Health Assessments

I cannot believe another week has gone by and I really don't want to miss updating those that have been following along on my journey.  This was my third week at the hospital.  The next three weeks will be spent at a nursing/rehab facility.

Each week I would drive into the hospital passing by a memorial that the Loving Arms Support group has set for those that lost their babies, whether be miscarriage, pre-term labor, still birth or even shortly after birth.  It's a support group for parents who have had a heartache that no one should ever have to experience.  This week I decided to stop and 'visit' our angel babies.  See, Dale and I lost three babies to early miscarriage in 1997 and our final angel in 2002 (ectopic).  So we have two memorials at the hospital.  I stopped this past week because it was beautiful out, the temp was nice, the sun was shining, but mostly because I had a little time before I needed to be inside the hospital.  Here are our babies memorials.

So, now, back to this nursing thing!!!

It's been a great week!  I had the same patient both of my clinical days.  This made things a tiny bit easier as I had basic info on my patient and I had already met them and helped with their care the previous day.  So my patient this week, was an older person who was admitted for respiratory issues but also being treated for wounds that were not healing.  The first afternoon when I received the report from my nurse, I was told they had trouble getting my patients temperature.  Other vitals were ok but temp wasn't registering.  After being moved to another bed, I was able to go in and assess my patient and get their vitals.  I was able to get his temp but it was in Fahrenheit and I had to convert it to Celsius.  Oh, no, what was that calculation!!!  I am so glad I put it into my brain a few years ago and it actually is there when I needed it. I already new my patients temperature was very low but after converting and charting it I let the nurse assigned to my patient know.  At that point a Bair Hugger was order.  (granted that's spelled right but sounds like bear).  And that was in hopes of upping my patients temp.  I had never seen one and only heard of one a week before.  So with my instructors assistance we were able to get this on my patient.  The next afternoon when I was able to get vitals I was glad to see that the temperature had come up, it was almost normal (it was still pretty low, but not dangerously low).  It was good to see how this device worked.  I was also able to watch as the specialist assessed the open wounds and (taught those shadowing him) decided on their plan of action.

I was bummed leaving the hospital on Tuesday night knowing I won't be back there for four weeks.  I thoroughly enjoyed my time there and all the things I've learned.  At the end of the evening we were given our interim evaluations and I did very well.  (It's basically either you get satisfactory or not).  

Today I was testing on my general health assessment.  We were taught exactly how to do this over the past few weeks.  Each student was testing individually.  When I arrived at my patients bed (this is a 'sim person so I can tell you all about her!!!) I was given her scenario.  My patient suffered a fall and dislocated her hip.  She also had her trachea caught on the blade of another ice skater (so assuming she fell while ice skating), thereby she now had a tracheotomy.  

So typical head to toe assessment her vitals were already done so we start with her general appearance.  My patient, Ms. Smith, had blue hair, swelling to her right jaw line and some yellowing of her skin.  She had no offensive body odors and no obvious piercings or tattoos.  So then we move to her head.  Now you have to realize that every time we practiced this on the simpeople, they have normal heads, flat stomachs, no piercings (some do have tattoos), so I was quite alarmed that my patient had a head that appeared a little to large in proportion to her body (just something we do note, not that a big head is a bad thing), she also had a scar on her nose and one above her lip, documented her blue, thick hair. I checker her eyes, making sure PERRLA (pupils, equal, round, react to light and accommodation), no drainage, conjunctiva pink; moved on to ears, appear proportionate in size and symmetry; moved to her nose which was clear and no issues breathing; her mouth was fine.  Then we move down to the  neck, since Ms. Smith had a trach I couldn't do all that I would need to do but did check her lymph nodes.  Next we moved down to the thorax (chest area) and at that point I remembered that I forgot to do the 'whisper test' while at her ears so I explained to Ms. Smith that I forgot to test her hearing and went back to that before proceeding (this was a major SAVE on my part!), so back to her thorax.  I first checked turgor here (a little pinch to the clavicle area).  Her chest seemed rather thicker front to back than side to side and that was noted.  I listed to her heart in the APETM spots (aorta, pulmonic; Erbs point, tricuspid and mitral areas) and then onto her lung sounds.  All good so far, moving down to her stomach, well darn, it was not flat!!!  It was distended.  I inspected first, then listened to her bowel sounds and then palpated the area checking for any pain.  It was firm in the center where it was swollen.  Going along good when we are told FIVE MINUTES oh no, this is strictly timed and I am taking my good ol time assessing my patient.  So now I move onto her extremities.  There was no issues with joint pain in her upper extremities and her radial pulse was good, her strength was good, so I moved onto her legs.  She had good pedal pulses and strength in her left leg but weakness in her right (due to her dislocated hip, see I remembered, that was part of the test too)!  One last think I had to check was her lung sounds on her back (and the skin on her back).  With the instructors help, we sat my patient up and listened to the six points we were instructed.  (at which point my instructor said 'great job in placement'!!!)

That was it, I did it and passed with no prompting from the instructor and no lab referrals to come back and be tested again!  I can breathe.  I am now studying for my next exam (tomorrow morning) so I will end here.

Thank you for following along with my journey.