Wednesday, July 7, 2010

A new day

Tomorrow offers a brand new day on the med-surg floor.I'm excited to be back at the facility but I have to admit, after my lack of confidence freak attack last week, there is a small amount of anxiousness to tomorrow. I headed over to the facility tonight to pick my patient. After picking up a chart, I set to work taking down his history, diagnosis, and medications. From the looks of it tomorrow will be a great day.

He was recently weaned from his trach and was discontinued from being dysphagic today. ( having difficulty swallowing) He was placed on a mechanical soft diet with thin liquids and a 1:1 feeding. Meaning.....I will get to feed him breakfast and lunch. I actually really like being able to sit and feed patients. It's another blessing to being a student because I have the time to be with them and let them eat at their own pace instead of rushing through it because there are more patients to tend too. He suffers from L sided hemiparesis....paralyzed on the left side....from a stroke so he will need extra assistance with ADLs. ( Activities of daily living) Along with many other health problems he has a seizure disorder and Hep C. This will be my first time with a patient with both of these.

If you get a chance, pray for some confidence to head my way tomorrow! I don't like this feeling of nervousness! Pray for my patient and that I can do my absolute best to help him tomorrow and make his day just a little bit better.

Now, I must sleep! I've researched his medications and my careplan ( 21 pages!) that is due tomorrow is finished and man, she is a beauty!

Goodnight!

An anxious RN student

Tuesday, July 6, 2010

The Fourth


I love the 4th of July! I have such good memories of this holiday from growing up. At our old house on French street, the whole block would get together for a block party. Kids would ride ride their bikes, run back and forth between homes, and those were the days of using sparklers! Moving to the Rivertrail house brought even more memories. The day would be spent at the pool and playing outside. My sisters and I would help my mom in the kitchen making dessert and preparing dinner. We would sit on the back patio, shucking fresh green beans, chatting away while my dad was grilling on the bbq. The 4th of July truly is the " All American" family day with those wonderful summer nights. Every year, for as long as I can remember, my mom makes the same dessert and I anticipate it all year. After whipping up a delicious batch of brownies, the fun begins! She would set up a station on the counter and Trav soon learned what a treat it was. He quickly was the first to get in line. After putting the brownie in her holiday blue bowls, we would load up with ice cream, strawberries, blueberries, cool whip, nuts, chocolate sauce, and you can't forget her lil flag candy toppings to polish it off!

On top of the dessert, Trav and I soon started our own traditions when we were dating. We started going to Peralta Park for their firework show. We always went early because we loved the atmosphere and would talk about one day taking our kids. The park fills up with families. Kids are running around playing frisbee, tag, soccer, football, you name it. There are booths selling snow cones, hot dogs, and other typical 4th food. Than, everyone finds their spot on the field and waits for the show. It's actually really good....and not cheesy!

This year, the 4th started out a lil rocky. The day before I had to say goodbye to my dad. It was a total killer. And on Monday, I said goodbye to my Millie girl. Leaving AZ this time was harder than I could have imagined because this time, I was leaving so many people I hold close to my heart. I would be coming home to a place where I could no longer drive 10 minutes to see my parents or know that I have them nearby. My morning was bittersweet as I listened to my sister and her girls plan their 4th of July activities for my parents coming over. We did however eat 4th of July waffles which were wonderful! Trav surprised me at the airport...I thought he was working! He is pretty sweet and knows exactly when I'm sad and I don't even have to say it. Sometimes silence is best. I was pretty teary eyed on the way home and he just sat and held my hand which is just what I needed. I wanted to crawl into bed so I could wake up and have everything be fine, but of course that is not the way to cope with things. Trav's parents were having a bbq that afternoon. I'm very thankful they are close by.....and that we have nephews here too! It makes holidays that much better! The ache I felt inside was soon soothed when we walked in the door to see Huddy's smiling face saying, " Ehhhmmmmmaaahhh!" Have I mentioned it totally melts my heart to hear him say my name?! Van man soon showed us how brave he is now that he swims without a life jacket! What a stud! While the tears were still a breath away, it was great having the Hardeman clan together to celebrate. Katie brought dessert and it made me so happy because it was close to my mom's! It was delicious...angel food cake, berries, cool whip, and ice cream. Yum!!

