Cardiac + Thoracic + Surgery = My Unit

Today we had a two hour orientation for our Med-Surg clinical. I'm on the TCV surgical unit. That's Thoracic & Cardiovascular. Very sick patients. Also on our unit is a 9 bed Thoracic Surgery Intermediate Care Unit (TIMU), which we'll  hopefully get assigned to towards the end of the semester.

From what I can gather from the hospital's website, the patients I'll be working with will be recovering from conditions or treatments/surgeries related to:

Cardiac - Aortic, Mitral, Tricuspid & Pulmonary Valve Surgeries, Coronary Artery Bypass, Aortic Dissection & Aortic Aneurysms, Atrial Fibrillation, Heart Failure Surgery/Transplant.

General Thoracic - Lung Cancer, Esophageal Cancer, Hiatal Hernia & GERD, Achalasia, Malignant Mesothelioma & Other Pleural Diseases, Emphysema & Lung Volume Reduction Surgery, Mediastinal Tumors, Hyperhidrosis, Indeterminant Lung Nodules, Airway Diseases (Tracheal or Bronchial), Lung Transplantation.

Definitely a lot of very interesting, very complex conditions which will hopefully provide many, many learning experiences! We'll only spend eight clinical days on the unit, plus one in ICU for this rotation/clinical. Very different from last semester where we were on the unit twice a week. I don't think there will be time to be bored...and I'm expecting Tuesday nights are going to be terribly long, but hopefully interesting. Last semester I got so bored doing careplan after careplan for knee replacements!

I think of all the units I could have been put on, and I am so glad to be one of the few students to be assigned to this unit.  Even though this cardiac & lung stuff scares me, I know it's a great environment in which to overcome my fear and it will help cement the theory I'm learning as I will be applying and experiencing it in the clinical setting! *BUT hopefully no one I know will be a patient there!!

My clinical instructor works on this unit, so she knows the staff and this population of patients well. She'll know where things are and know the protocols and the routine on the unit. And because she knows these types of patients well, she will be able to challenge us more than someone who doesn't normally work with cardio-thoracic patients.

Today after clinical orientation I decided it would be in my best interest to try to log on to EPIC (electronic medical records system) and see if I remembered my log-on info. Well, turns out my password had expired, so I had to call the help desk to get it reset. Then when I logged in, I had to search/add my instructor as co-signer, then needed to change unit preferences to this new unit and not last semester's unit. It took me about 30 minutes to get it all straight, but now I'll be ready to go when I go in for clinical prep next Tuesday. Only one other person from my clinical stayed and made effort to log-in and get things straight. While I typically enjoy helping people figure things out on the computer, I am going to be really annoyed next Tuesday if someone asks me how to access EPIC (when they see that I'm able to log-in). I don't think it's fair for them to steal my prep time (or any other prepared person's time), when they could have easily stayed after clinical today to resolve this for themselves. I just have a feeling that most stduents will be surprised that they will have issues logging in next Tuesday.

If you are a fellow student, and you are reading this, I HIGHLY suggest that you go early to your unit on your prep day (right after lecture) and attempt to log-in and get everything sorted out. This way when assignments are posted, you can get started right away.

• Chances are you will need to call the Help Desk (# is on the computer desktop) to get them to update your password. Be sure you have your user ID to give them. 
• Once you initially log-in to EPIC, you will have to search/select your unit. Use search tab...you can search "2 East" or "6 Central" etc... and hopefully it will pop up for you to select. 
• Then you will need to search/select a new co-assign. Last semester this was my clinical instructor. Thankfully my new clinical instructor is in the system because she works at the hospital. MAKE SURE YOU KNOW HOW TO SPELL THEIR NAME!
• Once you are into the guts of EPIC, you will realize that you need to change your preferences so that it will bring up your unit's patients. When I got in, mine still had my last semester's unit. It took a little "playing around" and coaxing from the deep far recesses of my brain to figure out how to do this. It was about 5 months ago since we learned to do this in our EPIC training. I don't remember the exact folder to look in, but there is one folder in the sidebar that will contain what you need. If you find your unit listed, you just need to click and drag it up and drop it into the "My Unit" folder (that was set up last semester). After you put your new unit in, you can delete your old unit. If you have a "My Patient" folder, just delete whatever patient (Mr. Jones) may still be in there from last semester, but DO NOT delete the "My Patient" folder. Once we have our patient assignment, you can drag that patient into that folder. 
• If you can't figure out how to change your unit, you will need to ask one of the unit nurses or PCA/PCT's. . .and hopefully they'll have time to help you.

I think I might be smart to write these directions down (with specific folder names) in the event that I'm at this same hospital next semester and have to figure this out again! I REALLY wish that the hospital had provided us with a written summary of our EPIC training that we can consult afterwards. But no. :(

Theme Song for Second Year

"Here Goes" was been my theme song for my first year of nursing school. It was my "fight song" or the "Rocky tune" that I played as I was driving into clinicals. It's been such a great song that I'm carrying it into my second year. Thought I would post again.



