Med Surg 5 3/27/15

Journal

     The MSU was very quiet and calm, except for some beeping of machines here and there. Most of the patients there were older adults who all had some sort of illness or injury. I mainly just observed my nurse. She made sure the patients were doing well, and she checked their vital signs and administered medicine. The equipment I observed was the vital sign machine. The nurse utilized the vital signs machine, and she also utilized her computer to input data.

     While in the MSU, I observed the nurse give medication and a bed bath. The health care professionals were very nice, and there were many of them on this floor. On the 7th floor, there were not that many. Two nurses worked together to give a patient a bed bath. They would talk to each other and ask each other if they needed help. I observed some safety procedures which included the fire extinguisher and the crash cart. The nurse would administer pain medicine to some patient who had a lot of pain. I had knowledge about what happened in the MSU because I had been to the 7th floor already. There was not really any new information that I learned because the nurses did the same thing as the nurses on the 7th floor. However, I learned from a patient that one of the doctors was on level 600 something on Candy Crush. I did not come into contact with any medical terminology; however, I came into contact with an abbreviation. The abbreviation was DOB which stands for Date of Birth. 

     The MSU visit went pretty well. It was not different than the 7th floor, but I still enjoyed observing. The patient they had to give a bed bath was not very cooperative. I learned that some patients will not cooperate with you, and sometimes you need patience. It is very important to make your patients as comfortable as possible in order for you to do what you need to do. 

Day Surgery 3/6/15

Report

1. This week in Day Surgery I read out of a binder for a good 30 minutes because they were not doing anything. After 30 minutes I was able to go into a room and observe the nurse. The nurse took vitals, and she asked the patient questions and informed him of the procedure.
2. This week I learned about what the nurses duties in Day Surgery are. They have to make sure the patient consents to the surgery, and they have to make them sign a paper.
3. The best thing that happened was that I got to sit down and read interesting stuff about edoscopies. I saw cool pictures, and also I was able to observe a nurse.
4. The worst thing that happened was that I was not able to do much observing. That's alright though. I was tired that day anyways.

This week was: FAIR

There wasn't much to do, but towards the end I was able to observe a nuse which made the day fair.

Record

Technology Observed:

I did not observe any technology; however, I read about an endoscope. An endoscope is a long, narrow, flexible tube with a light and video camera attached to the end. It shows images of the GI tract on a screen during surgery.

Diagnostic Procedures:

The only diagnostic procedure that I read about was an endoscopy. They use this procedure to diagnose what is wrong within the patient.

Therapeutic Procedures:

There were not any therapeutic procedures. They prepped the patient for surgery. They took vitals and made sure he was comfortable.

Diseases/Disorders:

I did not observe any disorders, however I read about some. I read about a hiatel hernia which is an opening in the diaphram that the esophagus or swallowing tube passes through to reach the stomach. If the hiatus weakens and stretches, part of the stomach and/or esophagus can squeeze into the chest cavity producing hiatal hernia.

Medical Abbreviations:

OR - Operating Room

PACU - Post Anesthesia Care Unit

Journal

     The Day Surgery unit was very calm and quiet. There were hardly any patients there at the time I went. When a patient was being prepared for surgery, the nurse asked him personal questions, and they told him about the procedure that is being done. The only equipment that was used was the vital signs machine and IV. The only technology utilized was the vital signs machine.
     I was able to watch the nurse prepare the patient. There was one nurse in the room with the patient, checking his vital signs, and then another doctor came in and gave the patient a form to sign. They teamed together to get the patient ready for surgery. The nurses would communicate with each other to provide the patient with the right medication. The major safety procedure performed was getting the patient to sign a form of consent.
     Going into day surgery, I had no idea of any procedures done. I learned that they prepare the patient for surgery for a while and then actually perform the surgery. The only abbreviations I came into contact with was PACU and OR.
     Day Surgery was not too bad. I had a decent time, and was able to learn a lot about endoscopy because I had to read a book for 30 minutes. I learned how the nurses prepare the patient and how important it is to have patient consent. If I ever want to become a day surgery nurse, I could use the people skills I observed. The nurse was very kind and informational.