You can't have 4th of July without fireworks and since Peralta had already done their show, we found that Fullerton High did one right by our house. Van man took a good nap so he would be able to go! Heidi and Dan came by and we walked on over. Ok, I should say trecked on over! After getting to the school we realized we had come in from the wrong side. Oops! So, we climbed though bushes, trees, and along side a hill to get to our spot! It was fun and the fireworks were awesome as usual. The best part was hearing Vans comments about each one and seeing his excitement!

Hope you all had a wonderful 4th of July and enjoyed time with family!

                                                                     Yum! Flag Waffles!
                                                                   Tessa loved her waffle!!!!
                                                                 Waiting for fireworks!
                                                                         Funny face!

Confidence Please!

Whew! The first day is done and under my belt!! What a day it was! After four hours of sleep the night before, I was seriously praying for some strength to get me through the 14 hours ahead....ok, and an awful lot of coffee!! It was a somewhat "rusty" first day but I think that is expected. We all needed a day to get used to the routine and the facility as well as what is expected of us. Figuring out the organization of the med room, iv room, and clean utility is enough to take a whole day!

My pt was a delight.  She suffered from multiple medical problems. Having dementia, she needed to be re-oriented to the time and place quiet frequently. She was pleasant and simply just wanted someone to be there with her. She had recently been transferred from a SNF and she was extremely malnourished. Her entire body had loss all muscle mass, completely atrophied. Each bony prominence displayed a  pressure ulcer. To me, it's unacceptable. I understand that being malnourished with multiple medical problems puts you at a high risk for decubs.....but covering the whole body? She should have been turned every two hours, heel protectors placed, supported by pillows and checked frequently because an ulcer can go from Stage 1 to unstagable all too quickly in a patient like her. But now she is suffering severe discomfort and having difficulty healing.

Anyways, I think I will sum up the day for you in positives and negatives because there was an awful lot of both!!!

Positive: I was involved in pt care! I've really missed the pt interaction and it felt so good to be working with a live person and not a mannequin!!

Positive: Our facility offers FREE coffee and flavored ( hazelnut AND french vanilla) creamer all day!!! Heavenly?!?! I think so!

Negative: I realized that I lost all confidence as a nurse. In the time between graduating my LVN school and now, it somehow flew out the window and I would love to get it back! Before, I was so sure of myself with med passing, dosage calcs, G-Tube feed changes & meds, and so much more. I walked into my pt's room, looked around, and literally thought, " Holy cow. I've forgotten it all!" I'm really hoping with each clinical day I gain some confidence back!

Positive: My pt had diarrhea. You just re-read to see if it was a positive or negative, huh? Ha! Well let it be true...it was a positive! You see, at the facility there are 20+ pts to one CNA. Meaning....pt care can often be overlooked. I'm glad to have my sweet pt because with frequent bowel incontinence she is prone to more skin breakdown, infection in her sacral ulcer, and simply being uncomfortable. Aside from that, her dignity gets taken away each time as she has to sit in it and just wait for someone to help her out. Would you like that?! Nope. Me either. So, it was pure joy to clean her each time right away while making her feel comfortable and that it was simply not a big deal.

Negative: I didn't get to change her IV. It was due to be changed but my RN I was working under had been off the floor for 3 months and wanted the practice again. I felt a little better though after she blew 3 veins before getting it. The pt was fragile and the veins were hardly visible. It would have been hard for me to start it being so inexperienced.

Positive: I worked with an awesome RN. I couldn't have asked for someone better. She made sure to take the time and explain everything she did. She question me which was scary but good because I do need to know the rationales for everything that is done. She was so great in teaching me lil tricks to save time and a way that wasn't confusing. I feel pretty blessed to have had her.

