1. An update.

    Hello to my dear darling followers. I know I’m a bad blogger and I haven’t posted anything in ages BUT, hear me out, I have a good reason (or twenty)!

    Over the last few months I’ve been writing my dissertation, which is now complete (!!) and may actually get published (!!!) so I can finally relax!

    Wait, wait, no I can’t, I’m a final year student nurse. The word “relax” doesn’t get spoken much at this stage!

    So now that my dissertation’s done, I’ve just started my final placement ever, which will finish at the end of July. This one’s particularly scary as you’re basically considered a staff nurse now, give or take a few months. To illustrate, on my first day last Tuesday, I thought my mentor was kidding when she said “Take that bay, off you go”. She wasn’t. No other help, no other support. Just, get in there and get on with it. Stressful? Yes. Overwhelming? No. Amazingly I did manage to get on with it and at the end of the day all my patients were alive and well! Huzzah!

    So as well as that, I’m also now applying for jobs, which is scaring the bejeezus out of me. I’m having a mini-crisis regarding exactly where and in which department I want to work, as the general consensus amongst all my nursey friends at the moment is “APPLY EVERYWHERE! JUST GET A JOB! WORRY ABOUT SPECIFICS LATER!”

    So that’s fun. 

    How are you all doing?

     

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  3. Things That Suck About Nursing

    NB. Picture is fairly unrelated but I thought it was so awesome I had to incorporate it.

    Ok, so I know a lot of people who follow me on here are starting nursing courses or thinking about it and may be pretty nervous about it. So, I figured, I’d do a post on the things that I think suck about training to give the truth about the course and the kind of worst-case scenario things that could happen so that people can read it and think - actually, yeah, I could handle that.

    1. Seeing suffering and death. The fact is that not all patients will be cured easily, and some not at all. Depending on the environment you choose to work in, you may see some horrific injuries that result in death or permanent disability, debilitating illness, people in intense amounts of pain, and the suffering of their friends and families alongside that. It is difficult to deal with. You will definitely cry at least once during your training. 

    Silver Lining: You will come to realise that although people are suffering in whatever way, you are doing your part to alleviate that suffering and people really appreciate it. Knowing that you made the most difficult, painful time of someone’s life a bit easier, a bit more comfortable - it’s rewarding and teaches you to appreciate everything you have while you have it. It will be an emotional rollercoaster looking after these people, but when you remember why you’re nursing and put their comfort above your own, you can look back and feel proud that you were able to help and that is so fulfilling.

    2. Work is hard. There will be days when you’ve already worked three days straight and your feet are killing you and the patients are all demanding and your colleagues are stressed and you’ve been yelled at and thrown up on and you’ve got a headache and you’re hungry and you’ve still got SO MUCH TO DO before you go home. 

    Silver Lining: These days, where everything is stressful and there are no high points, are incredibly rare. There will always be the one colleague who helps you out, the one patient that makes you laugh, the one patient’s relative who sincerely thanks you for doing something. So whilst every job has its down days, please see the silver lining to point 1: you’re still doing an incredibly worthwhile job, making a difference, and damn, you can feel like you’ve earnt those four hours you spent sitting on the sofa watching junk TV on your day off.

    3. Part of the job is, well, gross. You will see vomit, and excrement, and sputum, and have to do jobs you think you should be paid a LOT MORE to do. You may be shocked by what can come out of a person, feel nauseous for weeks afterwards, and occasionally have to leave the room in case you pass out. 

    Silver Lining: Ok, it’s gross, but it’s also really embarrassing for the patient to have someone else help them with these incredibly personal and private tasks. The level of trust they put in you as a nurse is a privilege and if you can respect their dignity and behave like a professional throughout any kind of embarrassing job, they will appreciate it and trust you all the more. And, once you’ve dealt with any kind of bodily produce once, you can handle it again.

    4. Rude people. Some patients, or their families, or even people you work with, are unpleasant. They may be aggressive, blame you for things you didn’t do, yell at you or just make your working day much more difficult. All you want to do is headbutt them in the face.

    Silver Lining: Again, you’d meet these people in any job, but the difference is that most of the people you meet who are being assholes are usually doing so because they’re super stressed, scared or anxious. So if you do your best to help them out, in my experience they generally seem to calm down. And if all else fails, I’ve found that saying ‘there’s no need to be rude’ paired with a stern look helps you stay professional but puts them in their place. As long as you haven’t given them a reason to be rude.