    

Radiology/Imaging 02/27/15

Report

1. This week the nurses duties included calling in the patient, making sure they changed into linen, laying them down on the table, making sure they were comfortable, and taking images.
2. Today I learned what an IVP is. IVP stands for intravenous pyelogram, and it takes images of the kidneys, liver and bladder.
3. I thought it was really cool to see the images after they took them.
4. I guess the worst thing that happened today was when the student there messed up while taking an image. He didn't let the equipment run long enough. It was corrected by redoing the image.

This week was: GOOD

I really enjoyed watching how the equipment worked and seeing the images produced. The staff was really nice, and they all worked well together.

Record

Technology Observed:

Today I observed a couple different machines. I saw the x-ray machine, and also a tomography machine. Both machines were controlled with a button, and they took an image very quickly. 

Diagnostic Procedures:

The nurses in imaging would lay the patients down and prep them. The patient first had to change into a hospital gown, and then the nurses explained what they were going to do. They also gave the patient contrast through an IV. 

Therapeutic Procedures:

There were not any therapeutic procedures. The most the nurses did was cover the patient with blankets to make sure she was not cold.

Diseases/Disorders:

The patient did not have any diseases or disorders. However, she was in the imaging area to get images taken of her kidney, liver and bladder because she had a urinary tract infection, and they wanted to see if she had any stones.

Medical Terminology/Abbreviations:

I only came into contact with one medical abbreviation. I saw on a report the medical abbreviation "DOB" which stands for "Date of Birth."

Journal

     When I walked into the imaging room it was a small office about half the size of a classroom. The personnel were all dressed in black scrubs, and there were about 5 staff members in there. The staff would go outside to get their patient and bring them into the room. They gave them time to change in a hospital gown and instructed the patient to lay on the table. The nurses used the tomography machine to take images of the patient's kidney, liver and bladder. After the image was taken, it would show up on the computer screen, and then they would move on to the next image they needed to take.

     I watched the nurses place the machine and patient in the correct spot. There was one imaging nurse instructing a student from medical school on how to work it, and she was also showing a new lady how everything worked. The nurse had to check with the doctor to make sure it was okay for the them to give the patient contrast, so they worked with the doctor and radiation therapist. Before taking each image, the nurses would move behind a wall, so they would not be exposed to any radiation. 

    Going into the imaging area, I knew that they took x-rays and other imaging stuff. I thought it would be really complicated to run the machines, but truth is, all they do is hold down a button, and the machine does the rest. I only came across one medical abbreviation that was on a patient's information sheet, and that was "DOB" or "Date of Birth." I also learned that IPV stands for intravenous pyelogram, and it is used to take images of the kidneys, liver and bladder.

     The imaging unit was very interesting. It was really cool to see how everything worked, and to see it behind the scenes. I am not used to being behind the scenes. I definitely learned what some of the imaging stuff is, and what different equipment they use. If I ever wanted to be in imaging, I could use some of the information I learned. 

GC 2/12/15

Dementia & Alzheimer's Disease

Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. Dementia is an overall term that describes a wide range of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person's ability to perform everyday activities. Alzheimer's is the most common type of dementia, and it accounts for 60 to 80% of the cases. Symptoms include memory loss, communication and language problems, ability to focus and pay attention and visual perception. The cause of dementia is due to damage to brain cells. There is no cure for the disease; however, there is treatment available to slow the process.

ICU 2/13/15

Report

1. Responsibilities: Retrieve medication, give medication to patient, check vital signs, assess patient.
2. Knowledge learned: Beta blocker is a medication that regulates heart contractions and slows down the heart. 
3. Best thing: I was able to learn about some medications and about different patients who were there.
4. Worst thing: Seeing the condition of patients, and being told how one may not survive much longer even though she is young.