While I find it to be easily applicable to nursing school, I also like it as a reminder for other areas of my life and the goals I've made. Although I still find it hard to apply to "never loved anyone with playing it safe."

I'm not poor -- just economically challenged

So with my bank accounts dwindling + a significantly smaller scholarship this year + little to no regular income= realization that I was going to have to borrow money from my parents to get me through next August (or whenever I'd be starting a job). So I made up a budget, trying to account for everything, so that I could estimate what I would really NEED. After it was all said and done, I realized I forgot to factor in my chiropractic treatments. :(

When it came to gas expenses, I pretty much had to go with past history. But now that I'm going to be driving an hour to my Psych location once a week (about 90 miles round trip)...I started to get concerned.

So I just calculated all the miles I will travel to go to church, school, gym, clinical sites, and work. 248 miles a week.  And this does not include running any errands to grocery store or Target (which I'm hoping I will do on my way home from somewhere)!  My old car is not getting the gas mileage that it use to, so I'm looking at probably having to buy a tank a week now (now factoring in likely errands). I think this summer I've been able to go about 1.5 to 2 weeks - when I wasn't driving to my sister's for wedding plans. In my budget I planned for about 3 tanks/month...so it looks like I should've budgeted another $50/month. Anyone want to donate to my gas fund? ;D  Not sure how my friend's who commute out of town for work do it. Oh right, they have jobs that help pay for expenses.

I am hopeful that I will be able to keep working for the local artist about 4 hours/week. AND I really hope that the same place I worked last Christmas season will hire me back again this year. Not sure I can comfortably squeeze any pet-sitting jobs in with my crazy schedule, but the occasional one would be nice.

So it now looks like I'm going to have to be a lot more disciplined in saying no. No to dinner out with friends, no to new clothes (which I will want with continued weight loss) and no to anything not in my budget . . .  :(

I don't like to say no. I don't like to deny myself. But I also don't want to be in huge debt either.

Operation Organization

I am a pretty organized person. Not a neat freak for sure. Organized, yes. But to be organized I must have a plan. This semester, because of my desire to get to gym/pool regularly, in addition to being successful in nursing school, I now have a plan for arriving at all my destinations with what I need.

You see, I'm more of a night person. So I really should not wait until 5:30/6:00 in the morning to pack my gym and school bags or to decide what to eat for breakfast, lunch and snack. My schedule is full and requires me to go from one activity to the next without stopping by the house to pick up something.

So I have made "pack lists" for each day

Lists include whatever I need for Lecture, Clinical-prep, Clinical, Aquatic class/Cardio, whatever I need to shower etc at the gym or stay at my parent's house...and what I need to pack in terms of food (lunch, snack).  After a week or more of editing/modifying lists, I will shrink lists to a 4 x 6 size and then laminate them for repeated use. Gotta love self-laminating products!

I've done really well so far to show up at school or clinical with what I need - setting everything aside the night before... but add in another activity before/after and I just can't expect my brain to remember it all. Nothing like showering at the gym and realizing you forgot to pack underwear! Or showing up to workout and realizing you've forgotten your iPod (I've already done this twice).

At first I was just going to go with lists taped up somewhere, but then had novel idea of having baskets to throw stuff in (even a week early). I really did not want piles, so it made more sense to have a portable collecting station. Well, baskets were going to be too expensive, so I settled for Sterlite containers (which will be used LONG after nursing school). They were on sale (thank you, back to school) and a fun Caribbean blue.

I'm not sure yet where these will live day to day. Right now they are downstairs in my kitchen/den area, but thinking maybe they'd be better in the dining room (out of the walkway).

Perhaps I'll get better at remembering and I won't need the lists so much. But I have a feeling that as the semester wears on, I will probably be glad for anything that can help my poor brain get through the day.

First Day of the Semester

The highlights:

1.  Managed to get to my 7 AM aquatic class!
2. Arrived 10 minutes early to Psych lecture.  Which means getting to gym and getting ready at gym is feasible (It's consider success if you remember your underclothes -- which I DID!)
3. Did not flunk first reading quiz. Got 9/10. :D
4. Watch a long-ish film in class on the history of psychiatric care in the US. Very interesting.
5. Went to lunch with my best buds from nursing school.
6. Ran errand to Wal-Mart and loaded up on toilet paper. I've been loading up on all important supplies...this was the last one.
7. Came home to find out I had some how missed the 5.8 earthquake that hit no more than 35 miles from where I live. People in Ohio and South Carolina felt it... Me? um, no. But good news is that I have AMAZING shocks on my car. Since I didn't get to feel the "big one", I'm now contributing all rumbly noises to be aftershocks. Definitely.
8. Pretty much wasted my entire afternoon watching Facebook explode about the earthquake while watching local TV coverage.
9. Got GREAT news that we don't have to wear our smurf blue scrubs or lab coat for our Psych clinicals! Yes! So happy!
10. Now I'm busy printing off Med-Surg clinical paperwork for tomorrow morning's orientation and wondering what Hurricane Irene will bring to Virginia this weekend. Will it be enough to cancel classes on Monday (which would cancel clinical)? Hmm?  Not going to count on it with Irene still way out to sea.

