Nursery

Nursery Responsibilities:

Observe a registered nurse monitoring infants.

New knowledge or skills:

The ripple effect seems fairly appropriate because when one baby cries, it is like a chain reaction.
I am very uncomfortable around infants.
Photo therapy is used when an infant has high jaundice levels.

Best thing that happened:

I got to witness photo therapy for an infant.

Worst thing that happened:

I did not like this rotation the nurses did not even acknowledge my presence and they did not want to explain anything even when I asked questions.

This week was: BAD

See worst thing that happened ^


Technology Experience Record:

Computer charting
Photo therapy
Vital Signs

Diagnostic Procedures Observed:

No diagnostic procedures were observed.

Therapeutic Procedures Observed:

Hepatitis Shot administered.
Photo therapy.

Medical Terminology Abbreviations Encountered:
none

Nursery Journal:
I knew going to the nursery was going to be a leap of faith for me because I'm not too comfortable around babies. I have no idea what my problem is but I do not like to hold them, touch them or anything else. I encountered a very rude lady over the intercom  and so at that point I was not to sure how I was going to like this rotation.

I walked in and was asked to wash my hands which I was going to do anyway and the nurse literally told me to sit in a chair and observe. I thought oh great it is going to be one of those rotations where nothing happens. One nurse who clearly knew what she was doing, and was good at her job asked me if i wanted to see a infant undergo photo therapy. Photo therapy is used when an infants jaundice levels are high.

I went back to the nursery and watched the nurses feed the babies and they cried a lot. I also saw a hepatitis vaccine be given to an infant. Really the whole time I just watched everyone and I asked questions but I was usually ignored. I did not really learn anything form this rotation other than my fear is real and what photo therapy does.

PACU (Post Anesthesia Care Unit)

PACU Responsibilities:

• Observe a registered nurse helping patients recover from surgery

New knowledge or skills:

• Information must be repeated to patients is crucial because they are sometimes not aware of what is happening after surgery.
• Monitoring the level of pain from the patient is important in the PACU to determine if additional medication is needed.
• Encourage patients to cough and take deep breaths after surgery is needed to help the patients get back to normal.

Best thing that happened:

• The nurse monitored my heart using a heart monitor and performed an EKG to show me what the machine did. 

Worst thing that happened

• I was not ready to leave when my time was done. I really enjoyed PACU.

This week was: Good

I was able to observe a pediatric patient coming out of surgery which is rare since we are not allowed to interact with pediatric patients. 

Technology Experience Record:

Computer charting

EKG
Heart Monitor
Vital Signs

Diagnostic Procedures Observed:

No diagnostic procedures were observed. 

Therapeutic Procedures Observed:

Pain medication was given to patients after surgery.

Medical Terminology Abbreviations Encountered:

EKG- Electrocardiogram

Appendectomy- Surgical removal of the appendix

PACU Journal:
When I went to the PACU I thought it would be boring since other students had told me that it was not busy. I was surprised to find more than half of the beds were occupied during my rotation. It was going to be a busy day.

The Charge Nurse asked me if I wanted to be hooked up to a heart monitor and she wanted to run an EKG.  It was a training heart monitor and EKG. The nurse was trying to show me how the use the machines. At first I was confused, but it was like a training session. I even received a print out of my heart activity.

The first patient I observed was an older lady. It looked like she had surgery on her foot. Her foot was in a big boot. The nurse that was watching her and was asking her about her level of pain from 1-10. The nurses were dispensing medication. The patient's throat was scratchy and the nurse gave her ice, which should help relieve the scratchy throat.

The charge nurse told me that a pediatric patient was coming out of an appendectomy. The patient came into the room and was hooked up to all of the machines. The nurse was waiting for the doctor's orders for the pain medication. Fifteen minutes went by and she did not receive any orders from the doctor. The nurse seemed confused. She told the Anesthesiologist that she needed orders for pain medication because if the patient woke up, they would be in a lot of pain. Finally after another ten minutes she was able to talk to the doctor. The nurse was glad she received the pain medication orders. The child's parents came into the PACU and I was able to see their reaction. I could tell they were worried but relieved that everything seemed good for their child.

This rotation was great. I would love to go back and observe more. The overall experience was good because I shadowed another good nurse. Every single person in the PACU was passionate about what they did. They were more than willing to teach me about what they were doing.

Medical Surgery 6th Floor Unit

Medical Surgery Unit Responsibilities:

• Observe a registered nurse dealing with patients in medical surgery

New knowledge or skills:

• Repeating information to patients in this unit is important because they are sometimes not aware of what is going on.
• When a patient is a fall risk, they must be checked on constantly for their safety.
• Family requests are accommodated for the comfort of the patients. 