This week was : GOOD

I was able to learn a lot, and the nurse i shadowed was very nice and actually taught me and explained things.

Record

Technology Observed:

In the ICU I observed basic technology. I saw the Pyxis which is where you get medication. I also saw the vital signs machine and how the nurses chart.

Diagnostic Procedures:

The nurse explained to me what had happened to the patients. One patient had a stroke. The nurse would explain to the patient what medication the nurse was giving him.

Therapeutic Procedures:

The nurse gave medication to the patient through the IV for pain. He also gave the patient medication to reduce the patient's heart rate. 

Diseases/Disorders Observed:

There weren't really any diseases or disorders that I saw. However, one patient had a stroke. You could tell half of his face was slightly drooping.

Medical Abbreviations:

There was only one Medical Abbreviation that I came across. The nurse talked to me about "a fib" which stands for atrial fibrillation. 

Journal

     Walking into the ICU I thought it would be like the PACU; however, it was very different. Each patient had their own room, and it was pretty calm and quiet. There were no nurses at the nurses station, and all of them were walking around, tending to their patients. The nurses provided the patients with medication, and made sure that they were doing well. The equipment that I saw was the Pyxis, which held the medication, and the vital signs machine. 

     The ICU was not clustered at all, and very organized. Ever drawer and cabinet were labeled with what they held. The health care professionals wore blue scrubs and worked very quickly. They helped each other with charting, and they also helped each other get medication. There was one new guy there who did not really know how the hospital's software worked, so the nurse I shadowed and the new guy would communicate on how to work it. Whenever the nurse put new medication into the IV, he wore gloves as a safety precaution. He told the patient what medication he was using, and gave him antibiotics, betablockers and pain killers.

     Going into the ICU I did not know much. I knew they dealt with patients who were in pretty bad condition, and they tried to bring them back to full health. I learned about some of the medication that was administered to the patient I observed such as a beta blocker. This medication regulates heart contractions, and it makes the heart slow down. The nurse told me that the patient needed this medication because of "a fib" which is a medical abbreviation for
atrial fibrillation." 

     The nurses in the ICU were very willing to teach, and they were very kind. I enjoyed my time there, and I actually learned some stuff. I learned about some medication, and also about some patients that they see in there. I learned that to work in the ICU, you have to be a strong person and really want what is best for your patients. 

GC (Activities 2/5)

Myths & Facts About Aging

It is important do know what is a fact and what is a myth regarding our older community. We tend to believe that the older people are not as capable as they really are. It is important that we treat them with respect and care, but not like babies. Treating old people like they cannot care for themselves may cause them to be depressed or lash out. So here are some myths/facts to keep in mind.

Myth: Older people suffer from some form of memory loss such as dementia or Alzheimer's.

Fact: Only 5% of those older than 65 will develop these diseases.

Myth: Elderly people need hearing aids. 

Fact: Sensory cells within the ear begin to die off as you get older; however. only 35% of 80 year-old's actually need a hearing aid.

Myth: As you age, you become grumpy.

Fact: Our personalities don't really change after age 30. Therefore, if you were nice when you were younger, you'll still be nice when you're older.

Myth: When you become old you will live in a nursing home.

Fact: Less than 5% of people 65 and over live in nursing homes.

Myth: Elderly people have more car accidents.

Fact: Elderly drivers are actually more careful on the road and tend to drive slower.

Med Surg 7 - 2/6/15

Report

1. This week my responsibilities included giving water, giving a bath and taking vital signs.
2. A new skill I learned this week was how nurses give bed baths. They take wipes and wipe down the patients.
3. The best thing that happened this week was being able to take vital signs and practicing the things we have learned in class.
4. I would say the worst thing that happened was giving an old lady a bed bath. She seemed to have slight confusion and was not very happy.

This week was: Good

I was able to observe more than I have in any other unit. I performed more hands-on tasks, and it was a lot of fun.

Record

Technology Observed: 

In Med Surg, I only observed basic technology. I was able to use the vital signs machine, and the ice/water machine. However, I also learned how to input some information into the computer as well.

