Aging Populations | Something to Watch

For my Fundamental class, on our section on caring for the aging adult, we were required to watch a video produced by PBS titled "Living Old". http://www.pbs.org/wgbh/pages/frontline/livingold/view/.  It's 60 minutes long. I totally recommend it. It's not an easy watch by any means. Definitely sobering and thought-provoking. Statistics say that by 2030 (20 years away), over 20% of our population will be over 65 years of age.  I think this PBS special definitely discusses some of the relevant issues surrounding this topic. It's NOT a nursing video...it was written for the general public, but there are healthcare providers, family members and members of this aging population that were interviewed.

I'm 36 years old. My parents are in their early to mid 70's... I certainly have wondered/thought about what the next 10-15-20-25 years will look like. What is it going to look like for my parents as they age and their bodies become less efficient and less robust. My parents became vegans over 10 years ago and they certainly believe this is going to help them stay strong, healthy and help prevent chronic disease or cancers from stealing their years.  Thank God, they are strong and healthy now (they brag they are not on any prescription medications), but that doesn't protect them from the unexpected (car accident, serious fall/fractured hip, back injury...) which could potentially impact their ability to manage their ADL's (activities of daily living) and remain independent. They certainly expect they will remain independent a long time. I just pray that is the case...

Interesting statement was made in this PBS program, the gist was that if you have three or more daughters and/or daughters-in-law ---chances are that you may be able to avoid going to live in a nursing home. My parents did well to have four girls. I've always said that having children seems like a pretty good retirement plan. ;-)   At this rate, I'm WAY behind...but not much I can do about it in my single state. I suppose someone better mention to my four nieces and nephews that they may be called upon to care for their elderly parents AND their elderly aunts. I'm sure they'll be excited to hear this--seeing as none of them are in highschool yet.

Well, I really just wanted to post the link to this PBS/Frontline special.  Nothing much else to post...I'm just busy studying right now for my final two tests which I have at the end of this week. Next week I'll be studying for my final exam which is next week...nearing the finish line! woot!

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Joy

The End (of the semester) Starts Here

Just finished my last clinical assignment of the semester: self -evaluation. I know I've been counting down clinical days all semester, but it's finally here. Tomorrow is our last clinical day of the semester! We're all bringing in breakfast foods and will share with the unit staff tomorrow as a 'thank you'.  Then we'll be on the floor for 3.5 hours, leaving about 11 AM. Then we're all headed to lunch together...which should be fun. Hopefully no major disasters in the morning to sober our celebrations! 

This Thursday and Friday are the last "new content" days of the semester in my lab skills and lecture classes. The timing of it all is really perfect, as this weekend I'm headed to Pittsburgh for a family wedding and since I will have entire week of Thanksgiving off (just the way my class schedule worked out), my family will end up staying an extra day or so and come back early next week. So nice not to have to worry about school stuff over the weekend or holiday week! (Some people DO have class on Monday--just NOT me!) However, I still have to go next Tuesday for my final clinical evaluation with my clinical instructor--but nothing really to prepare for that (that's what I'm turning in tomorrow).  

The Friday after Thanksgiving I will get trained for my seasonal job which will start the following Monday. Looks like I will work M/Tu for couple weeks while I finish up tests/exams in early December...but as soon as the semester ends I will work the early shift 3 days a week. Will be nice to earn a little extra cash to help pay for this upcoming trip to PA (hotel room), purchase C'mas gifts, buy much needed clothes, and throw a chunk back into my dwindling saving account!

I have already started my "to do" lists for my holiday break. I will have to be a bit more organized since I'm working, but this will be the longest break that I will have had since I started taking classes the summer of 2009. Last year I had 5-6 weeks off between semesters but I was still working full-time, so I really didn't get a break. But this time I will have 4 days off a week while I'm working and two full weeks off in January. And because I'm working the early shift, I will get all my evenings off (which tend to be my most productive hours anyways). I'll be staying in the area for C'mas--hanging out with my parents and two of my sisters, and then the rest of the family arrives for our main family event over New Years weekend. The homeowners will be home just before C'mas and we'll overlap some, especially the days I'm working, but we get along great. It's such a great arrangement. I might lose my room over New Years but since I'll be doing family celebrations at my parents, it won't really matter.

Well, off to gather my bits for clinical tomorrow. Cheers.

ABG Interpretation

This week we've been reading about Acid-Base and Arterial Blood Gases.

I just wanted to share two sites that I located that have been helpful.

For ABG interpreting practice: http://www.vectors.cx/med/apps/abg.cgi. With each set of ABG values, it will let you know if you are wrong, right or mixed in your answer...and then provide basis for answer. Seems to have UNLIMITED ABG values to analyze.

For general overview of ABG's and interpreting, here is a PDF packet: http://orlandohealth.com/pdf%20folder/Inter%20of%20Arterial%20Blood%20Gas.pdf.  This looks like it might have been a continuing ed type of thing a number of years ago...but helpful nonetheless.

There are LOTS of other sites out there, but these I've used and have found helpful.

