Saturday, August 7, 2010

Done and Done

First semester of my practicum year is over! Already! I can't believe it.

I was thinking today about how much I have changed already. When I started at this hospital I couldn't find anything. I remember the first day - I sat on a chair in the atrium of the hospital, until one of my classmates showed up. And then we asked information for directions to the Respiratory Department. Yes, it was that pathetic. I stumbled through my first weeks on the wards, and eventually became comfortable doing assessments on patients, assessing their oxygen needs, doing 3 billion ECGs, administering respiratory meds, and calming panicked nurses. Some of the time. I also was able to attend traumas, conscious sedations, and cardiac arrests (to name a few) in the Emergency Department. I now know exactly what needs to be set up before we start, and I can do a conscious sedation on my own (even though it is illegal - it happened just yesterday). I don't look like a deer in the headlights when someone asks me for something in the middle of a code.

Just when I was getting comfortable with all of that, I started my rotation in the ICU - very late in the semester compared to my classmate. I was so nervous, uncomfortable, lost and just plain useless - all over again. It improved. I can independently monitor and assess the patients now. I am comfortable asking the nurses questions and they ask me questions about the ventilator, and most of the time I can answer them. When I started running ABGs on the analyzer I was a nervous mess. I couldn't even transfer a sample into a capillary tube. Now it is just a matter of routine and happens dozens of times a day. I draw gas after gas after gas. I look at it. We make ventilator changes. The doctors ask us what we think should be done - ventilation wise. I love being a part of that process. I am finally comfortable with a few of the doctors to ask questions, clarify med orders, and just plain old get my hands dirty in the ICU. Of all the places in the hospital ICU is still where I am most unsure, but I have a ton of time left to learn in the next two semester.

The best thing about the ICU is that I am actually using things that I learned in school. The therapists and nurses that work in that are are specialized and have to stay on top of those skills.

Updates:

Code story from two days ago. We coded a 30 year old approximately 10 minutes after shift report. It was chaos. I got to do CPR for the first time ever. The bed was too high and the patient was too far over. My arms could have gone forever but I got the WORST leg cramps ever from being on my tippy toes and doing compressions for the longest 2 minutes of my life. There just happened to be a ton of nursing students around that day (which was nice because they were newer than me, so I felt like I knew something). The students all gloved up and got in a line up to do compressions. This resulted in me not having to do compressions again, but instead being the runner for everything my preceptor needed. Compressions continued for 25 minutes. She did not make it. Her nurse, who is always very tough, went home early that day.

Yesterday I was setting up for a conscious sedation (because my preceptor was with another apneic patient from the previous conscious sedations - lots of cardioversions happening). I had just got the oxygen mask on the patient when the nurse says, "Propofol's in." Um. WTF, I am wearing bright red, it is obvious I am not a real Respiratory Therapist. Anyway, what could I do but a jaw thrust? So I dealt with the situation at hand, and it was over a few minutes later. My precepter waltzes in and says, "Oh good, you got this all set up, when are they starting?" She was PISSED. I don't know, something about losing her license if something went awry.

And now today. Happy story first. Patient who I thought would never get off the vent, is in fact on the wards now! Hurray!

Then I got to do my first apnea test today. That is a test to assess for brain death. Essentially you disconnect the vent, and stick a suction catheter which is attached to an O2 flowmeter down the ETT. Hopefully they breathe. Our patient did, which meant he failed the apnea test, and is now back on the vent. Now I will never know what ends up happening with him. I hate that.

I'm moving out of my dorm room tomorrow. I won't miss it. I will however miss this spectacular view.

1 comment:

  1. Congratulations honey. I am so proud of you!

    ReplyDelete