Negative: I was driving home...to an empty house...and was about to get off the freeway to see my parents and share about my day. But, they are in AZ  so I quickly got out of the turn lane and headed home. I'm going to miss that. Walking in the front door to see them sitting at the table. Joining them and sharing the joys and challenges of the day as they offer support.

Positive: I watched a condom cath put on as well as wound care on bilateral cellulitis of the lower extremities. I know it sounds like nothing but I love the opportunity to see everything no matter how big or small it is.

Negative: I MUST get contacts! I don't know what happened but while watching wound care on a friend's pt I had the most embarressing experience. It was an isolation room, so we all ad a mask on. It's always fun wearing a mask and glasses. Anyways, while assisting with setting up supplies I must have breathed weird because the air shot up out of the mask, fogging up my glasses! I couldn't see a thing! Don't they have defrosters or snap on wipers for moments like this.

Positive: I was able to give patient and family teaching. Since my pt suffers from dementia, she comes in and out of reality, so I was thankful when family stopped by  and I was able to talk with them. My pt hadn't been provided good oral care...at all. She was hesitant to let anyone else provide it for her, stating" My niece will do it when she comes on Sunday." Poor oral hygiene can lead to great complications. So, I was able to instruct the family on daily oral care with swabs because the mouth is a an environment for bacteria to enter and travel....causing cardiac problems is a major concern.

Positive: I felt that even though I lacked confidence and elt a little overwhelmed, I still made a difference in her life that day. I was someone who had the extra time to sit with her, hold her hand, clean her, and simply smile. THat is a positive of being a nursing student. We arent' juggling a handful of patients. We are able to really focus on the ones we have. It's truly a blessing.

Today may not have been picture perfect. It may have been a little rusty and confidence lacking. But it's a learning process and that's why we are here, in school, to learn and grow into fabulous RNs. Let the clinicals continue!!

Untill next time,

A confidence-seeking RN student

Wednesday, June 30, 2010

Tomorrow, Tomorrow...

Back from picking out my first patient and totally overwhelmed....ah!!!! I'm pretty excited about my patient though. For those of you who have sat through a Grey's Anatomy episode, you will appreciate this next reference. On the show the interns always fight for patients. They run to the ER doors to grab one coming off the ambulance or watch the surgical board for interesting cases. Christina Yang is always looking for the worst of the worst. Tonight gave me a little glimpse into their intern world. While standing around the nurses station, we couldn't help but ask for help with patients. You see, deep down we all really wanted one that would give us a great amount of experience. IVs, Foleys, G-Tubes, Wound Care....you name it. The nurses were great and gave us a list of rooms that would help keep us busy and give some experience. My pt has unstagable decubitus ulcers on literally every single bony prominence. In non-medical terms that means....awesome wound care for me to help out with tomorrow. Wound care has never been my strong point but tomorrow I will get a ton of practice. Plus, with each treatment, my patient will be that much closer to healing and with those types of ulcers, she is far from comfortable right now. She also has IV piggy back meds as well as IV push and I have never done those before.

Tomorrow holds alot of "firsts" for me but man, I'm excited! Say a little prayer the day goes smoothly. I will be pulling an all nighter tonight as I reasearch her 24 medications and memorize the classification, reason, and side effects for each in order to pass meds tomorrow. It's ok though because even if I was laying in bed, I certainly am too anxious to sleep right now!

Untill tomorrow......

A very excited, RN student

Oh Kindred...

In this nursing term, I have clinicals on the Med-Surg floor as well as an OB rotation every other week where I will gain experience in the NICU, Post-Partum, and L&D. I was really looking forward to clinicals and the chance to be with patients again.

Last week consisted of orientations to our clinicals sites/floors. We met our instructors and I came home with an intense amount of anxiety regarding my Med-Surg instructor. Past clinical instructors have been pretty laid back. That is the last I will see of that. After laying out the plan for the next 8 weeks, I realized I may be in over my head. I was already nervous about heading back out on the floor and that day just didn't make it any better. I've come to realize though that as an instructor she is going to push me to do my best. She is going to challenge me & teach me things that you can't learn in a textbook. She is going to question my judgment to make sure I have it in me to stand up for my decisions, patient care, and that I am my patient's advocate.

