Day Surgery- March, 27, 2015

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What were your responsibilities or duties this week? 
  My responsibilities included being professional and observing the nurse I was following. I was to be respectful and considerate to the staff and patients.
What new knowledge or skill did you learn this week?
   I observed an admission of a patient and what to ask for during admission. I also learned about the consent of the patients.
What was the best thing that happened at the unpaid work-based learning site this week?
   I loved that the nurse I had was actually trying to teach me things and explain the best that she could. All I heard were bad things about Day surg so it was nice that it wasn't that bad.
What was the worst thing that happened at the unpaid work-based learning site this week?
   The actual admission wore me out. I was just kind of standing there watching a nurse ask questions and I started yawning and I felt so bad because the patient could see me. 
If the "worst" was a mistake, how was it corrected?
   I should have asked questions as the admission was happening but it seemed rude. I also probably should have gotten more sleep than I did the night before.
This week was FAIR. Why?
    It wasn't exciting, but it wasn't terrible or boring by any means. I learned a lot, just not about what I was interested in. 

Radiology- March 6th, 2015

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What were your responsibilities or duties this week? 
  My responsibilities included being professional and observing the radiologist I was following. I was to be respectful and considerate to the staff and patients.
What new knowledge or skill did you learn this week?
   I observed a lumbar myelogram with full explanation as to how you can tell the fluid is working, the differences in spinal procedures, and how pain correlates with finding the right entry in the spine. I also got to see the procedure for a chest x-ray.
What was the best thing that happened at the unpaid work-based learning site this week?
   I loved that the lumbar myelogram was explained to me as the procedure went on. I was able to get tons of notes on the procedure and I wasn't as confused on why things were happening.
What was the worst thing that happened at the unpaid work-based learning site this week?
   The only complaint I would have is that the chest x-ray wasn't really explained to me, but I mean it was self explanatory. There was few acronyms that I didn't get, but I wrote them down to look up later.
If the "worst" was a mistake, how was it corrected?
   I should have asked questions after the X-ray was over, but I think the writing down of terms I didn't know was pretty useful. I couldn't do much due to the privacy of the patient. 
This week was GOOD. Why?
    Radiology got me thinking and got me interested. I thought the X-rays were so interesting and there wasn't really much down time when I was there which I enjoyed; gave me more time to observe. Also, it was nice to have something explained rather than just stated to you like some of the other rotations.

Record

Technology observed: I saw the computer where the X-rays would come up. Also, I observed the camera that they use to do the imaging along with the special table/bed where the patients lays; it tilts up and down and in all sorts of directions for the purpose of effective imaging. I didn't ask for any of the names of the technology, which I'm not punching myself in the face for.

Diagnostic procedures observed: When evaluating the patient, the doctor checked the previous CTs to make sure he was entering the spine at the correct point. The patient had an extreme narrowing in this L3 and L4, causing the route to injected the contrast for the CT so the spine really shows up and isn't as vague. 
Therapeutic procedures observed: During the chest X-ray, the radiologist acted as if she had known the patient for years. She was so kind and sweet and supportive to the patient, and then in the myelogram comfort was always one of the main concerns of the radiologist during the procedure.
Diseases/disorders observed: The narrowing of a the spine in the lumbar section on an elderly patient was the main disorder observed. The chest x-ray was taken for a woman with almost deformed looking lungs; could have been an smoker, but the lungs didn't look in too great of condition. 
Medical terminology/abbreviations encountered: Myelo-  any part of the spine, and always entered through lumbar. 
BE- barium enema
IVP- intravenous pyelogram
UGI-upper gastrointestinal 
MRI-magnetic resonance imaging