Best thing that happened:

• I observed the nurse dealing with a patient that was suffering from possibly Dementia. The nurse was very willing to help the patient even though they were not aware of what was going on.

Worst thing that happened

• I was disappointed that I could not go into a isolation room. 

This week was: Good

I observed sympathy and empathy by the nurse in the hospital. I was fortunate to have a really good nurse to observe. 

Technology Experience Record:

Computer charting

Patient monitor that alerts the nurse if a patient gets out of the bed

Diagnostic Procedures Observed:

No diagnostic procedures were observed. 

Therapeutic Procedures Observed:

One of the patients received a shot to prevent clotting. 

Medical Terminology Abbreviations Encountered:

IV- intravenous

ABG- arterial blood gas

Medical Surgery Journal:

I went to the 6th floor of the hospital. I was familiar with this unit because I had already observed the 5th floor medical surgery area.  I was assigned a registered nurse to shadow this time. 

I waited outside the patients room because the nurse was already helping the patient drink some chocolate milk. The nurse did some charting and went to assess the patient's mental state. This patient seemed confused and did not know that they were in the hospital. The nurse must have told the patient several times. 

I was surprised that the nurse was so patient in dealing with them.  The nurse told me that the patient had fallen and hit her head. The patient was not acting the same since the fall. The patient was lethargic and unaware of her surroundings. I think the fall might have contributed to her confusion. The IV needed to be replaced because it was leaking. The patient received a shot in the stomach to prevent blood clots. We tried to give the patient her medicine but she kept falling asleep and did not want to take her medicine. 

The next patient was in isolation with the flu. I was disappointed that I could not go into the room. But I understood the reasons why. I noticed on the door there was a droplet precaution. The nurse was putting on gloves and a mask. Even though I did not get to go into the room. I was able to listen to what was going on in the room. 

This rotation was not boring. I was able to observe many things during my time with the nurse. I feel I observed the toughest part of being a nurse, dealing with a patient that was not cooperative. I think this will help me become a better medical physician in the future. 

Radiology Unit

Radiology Unit Responsibilities:

• Observe Radiology technician at the hospital.

New knowledge or skills:

• There is a difference between a break and a dislocation.
• Barium is used to show images in the body.

Best thing that happened:

• I was able to see a catheter in someones bladder on the imaging screen.

Worst thing that happened

• Nothing bad happened. I really enjoyed this rotation. I would like to do this again.

This week was: Good

I observed many xrays and eventful scenarios.

Technology Experience Record:

The technology I observed was the xray imaging machine.
Charting, images on the computer screen.
Machine that delivers radiation during an xray.

Diagnostic Procedures Observed:

Radiology Technicians cannot diagnose, only the Radiologist can do this. 

Therapeutic Procedures Observed:

None

Medical Terminology Abbreviations Encountered:

MRI- Magnetic Resonance Imaging
CXR- Chest Xray

Radiology Journal:

I was assigned to shadow the Radiology Technician. The technician was taking images on a patient that came in earlier that morning. After viewing the xrays, I noticed that the patient's elbow looked out of place. The technician told me that the patient's elbow is definitely dislocated. The patient came into the hospital because of an accident walking a dog. The dog was chasing another dog and the patient did not let go of the leash. This lead me to believe that this is why the elbow was dislocated.

The technician explained how they use barium to look inside a body. I asked the technician what does the radiologist do after they look at the images. The technician explained that the radiologist evaluates the images and charts and reports any abnormalities. The radiologist can make a diagnosis at that time.

The next patient was complaining about leg pain because he accidentally shot himself with a BB gun. The technician took an xray. Of course, there was a BB from the gun in his leg. The patients relative asked if there was a BB in his leg. The technician told him that he could not diagnose the problem. The told the patient that the Radiologist will evaluate the xrays and inform him of the diagnosis. She did allow them to look at the images.

The last patient complained of her bladder leaking maybe from a previous surgery. The radiologist put a catheter in her bladder and filled it with a clear liquid. After the bladder was filled, the radiologist if they were feeling any leaking. The patient was saying yes. But I could not see the liquid leaking on the imaging screen. Before the procedure ended, it was time for me to leave. I was disappointed that I was not going to get to see to result.

I really enjoyed this unit. I think it was the best unit so far. Everyone in radiology was friendly and willing to share information.

