5/01 WILTW: Margaritas and Oral Thrush

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I've been asked to start the WILTW thread, and I'm more than happy to!

This has been an exciting week for me, as it was the last week of my Med/Surg I rotation. I'm trying not to feel too relieved though, because finals are next week. That being said, I will still absolutely squeeze in time to catch up on GOT.

This week I learned:

That my clinical instructor is a big ole softy. I can't believe that I thought she was super scary when the rotation first started.

That having just one year left of nursing school doesn't feel like enough time. Don't get me wrong, I feel like I've learned a ton in the one year of school I've had (and I'm more than ready to graduate so that I can get my social life back), but when I think of just how much I still don't know, I get a little worried.

That I wish I could take some patients home with me. Throughout clinical, I had nice patients, but none that really lingered in my thoughts when I went home for the day. But last week I had a patient who had already been through so much. His whole family had already been through so much. Sometimes it's hard to know just what to say, and I hope I was more helpful than I felt I was.

That I'm probably going to have a lifetime of telling family members, I'm not a doctor. You really need to talk to your doctor about that. I will probably NEVER be able to diagnose you.”

I've also learned that said family members, when you actually do give them advice (such as dietary advice), will say Oh, you're just regurgitating what you've learned in school,” and will continue to eat everything under the sun while wondering why their blood pressure isn't controlled. Why yes, I am telling you what I've learned in school, but apparently you'd rather hear that steak for every meal paired with a margarita is the best possible chance for survival.

That being said, I do follow the steak and margarita diet. But hey, I'm working on it.

That the best way to get a resident to like you is to empathize. Let them vent. Losing my independence is something I can hardly fathom, and I'm sure I wouldn't handle it with grace. (Like, really I'm very certain that I'll be the LOL trying to escape everyday and falling out of my wheel chair in an attempt to lunge out the door). It's ok to let residents feel angry about it. It's ok let them know that, yes, it does suck, and that you'll be right around the corner when they're ready for help.

But it's not ok if they scratch you. Or bite you. Oh swear at you. We still need some limits.

That I will never ever forget to do an oral assessment on my patients. This is the second time I've shined a penlight in there and found a massive case of oral thrush.

On that note, I'm also very glad I'm not a dentist or dental hygienist. I'll wipe all the butts in the world, but don't bring that mouth any closer to me.

But what's grosser than the grossest mouth? Maggots. I was not pleased to learn that maggots are still being used for wound debridement. That...is my limit.

So what did you learn?

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

That I'm probably going to have a lifetime of telling family members, I'm not a doctor. You really need to talk to your doctor about that. I will probably NEVER be able to diagnose you.”

Long ago I learned that many patients and families are more comfortable asking the nurse for medical advice and diagnoses because they perceive there's too much professional distance from their physicians.

One time I asked one of my former patients, "The doctor was in your room 20 minutes ago. Why didn't you mention these issues while he was here in your room?"

The patient responded, "He seemed like he was in a hurry. I didn't want to bother him, so I thought I'd ask you."

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I was off for Spring Break this week. One of the joys of being a SN is the time off.

I got less done than I wanted to, damn you, AN! :blink:

I have learned lots of non nursey stuff that I'm still trying to process.

I've learned I can trust my instincts online. I knew I could in real life, as I am surrounded by many awesome people who love me and have my back. Online is a whole 'nother animal, though, yes? I have been soooo right about the good, and sadly, also right about the bad.

I've learned that when life hands you lemons you squeeze them hard and make kitty cat hats outta them. Sometimes the lemon is worth the squeeze.

I've learned that I am horrible with time management if I think a task is easy, but I bang it out if I feel challenged. I knew that, but had it reinforced this weekend as I blew off my HH paperwork to go to my kid's lax game, and you know, play here. It is still hanging over my head. I'll get to it.

Speaking of HH, I've learned that taking time and talking to one of the patient's daughters for 45 minutes off the clock is okay, and sometimes necessary. I helped her. She had a hot South African accent. It felt good to put her at ease. And now I blocked her number. :)

I've learned that my mom wearing sun glasses over her regular glasses will send me off the deep end. Stop it!

I've learned that my GF who pushes me to move and gets in my face about working out is probably my favorite/least favorite person in my life right now.

Purp, on your instructor- congrats, you have just interacted with a COB. Hard on the outside, loving on the inside.

I'll make you a deal: You do my poopy patients and I'll do your oral care.

Then we will go out for margaritas and discuss.

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Long ago I learned that many patients and families are more comfortable asking the nurse for medical advice and diagnoses because they perceive there's too much professional distance from their physicians.