    5. There’s a lot to learn. Sometimes it can be overwhelming to think about how much you need to know to keep people alive. All the anatomy, physiology, pharmacology, policy, procedures, skills and psychological aspects of work may be incredibly daunting if you’ve never done anything like nursing before (I hadn’t), and it’s scary to think of the amount of responsibility you’re going to have as a qualified nurse. Will you be able to remember it all? Will you know what to do in every situation? Can you handle the pressure?

    Silver Lining: Honestly, probably not. At least not right away. I am currently terrified because there’s only one year until I qualify. BUT what I keep hearing from all the nurses I know or work with is that it just takes time and experience to find your feet. In twenty years’ time, you won’t be stressing because you need to give this medication and you’ve never drawn it up before, or freaking out because you’re not sure exactly what the pancreas does (that has never happened to me… ahem). Everything will fall into place, and if you get stuck, ask. And it’s as easy as that.

    Those really are the worst points I can think of in nursing. Although I’m sure everybody’s got things that annoy them or stress them out to do with the job, I think 99% of nurses would agree that the fulfilment you get from knowing you’re doing a beneficial job and achieving something good with your life outweighs those days where you want to kill everyone. Hopefully this hasn’t scared anyone but just given a better picture of the highs and lows of nurse training! Any other suggestions or comments?

     

  4. theitunurse:

    What makes a GI bleed, a GI bleed?

    Either by where the bleeding is coming from, or the type (variceal, nonvariceal). When someone is said to have an upper GI bleed that refers to a bleed coming from above the ligament of Treitz at the duodenal jejunal junction. If lower, occurring below the…

    THIS IS SO CONVENIENT considering I start on a GI ward on Monday!!

    Good work Mikey, thanks!

    (Source: theitunurse)

     
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  6. Random medical fact:

    The higher your IQ, the more you dream. 

    (Apparently)

     
  7. Scans!

    Your handy-dandy guide to what scan does what in very basic terms.

    CT/CAT Scan (Computerised Tomography) - A very detailed x-ray made by sending several x-ray beams simultaneously through the body via a large donut-shaped machine. Used for creating 3-dimensional images of originally the brain but now practically anywhere on the body. Particularly useful for locating bleeds or aneurysms, tumours and internal injuries as well as finding bone fractures and looking at certain lung diseases. Can also be used during biopsies. 

    Example of a CT Scan

    MRI Scan (Magnetic Resonance Imaging) - A scan that uses magnetic fields and radio waves to produce a picture of the inside of the body, but does not expose the patient to radiation. As the scan is so detailed, it is very useful in diagnosing many health conditions such as Alzheimer’s, dementia, cancer, atherosclerosis and damage to organs and tissues. Due to the strong magnetism used in the scan, patients with metalwork in their bodies should not undergo an MRI scan.

    Example of an MRI Scan

    DXA/DEXA Scan (Dual Energy X-Ray) - Used to determine how much calcium is within the bones in diagnosing osteoporosis or assessing effectiveness of treatment. This measurement is referred to as BMD (bone mineral density).

    Example of a DEXA Scan

    PET Scan (Positron Emission Tomography) - detects a radiotracer (a radioactive substance), introduced into the body as a radioactive version of a molecule such as water/glucose, etc. The breakdown of the molecules will be shown on the scan in different colours/brightnesses to illustrate how the body is functioning. Particularly useful in diagnosing or assessing diseases such as Alzheimer’s, cancer, epilepsy and heart disease. Patients must receive the radiotracer either by injection or inhalation 30-90 minutes before the scan and then relax until the substance is able to travel around the body. The scan itself can take around 30-60 minutes.

    Ultrasound - Uses sound waves to create pictures of organs or structures within the body. Often used during pregnancy to monitor the development of the foetus, but can also be used to look at organ defects, aneurysms and internal damage.

     

  8. Patients I will never forget #3

    On the elderly care ward I worked on last summer, I had a whooooooooole bunch of patients who will forever stick in my memory, for reasons both good and bad.

    One of the patients whose cases I will always remember is not a happy one but stunned me at the time.