Another Good Clinical Day

Another great clinical day. It's really nice to be "on our own" doing assessments, providing care and documenting our work. It's a great clinical day when the nurse you are working with treats you as a person and not as if they find you completely annoying and a waste of their time. I haven't worked with all the nurses on the unit, but I think once you show them that your goal is not to waste their time or ask them tons of questions, but that it's because we ARE active learners...learning to be critical thinkers, learning to be solid care givers in the midst of a lot of first time experiences, then they DO respect the learning process and you as a student nurse. Now, I'm sure there are some nurses who just hate nursing students and can't remember what it was like to be a student...but I don't think I've met one this semester. Which is a really great thing for my first clinical experience!

I love it when I can contribute (and not simply lighten up someone else's patient load), whether that's discovering some new relevant assessment data or making a connection that the abnormals are side effects to meds/procedures, or discovering something that's out of compliance and finding a way to fix it. Those little things build trust with the nurses you are working with. And I think as time goes on, we grow in our confidence, have fewer questions and ask fewer questions, our assessment skills improve, our critical thinking improves, our organization of our time improves. I remember back to our first clinical day at the hospital and everyone was so nervous and anxious about doing head to toe assessments...and now it seems across the board we have all grown in our confidence levels. Now we judge our days on whether we got to do/learn new skills! That first day EVERYTHING was new and everything was stressful...but now we actually WANT new experiences! Amazing what happens in 8 weeks time. Sure, there certainly are days with challenging patients that require so much attention and bedside care that we wonder, how in the world would a normal nurse be able to care for this patient AND 4-5 more! Is this really what I want to do? One day I'll have a day like this and then have to be ready to show up the very next day to do it all over again!

Some other students have struggled with relating with some of their nurses and I can't explain why my experiences seem to have gone better. Perhaps the student's experiences with their nurses were different than what they expected and therefore they were disappointed. Or possibly it was just a really harried, crazy day for that nurse and unfortunately the nurse took her stress out on the student nurse. Or maybe the student nurse really was asking a low priority question during a high priority moment. I dunno. All I can say is that I've had really great experiences for my first clinical and I'm SO GRATEFUL! My clinical instructor is also very good. We all really like her. She's very interested in our progress and doesn't hesitate to hold us to high standards and to push us to improve and get better. My wish is that our clinical groups were smaller in number. Most clinical groups start with ten. We started with nine and have not lost a single student. Rumor has it that some clinical groups have lost a number of people (due to poor grades, life situation, decided nursing was not for them...).

Early on, clinicals were such a mysterious thing...causing great anxiety and stress...now, perhaps because there's much less mystery, I am looking forward and wondering what next semester's clinical days will be like. Next semester we will have clinicals 2x/week. The afternoon before the first clinical, we will get our patient assignment and we have to work up a care plan without having met our patient...and then we go to our first clinical of the week, care for that patient (unless they've been discharged in the meantime) and then we have a day to evaluate our care plans and revise as needed and then we go back again for a 2nd clinical day caring for that patient (if patient is STILL there).

This coming week we don't have to turn any care plans in...but we have to turn in a self-evaluation. Then we'll be meeting one-on-one with our clinical instructor at a later date for our final evaluation. Not a big deal... but I do want to find out what she believes my strengths and weaknesses are. If they match up with my perceived strengths and weaknesses.

Next week clinical will be a half day (since we've gone over our normal 6.5 hours on a few other clinical days) and then we'll go to lunch as a group. Yay!

Well, I need to sign off here and get some reading down for my lab skills class tomorrow. Didn't get it all done at my parents house. Was having to much fun!

Personal Experience

Survived my lab skills test on drug administration this past week...even though I wasn't feeling that well. Glad to have that behind me. Only new material over the next two weeks, then a week long Thanksgiving break (thanks to having no classes on Mondays and Tuesdays)! Then all that's left is 1 lab skill test, 1 lecture test and then final comprehensive lecture exam.

I'm so proud of myself for getting the bulk of my General Assessment done today. All I have left is the three care plans, which I hope to do tomorrow afternoon after church.  Monday I'm heading over to my parent's home to stay with my dad as my mom goes to DC area to take care of my niece/nephew for a few weeks while my sister is out of town. Thursday night my dad had a severe nose bleed that even after my mom (retired nurse) packed his nose with gauze, added ice packs and called the 24/7 insurance nurse....they ended up making two trips to the ER that night...three procedures later and now he has a saline-filled balloon type thing up his nose putting pressure on things. My mom will drain the nose balloon thing tomorrow (to reduce risk of sinus infection). So hopefully things have clotted up sufficiently that he won't bleed Sunday into Monday.  He's got a ENT appt on Monday. I'm just going over there for a couple days as a precaution and to be an extra hand if he starts bleeding again. His BP was fairly high compared to his normally low baseline. So it's good that I get my Care Plan out of the way this weekend, so that when I'm at my parent's house, I can just focus on readings for lecture/lab skills--which is a lot less to haul around. With CP's I'm using lab diagnostic handbook, drug guide, nursing diagnosis book, medical dictionary and sometimes an old pathophysiology text book, PLUS my laptop.  So hopefully I can leave all that stuff behind. Since I have clinical on Wednesday, I don't know if I'll go home Tuesday night so I don't have to drive so far the next morning. Guess it will largely depend on how my dad is fairing. My other sister could conceivably spend the night if needed. And if needed I can spend the rest of the week there, coming and going for classes, if there is continued concern.  The interesting hx about this is that back when my parents were first married, they were staying with my dad's parents and my grandfather had a severe nosebleed. Physician said the nosebleed was a good thing because it prevented him from having a stroke!  So that's why my dad's elevated BP with this bloody nose is a bit disconcerting.