Diagnostic Procedures Observed:

There were not any diagnostic procedures that I observed. Mainly the MSU is where patients come to recover. Therefore, it is mostly therapeutic procedures.

Therapeutic Procedures Observed:

In the MSU I observed several therapeutic procedures. I helped turn a patient because she had a wound on her back, and I also helped give the patients water. 

Diseases/Disorders:

I did not really see any diseases or disorders. However, there was an older lady who had a wound on her back. 

Journal

  Walking into the MSU was very quiet and calm. There were only three nurses walking around, and I was told that each nurse had 10 patients. I provided the patients with some ice water, and checked vital signs for some. Therefore, I utilized the vital signs machine, and I was also able to use the computer to input data.

  I observed the nurse take vital signs, and use PPE. The health care professionals worked very fast and moved in and out of rooms quickly. The only time I saw them work together was when one nurse did not know where something was, so a nurse instructed her. The safety procedures that I observed were standard precautions. The nurses used gloves and masks. The therapeutic and diagnostic procedures were mainly just making sure the patient was comfortable. We did give a woman a bath, and we also made sure patients had enough blankets. 

  Going into the MSU I only had basic knowledge about it. I knew the nurses took care of patients who have had surgery. I learned that one nurse sees many patients, and has to work very fast to get everything done. I learned how to use the vital signs machine, and I learned how to chart certain information. 

  The MSU 7th floor is definitely the place where I have learned the most stuff. I really enjoyed the staff there, and the nurse I followed actually explained information to me. I was able to really see how nurses work. I learned that you have to be patient with some of your patients, and really love your job and what you do.  

  

GC Assignment (LTAC 1/29)

Sundowner's Syndrome

What is it?

Sundowner's Syndrome is the name given to a syndrome that causes symptoms of confusion after sundown. These symptoms mainly appear in people who suffer from Alzheimer's and dementia; however, not all patients who suffer these diseases suffer from Sundowner's Syndrome.

Symptoms?

Symptoms include:

• Forgetfulness
• Confused
• Delirious
• Agitated
• Anxious
• Restless

Causes?

There is no evidence as to what causes these symptoms;however, there are theories. Some doctors believes that it is an accumulation from all of the sensory stimulation from the day which begins to overwhelm and cause stress. It could be due to hormonal imbalances that occur at night or simply fatigue after a long day. Lastly, some doctors believe it is anxiety caused by the inability to see as well in the dark. Studies have shown that the symptoms of Sundowner's seem to wear off an hour before sunrise. 

Treatment?

• Encourage exercise to help sleep
• Limit caffeine and sugar
• Keep snacks light
• Good sleeping environment
• Calm reassurance

Emergency Room 01/30/15

Report

1. In the emergency room, the nurse was responsible for taking vital signs, keeping the patient comfortable, telling the patient what she/he was doing, drawing blood for testing (if necessary) and checking up on the patient. 
2. This week I learned that ER and Imaging staff work together often. One of the patients needed a chest x-ray done, so the imaging staff came in to do that.
3. The best thing that happened in the ER was observing blood being drawn. 
4. The worst thing that happened in the ER was watching two nurses hold down a young, autistic girl because they needed to draw blood, and she would not stop moving.

This week was:  Fair

The ER was not very busy in the morning, and I was not able to see much. The nurses were not very responsive to the questions I had.

Record

Technology Observed:

In the ER, I observed basic technology. There were vital sign machines, and EKG machines. I also observed a machine that was brought in by the imaging staff that took x-rays.

Diagnostic Procedures Observed:

I observed two diagnostic procedures while in the ER. One was the x-ray machine that took an x-ray of the patient's chest, and the other was drawing blood to take several different tests. These tests included checking liver/kidney, dehydration, seeing if the patient is anemic and white blood cell count.

Therapeutic Procedures

I can only think of one therapeutic procedure that I observed. The nurses gave the elderly patient some medication to help with his cough.