    Mrs N was a patient whom I did not nurse personally for more than about one or two shifts, and she rarely needed assistance with anything anyway. I assumed, before I got to know her, that she had come in for something minor and would be returning home soon. She was a real sweetheart who was always incredibly polite, with a very nice family who came in to see her all the time. She reminded me a bit of my stepmother, so I liked her a lot. 

    As I helped with her care, however, I realised that actually, she had some serious health problems. I’m still not entirely sure what they were (helpful, I know) but I remember being shocked at the sheer level of peripheral oedema she had - fluid was literally leaking out of her skin all the time and you could dent her with your fingertip. I assume a major cause was cardiac-related but I really couldn’t give you specifics. I overheard a conversation between her consultant and a staff nurse one day where they were discussing the fact that Mrs N only had weeks, if that, left to live, and there was literally nothing that could be done for her. 

    She knew her prognosis, and yet she never seemed scared, or even sad. She wanted to go home to her family, and I remember her being concerned for their welfare and wellbeing, and when I sat and talked to her she just seemed so selfless. She was facing the terrifying inevitable right in front of her, but she was dealing with it like I could not believe.

    The significant event that causes Mrs N to stick out in my mind was a true reflection of her kind and selfless character. It was one evening just as everyone was getting ready for bed when she called me over to her and asked if I wouldn’t mind getting her a towel or two to put on her bed. I brought her some, slightly confused, and watched as she layered them underneath the top sheet. She explained that she didn’t want the fluid that was leaking out of her legs to make a mess and cause extra work for the nurses on the night shift. 

    Now, I don’t know about you guys, but I figure that if I had been told I was going to die within the next month or so, I would take a rather selfish stance on everything else. The fact that this amazing lady was still thinking of the tiniest things to make life easier for others just astounded me. 

    When she was discharged from the ward, she was absolutely full of praise for all the staff and thanked every one of us individually. I gave her a hug and told her I thought she was amazing, and even now I’m still welling up thinking of Mrs N. It’s patients like her that make up for every bad day, every rude family member and every horrible patient. 

    Yet another sappy post, I know, I know. 

     
  9. First Aid at Home - Dealing with some common illnesses and injuries

    I wanted to do a post on this topic because I sometimes feel like as a student nurse, I get taught to cope with serious illnesses and injuries, but slightly more common mishaps (the kind that you’re bound to get someone going, ‘You’re a nurse! What do I do?’ in) are often overlooked. So here’s some basic first aid! Enjoy.

    Basic Life Support

    Although you rarely need it in your everyday life, it’s one of those things you REALLY ought to know. Just in case.

    I was going to write out a humongous list of steps of what to do if you discover an unconscious casualty, but then I found this video:

    http://www.youtube.com/watch?v=uCDa-AhrjHo

    and this video:

    http://www.youtube.com/watch?v=AGznNGtT4xw&feature=relmfu

    which explain the steps a lot more efficiently than I would have. 

    Nosebleeds (Epistaxis)

    1. Sit down and pinch the top of the nose.

    2. Lean forwards and breath through your mouth. Leaning forwards prevents blood from running backwards down the throat.

    3. Stay like this for around 20 minutes in order to clot the blood. Stay upright (do not lie down) as this will decrease the blood pressure in the nose and reduce the amount of bleeding.

    4. Place an ice pack on the area to reduce swelling. 

    5. Do not undertake any strenuous activity, bending or blowing your nose for around 12 hours after a nosebleed. If nosebleeds happen often, see your GP as there may be an underlying cause.

    Burns and Scalds

    1. Remove the cause of the burn/scald as quickly as possible (i.e. by pulling the casualty away from a fire, for example).

    2. Remove any clothing, jewellery, etc around the burn/scald but do not remove any item of clothing or anything that is actually stuck to the burnt area.

    3. Cool the burn/scald with cool-lukewarm water for 10-30 minutes. Do not use cold/icy substances or creams/greasy substances and this can damage the aea further.

    4. Ensure the person is still kept warm to prevent hypothermia (this step is only really necessary if cooling a large area in cold/lukewarm water, particularly if the casualty is elderly or a small child).

    5. Cover the burn/scald with clingfilm (place a layer on the burn, do not wrap it around a limb, for example) and administer painkillers such as paracetamol.