Next up tonight: 

• Will review some dosage calculation problems and conversions. We've got THE big, scary dosage test tomorrow before our clinical orientation. You know, the one test that is not calculated into your course grade but has all the power to see you kicked out of nursing school if you score less than 90% (There are only 10 problems). 
• Prepare bags/stuff for tomorrow. I have a whole system set up (my next post).
• And perhaps some fun reading (since I'm obviously not going to tackle any school reading tonight).

Thankfully tomorrow is not a real clinical day. Otherwise I'd be going to bed at 8:30pm and getting up at 4:15/4:30am. THAT starts next week. :(

Oooh! literally as I was about to post, we had an honest to goodness aftershock. Initial report is that it was a 4.2 . . . (yay!)

 

All I've got is this weekend. . .

. . . and it's half over already!

*SIGH*

It's official. I am going to have to work my tail off like never before. I'm going to have to dig deeper like never before. I'm going to have to start taking performance enhancing drugs, drink liters upon liters of caffeinated drinks. Okay, so maybe not those last two, but I'm already terribly overwhelmed and classes don't start until Tuesday. I think it's the normal pre-semester shock when I open up Blackboard and there are a dozen more clinical docs (this time for Med-Surg). There's also something called "Simulation Day" on the Med-Surg calendar that pretty much sends me into a bout of tachycardia!

I did get some things crossed off my list this week, but I still have a few more that I'd like to get done before Tuesday - specifically, I'd like to get two more batches of soup made (not sure why I'm dragging my feet?) and my bedroom/bathroom need some attention desperately. I haven't done anything yet about my vacuuming out my car or getting it washed, but maybe I can get that squeezed in too. The homeowners are in town until Monday, so that has been an added distraction. And I dog-sat a few days for my aunt/uncle this past week, which prevented me from the above projects too. Thursday night I had a REALLY rough night with the dog (I think he woke me up about 6 times during the night and every time I dutifully took him outside afraid that maybe he had to pee.) So needless to say, I did not make my 6:15 aquatic class on Friday morning, and generally felt pretty fatigued/lousy all day on Friday :(

I'm beginning to think that maybe I'm being a bit optimistic that I will get to the gym 5-6 days/week.  Only two of those days are afternoons trips (after clinical), the other 3-4 days are early morning aquatic classes. The only way I'm going to be able to get up for those early morning classes is to make sure that I'm getting to bed on time. I am not very good at getting 7-8 hours of sleep a night. I'm a night owl, but my life requires getting up early.

Below is my traffic flow (schedule) for the next semester. You can see that my schedule is mostly school and gym at this point (and 4 hours of work) and I've filled in every other hour with "read/study" time. I am fully aware that I only have 24 hours a day to work with, so anything extra (aside from meals/travel time) like house-cleaning, paying bills, chiro appts, social outings will come from my read/study time slots. Monday and Wednesday nights will basically be reviewing/studying for quizzes/tests the following morning. Note I've included my wake and bed times (calculated for 8 hours of sleep). Yes, this is a very optimistic and terribly depressing schedule.  I honestly don't think there's any way I will get to bed on Tuesday nights by 8:30. Clinical prep you stay up until you are done--whether that's 10pm or midnight or later :(


My gym time should provide the necessary stress-outlet - all the while either helping me to lose weight or at least not gain weight.  Hopefully the Slimdown program at my gym will enable me to stay focused and motivated - or at least make me feel guilty when I don't get to the gym and re-motivate me to go.

So RIGHT NOW (!), to motivate myself to clean my bedroom and bathroom, I'm going to clean for 15 minutes and then read Book #2 of the Hunger Games for 15 minutes and then clean for 15 minutes and then read for 15...until I'm done cleaning. It could be that I will get so into the cleaning, that I will skip the reading. Here goes!

10 Days Left of my Summer Vacation

Greetings on a beautiful, sunny, warm Virginia day! Note I did not say hot. It's actually quite pleasant. I'm so ready for fall temps...but really not ready for what's about to hit a little over a week from now.