Journal

   Imaging is dark. The lights are dimmed and there are maybe 4 computers open that aren't in the 4 screening labs, with two of the radiologists in there; both women. The radiology department does a lot of the screening including X-rays. Special cameras, tables that are able to tilt, PPE, sterile gloves/syringes/masks, and previous testing results are used. All the stations are extremely dark which I'm guessing because of the harsh light and special cameras they use. The doctor was in a gown, mask, gloves, goggles- the whole 9 yards of PPE and the nurses were just in scrubs. Probably because they weren't directly touching the patient in any way, other than in the chest x-ray where she was turning the lady because the patient was unable to do so on her own. 
   Communication skills between the imaging nurse and the doctor were frequent and efficient due to the nurse being in control of how the doctor views the spine and the body. During the Myelogram, the doctor was fully gowned because of harsh lights and possibility of spinal fluid coming out of the tube being entered into the lumbar while injecting contrast. The nurse had the man on his side because it was painful to be on his stomach for a long period of time while the nurse in the chest x-ray had to physical turn and help the patient because she was unable to stand against the camera without getting weak in the knees. 2nd hand opinion was used during the myelogram; the doctor was super sketchy about how he was going to inject the fluid into the spine due to how small of an opening was (narrowing). 
   During myelograms of any sort, personnel always go through the lumbar part of the spine. If it's the cervical portion of the spine, the doctor will inject the fluid into the neck then tilt the table forward so the fluid runs to where it needs to be. Also, I thought it was really weird that the staff used just a pair of surgical scissors for alignment and the numbing medicine they use is the same as the one you receive at the dentist. When the doctor started the myelogram, it looked like he was just poking a needle into the patients spine and the patient started complaining about a shooting pain in his right leg, signaling that the doctor had hit a nerve. I learned that if spinal fluid comes out of the syringe then you're in the spinal canal. The patient also had to be moved during the procedure because he was too far up the table when trying to tilt him and then the doctor had to stop. Something to do with how narrow the spine was and how he was now pushing into L5; stenosis essentially. Most of the problems during the procedure had to do with flow and narrowing, but nerve endings and spinal fluid not coming out also became a problem.
   I loved imaging because of how most of the procedure was explained to me and how the nurses were willing to teach. You don't get that a lot in the hospital, which is kind of disappointing. It allowed me to view what the staff does on a daily basis while also getting a close view of procedures going wrong. The nurse seemed pretty impressed with the amount of notes I had taken and they were all really laid back. I gained a lot of new medical terminology and insight on the profession while I was there, along with getting a good understanding of why things are done during procedures which kept me interested. I would love to go back and view what else imaging does; the rotation got me very curious in the profession.                                                                                           

Med Surg 5th Floor- February 13th

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What were your responsibilities or duties this week? 
   My responsibilities included being professional and observing the nurse I was following. I was to be respectful and considerate to the staff and patients.
What new knowledge or skill did you learn this week?
   I gained new medical terminology while in med surg. I also got a better understanding of what goes into charting.
What was the best thing that happened at the unpaid work-based learning site this week?
   As dumb as it might seem, my favorite part of this rotation was a chart. Med Surg has this little customer service and each time a staff member gets a good report, they get a little gold star. It's like the good noodle chart, but professional and childish (which are probably two words that shouldn't be in the same sentence.
What was the worst thing that happened at the unpaid work-based learning site this week?
   If I had to pick a worst, it was probably the patient's daughter during one of the injections the nurse was doing. She gave me this whole lecture on the importance of hand washing, her mom's past medical history, what I should look forward to as a nurse (which isn't what I want to do) and her opinion of the hospital. I was thoroughly uncomfortable, and just nodded my head and smiled, watching what the nurse was doing.
If the "worst" was a mistake, how was it corrected?
   I could have been nicer about it and actually held a conversation with the daughter. In my defense though, she was being very hard to be conversational with talking about her mom getting hit by bus and how well I should be washing my hands so I could be like the nurse I was following.
This week was FAIR. Why?
    Well aside from the fact it was Med Surg, it was more active than it usually was. I got to see a rectal injection, understand dietary changes, and see complex soft skills. There was still a lot of charting and waiting around, but the nurse was very active in making sure I understood what was going on.

Emergency Room- February 6th, 2015

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What were you're responsibilities or duties this week?

   My responsibilities this week included professionalism, soft skills, and knowing my boundaries. I was to assist the nurses and technicians I followed, without touching the patient and knowing my limit of knowledge in the hospital. I also was required to enforce federal law, even though it went against the nurse's opinion. 

What new knowledge or skill did you learn this week?

   I learned a lot about CPR, including by the third compression the ribs should be broken (if you're doing CPR right) and the depth of the compression will differ from body masses. I also learned medical terminology and new medical documenting.

What is the best thing that happened at the unpaid work-based learning site this week?

    I got to see a full code! The whole thing! One of the coolest things I've ever seen in my life, along with one of the most real things. It was definitely an eye opener. 

What was the worst thing that happened at the unpaid work-based learning site this week?

   For the first few minutes of the rotation, it was pretty slow, then my instructor came in and kind of got the staff aware that I wanted to learn. From there it was pretty minor stuff, like putting in an IV. It escalated as time went on. 

If the "worst" was a mistake, how was it corrected?

   I probably should have been more prominent with staff. Ask questions to the nurses and have more a voice in the beginning. 

This week was: GOOD. Why?

   The code blue was literally such an eye opener for me. I finally got see why these people do what the do. The rush. The need to help. It was a good change from not seeing much to seeing why medical professionals get that drive and passion to help. 