GC Dining:

A Gerontologist is a doctor that studies aging. Including social, psycological and biological affects of aging. Works with the elderly. I have not seen a Gerontologist at GC. Although, I believe the a Gerontologist must visit. They work with people in nursing homes, senior citizen care centers and other facilities for the elderly. There are three different types of Gerontologist. Research Gerontologists do research on the aging process and how it affects people. Applied Gerontologist work with the elderly and their families. Administrative Gerontologists develop programs for the elderly to make their lives better.

While I was helping out in the dining hall our group set up tables and menus and folded napkins. We put cups on the table. When we finished early, we were allowed to eat ice cream.

ICU Observation/ GC Activities

Responsibilities:

• Observation

New knowledge or skills:

• Rooms with yellow coverings with PPE in them means that those patients are isolated
• A goal in the ICU is to make the patients as comfortable as possible
• Hand washing and sanitizing every surface (keyboards, tables, door knobs) is important to keep germs  that can harm the patients from spreading
• The ratio of patients to nurse is 2 to 1 in the ICU

Best thing that happened:

• I was allowed to help reposition a patient

Worst thing that happened

• It was a slow day and the nurses had already finished all of their runs

This week was: Bad

I was excited to go to the ICU but there was not very much going on that day.

Technology Experience Record:

The technology I observed was medicine given through an IV.
Some patients were on heart monitors.
Crash cart was in the ICU.

Diagnostic Procedures Observed:

None 

Therapeutic Procedures Observed:

Vaccines, oxygen therapy

Medical Terminology Abbreviations Encountered:

DNR- do not resuscitate
PPE- personal protective equipment

ICU Journal:

I was excited and looking forward to going to the ICU this week. But, the day was relatively uneventful. I was disappointed. I saw vaccines given, IV's changed and blood pressure taken. None of this was new to me.

One patient was getting transferred to medical surgery. That patient happened to be the nurse's patient that I was shadowing. Many of the patient's rooms were isolated, so I was not able to observe in those rooms. Again, not very much was going on in the ICU today.

A patient was not breathing properly and they were already hooked up to a machine to help them breath. The nurse changed the patient's IV and gave them some pain medicine.

Another patient was slumped too far down in the bed. They were entangled in the wires attached to all of the machines. We had to reposition the patient to make them more comfortable and make sure the wires were not tangled up.

The nurse was explaining to me that everything is electronic and the doctors can give orders electronically. After the doctor's order is completed ( Ex.give medicine to patient) it is charted and the amount of medication is recorded. 

GC Journal:

I was assigned activities in the Garden Bridge area of the nursing home this week.  I went to the activities room to see the head Activities Nurse. She told my partner and I to bring the board games into the room. Our task was to get the residents involved in playing the games. The games included Go Fish, Candy Land, and Chutes and Ladders. I had to explain to the residents how to play Go Fish and what the rules were. I thought that was strange since I have been playing this game since I was very little. I thought everyone knew how to play. After explaining the rules, we helped them play and get cards for them. The residents were very excited when they got a book (4 of a kind). I was glad to see them having fun and getting involved. Time went by fast because we were all having fun. Suddenly, I realized it was time to go. Everyone was glad we there that day to play games with them. Overall it was a fun experience.

Myths and Facts about Aging

Myths:

• People 65 years and older have moderate to severe memory impairment
• Most people 65 years and older have a moderate to severe disability
• You will live in a nursing home if you live long enough
• If an older person has been a life-long smoker there is no point in quitting it will not matter 

Facts:

• Long term memory remains even though short term memory declines
• The majority of people 65 years and older are not disabled
• Less than 5% of people 65 years and older live in the nursing home
• First off it is never to late to quit smoking. Quiting make it eaiser to breathe and blood flow increases

It is important for a healthcare worker a to differentiate between myths and fact with aging. For example, diagnosing, healthcare workers do not want to diagnose their patient incorrectly, and knowing these myths and facts allows healthcare workers to give the best care they can possible give.

Medical Surgery Observation/ GC Garden Bridge- Nursing Home

Responsibilities:

• Observation

New knowledge or skills:

• Learned patient discharge procedures
• Learned how vaccinations are administered
• 
  

Best thing that happened:

• Brought a patient in a wheel chair to their vehicle during the discharge
• The nurse that I was shadowing was really passionate about her job

Worst thing that happened

• There was a lot of computer charting

This week was: Good

I had more hands on work the nurse was will share her knowledge.

Technology Experience Record:

The technology I observed was patient charting and discharge procedures on the computer at the nurse's station.

