I am honored to be filling in for our beloved ixchel's WILTW thread once again.
As I continue adjusting to my new job as well as reaching the halfway point in my assessment class for my MS PMHNP progeam, I am glad to have this opportunity to reflect on what I have learned. I also really enjoy seeing what we can learn from each other and how our varying nursing roles result in varying weekly lessons.
Brain Development
I attended the third of my sexual reproductive health trainings this week, and learned a lot of new information about adolescent brain development and the translation of said development in various activities and education needs. I found it really interesting to learn a possible cause for the impulsivity, thrill seeking, and at times promiscuous behavior of many of the teens with whom I have contact.
The brain goes through a period of development during the adolescent period (ages 12-26) after which both the limbic system and prefrontal cortex ate completely developed. However, these two systems do not develop at the same rate. The prefrontal cortex develops more slowly than the limbic system. As the limbic system seeks pleadure, risks and reward and the prefrontal cortex is involved in logic and decision making, it would make sense that during adolescence teens seek thrills and rewards at a rate at which the prefrontal cortex cannot keep up.
Standardized Patients
As a student in a MS PMHNP program, I had a midterm in a OSCE environment and was required to conduct an H&P on a standardized patient. As I had used standardized patients in my RN to BS P
program I thought I knew what to expect. The experience was good overall.
However, I am short, barely over 5 feet. The standardized patient was 6'8". I had difficulty with the HEENT component if the exam because I could not reach the SP's face. This struggle got me thinking about how I would address this in an actual clinic. I had never encountered this issue (possibly because of the do I if setup). Any ideas?
Female Condoms
This week I found out that female condoms are still in use and provided to our clinic. We found this interesting because none of the nurses, PNPs or MDs have been using them in practice. When we got a new drluberyofcondoms from our DOH, there they were. We all has to figure out how to use them because we have not seen them or used them in quite some time.
-This week I learnt, or rather it was reinforced, complications from common surgeries are real and can happen at any time.
I was recovering a patient post left carotid endarectectomy. He woke up just fine, and neurologically he was intact during the first 45 minutes of recovery time. I was getting ready to tell his family to come up to the ICU waiting room and hand off to the ICU nurse assigned to care for him, when everything went downhill. His entire right side went completely weak, his BP dropped, he become pretty much nonverbal, and his breathing was becoming more agonal. The ICU nurse who I was supposed to hand off too overheard the action, and jumped in. I called a stroke code, helped the ICU nurse transport the patient for CT scans, and ultimately back to the OR. Turns out his left carotid was completely blocked again, and when he was opened up they found lots of big clots. Clotting disorder? I hope he's doing okay. This is a very rare complication. A more common complication can be bleeding from the site, but restenosis is extremely rare. Nevertheless, I won't forget this.
-This week I tried to bench press 100 lbs, and had to have the bar pulled off me because I couldn't finish the rep. I had done 95 lbs for 3 reps with not too much trouble, but an increase in 5 lbs was enough to lead to complete failure. How embarrassing.
My NCLEX date is fast approaching, 8 days away. And I am starting to get nervous!
I've put in a few job apps but as of yet haven't heard back on them.
I've learned that people have some really screwy beliefs on human anatomy. An adult women told me at a BBQ that women who have mixed race twins with different skin tones, do so because they "store sperm inside them from different fathers". I really wish I was kidding! My "genetics for dummies" lesson went right over her head despite the lovely diagrams I drew.
My extreme dislike of making phone calls has gotten tougher to overcome. I need to call a hospital regarding their new grad program but it's giving me anxiety.
Ugh! This didn't happen when I was on the floor making phone calls. Just at home.
Anyway I'm headed back to my office for another rousing round of Kaplan Q-trainer tests. And then into my pharm books to look up meds that Kaplan uses which I've never heard of.
I have the same issue with phones. I have no problem making calls at work, its a big part of my job. On my time though the phone is enemy.
Specializes in Pediatrics/Developmental Pediatrics/Research/psych.
Re: female condom, I worked women's/ community health clinic for a year and still can't recall a time that we ever gave any of those away. I honestly would have no idea how to use one myself if needed. Many of our clients find the cost prohibitive compared to a male condom.
According to my friend who does NGO work in Africa around sexual health, female condoms are more popular there to prevent HIV.
We have never used them either. No idea why the DOH decided to give them to us now.
This week I found out that female condoms are still in use and provided to our clinic. We found this interesting because none of the nurses, PNPs or MDs have been using them in practice. When we got a new drluberyofcondoms from our DOH, there they were. We all has to figure out how to use them because we have not seen them or used them in quite some time.
What did YOU learn this week?
We were told a year or so ago that the preferred term is "internal condom", because males can use them with male partners . We don't get many requests for them; most people I speak with have never heard of them.
1) Being without the boyfriend isn't as tough as originally thought. And I really do like NYC 100 times better when I'm only visiting as opposed to living there again.
3) LOVE to read. Read the 700 page Harry Potter book in one day. It can be maddening for someone to say "you're such a great reader, you should have no trouble reading those nursing books!"...oh dear well-meaning family. It is an entirely different barrel of monkeys reading for fun as opposed to reading to educate yourself.
4) Constantly leaning on the "take school day by day" is working well...managed to keep the stress level low. Fingers crossed 0_0
5)Trying to reverse spiral the dog's leg didn't work out as planned. Mummified my dog today, how about you?
6) Thank you, silly woman who hit my (first) brand new car. At least you had insurance, AND you were honest. My car is all bright, shiny, and dent-free again.