So for me, as a nursing student, this is interesting and will of course stick in my mind in the future. I'm also curious if the ENT will order blood labs and if there will be anything abnormal. So hopefully I'll be taking my dad's BP several times while I'm there. A little practice for me. Appropriate monitoring for him.

When my mom was first telling me about this (between ER visits on Thursday), I kept thinking...now what would my nursing dx be? What would my nursing interventions be?  I didn't get farther than thinking about it...b/c I figured my mom has a good handle on the interventions...but I'm still thinking about the nursing dx.

Resisting Temptation

Practicing drawing up meds tonight in anticipation of my skills test tomorrow. Now if only tomorrow, no bubbles would appear in my syringes. My fingernails are already mad at me. sigh.

Also, I swear it's pretty darn tempting to want to try to give myself a fake TB shot with sterile syringe and sterile water or normal saline. I really want to see if I can make that cool little bubble under the skin! But I won't. I'm smart that way. But it is tempting.

I love all the little bottles and "Demo Dose" supplies we got with our Pocket Nurse Totes that were required for skills lab. (We got WAY MORE than this!) Not that we (I) will open or use them all.

The little colored caps that come off the top of vials are particularly fun for me. You see, as a child, my mom would collect them where she worked as a nurse and then would bring them home. My mom used them as "tokens" for my younger sister and I. We'd earn them by practicing piano or doing some other dreaded activity...then we'd individually get to trade in a bunch of tokens for a prize or something that we had managed to beg my mom to buy at the store. So I anticipate that the cap of my very first injection will probably be saved for posterity's sake. Not sure what I will do with it though. I suppose I could collect a whole bunch and then make something out of them. LOL. Oh, yeh, no doubt I'm a nut. Certified.

Moving Right Along

Another great clinical day. Today wasn't that busy, but I did get to go with my patient down to radiology to watch them insert a Hohn central line (on my patient). Pretty cool. Not much going on with my patient, he was pretty independent and able to handle his ADL's for the most part. Today was the last General Assessment we have to do this semester and last care plan that we'll have to submit (after the fact). I think it's just a end-of-the-semester-I'm-so-ready-to-be-done-with-this-semester feeling. It was nice to have a pretty relaxed clinical day. I felt more organized..but granted I wasn't running my legs off either. Next week I'll probably get a patient that needs more care...but that will be okay because I won't be having to write up an extra assessments or careplans after this week. Bring on the tough stuff next week! ;P

Hard to believe we've only got two more clinical days and the last one is a mix of patient care, partying with unit staff (we bring the food) and then lunch out as a clinical group. So next week is our prime week to get some added skills experience. Haven't had the pleasure of inserting a catheter, but for many skills it usually is a matter of being in the right place at the right time with the right patient!

Tomorrow I have a skills test on drug administration. Basically administering oral, injectionable and IV meds...and paying attention to asceptic technique and being careful to observe 3 checks and 5 Rights of Medication Administration. A bit nervous since we haven't had but 1-2 weeks on the various drug admin topics...and this is pretty important stuff! Next week we'll be doing venipuncture. Woot!

One thing I wish our program offered is a pathophysiology course. It's not currently required. I think BSN programs require it...but really I think it would be soooo helpful as we work on care plans and understanding the various needs of patients with specific disease processes and conditions. Right now we are only learning about the disease processes of our patients and not across the spectrum. So I've submitted my recommendation to our student rep on the Curriculum Committee for the nursing program. One option I do have is to see if I can take Patho at UVA...but then I'd have to apply to UVA and pay big bucks to take it online at UVA.  That's just silly. But might be what I have to do.  Right now, to get by to learn about disease processes of my patients (for care planning) I have an old Patho text book that I swiped from the local recycling station. It's 12 years old...but really I'm sure that basics are pretty much the same. I might see if I can find used copy of the Patho text that UVA nursing students use...

We got grades back for our 2nd lecture test...again I scored an 88. Well, I'm consistent. I really had hoped to do better. But again, I'm not sure how I could've studied any harder. Friday we'll learn what we missed and what the majority of the class struggled with. There were a few that I knew I missed... not sure if I want them to be stupid mistake or not. So we've only got one more lecture test and then the final comprehensive exam. I really need to get high A's if I'm going to get an A in this class. Frustrating. I'm doing very well on my careplans, but we don't get grades for those ;(

Well, I think I am fighting another cold. Just a touch of a sore throat and I think a runny, stuffy nose. I just need to get through Friday. I'm supposed to donate platelets on Saturday, but I'm guessing I'm gonna have to cancel. Bummer.

Well, onto review skills videos for medication administration. Hoping I can stay awake!