Diagnostic Procedures Observed:

None 

Therapeutic Procedures Observed:

Vaccines

Medical Terminology Abbreviations Encountered:

None

Medical Surgery Journal:

I did not know what to expect with the Medical Surgery Unit last week. I was very busy with hands on work and patient interaction.  I observed the nurse in charting and discharging a patient. I asked the what the nurse to patient ratio was in medical surgery. I was told one nurse to five patients. I learned that when a patient is given medication, there has to be a witness. During discharging the patient the nurse has to explain the medication and prescriptions to the patient. The nurse must make sure the patient understands what medication they are prescribed and the dosage required.

After the patient filled out all of the discharge papers, the nurse and I went to get a wheelchair and a cart. I helped load all of the patients belongings and the visitor's belongings. I was able to assist the patient into the wheelchair. Then the nurse let me escort the patient to their vehicle. Even though the patient was not fully well, they were happy to leave the hospital.

The nurse I shadowed was eager to teach me about her duties. She taught me how to chart patient information, how to administer a vaccine safely and discharge procedures. I learned how to send a patients request to change the room temperature or if they needed more blankets.

This rotation was a success. I learned a lot. It was enjoyable. I attribute the overall success to the nurse's enthusiasm and willingness to teach me her duties. Of all of the rotations that I have been involved with so far, this nurse was the most passionate. She made the education value worthwhile. I feel I had the best experience that was available.

GC Journal:

I was assigned to the Garden Bridge area of the nursing home. I was assigned the task of socializing with the residents. I tried to get the residents involved in exercises and games. None of them were willing to participate. Our group sat with one resident while she watched a horror movie. I was shocked at her interest in this movie. But, she was happy and had a great sense of humor. It's difficult to get the nursing home residents to get involved. I am not sure if they just don't want to socialize or if they are unhappy. I wish I could ask them about their situation and try to connect with them, but I feel it is too personal and probably inappropriate. We have been told that they enjoy our visits and they look forward to us coming to socialize with them.  Overall, my GC experience has been good.

Emergency Room Observation / Dining Hall- GC Nursing Home

Responsibilities:

• Observation

New knowledge or skills:

• Emergency Room workers have to work as a team in a crisis situation
• The emergency room nurses need and use a lot of supplies
• Attitude is important in dealing with situations in the emergency room

Best thing that happened:

• I observed an EKG performed on a patient
• Lots of blood drawn

Worst thing that happened

• The employees unprofessional behavior

This week was: Fair

The emergency room was not busy.

Technology Experience Record:

The technology I observed in the emergency room was the EKG machine. I also observed patient charting on the computer at the nurse's station.

Diagnostic Procedures Observed:

Although I observed the use of the EKG machine, no diagnosis was given. The technician sent the results to the doctor. 

Therapudic Procedures Observed:

One patient was having trouble breathing and was given Albuterol breathing treatment.

Medical Terminology Abbreviations Encountered:

EKG- electrocardiogram

ABG- aterial blood gas air

ER Journal:

This past week I was able to visit the emergency room. I observed the emergency room technician. This technician was responsible mainly for drawing blood and operating the EKG machine. The EKG machine measures how the heart is working. I learned that the emergency room uses a large amount of supplies.  the nurses are always replenishing and ordering supplies due to the urgent nature of the patient's situations.

A patient was having respiratory issues and the technician ran an EKG. This was my first time to see this test. I found it very intereting. The tecnician also replaced the patient's IV and did some blood work.  I saw many IV's replaced and blood drawn from many patients. The blood was sent to the lab for testing.

The only thing I found shocking was how some of the staff behaved unprofessionally because the emergency room was not busy.  Some of this behavior included gossip about patients and shooting rubber bands at other staff members.  I did not participate since I would not want to be treated at an emergency room where the staff did not take their jobs seriously.  I learned that this behavior is an example of what not to do in any medical profession.  Overall my experience was fair. The emergency room was not busy.

I think that emergency room nurses have a tough job. They have to be able to think on their feet and adapt to any situation based on a patient's condition.  The emergency room staff has to work as a team even in a crisis.

GC Journal:

Last week at GC I was assigned to help in the dining hall.  I have done this before so the tasks were familiar to me.  I know that it is very important to wash my hands often.  Our main assignment was to set up the dining hall for lunch. I folded napkins and placed menus on the tables. I also set the tables with silverware and glasses.  I delivered food and drinks to the nurses stations.  After everything was done my partner and I were offered to have some ice cream.  I could not say no.  It was very good.