Aside from that, I was really excited about being able to go into the OR, ER, Telemetry, and Ortho units. Until our site was changed to Kindred Westminister. Now, I spent my Med-Surg clinical for LVN school here and it was great for that. I was able to grasp passing meds and injections as well as insert my first NG tube, watch a chest tube insertion and more. But for this term, I was totally bummed to hear the news. I was ready for something different and completely jealous of my friends who are scrubbing in the OR today or running around the ER tomorrow. Why did I get stuck with a facility that is pretty close to being an assisted living/long term care facility?

Growing up, when my mom didn't like my attitude she would tell me to have an attitude check. After telling her my disappointment for tomorrow's clinical, she did the same. She reminded me that the patients at Kindred need just as much care as a patient in the ER. My sister piped in to remind me that there is a reason I was placed at this facility. The Lord knew that the patients I would encounter here need something I have to offer. What would I do without my family's support?

So, my attitude has changed. I will still be praying the entire drive to the facility tomorrow for strength, patience, and guidance but I know that He has a great plan for me at Kindred that I don't even know yet. With every patient I encounter, I always treat them as if they were my loved one. For that patient is someone's parent, sibling, child, grandparent, friend and most importantly loved by the Lord. I can only pray that His love shines thru my work in clinicals to touch and heal lives. I pray that I will be challenged to the ultimate this term and that because of it, I leave as a confidant, joyful, and hard working RN. I also pray that my perseverance and dedication to this term allows the door to open for the clinical group at CHOC next term....which would be my dream. So, if this is a stepping stone....a bump in the road....a challenge to overcome than bring it on. I'm ready. I'm ready to make a difference. I'm ready to learn. I'm ready to care.

Here's to tomorrow and the beginning of a beautiful Med-Surg clinical at Kindred.

Tuesday, June 29, 2010

Push thru the valley......find the peak!


I thought I would wait on posting about nursing so I could recap these past 4 months in our married life. Travis is still working for Target and really excelling. It's pretty amazing seeing the man you love working hard and being acknowledge by his colleagues. This job that God placed in his lap has been such a growing experience for Trav and he enjoys it! I finished up my position working for the Ophthalmology surgeon at the end of May to focus on school. It was a bittersweet farewell. I was anxious to say goodbye to the sleepless nights with early mornings & last minute preparation for class but anxious knowing that there will no longer be 2 extra pay checks coming in each month. It certainly is a test in our faith and trust that the Lord provides if we just keep our focus in Him.

In the midst of all that though have been some challenges. I would love to say we have the perfect marriage, we never argue or get irritated with each other, and everything is simply out of a movie. But who would I be kidding, right? There is no such thing as "perfect" and I've learned if there was and we did agree on everything, that in itself would probably drive me nuts! It's interesting that when I stopped posting on here was right about the time our marriage took it's first major challenge. I probably stopped writing because I don't like to show weakness. I have the "Rutherford/Kahler" genes, as my parents would say. I'm stubborn & like to put on the "everything is fine face" when inside I'm hurting or sad.

In those 4 months I probably saw my husband about 30% of the time...and that's being generous. If you know Trav & I, you know we are family people and we like to be together...we thrive off it. So when that was taken away, it set us up for a pretty big hurdle to overcome. It started out slowly and before we knew it, it was overwhelming. Trav was working crazy hours....and majority of the time he was putting in overtime on top of it. He also played in a men's league and although that took away a night together, I would never ask him to give that up. Basketball makes him tick...it's his outlet...and I'm thankful he still has his fingers dipped in it even after the college days are over. I was balancing work and school....usually both on the same day. I was up and out the door before Trav would wake up. And would either come home before him but be in bed by the time he made it home or vice versa. Our dinners together simmered down to 2 a week....on a good week. Communication came from texting only. Making dinners for one was not fun and being alone in a house all the time can really get to you. When we would finally have a night or even just a few hours to spend together, we were both so over the top frustrated from being apart we blew the time we had. Our frustrations ended up coming out on each other and it was this viscous cycle.