    If the burn/scald has caused blisters, is deep or large, or other symptoms are experienced by the patient such as shock, exhaustion, heatstroke, etc., further medical advice should be sought. This also applies if the patient has an electrical/chemical/infected burn, or has inhaled smoke, or has other injuries or health conditions.

    Choking

    1. Ask the patient to cough as effectively as they can (although people normally don’t need to be told this if they’re choking…)

    2. If the item causing the blockage doesn’t budge after a good cough, administer five ‘back-slaps’ with the palm and heel of your hand in an upwards motion, directed between the patient’s shoulder blades. Check to see if the item has been dislodged between each slap.

    3. If the item is still not dislodged, stand behind the patient and place one hand (in the shape of a fist) in the area above their bellybutton but just beneath the ribcage (on women this is usually just below the bra strap). Place your other hand over the top and push in and upwards in a rapid motion. Repeat up to five times if the item does not come out.

    4. Repeat the back slaps another five times, followed by abdo-thrusts another five times. Repeat this entire process five times and call for medical assistance if the item is still not dislodged. Continue until medical help arrives, but as the patient’s airway is blocked it is likely they will pass out if the item continues to prevent breathing. In this case, it is necessary to start CPR (see the link to the second video I posted under Basic Life Support).

    Anaphylaxis (Allergic Reaction)

    Anaphylaxis is a medical emergency! If someone becomes very unwell or collapses following something like an insect bite or accidental ingestion of a known trigger, call for an ambulance and tell the operator you believe they are experiencing anaphylaxis.

    In severe cases of anaphylaxis, an injection of adrenaline must be given. Usually people with a known allergy will have a kit on hand which they can administer or you can help with. 

    If the person is experiencing difficulty breathing, help them to sit upright, perhaps leaning over the back of a chair to help expand the lungs.

    If they are experiencing hypotension (low blood pressure, feelings of light-headedness or dizziness, tiredness, etc) get them to lie flat and elevate their legs.

    If the patient becomes unconscious, place them in the recovery position.

    In milder cases of anaphylaxis where the patient is experiencing skin reactions to a trigger (rash, itch, etc), adrenaline is not usually needed but antihistamines and steroids may be required. All cases of anaphylaxis should be treated as an emergency.

    Stroke

    Using the FAST guide (face - is their face drooping on one side? Can they smile?, arms - can they raise both arms to the same level? speech - can the person not speak correctly, are they slurring, can they not understand what you’re saying?, time to call an ambulance) to identify if you think someone has had a stroke, call an ambulance as this is also a medical emergency.

    Bleeding

    If someone is bleeding severely, medical help must be sought ASAP to reduce symptoms of shock and effects of blood loss.

    Wearing gloves if possible, check there is nothing embedded in the wound. If there is, apply pressure around the object but do not push on it, and pad well around the item before bandaging to prevent the object from becoming embedded further.

    Apply and maintain firm pressure on the wound, preferably with a clean pad or cloth, and then bandage the area firmly. If possible, raise the area to reduce blood flow. 

    If a body part has been severed (like a finger), wrap it in a clean material such as clingfilm or a plastic bag and keep it cool. Try not to put it in direct contact with ice to reduce damage to the skin.

    Fractures

    Medical attention should be sought for fractures, sprains, etc. so call for assistance if you are unable to take the patient to hospital yourself (i.e., if the patient has a broken arm/wrist, etc, they can be taken to hospital in your own car or via public transport, but if they have a broken leg or something that prevents them from walking easily, call for an ambulance).

    Try to keep the patient/affected area as still as possible until they arrive at hospital. If the patient is showing signs of shock (clamminess, weak pulse, shallow breathing), lie the casualty down and raise their legs above their heart, loosening any tight clothing, and call for urgent medical assistance.

    Do not give the patient anything to eat or drink as they may require a general anaesthetic at hospital.

    So those are some very basic guidelines on what to do in a few more common medical emergencies. If you would like more info, check out the British Red Cross website which has more scenarios and lots of other really useful information:

    http://www.redcross.org.uk/What-we-do/First-aid/First-aid-tips-and-videos

     

  10. Patients I will never forget #2

    On the same placement that we had Mrs J (patient #1), there was also Mr S. 