Diseases/Disorders Observed:

One disorder I observed very briefly was autism through the little girl. It was evident that she did not really know what was going on which made her very scared and caused her to act out. She screamed and cried the whole time while the nurses tried to hold her down in order to draw blood or put in an IV.

Medical Term/Abbreviations:

In the ER I encountered one term and one abbreviation. On a paper I saw the medical abbreviation "ASA" which stands for aspirin. I also overheard the nurses talking about a laceration which was a medical term we learned about which is a wound that is produced by tearing of soft body tissue.

Journal

    The Emergency Room was very calm and quiet when I first walked in. After being there for about 20 minutes things began to get louder. The personnel were very calm and patient as well which did not surprise me because I feel like working in the ER requires someone with those characteristics. When needed, the nurses would take vital signs and assess the patient. They would look for wounds and ask the patient how they're feeling. 

    I observed the nurses using the vital sign machines and drawing blood on two patients. The nurses would work together to record things and if they needed help with one of the patients who would not cooperate well. They also worked with the Imaging staff to take x-rays. The nurses would administer IVs and draw blood to take tests that for the elderly patient in particular, determined kidney/liver levels, dehydration and white blood cell count. 

    Going into the ER, I did not have much previous knowledge about how the staff worked. I knew that they dealt with many different patients and many different situations. I learned that they work together a lot. There can be two nurses to one patient, and they can help each other out. I came across the medical abbreviation "ASA" which stands for aspirin, and the medical term "laceration" which is a wound produced by tearing of soft body tissue. I also learned that the nurses check the patients for the Flu by putting a long swab up their nose.

    Overall my experience in the ER was fair. I was only able to observe two patients, and the nurses did the same thing for both patients which included taking vital signs and drawing blood. The experience was somewhat educational. It allowed me to see how the staff in the Emergency Room operates, and the different types of patients that they see. 

Clinical Report/Record/Journal - Physical Therapy 01/23/15

Clinical Report

1. In Physical Therapy I did not have any responsibilities. I asked about some questions about the exercise equipment, and talked to the patients.
2. I learned that the physical therapist will usually see two patients at once, and about 16 per day. At this hospital they usually have older adults come in, and most of the patients there were in to work on their knee(s). 
3. The best thing that happened was being able to observe the different exercises they had the patients doing and talking to the patients. 
4. One thing I did not enjoy was seeing the patients do their workouts and being in pain. That was probably the worst part; however, I know they have to do it to get better.

This week was: Fair

I was not able to do many hands-on duties this week, so I really just observed the exercises and talked to the patients. 

Experience Record

Technology Observed: 

In physical therapy I observed a lot of exercise equipment. They had many bicycle machines that would work on your legs, a total gym that also worked on your legs (it could do a lot more, but they just used it for the lower body). They also had weights and exercise balls. 

Diagnostic Procedures: 

In physical therapy they do not really diagnose patients. Physical therapy is usually where patients go after being diagnosed.

Therapeutic Procedures:

Physical therapy is all about therapeutic procedures. They use various amounts of work out equipment and exercises. I observed a patient who have a full knee replacement done, and she used the bicycle machine, the total gym, and she had to lift her leg high to walk over cones. 

Diseases/Disorders Observed:

I was not able to observed any diseases or disorders, for the patients I observed did not have any. However, I asked the therapist what diseases or disorders he has seen while working, and he said he mostly just sees patients with knee problems. Sometimes there are patients who come in who have had cancer.

Medical Terminology/Abbreviations:

The therapist I was shadowing said one medical abbreviation that we just learned. He talked about ADL (activities of daily living) with one of the patients. 

