5/01 WILTW: Margaritas and Oral Thrush

Nurses General Nursing

Published

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?

Specializes in Cardiology, Cardiothoracic Surgical.

Cool things I picked up this week:

1) how to zero and monitor a CVP line through a central line (someone though it was a good idea to have this in the stepdown unit)

2) slow A fib in the 50-60s with pauses and PVCs is apparently the rhythm of the week

3) the "are you f------ kidding me" look is enormously effective in staring down residents. You're not dropping a Foley into a pt simply for aggressive diuresis for fluid overload when she's alert, ambulatory and willing to get up and pee. That does not fly on SO many levels.

4) I got enormously mad that no one had connected my chronic pain pt's continuing GI symptoms (nausea, vomiting, epigastric pain, cramping) to both constipation and lack of adequate pain control. After cardiac r/o, 5 mg oxy and some Colace ain't gonna do ---- for a woman who uses enough narcotics at home to take down a horse, and subsequently is on a well managed bowel regimen. Took me 2 nights, everything I could think of short of an enema, and asking for better pain meds to get her comfortable enough to poop.

And poop she did after 6 days!

5) Starting to learn about identification of bundle branch blocks and how that connects to my pts' wonky rhythms.

Specializes in allergy and asthma, urgent care.

I learned this week:

That rashes aren't always what they seem to be. We had a patient with a very allergic appearing rash which turned out to be cutaneous T-cell lymphoma. It looked nothing like the textbook pictures. I'm glad I did a biopsy.

That even after 2 jobs and almost 7 years as a NP, I am pretty nervous about starting a new job tomorrow. It's in my current specialty, but I'm still anxious.

That giving my cat subQ fluids is scarier than starting any human IV. I don't like to hurt my kitteh...

Congrats to all the new graduates!

My last day of clinicals was last week , last test and class on Thursday, and final exam following Tuesday. I am READY to be done with this year.

And then sometime in July I'll be itching to be back7.

I feel *exactly* how you do Purple. Its next to impossible to imagine myself working a year from now. Or that ill be interviewing in 6 months. Like you wanna hire ME? I feel like I'll barely know enough to not kill anyone. The more i learn in nursing school how much i don't know increases exponentially.

I just had a brunch with the midwives who cared for me and with whom i had a home birth, who inspired me to go to nursing school. I miss them dearly and cant wait to someday have the impact on others that they had on me and my family.

This brunch involved taking an overnight trip to NYC when it really should have been home studying. It was well worth it, as it also involved staying at a dear friend's house who has gone from L&D nurse to unit educator and safety manager. I love her and she amazes me and apparently the feeling is mutual. I want to be her when i grow up.

Specializes in Oncology; medical specialty website.
I learned this week:

That rashes aren't always what they seem to be. We had a patient with a very allergic appearing rash which turned out to be cutaneous T-cell lymphoma. It looked nothing like the textbook pictures. I'm glad I did a biopsy.

That even after 2 jobs and almost 7 years as a NP, I am pretty nervous about starting a new job tomorrow. It's in my current specialty, but I'm still anxious.

That giving my cat subQ fluids is scarier than starting any human IV. I don't like to hurt my kitteh...

Congrats to all the new graduates!

Oh man, do I have a story I could tell you about the time I tried to give my kitty (dearly departed) Thomas sub-q fluids. ¡Ay de mí!

Specializes in Pediatric Hematology/Oncology.
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.

Ooh! I just learned today what delayed sequence induction really meant (particularly the apneic oxygenation part) and mind. is. blown.

Anyway, I am getting to the point where I am so busy that I can't even remember what new stuff I learned and it is giving me serious NCLEX-worry. :woot:

Specializes in Pediatrics, Emergency, Trauma.

I looked on my Facebook today while kick starting my birthday month and saw a "memory" post where I stated I was hoping to do well on a final-it was my next to last semester of nursing school.

I'm glad I did well after all that worrying 5 years ago! :D

I learned:

Trauma season is alive and well...having triple traumas occur within ten minutes is so much..."fun" :sarcastic:

That I still have a "no" list in terms of doing favors for people, even co-workers; I haven't done it in a while because I work with a good crew of people (even though we are short staffed) and this one coworker I will not do a favor for ever AGAIN.

I also learned that there is tremendous physician support for my staff; I have ideas on what to do to turn morale around, and if may have to involve the physicians as well; it's going to be a LONG process, however, I'm committed to making it happen, even if it means circumventing management for it to be successful...I am still unsure how to circumvent management, or rather how to diplomatically say that they are HUGE reason that morale is down.

I learned that I can have enough days off to string a spring vacation together, even if it's a staycation, I will be catching up with friends, family, and get to enjoy my days off! :D

I didn't read all of the comments. You lost me at steak and margaritas aren't my best possible chance of survival. Not sure where I'll go from here..

I didn't read all of the comments. You lost me at steak and margaritas aren't my best possible chance of survival. Not sure where I'll go from here..

I know. It was a shock to my aunt too.

Purple_roses, I'm about to go from a little ICU to a big CCU and I'm terrified of what I don't know too.

I'm sure you know by now that nursing school is just a foundation. You learn to be a nurse by being one.

I learned that there are aspects of night shift I am rather looking forward to.

Purple_roses, I'm about to go from a little ICU to a big CCU and I'm terrified of what I don't know too.

I'm sure you know by now that nursing school is just a foundation. You learn to be a nurse by being one.

I learned that there are aspects of night shift I am rather looking forward to.

Good luck on your transfer!

Good luck on your transfer!

Thanks! It's a career move I've been wanting to make, but I'm nervous all the same. What if the unit politics suck? What if my new co-workers aren't as awesome as my current ones?

All will be well, I know. I really really dislike the whole being-the-newbie-going-through-orientation-asking-questions-constantly thing.

Specializes in Pediatric Hematology/Oncology.
This Thursday! I just bought a pin off of Amazon. I'm not too sentimental.

I wish we could do that!!! I would get the jankiest pin I could find!!!!! :lol2:

+ Add a Comment