I don’t need to “live my classes”

After a little hiatus, I am back blogging about my experiences in nursing school. The last week and a half have been absolutely crazy! Last week my Dad experienced a heart attack. For those of you in the Nursing/Health profession, the more accurate term is Acute Myocardial infarction. He had been experiencing angina for a few days, but was not alarmed because he had felt this pain before. Of course, I was really worried about him and urged him quite insistently to go to the hospital (I tend to be a little bit of an alarmist because of school right now- a good thing this time!!!). As it turned out, Dads pain was getting progressively worse and was actually changing from stable to unstable angina. Apparently, and unknown to me, he had been experiencing some stable angina for some time and attributed this new bought of pain to problems with his CPAP machine. When the pain was finally too much to bear, he decided to go to the hospital- and just in time because he was actually experiencing the infarction when he arrived. The medical team put him on a thrombolytic TNK- which, from my understanding, breaks up the clot to restore coronary blood flow to the myocardium. It was amazing, after the administration of TNK he felt loads better and was resting comfortably for the next day or so. The doctors decided to do an angiogram to locate the occlusion and then performed angioplasty to open the occlusion and stabilize the artery with a stent. I live 2 ½ hours out of town so by the time I got down to see him the procedure was done and he was resting with a 10pound weight on his groin to prevent bleeding at the femoral artery access site. Dad has since gone home and is feeling good- he even seems to have more colour in his face! It has been a scary couple of days! To top it all off- we are studying the pathophysiology of cardiac problems and MI at school. One of my teachers told me to stop “living out the lessons”. I agreed! :)

Everyone should know this- and please don’t diagnose yourself or shrug it off based on this information- SEEK PROFESSIONAL MEDICAL HELP IMMEDIATELY!

Patient Presentation of Acute MI (Emedicine.com) READ THIS IT’S A GREAT READ FOR MEDICAL/NURSING STUDENTS.

There are two types of Angina:

Stable: Chest pain with a typical pattern- often induced by overexertion and alleviated by rest.

Unstable: Chest pain that is unexpected- resting or taking nitoglycerin may not help. This is characterized by pain getting worse, lasting longer, happening more often or occurring at rest.

Signs and Symptoms:

Most common = severe chest pain

Many people describe the pain as: discomfort, pressure, squeezing or heaviness in the chest; also look for the patient making a fist to their chest to describe the pain. Pain may often present as a spreading down the left shoulder and arm or other areas such as the back, jaw, neck or right arm.

People often experience these symptoms as well:

  • Pain in the upper belly- often thought to be just heartburn
  • Sweating
  • Nausea and vomiting
  • Trouble breathing or Shortness of breath
  • A feeling that the heart is racing or pounding (palpitations
  • Feeling weak or very tired
  • Feeling dizzy or fainting

All of this information is taken from WEBMD and I encourage you to read the full article- which is far more in-depth.

Go to the WEBMD Article for full information.

Experiences in the Operating Room

The other day I had the opportunity to observe a number of surgeries in the operating room. It was quite the experience. The morning started off a little bit tumultuous because the lady at the front desk was expecting students from another program that day. After showing my identification, assignment and dropping my clinical teachers name she realized the mistake. She handed me a swipe card for OR scrubs (we have to do this because people were going home with OR greens too often). The card didn’t work, so the lady sent me down to another part of the hospital to retrieve a pair from the uniform department. After a short adventure trying to find this place, I ventured back to the operating unit to get changed. By this time I was late and the preconference had already taken place. I walked out into the unit and was overwhelmed by the people buzzing around everywhere. I approached someone and told them I didn’t know where I was supposed to be, but explained that I was a student observing for the day. The person quickly found the clinical instructor who was expecting me and we rushed to the operating theatre while I was trying to throw a mask and cap on. I walked into the room, all the nurses where busy organizing the room and various instruments for the procedure. The surgeon sat in the corner relaxing. He was scrolling through his IPOD to find the right music. He would be performing a WHIPPLE procedure which I have heard can take up to 10 hours to complete.

A WHIPPLE procedure (pancreaticoduodenectomy) is quite an extensive surgery from what I understand. It involves the removal of a portion of the pancreas, part of the duodenum and stomach. Surgeons will often take out the gallbladder at this time too because it is convenient. I believe this surgery was being performed as a palliative measure for cancer. I also discovered that they don’t perform this procedure very often, so you can imagine all the eager medical students trying to get a peak. From my point of view (the surgeons back) I couldn’t see very much. The medical students couldn’t really see much either because the attending surgeon and his two residents were huddled quite closely over the patient for this procedure. We relied mainly on the overhead monitors to get a closer look. What struck me most was how they prepare a patient for extensive surgery. A resident performed an epidural and the upper year medical student put in his 5th IV. They also inserted a central line (for the quick administration of fluids) and an arterial line for monitoring blood pressure etc. After the patient was asleep the doctor let the medical student intubate- which he also did flawlessly. Apparently, on the admission of the med-student, intubation is actually easier on a live person compared to the dummies they practice on. I couldn’t help but think about how scary this must have been for the patient. The nurses were great; as the doctors and med-students were performing all of these tasks (quite well I might add) the nurse was explaining and reassuring the patient about what was going on. The patient was very brave.

I learned a great deal about the nursing roles in the operating room from this experience. There were two roles in this operating environment, scrub nurse and circulating nurse. The scrub nurse was responsible for working within the sterile field. The scrub nurse also organizes, anticipates and provides the tools necessary for the surgeon to complete the procedure. The two other nurses in the room were circulating nurses. These two were responsible for retrieving supplies outside of the sterile field. These nurses also anticipate the needs of the scrub nurse and monitor/record counts. This is an important task because you wouldn’t want to forget a sponge in someone.

This experience was definitely a highlight of my clinical time so far… I can’t wait to do it again someday.

The ethics of blogging patient interactions

It’s no secret that nursing blogs and the detailing of patient conditions and clinical experiences are on the rise. A quick Google of “nursing blog” returns a plethora of sites where nurses are eager to share crazy patient scenarios, stories of annoying or ignorant interns, and a myriad of personal gripes pertaining to the understaffed, overstressed environment in which we all work. And let’s face it, for the most part we like to read and wallow in the negative experiences of our colleagues citing “coping and venting” reasons as an excuse for eagerly consuming all this crap. Don’t get me wrong, I love reading about clinical experiences and I believe blogs are the best way we can learn from each other.

So this brings me to a recent thought. We all know that it is our duty to uphold confidentiality and the right to privacy for our patients. Does blogging about experiences violate this basic human right? I’d like to hear some of your thoughts.

In the mean time, here is what the Canadian Nurses Association has to say about Confidentiality.

Nurses safeguard information learned in the context of a professional relationship and ensure it is shared outside the health care team only with a person’s informed consent, or as may be legally required, or where the failure to disclose would cause significant harm.

Nurses must protect the confidentiality of all information gained in the context of the professional relationship, and practice within relevant laws governing privacy and confidentiality of personal health information.

A link to the document on the Canadian Nurses Association website can be found here.