    There were only 2 student nurses on the ward at the time, myself and my friend Cathy. Our ward sister told us that there were two pretty similar patients coming in that afternoon to have surgery the next day (pleural biopsy, nothing too major), and we would both be responsible for each of them - admission, preoperative checklist, surgery, recovery, discharge, the whole shabang. Cathy and I were excited, we’d never had that level of responsibility before, so we picked our patients at random and started preparing. I got Mr D, Cathy got Mr S.

    Mr D arrived first with his wife. He was very pleasant, I admitted him with no problems and returned to the nurses’ station feeling very pleased with myself. Mr S still hadn’t arrived, but suddenly he erupted from the lift with his wife and son in tow, booming something along the lines of ‘I’M BLIND, I’M DEAF AND I’M ALLERGIC TO EVERYTHING! WHERE AM I GOING?’ 

    Cathy looked terrified. She spent the next 3 hours admitting him and eventually returned to the nurses’ station looking exhausted and exasperated. Apparently the S family were talkers, and had some rather outlandish opinions and beliefs (mainly regarding aliens and ghosts). Mr S was not actually blind, deaf, nor allergic to everything. He had some sight and hearing difficulties and had had some bad reactions to various medications in the past. He was about 70 years old, his wife about 60 and their son around 40. She had travelled down to London to stay with him throughout his surgery and was staying in a hotel around the corner.

    The next day I followed Mr D through surgery (it went well), back through recovery and after one more night on the ward, I discharged him home with an all-clear result from his biopsy. Cathy, meanwhile, had her hands full.

    Mr S’s surgery had been delayed by a day so they had just remained in his room, and over the course of the day had told Cathy extensively about their experiences with the paranormal, both ghosts and aliens, and their sex life, which sounded quite impressive considering their age (although not something I especially wanted to picture). Cathy finished her shift looking a little traumatised. 

    After his surgery, the results of the biopsy took a few days to process, so he stayed on the ward. The rest of the nursing staff quickly got tired of his complaints about his medications, the way he barked orders at them and his rather unusual stories. I couldn’t WAIT to meet him properly, so the next time his call button went off, I went to answer it.

    I spent an hour sitting in their room listening to their tales of alien abductions and ghostly encounters and relished talking to them about the mild supernatural encounters I’d had over the course of my life (nothing particularly interesting but I love a good ghost story). They were the most captive audience I’d ever had for the tale of my sister’s haunted flat though, and I loved hearing about their conspiracy theories. I did have to come up with an excuse to leave when they started giving me sex tips, but still, kudos to them!

    A few days later the biopsy results came back with bad news. Mr S had extensive mesothelioma from his previous work involving asbestos, and excluding radiotherapy, there was very little that could be done. Mr S, however, did not show any signs of defeat and carried on as normal. Mrs S also seemed surprisingly fine. Neither of them really wanted to process this terrible news, and seemed convinced that everything would get better over time and life would return to normal. The doctors had told them the likely prognosis, but they chose to ignore it. Arrangements were being made on their behalf to find a place in a hospice for Mr S but he was still convinced he’d got another 30 years left in him. I was pretty amazed by how optimistic they were that I started to agree with them.

    It wasn’t until I heard some of the nurses talking about how Mrs S had shouted at them over something completely trivial and then broken down in tears at the nurse’s station before I realised how terrified she really must have been. I admired how brave she was being for her husband, but felt guilty that she had snapped and gone into meltdown before she’d talked about how she felt - I felt like she should have had the opportunity to discuss it with someone before she reached that point.

    Cathy and I finished placement before Mr S was discharged to the hospice, but I had to return a couple of months later to get something signed. I asked one of the nurses what had happened with him, and they told me he’d died a couple of days after we finished placement before he even got to the hospice. 

    What did I learn from Mr S?

    - Don’t dismiss people’s beliefs as wrong just because you believe something different - you can expand your mind and your view of the world a lot by talking to your patients about their beliefs and culture. 

    - You can’t take your patients at face value. Just because someone seems fine doesn’t mean that they definitely are, and you should always give your patients the chance to discuss their feelings. Be approachable and make them feel like they can talk to you - psychological and emotional care is part of good holistic nursing.

    - Love (and sex, apparently) really can last a lifetime.