Coda, Act I

These days I frequently throw my little Canon digital camera in my pocket when I leave the house. I find that many days, I come across something that's beautiful, funny or memorable.

Yesterday morning, we got our first significant snow of the year here in Chicago, so I decided to drive to school. I usually take my bike, but I wasn't sure how icy the roads were. I keep in mind that while I may be an avid bicyclist, I'm also a middle-aged avid bicyclist, and that I need four unbroken limbs in order to complete nursing school.

When I drive, I am usually able to find parking on Montrose Avenue, right next to Graceland Cemetery, which is filled with many of Chicago's and Illinois' historic figures-- Governor John Peter Altgeld, architect and planner Daniel Burnham ("Make no small plans"), George Pullman, Marshall Field, Jack Johnson (the first black heavyweight champion), Mayors Carter Harrison and Carter Harrison, Jr., and even "Bauhaus" architect Ludwig Mies Van der Rohe, with his mimimalist "less is more" tombstone.

Walking from my car to class, I had a moment of bliss and had to stop and take a picture-- there's a certain way the Chicago sky gets on a winter day. To see this sky over this beautiful old cemetery, with Chicago's skyline in the background just took my breath away.

I also had the realization that I was walking into a final exam completely confident; I knew I had a grasp on the material and was not in any way nervous.

I thought back to my first days in the nursing program-- how nervous and expectant I was. I realized that I've come to really enjoy this all. I look forward to class. I look forward to the clinicals. I love opening an electronic chart, poring over the data and putting together a big picture based on what I see and what I've learned.

Looking at my main textbook from the program, Craven's "Fundamentals of Nursing"-- I'm astounded at how many pages of a 1000+ page textbook I put Post-It's on to refer back to later. I also remember how, when I previewed it at the beginning of the semester, it was a little terrifying; it was filled with terms and numbers that I was going to be expected to know. And yet, here I am at the end of the first semester not only knowing all this stuff, but able to have lively discussions about those things, what they mean and applying them to the nursing process.

As part of our exit from the first semester, we were assigned to make a list of 20 things we learned in Nursing 101. When I sat down to do my list, I was floored-- which 20? I had learned so much.

So what did I learn? Here's my list of 20. I could have listed 200 without batting an eye.

1. Before administering Digoxin (digitalis), check potassium level and check apical heart rate for 60 seconds.
2. Never give IV potassium as a bolus—give as a drip over at least an hour.
3. Due to changes in peristalsis, metabolism, muscle tone and other factors, older adults stool less often than younger adults. It is important to educate them on this.
4. Use at least three means of identification for a patient before administering meds.
5. Oxygenation is the highest priority.
6. In case of a fire, RACE: Rescue, Alarm, Contain, Extinguish.
7. Older adults are frequently at high risk for falls.
8. With contact precautions, one uses gloves and gown.
9. Older adults have lessened taste sensation, lessened thirst sensation and reduced respiratory capacity.
10. That listening is one of the best tools a nurse has at his or her service.
11. One of the first signs of hypoxia in an older adult is restlessness and confusion.
12. First level behavior is behavior that is observed directly by the nurse.
13. Patients with renal failure frequently have anemia because the hormone that triggers hemopoeisis is produced by the kidneys.
14. The five rights—Right Patient, Right Medication, Right Time, Right Dosage and Right Route. There is also a sixth right: right of a patient to refuse medication.
15. A normal, non-fasting glucose level is 80-110 mg/dL.
16. Albumin level should be approximately the same as K+, 3.5-5.0, and is an indicator of protein deficiency. Prealbumin is a better, more immediate indicator. That should be 16-35.
17. The dignity of a patient should always be a primary consideration.
18. About 1500 mL of water consumption a day are the minimum to maintain kidney function, 2500-3000 mL is the optimal consumption.
19. A patient with vomiting and/or diarrhea should be monitored for low electrolytes.
20. Monitoring daily weight is the best way to check for fluid build-up or loss.

Tonight, I'll sit down with a glass of red wine and I'll unwrap Lewis' "Medical-Surgical Nursing," which will be my main textbook next semester, and preview it. I have a feeling that I'll find it less intimidating than I found Craven's "Fundamentals of Nursing" at the beginning of the semester. And then tomorrow, I'll run over to my school, get my final grade for the semester, register for next semester's class, Nursing 102 and while doing so, I'll get to hang out for a while with the people I'm sharing this adventure with. I can't wait.