Remember that the latest and last written doctor's orders supercede all the other orders.

You want to develop a "To Do" list. I used to make them out on the back of my report sheet. Just a simple grid of two columns. On one side, the tasks I need to do and in the order they need to be done. On the other side, the time each one of these things needs to be done by. This is where you kind of set up and organize what you want to accomplish for your time in the clinical area. Now, you have something written down to help you remember everything that you have to do with that patient. As you complete tasks you just draw a line through them--done! If you get sidetracked, as tends to happen to all us nurses, you only have to look at your "To Do" list to figure out just where the heck you need to be! Refer to your list and your watch periodically to make sure you are getting things done on time and in order of priority.

Let me reassure you that you did OK with the catherization. Women can be difficult to cath at times. Even I can't find the "right" hole at times and I've been doing caths a long time! It takes many, many, many times of doing procedures to master them. Your instructor knows this. I don't know how to help you with the IV rates and tubings, etc. I have web links, but they are for IV drip calculations. I'll have to see what I can find on actually IV tubings. When a patient has a lot of different IV tubings hanging and it looks like a tangled mess, the best thing you can do is actually touch the tubings and trace them from the drip chamber to where they end. I used to spend a good deal of time untangling IV tubing because I didn't like it all bunched and twisted up--too easy to make a mistake when something needed to be injected into one of the lines.

[suzy253, RN]

Try not to be so down on yourself. Sounds like you did everything exactly right. It was your 1st clinical med and your instructor doesn't expect perfection. Yes, practice does make perfect to keep up the good work.