Our Psychiatric Nursing course has been posted on on our Blackboard and so I've been downloading all the docs that have been posted so far. Twenty three. Syllabus, calendar, and the rest are mostly clinical documents. No doubt I have killed a few trees this afternoon...  I'm so glad God gave me a bent for being a planner and organized. I'm definitely not a neat freak and definitely not obsessive-compulsive when it comes to bathroom cleanliness, but I am INSANE about staying on top of requirements, instructions and rubrics for school. It's the ONLY way to make sure that I don't forget anything or drop any balls. I hate looking incompetent and clueless, so it's pretty much a guarantee that by the time I step in to my first class/clinical setting, that I will have read every document given to me for that class. Yeh, I'm one of THOSE people who stop and read the instruction manual. 

If my Psych docs are any indication, this semester is going to blow my mind (no pun intended). I was reminded yesterday that this Psychiatric Nursing course is considered an intensive writing course. lovely. Well, at least it's not creative writing or a research paper, those I would need serious anxiety meds for. :/

Nothing has been posted for Adv. Med-Surg. But after being overwhelmed with the above twenty-three docs, I'm a-okay if they don't post anything until later next week.

So in my last week of freedom, I have the following must-do list (aside from work/gym):

• File VA taxes (refund)
• Get car inspected (expires end of August) + find out why the check-engine light is on
• Vacuum/Wash car (this will just make me feel better)
• Haircut (I know it's time when I can't remember the last time it was cut!)
• Do couple trial runs at downtown gym (aquatic class + getting ready at gym) in preparation for lecture days

And MAYBE, I'll get to watch an embalming at local funeral home next week. Need to remember to call.

(Which reminds me...I never did get to the women's prison to observe healthcare/nurses there, maybe I can work on that for during C'mas break)

In other news... I joined my gym this week and learned about their "Slimdown" program. It's a weekly weigh-in and 30 minute group discussion generally focused around nutrition and/or exercise tips. It's really more about behavioral modification than about calories in/out (like getting enough sleep, getting veggie's daily, etc..). I'm doing fairly well with food choices and regular exercise at the moment, but when the busyness of school kicks in, I will be glad to have a weekly reminder of my goals. The program is set up that it "costs" $20/month, but if you weigh-in weekly and complete an online record, they'll credit you back $5 per week (meetings/discussions are optional). So essentially if you simply show up, it's FREE. Who says no to FREE?! They offer four different times that you can weigh-in and go to the meeting, but sadly only one of them is feasible for my schedule. But at least there IS one. :D

Tonight I have to put Netflix on hold (end of billing cycle), as I do at the beginning of every semester. It's always a sad moment. But I try to counter it with noting when the semester holidays are: labor day, fall break, and thanksgiving break! Ah, the little things that carry us!

Later.

Clinical Assignments!

Today we FINALLY got our Med-Surg and Psych clinical assignments for the fall. For Med-Surg I am going to be on the cardiac unit at the local teaching hospital. I'm excited but a bit scared/nervous not knowing what we'll see or experience. I have a feeling I'll be dreaming EKGs and lab work!

Psych will be at a State facility over an hour a way. Despite the distance, I'm actually very glad to not be at the local hospital again as it's the ONLY place I've done clinicals so far. It will be very nice to have a different experience! The patients I'll be working with will be those who have been institutionalized, whereas I think the ones at the local hospital are shorter-term stays. I originally thought clinicals were going to be Wed/Friday, but somehow I lucked out and got a Monday clinical for Psych (not Friday). Rumor has it that Psych prep is different (not requiring trip to the hospital the day before), so I'm hoping that means that I can go stay overnight at my parent's house the night before, cutting 45 minutes off the drive! Woo hoo! Also, Psych clinical starts at 8 am (an hour later than normal clinicals). Nice!

Hard to believe there's a little over two weeks before classes start. Excited, but also sad to be heading into that crazy-life world again.

I'm seriously considering joining the local gym full-time. My temporary membership ends right before classes start, so I need to make a decision soon. While the fitness center at school is free, it does not have early morning hours and may not be available the afternoons when I need it. It's also closed weekend and during school breaks (holidays etc..)  The local gym is open all the time, plus has the aquatic classes I love AND is on my side of town! Why mess with a good thing? I've lost close to 10 pounds (although I can't really tell), and I'd like to keep the momentum. I'm looking at my schedule and thinking I could pull off a few early morning aquatic classes each week on lecture/prep days, and cardio after clinicals. It will require advanced planning on my part (swimsuits laundered, gym bag packed the night before, showers/getting ready at the gym in the mornings). The only thing that I worry about is getting enough sleep. Our class/clinical schedule does not seem to allow for much time to get reading/studying done (except on weekends)...therefore if I'm up late studying/reading, it will surely mess with my desire to get to gym early--especially if I'm not getting enough sleep. I will have to be extra focused this semester. Pfft. Humbug! No fun for me.

Well, off to figure out my "life schedule" for next semester now that I know when/where my clinicals & classes will be.