One time I asked one of my former patients, "The doctor was in your room 20 minutes ago. Why didn't you mention these issues while he was here in your room?"

The patient responded, "He seemed like he was in a hurry. I didn't want to bother him, so I thought I'd ask you."

"I have time for that."

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Purp, on your instructor- congrats, you have just interacted with a COB. Hard on the outside, loving on the inside.

I'll make you a deal: You do my poopy patients and I'll do your oral care.

Then we will do out for margaritas and discuss.

Deal! And not those frilly Americanized margaritas. The real deal! With a side of chips and super spicy salsa.

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Purple-Roses . . . I learned that the young woman taking care of my son while he was hospitalized was not a seasoned nurse yet but a nursing student and she ROCKED. My son was very impressed by his care at this hospital.

I learned that it is very hard to sit across the room and just "be the mom" and watch someone who looks 16 years old care for your son. I also learned that the stereotype about cocky surgeons held true for the man who did my son's surgery. And I already knew that I can exchange a good bedside manner for superior surgical skills.

I learned that pathology departments (in some places) are closed on the weekend. :bored: That can change the plan for surgery.

I learned just now from Farawyn's mom about how to read while out in the sun and needing to keep your sunglasses on! Eureka! I've always put my reading glasses OVER my sunglasses, which my kids tease me about. Now I can put my sunglasses OVER my reading glasses!

I learned that many of the friends I've made here on AN are real, true friends.

:inlove:

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Specializes in Emergency Department, ICU.

I was reminded this week that I remain perplexed by the docs who don't want to intubate patients who clearly cannot manage their own airways, instead wanting to see if we can wake them up enough for BiPAP. Call me crazy, but a patient that's been breathing an average of 50 breaths a minute for over an hour, AMS, with a crap sat and low BP to boot with massive pulmonary edema and the inability to cough up secretions is probably a good candidate for a tube.

Sometimes everyone but the doc agrees about a plan of care, and it's miserable to watch a patient suffer.

I learned that I am getting better about picking on the afebrile patients that the docs are going to order blood cultures on. Score :)

The psych patients that you need a urine from in order to give medical clearance never have to pee; it stinks to come in to a patient that needs a UDS who is now out of restraints and not as sedated that wasn't straight cathed while they were out.

At exactly the moment you don't have time for it, the lab will call with critical lab values on at least half of your patients.

I wish more families would get DNRs on their loved ones instead of deciding after they've been resuscitated that this isn't what their loved one would have wanted. Call me crazy but if your loved one has dementia and a host of other problems, I think that AND is the most compassionate choice.

I was reminded just how badly I feel for patients in sickle cell crisis.

Few things are more frustrating than trying to get a hypertensive crisis under control in a patient whose resting HR is in the 50s that is also allergic to hydralazine.

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Finished my last week of nursing school, and here's some of the things I've learned:

I've had no trouble hearing back from MI hospitals, but personal situations required me to turn down a few, unfortunately.

I love that I can PM some random AN members with questions and get more answers than I initially hoped for.

Cholinergics aren't administered to pts with urinary strictures or obstructions.

Administer fluoroquinolones with a glass of water and maintain pt's urinary output to 1200-1500 mL to prevent crystalluria.

Sulfonamides can cause several blood disorders (e.g. hemolytic anemia, leukopenia) - notify the physician if signs of infection are observed. Also, use with caution in pts with renal insufficiency.

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Congrats crackle!!!

When is your pinning?

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I learned that I am not important in the big scale of things, but I am everything to my dogs.

I learned that telling the obviously manic new nurse that she isn't safe around patients right now is freaking hard.

I learned that a drug addict who is undertreated for pain will call her boyfriend to bring her some meth in to the hospital. Just give her the GD dilaudid, already!! She has skin pop scars -- 2mg of morphine isn't doing anything for her!! She's already addicted to drugs, stop trying to force her into your own moral mold.

I learned that a scary number of people on AN really believe men are better than women. At everything. :eek: Let's just see one have a baby. Hmmph. (No offense, dudes. You are awesome. Just not "better than.") As a woman who escaped socialized misogyny, this REALLY irks me.

I also learned, or had reinforced, that therapeutic communication and limit setting works well with sundowners and manipulative patients.

Far, I'm the opposite. If I think something is going to be easy, I knock it out. If I think it's going to be hard, I'll put it off as long as I can. Then I'm mad at myself when I find out it isn't that hard, after all, and I wasted all that worry over nothing.

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Congrats kraken!

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Cani, I love you. Have I ever told you that?

Oh, I have?

You are gold, Ponyboy.

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