GRACE- Number 4

Search for additional info on emphysema and bronchitis

    Emphysema is a type of COPD (Chronic Obstructive Pulmonary Disease) that causes the air sacs to be damaged leading to them swell and eventually burst. It also causes carbon dioxide to build up in the body. In 2005, most of the US population who had Emphysema were male, most to all were people who smoked due to cigarettes being like poison in the lungs. Testing includes CXRs, ABGs, CBCs, and pulmonary function tests, while treatment includes antibiotics and oxygen therapy. This disease is almost completely preventable because it's gotten through smoking. Stop smoking, stop yourself from getting another disease.
   Bronchitis is the inflammation of the bronchus, ranging from acute to chronic(Thanks med terms). This also is a form of Chronic Obstructive Pulmonary Disease. Just like emphysema, it is caused when there is damage to the lungs. For instance, smoking. Who'd of thought? Chronic is usually cause by smoking and involves chest pain, coughing with mucous, and chest pain, yet acute can also be assumed or associated with asthma. The preventives to chronic is stop smoking or stop inhaling harmful gases that could possibly kill your lungs while the acute bronchitis is usually caught early on and can be treated with antibiotics.

Physical Therapy/ Sports Medicine- January 30th, 2015

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What were you're responsibilities or duties this week?

   I was to observe a PT who also worked with sports medicine, and develop an understanding of muscle and bone strengthening. Professionalism, considerate care, and alertness was also part of my duties

What new knowledge or skill did you learn this week?

     A new piece of equipment, goniometer, which is used frequently in physical therapy was introduced to me. Also, different shoulder and arm evaluations were shown to me.

What is the best thing that happened at the unpaid work-based learning site this week?

    The best part was just kind of feeling like this is where I am supposed to be. I wasn't that awkward, and I understood why and what was going on and was throughly interested. The people, aside from the first lady I was with, were all very open and humorous but understood that they we're there to do a job.

What was the worst thing that happened at the unpaid work-based learning site this week?

   For the first half of the rotation, the person I was following was so inattentive and didn't even acknowledge I was there. The person getting therapy had a cool injury too and I didn't even get to understand what was going on!

If the "worst" was a mistake, how was it corrected?

   I just moved to one of the other PTs who was doing something. The patient looked like an athlete so it seem to fit that I went with them.

This week was: GOOD. Why?

   It felt awesome that I could see myself in their shoes someday. Hopefully, in a more exciting place, but I just felt at home a little. I learned new things and I understood what was going on and how to act.

Record

Technology observed: A goniometer was shown to me. PTs and athletic trainers use it to measure angles on people so they get a better understanding of their range of motion which explains why it looks like a giant protractor. 

Diagnostic procedures observed: Evaluation of a shoulder with resistance testing and feeling the wound was used. The PT then evaluated the injury after to see what treatment should have been done for after the work out.

Therapeutic procedures observed: The athlete weight strengthening with the right arm to build endurance and wall jumps for resistance was shown. The PT would then use physical resistance pushing her hand into his shoulder blocking his range of motion to test and build strength for his shoulder.

Diseases/disorders observed: I saw a man with amputated leg with the first physical therapist I was with. It had to be fairly new because pain could be shown on his face when anyone touched it and the redness hadn't gone completely away. I assume it had to be his first or second therapy visit. 

Medical terminology/abbreviations encountered: Everyone just says PT instead of the whole name and most of them complain about doctor's handwriting (Looking at you 3rd/4th period). Also, ROM (Range of Motion) and ADLs(Activities of Daily Living) were used quite frequently.

Other: The therapists there were all very interested that I wanted PT and/or Psych. They were more shocked that I had an actual plan after leaving high school considering most of the kids who come through, "don't know or say 'I want to be a nurse' like every other person". 

GRACE- January 12/22, 2015

      The residents haven't been on as edge as they usually are. Last week, when in G.B., a few of my peers and I hit a balloon back and forth to keep the residents busy. I stood between one lady who seemed almost afraid of the little red balloon and a man who was more than excited that he got to hit something. There wasn't a lot of talking or social skills, it was more helping the residents if anything; which I like. To be honest I prefer being able to help without word than I do sitting down and holding conversation about stuff I really have no interest in. Residents seem to really enjoy Disney songs, though. One of my close co-workers and I started singing "Make A Man Out Of You," from Mulan (aka the best Disney movie to possibly exist). I think that's one of the happiest times I've seen the residents. We continued on with more songs, which they loved. I think it makes them feel young or go back to happier times, which is sweet. I kind of want to encourage the others to sing. It makes the residents feel like they're sort of relevant to our generation, along with allowing them to relive some parts of their childhood or teenage years.
      Moving on, Therapy honestly isn't as bad as everyone makes it out to be. I enjoy it, especially because the residents have more of a reason to talk to you. Calms my anxiety of being ignored or regretted a little bit. Also, the workers in therapy (if asked) are super willing to help you. Don't get me wrong, a few of them are little standoffish and question your every move, but the two I normally talk to are always really nice and ready to help teach me. Exciting news! I got to feel what a shoulder after a reverse shoulder replacement felt like. Reverse shoulder replacement, for the resident, occurred because her rotatory cuff made up of 4 muscles was almost towards the middle of her humerus. Compared to her other shoulder that was soft and loose (and mobile), her left shoulder seemed tight and very limited. I would describe it as a really big knot or a piece of ply wood under the skin but both relations seem a little under exaggerated or over exaggerated.