Specializes in M/S, LTC, Corrections, PDN & drug rehab.
My son's surgery went rather well. The tubes were put in in less than 10 minutes & I'd say the whole day was rather painless. All the nurses were so great & so nice.
I'd say the best part of the day was when they gave him some medication to make him all loopy & calm before surgery. He was acting so goofy. I don't know what medication that was but can I have a barrel of it? LOL!
Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.
Brain DevelopmentI attended the third of my sexual reproductive health trainings this week, and learned a lot of new information about adolescent brain development and the translation of said development in various activities and education needs. I found it really interesting to learn a possible cause for the impulsivity, thrill seeking, and at times promiscuous behavior of many of the teens with whom I have contact.
The brain goes through a period of development during the adolescent period (ages 12-26) after which both the limbic system and prefrontal cortex ate completely developed. However, these two systems do not develop at the same rate. The prefrontal cortex develops more slowly than the limbic system. As the limbic system seeks pleadure, risks and reward and the prefrontal cortex is involved in logic and decision making, it would make sense that during adolescence teens seek thrills and rewards at a rate at which the prefrontal cortex cannot keep up.
Here's an excellent video series on adolescent brain development that I found a few years ago. I made my son sit through it with me, and stopped it from time to time to explain what was going on and how it related to his adolescence and the "why" of adults needing to be in charge of teens, simply because teen brains aren't ready for prime time yet.
Part One:
Part Two:
Part Three:
WILTW:
1A. I've been on my own (off orientation) for three weeks now, and I'm starting to feel like I've got a handle on things most nights. I work with an excellent team, and the nights when I've felt completely overwhelmed are nights when even the most experienced nurses have also felt like things were bat guano crazy on our unit. So I've learned that I made the right choice in moving from Private Duty to a hospital job.
1B. I overheard two totally different patients with totally different circumstances mention to other staff how much they liked having me as their nurse. This affirms that I made the right choice in moving from Private Duty to a hospital job, and I am doing something right after all.
2. I learned that wannabeny can't count (missed #2 on your list! LOL).
3. Surgeons may have a crap-ton of information in their brains, but they don't know that the chest tube and its drainage collection system need to go into a red bio-hazard bag when removed at the bedside -- not the regular room trash can.
4. Clinimix is a PITA. We have three different patients on our unit on Clinimix infustions right now, and I keep having to check all three med-rooms to find the filters when changing the tubing because we're going through them so quickly. Clinimix has to be hung alone -- nothing can run with it concurrently (Y-ed into the line) or piggybacked. And you have to change the tubing -- and add a filter -- every time you hang a new bag. And Pharmacy doesn't keep track of when a new bag will be needed, so you have to keep an eye on it and order a new bag far enough in advance for Pharmacy to prepare it and tube it up to the floor. Did I mention that Clinimix is a PITA?
5. Working eight 12s in nine nights is rough, but it won't kill me. And the paycheck is gonna be nice with all that OT and holiday pay on it.
My son's surgery went rather well. The tubes were put in in less than 10 minutes & I'd say the whole day was rather painless. All the nurses were so great & so nice.
I'd say the best part of the day was when they gave him some medication to make him all loopy & calm before surgery. He was acting so goofy. I don't know what medication that was but can I have a barrel of it? LOL!
I know where I work we give some kids oral versed, which comes in liquid form. Personally, I don't think the versed works. It just exacerbates any anxiety they may already have. Some kids go in calm, and after the anesthetic gasses dissipate, they're back to their normal calm selves. Other kids go in very anxious, and come out bawling even after the gas dissipates, and leave that way too. Versed does not make a difference. In fact, we try to really avoid giving it even if the anesthesiologist insists.
Specializes in M/S, LTC, Corrections, PDN & drug rehab.
I know where I work we give some kids oral versed which comes in liquid form. Personally, I don't think the versed works. It just exacerbates any anxiety they may already have. Some kids go in calm, and after the anesthetic gasses dissipate, they're back to their normal calm selves. Other kids go in very anxious, and come out bawling even after the gas dissipates, and leave that way too. Versed does not make a difference. In fact, we try to really avoid giving it even if the anesthesiologist insists.[/quote']
Thank you! Thankfully my son was goofy & calm when he went in & calm when he came out. He was only upset because he wanted more to drink, which is understandable. But thank you for your insight. I wanted more information on the drug. [emoji4]
whichone'spink, BSN, RN
1,473 Posts
-This week I learnt, or rather it was reinforced, complications from common surgeries are real and can happen at any time.
I was recovering a patient post left carotid endarectectomy. He woke up just fine, and neurologically he was intact during the first 45 minutes of recovery time. I was getting ready to tell his family to come up to the ICU waiting room and hand off to the ICU nurse assigned to care for him, when everything went downhill. His entire right side went completely weak, his BP dropped, he become pretty much nonverbal, and his breathing was becoming more agonal. The ICU nurse who I was supposed to hand off too overheard the action, and jumped in. I called a stroke code, helped the ICU nurse transport the patient for CT scans, and ultimately back to the OR. Turns out his left carotid was completely blocked again, and when he was opened up they found lots of big clots. Clotting disorder? I hope he's doing okay. This is a very rare complication. A more common complication can be bleeding from the site, but restenosis is extremely rare. Nevertheless, I won't forget this.
-This week I tried to bench press 100 lbs, and had to have the bar pulled off me because I couldn't finish the rep. I had done 95 lbs for 3 reps with not too much trouble, but an increase in 5 lbs was enough to lead to complete failure. How embarrassing.