Journal

  Walking into physical therapy was similar to walking into a gym just not as many work out machines. There was even a little hint of nice sweat smell. In the room were probably about six therapists, and they all had patients with them. They were all working with their patients, and they were helping them exercise. One lady was lifting weights, some were stretching, and a couple were using the bike machines.
  Scattered around the room were medical beds, and around the walls there was work out equipment. The therapists all had black shirts on and khaki pants. They would work together, and they would share the work out equipment. I saw some simple safety procedures such as putting a pillow under the patients head while they used the total gym, so they wouldn't hurt their neck. I observed therapeutic procedures the entire time I was there from stretching, to exercise and balance. 
  In physical therapy I went in with knowledge about what they do. I knew that they stretched their patients, and they would give them exercises to do; however, I learned some things too. I learned that the therapist usually has two patients at a time, but not more than two. I did not encounter any medical terminology, but I did encounter a medical abbreviation which was ADL.
  I enjoyed observing the physical therapy area. Physical therapy is something I have been thinking about doing as a career, so it was really interesting to observe. I think seeing some of the exercises done can also benefit me personally because I have an injured knee. Maybe I can do some exercises and strengthen my knee! 

Clinical Report/Record/Journal - Pharmacy 01/09/2015

Clinical Report

1. In the pharmacy, my duties included reading off a list of medication, finding the specific medicine and pulling out the correct number of pills to put in a baggy. After doing so, I had to put labels on each bag, and set them on the counter for inspection by the pharmacist.
2. This week I learned how to look at a paper and figure out what medication (including the mg) is needed, and where to locate that medicine. 
3. The best thing that happened in pharmacy was being able to actually perform hands-on duties. 
4. The worst thing that happened was probably the fact that it was really difficult for me to understand the pharmacy technician. She had a very strong accent and talked very quietly. 

This week was: GOOD

I really enjoyed pharmacy, and I believe it was the first time I was actually able to learn a lot. I did the most hands-on duties in this rotation than I have in any other. 

Experience Record

Technology Observed:
In the pharmacy I was able to observe some of the technology used. I was able to make labels myself using the computer, and print them out of the label printer. Also, when an IV bag is taken out of the package, it is only good for a certain amount of weeks, so I had to make my own sticker with an expiration date on it. Lastly, I observed the technician put pills into a machine, and the machine packaged the pills.

Diagnostic/ Therapeutic Procedures:
I believe the pharmacy in itself is the diagnostic and therapeutic procedure. When somebody is diagnosed with a certain illness, nurses or doctors go to the pharmacy in order to give that person some medication(s) that will help them. 

Diseases/Disorders Observed:
In the pharmacy there were not any diseases or disorders that I observed. However, some of the medication in the pharmacy are used to treat illnesses that may deprive from diseases or disorders.

Experience Journal

   Walking into the pharmacy was messy but organized. It was not as loud as other places I have been to. For example the PACU, which is just a ton of random beeping noises that can probably drive a person crazy. There were probably 3-5 technicians working in the pharmacy, and each one was pulling medicine off of the shelves and making neat piles of pills, only stopping to put a label on a bag or to input information into the computer. There were computers along the wall, and some on the counters with label printers as their neighbors, and I was able to utilize both. 

   After completing the duties given to me, much like the duties explained above, the pharmacy technicians had the pharmacist come in. They were a team. The pharmacy techs would grab all of the necessary medications and baggage them, and then the pharmacist would come in, and he/she would communicate with them if they forgot something or had everything correct. The pharmacist and the tech. both performed the safety procedure of double checking every medication that was pulled out. They could not stress how important it was to make sure you had the right medication. After the checking process was complete, the pharmacist left. 

   I gained quite a bit of knowledge about what workers in the pharmacy do. I was taught how to read a paper that determined what medication to pull out, and how many pills were needed of each medication. I was also able to learn how to input certain information into the computer to make labels specific to the medication that was pulled. I utilized much of the equipment they had, and was able to learn a lot.

   The pharmacy was my best experience yet. The technicians were kind, and Hahn (the tech I shadowed) had a lot of important information to share with me. I never really thought working in the pharmacy would be to interesting, but I really enjoyed my time there. I could definitely use what I learned there in the future if I ever wanted to go into pharmacy.