I remember laying in bed one night and praying, " Please don't let it always be like this. He is my teammate and I need him here with me more than this. Are we always going to be in this valley?" How naive am I, huh? Of course we aren't always going to be in a valley. But in those moments, I couldn't see the light at the end of the tunnel, the pure joy that would come from this valley. Life is all about seasons. And in those seasons are a series of valleys and peaks. Each valley we go through strengthens us, pushes us to persevere and grow. Tests our faith. And that is what makes the peaks so much better. If life were always at a peak and we never had situations to challenge us, how would we grow? Our relationships would be stale, our faith stagnant. There is good that comes from each valley and it took us both a little while to figure it out.

After my job ended, I was hoping that it would mean we would have more time together. However, once again....we didn't cherish the time we had. You would think we would have learned our lesson from that already! One Sunday we had the whole day together. We went to the beach with friends and came home to BBQ. Trav thought he was super cool & invincible, so he tried jumping sleeping bags on his bike in our front yard. Needless to say he fell short of the jump only to break his hand. My nursing instinct was the first to come out but was soon overtaken by my spousal ( is that a word?) reaction. After going through triage at the ER we were sent to hang out in the waiting room until he was called for x-rays. Who would of thought that all of the healing from these past four months of hardly seeing each other would come about in an ER? The Lord has a pretty awesome sense of humor.

We sat down and with his one good hand he wrapped his jacket around me. We were sitting right next to each other, but we were in a hospital so it's not like we were sitting as if we would on our couch at home. Our arms were a few centimeters aways and Trav looked at me with all seriousness and said, " Why are you sitting so far away?" Before I could think of a witty comeback, he had pulled me into a huge bear hug with my face in the crook of his neck. Neither of us moved for minutes. I can't even tell you how wonderful it felt to just have him hold me....even in an ER waiting room. Than as if the rest of the world blurred out of focus we starting talking. We spent that time talking about our future, about what had been going on recently, about our fears, and we sat and prayed. It was wonderful. The greatest 3 hours I had spent in a long time. I still get chills thinking about it. There are many times when I fall in love with Trav all over again, each time stronger than before. This was one of them.

After coming home with a cast on his dominant hand, Trav soon found he couldn't do much. This reminded me of when my mom had cancer and our roles reversed. That time it was healing for me to take care of my mom. This time it was Trav. Each morning I would get up early to get myself ready so I could help him. All of a sudden we went from having no time together, to these moments that I will forever cherish. I know it was just as humbling for him as I had to dress him, tie his shoes, and even put his tooth paste on the toothbrush.

My school schedule has changed and now Trav and I have the same days off. We are still tired with crazy hours, but at least we are together...and can be tired and crabby together! :) While I don't have a job right now, we know He is going to provide. Afterall, he did bring us out of the valley & we both know this peak we are entering is going to be greater than the last. I'm so thankful for a husband who has a faith grounded in our Lord and knows that each valley only makes us stronger. I heard this quote awhile back and I really liked it. "You cant see the rainbow if you don't go through the storm....so always look to the sky and watch the clouds part. Remember, the God in the valley, is the same God on the mountain."

What an awesome God!

A Place for Thoughts

February 2010 was the last post. Alot has gone on in our lives since than! I've let a 4 month gap go into between posts so I'm going to try this again. Except, this time it will be a little different. You see, I have 26 weeks of nursing classes left but they are going to be crazy busy. Using words to convey my feelings is not always easy for me. I'm able to open up to Trav about everything but I can only share so much when he gets home from work because I simply don't want to overwhelm or burden him. That being said, I have redesigned the blog to be a place similar to a diary to that I can share thoughts, experiences, and challenges from my nursing school days. Don't worry though. I won't always bore you with that. I will still update on our married life as well as all our dozen nieces and nephews who are easily our pride and joy!

So, come with us as we finish out this journey together and step into the life of a nursing student. :)