A few lessons learned.

1.  Don't assume relationships to the patients.
I had my first foot in the mouth experience at work a month or so ago.  I took morning vitals on this baby and there was a woman sitting in the chair very attentive while I did it.  She didn't speak english, so it was simple convo and that was it.  I came back later in the day and assumed that the lady in the chair was the mother.  So when this young girl came up and was translating as I talked to her I asked, "Are you the older sister?"  To which she replied, "no I'm the mom."  I couldn't believe I just did that and to dig deeper I stupidly replied, "Well you look great for having such a new born."  Well no shit, she was 16.  Turns out the lady in the chair was the grandma.  It made the entire day awkward and I vowed I would never make that mistake again.  So when I walked into another patient's room a few weeks ago, and I was convinced that the man visiting was the kid's grandpa, I asked, "Who this lovely man who came to visit you?"  And the patient said... oh this is my dad.

(Picture picked for you Matt)

2.  Set two alarms when you are sleep deprived.
One day, when I was still training, I woke up for work and noticed light coming through my window and instantly freaked out.  I wake up way before the sun comes up, so I knew, even before looking at my phone, that I had overslept.  I had merely 20 minutes before I was suppose to be at work.  Panic stricken I called the educator that was scheduling me and let her know I was going to be a little late.  There was no way I'd make it in time taking the el so I hopped in my car and drove to the hospital thinking paying for parking was worth saving my butt an extra half hour of being late.  I made it into work only 15 minutes late and was able to relieve the night shift SNA at her regular time.  She even mentioned that she thought I was going to be late.  Which technically I still was.  So I finished my day and went to the lot knowing parking would be expensive, but I had no idea just how expensive.  To park in the garage across the street from the hospital for 6-12 hours costs $45 buck-a-roos!  I probably would have been better off calling in sick or, in retrospect, taking a cab...

3.  Don't go to Bass Lake the weekend before a test.
Last minute I realized I started clinical a week later than I thought and was free, so naturally I scoped out what was going on down at the cottage.  Aunt Neici and Uncle Bob were suppose to help Peachie and Steve work on their garage, so in my head I was thinking they would be preoccupied with that and I can study while glancing up at a great view every once in a while.  Turns out the garage wasn't an all day project and the godparents were out to play.  I may or may not have mentioned that I've never been on a bass lake bar crawl on the golf cart and from there on out the day was shot as far as studying was concerned.  I more or less winged it on the exam and ended up getting a below average grade aka a D.

4.  Don't let life pass you by... even when in nursing school.
The weekend before my second test I went to Apple Canyon.  It was the weekend after Thanksgiving so it seemed justifiable.  I got to spend quality time with my family and experience all that is Diamond Jo Casino.I actually spent some time studying and got an A on the exam which is more heavily weighted than the first.  Come end of the quarter I ended up with a solid B in the course.  That has pretty much become my baseline and I'm not freaking out about it anymore.  Looking at my grade configurations I needed to get nearly 100% on the first exam to get an A (an event that has only been achieved once in my nursing school career).  Im not upset I got a B in the class and Im not upset I got a D on the first test.  It was a great impromptu weekend to Bass Lake and Apple Canyon.

 5.  Cross out Don't go to Bass Lake the weekend before a test.

Learning through practice

In class we had a short blurb about sickle cell disease during our hemolytic diseases lecture .  Pretty much they said it was a genetic disease, predominately in African Americans (8% effected to be exact which is huge) where the red blood cell sickles making it hard to get through small vessels.  See a normal red blood cell is concave and easily squeeze through small vessels, however when they take on the sickle shape they don't bend and maneuver through small spaces.  Sickled cells also adhere to the walls of the vessel causing an occlusion and decreased blood flow which leads to further sickling in the hypoxic (low oxygen) environment and we have a vicious cycle.  Our guest lecturer said, “Treat the pain.  That't the biggest concern” and I thought well that's simple enough.  

Until I had my first sickle cell patient at work I had no idea how unbearable the pain caused by sickle cell disease could be.  I mean I felt uncomfortable in his room at first because of the pain I had to watch him experience.  My patient was a 16 year old boy who was as polite as could be.  He referred to me as Miss Christina and always answered with a “yes ma’am or no ma’am”  even despite the the pain crisis he was in.  He instantly became one of my favorite patients of the day.  

90% of all sickle cell related visits to the Emergency Department and 70% of hospitalizations are due to pain crises.  The average length of stay to manage the pain is 8-11 days.  Yet there is a catch, you can't just dope them up because the body builds a tolerance to opioids and we don't want to go all out because we are talking about a lifetime of pain crises.  So doctors try to prescribe a dose that will take most of the edge off to make the pain bearable and then we try to use other methods for pain control to get them through.  With this two way attack to pain we A) treat the pain and B) treat the source of the pain, which in this case is decreased circulation.  I always made sure my patients room was stocked with heat packs.  His legs were the greatest source of pain so we'd constantly have heat packs on his knees and ankles.  A simple walk to the bathroom would bring this poor guy to tears and breathless.  

Theoretically the heat should help dilate the blood vessels and increase blood flow, but when I kept doing pain assessments and asking him what makes it feel better or worse he expressed that nothing really makes the pain better.  Another important key is to stay hydrated, because the increased volume with dilate vessels and increases blood flow.  In fact, dehydration is often a trigger for the onset of a pain crisis.   

Now my patient was not drinking his water... or poweraide... or juice so I had to get a little Nurse Ratched on him.  He told me it's hard to drink when he's not thirsty.  I told him thirst is one of the later signs of dehydration.  I knew he knew it was important to drink but I don't know if he knew why so I asked him to explain it (best way to know if someone knows something).  That's when I took the opportunity to educate.  He promised to finish his pitcher of water by the next time I came back to his room.  To which I replied, "well isn't that ambitious considering I'll be back in 20 minutes to take your vitals again."  He was adorable and like aw man I shouldn't have made that promise and the best part was he was smiling :o)  It was the highlight of my day and perhaps confirms that laughter really may be one of the greatest medicines.  I learned so much more through working with sickle cell patients, even as a student nurse assistant, than I ever would in the classroom.  

Under Construction...

Okay so I knew I was behind in blogging, but not until I checked out my last post did I realize how behind I am.  Over break I will be updating the blog so you can be up to par on all my recent learning experiences.  Just bare with me for a few more days and enjoy the holiday.