Friday, September 02, 2011

The "One Month In" Friday Random Ten

Today marked the end of my first month as a nurse. We had three days of classroom training, ending with a final on Wednesday. I got a 93%, well above the minimum 85% I needed to get. I was happy to finally get into the field and work a couple of days as a nurse. I'll be working with a preceptor for the next month.

Yesterday, I had an experience that made me realize I'm beginning to know what I'm doing. My patient was doing well, then suddenly her blood pressure started dropping fast (we monitor the blood pressure constantly). She told my preceptor and I that she had a headache (a common side-effect of dialysis), and then I noticed a change in her demeanor and pallor. My preceptor, who obviously had a lot more experience than I, noticed it too. We tried a couple of interventions without result, and quickly decided to end the treatment. She quickly recovered. I was happy to realize that I had recognized this event that up until now had been just something we talked about in the classroom.

Today I was working with my first patient of the day, who had only recently discovered he had renal failure; this was only his third dialysis session.

When a patient is either new to dialysis or a temporary patient, we use a catheter to gain access to their veins; it's similar to an iv, but has two lines and is placed in one of the big veins in the neck or upper chest. We try to limit their use because they are prone to infections. This can be a real problem because they can spread infections throughout the body since they're placed in big veins. If someone will be getting dialysis for a long time-- even the rest of their life-- surgeons create a thing called an arterio-venous fistula or an arterio-venous graft. In the first, a surgeon connects a big vein and a big artery in the upper or lower arm, creating a place we can access for dialysis. In the latter, a surgeon uses either a donor vein or an artifical tube to connect an artery or vein. It doesn't look pretty, but it's way safer for the patient, with only 1/7 th infection rate of a catheter.

In any event, my patient was clearly scared and confused. My preceptor and I answered a few questions he had. Later, a young resident walked in and told him that he would go later for an ultrasound to map out his veins for a fistula or graft. As she blabbered, I could see the anxiety and fear level in his eyes rise. I tried as politely as I could, trying not to step on her toes, to suggest that a little "patient education" might help. She completely missed the cue. She walked out, and so I explained to my patient what fistulas and grafts were and why they were beneficial. His anxiety level dropped notedly.

I helped my preceptor set up the last patient of the day. He was obviously diabetic, and had lost a leg to the disease. A son and a daughter. who were in their forties, were there caring for him. The son had to leave for a while. As we were getting ready for the dialysis, it became clear that our patient needed his adult diaper changed. His daughter struggled to change it, and was going to call the nurse's aide. I told her I would help, and showed her how a little easier way to do it. She was very, very grateful. I realized later that she had appreciated not only the help but that I'd helped her father preserve his dignity. Between this moment and the others in the last couple of days, I realized that I was in the right profession.

1. Soul Survivor- The Rolling Stones
2. Baby, I Love Your Way- Peter Frampton
3. Crystal Ship- The Doors
4. Low- Cracker
5. Just Got Lucky- The Joboxers
6. Livin' In a Fool's Paradise- Mose Allison
7. Theme From Shaft- Isaac Hayes
8 You're On My Mind- The Dirtbombs
9. Morning Sky- Chris Hillman
10. Incense and Peppermint- The Strawberry Alarm Clock

1. The closing track on "Exile On Main Street," the greatest rock album ever recorded.
2. Was never crazy about this song, but reconsidered it after hearing Lisa Bonet singing it in "High Fidelity."
3. My son was telling me a year or so ago that he was surprised to discover that the Doors' self-titled first album was not a "greatest hits" package. A phenomenal debut.
4. Just have to crank this one when it comes up on the radio or shuffle. Got one of my top ten favorite lines in a song ever, "Don't you wanna go down/Like a junkie Cosmonaut?"
5. This snappy little single stood out, even in a year full of snappy little singles, 1983.
6. Heard this song a lot as a young guy, but didn't know who did the version I heard. Thanks to Youtube, I was able to figure out it was Mose Allison.
7. Issac Hayes had written lots of hits for others before he finally had one with this smash hit. This song was on the jukebox at the Gingerman Tavern in Chicago in the late eighties through the early nintie; it was played 25-30 times a night, and every single time, every patron (myself included) would shout "Shut yo mouth" at the appropriate time.
8. This was originally done by Ronnie Wood's old band The Birds (not to be confused with Chris Hillman's old band, The Byrds).
9. Hillman's a founding member of the Byrds (not to be confused with Ronnie Wood's old band, The Birds)
10. I never get tired of hearing this big hunk of psychedelic cheese.


SkylersDad said...

Hey! We have something in common, changing adult diapers!! ;^)

jane said...

Brian, What you did for that family is the hearts blood of nursing. Never forget it or that feeling, well done rookie.


Erik Donald France said...

Huzzah! Well done~~!

And groovy grooves, certainly !!