Wednesday, November 26, 2008
Remember way back when Amanda and I got fabric to make kitties? And then she made hers in a reasonable time-frame? Well I finally finished mine. Behold!
The little guy's purple nose is hard to see. I'll probably replace it with some peach felt. Otherwise I like them very much!
I had the pleasure of seeing Andy perform as Mies Gloriosous in A Funny Thing Happened on the Way to the Forum last weekend. It was a great show - the perfect part for him I think. It was a whirlwind trip but a lot of fun seeing all my mom's side of the family. I put up some more pictures on flickr.
Tuesday, November 25, 2008
Friday, November 21, 2008
* Describe your patient assignment this week. What was the child's diagnosis, treatment, nursing challenges?
I cared for a three year old girl with neuroblastoma. She was here for a 4 day course of chemotherapy, I cared for her on the third and fourth day. The first day she was very quiet, sleeping a lot, not feeling well. Her father was at the bedside and I get the feeling he wasn’t thrilled about that. Not involved in care. The second day her mother came in the afternoon and the girl perked up immensely. Suddenly she was all about playing and talking. Very fun and sweet.
With her chemotherapy her I&O’s are extremely important. her kidneys get blasted so you want to keep fluids going through her. We had her on D5W + ½ NS + 20 mEq KCL round the clock. We weighed her diapers and measured emesis to make sure her output was at least 45 m/hr per orders. Otherwise you replace ml per ml. She also has a strict regimen of fluids and electrolytes after her chemo, which was during the night shift so I didn’t really get to see that.
* What was your most significant thing learned during week #2? (In other words, an "aha" moment!)
First to answer some of the group’s questions, the oncology patients are here for various amounts of time. Like I said, my girl was here for a specific course and many are like that. In for a week at a time every month or two. Another child I cared for was here since he was diagnosed 9 days ago. My nurse also had a patient in the BMT (bone marrow transplant) unit so I got to shadow the care there. It was an 11 year old girl with aplastic anemia (her marrow stopped making all types of cells). She had a 10 day course of chemo, then go a transplant of stem cells from cord blood, and now was waiting for her body to respond. It can take just a week or two to work, but she’s been here in isolation for 34 days now with no response. They talked another a kid who took 120 days for his body to start producing. They also had a 18 month old kid who had been the hospital since birth. So the length of stay on our unit can vary quite a bit.
I’m not sure I had an aha moment, but obviously I’m already learning a lot about oncology care. I got tons of practice giving IV medications (working with the tubes, doing calculations). I also had some variety with my little 3 year old – getting assessments while she sleeps and getting assessments while she’s talking and jumping and playing with my steth (including banging the bell with it in my ears – OUCH!). You have to make special accommodations to get the information you need. You have to be creative and flexible.
Wednesday, November 19, 2008
Despite going to bed at 9 pm last night it was not restful. I had just finished my prep sheet for my first patient the next day and I was in a state of panic. How do I measure input and output for a three year old? How do you get a UA dip each time she pees? How I will know when she needs to pee? How do I get into their omnicell? What counts as hypotension for a kid on chemo? What does chemo look like? And these are in addition to all my normal anxieties about new clinical, such as will I get a good nurse? Will she like me? Will I be bored? Will I get to do anything good? And what if I screw it up? What if I get sick tomorrow? What if I'm late? How early do I need to leave? How will I meet my clinical instructor? Like I said, I'll stop there to keep it short.
So I slept from about 10 pm to midnight, then woke up every 45 minutes until 5 am. As usual breakfast (oatmeal, banana, OJ) did not taste good that early. I felt like throwing up and had diarrhea - my usual anxiety woes. They usually dissipate by the time I get to my clinical/first rehearsal/performance, but they make the getting there part fairly awful.
I was nearly late and had trouble with my badge access to parking.
Luckily my nurse Anna was in no hurry and set me up for a great day. She worked with me at my pace and let me do all the things I wanted, without pushing or assuming I knew a lot. Of course I fumbled and felt flustered and slow throughout the day, but she was a great cheerleader and teacher. I even dropped an open port of tubing on the floor TWICE in one hour and she showed no disappointment in me. I worked with all three of her patients including the one who I prepped to care for, a 3 year old girl with a stage 4 neuroblastoma. She was a cute little girl who liked The Little Mermaid and wanted to play with the empty syringes and bags after we changed her fluids.
I felt like I mostly shadowed today, which is what I wanted. They had set me up to believe I would be doing total patient care, and indeed I heard some horror stories from other students who were at the hospital last weekend. Nothing like that for me. It's a top of the line hospital with the cheeriest staff ever.
My biggest complaints with my rotations so far have been 1) It's too slow and 2) I don't get to do enough procedures. Well today was anything but slow with NO downtime and I worked with more IV meds/tubes today than I have in all my schooling combined.
I don't know how I feel about peds. I don't have any spark of "Oh yes! Working with kids is the best/my calling/all I ever dreamed of. " But I don't dread it or have any trouble getting over the fact that we have to do things to the kids that hurt. I'm dead neutral. I wonder how I'll feel in four weeks.
Tuesday, November 18, 2008
Thursday, November 13, 2008
Tuesday, November 11, 2008
I made a sour cream apple pie this weekend and it's heaven. I could eat the whole pie in one sitting.
I'm still waiting for the first snow so I can make waffles! I'm getting impatient.
Saturday, November 08, 2008
We had thai food at Tuk Tuk on Speer. It was meh. Who thinks putting bone-in chicken in a curry is a good idea? At least the curry sauce was good. Mostly I enjoyed the company and conversation. (Summary = American school system needs major work)
Then we went to the art museum for the Houdon exhibit. The sculptures were amazingly detailed and lifelike. Amanda has a membership so we visited only the part we wanted without feeling like we had to "get our money's worth." A little at a time is a great way to see art. Behind the Houdon works was a demo area with modeling clay and styrofoam busts. Probably for kids, but we jumped in anyway. I had to cut Amanda off. It was obvious that this girl needs to enroll in a puppetry and mask-making work-shop (I mean for enjoyment, not for lack of talent).
Before going home we dropped by the Recycled Lamb to check out their spinning supplies. Amanda leveled-up her spindle and got a great deal on some alpaca roving. So silky!
Back in Lakewood Ben had spent the day with Carl, Nate, and Brian to make a camera out of a scanner, based on this project in Make Magazine. They put the camera together but didn't have much success with waning daylight.
Amanda had to leave to do important grown up things. I joined the guys at Brian's house to use his super lights that we use for movie-making. They actually got it to work.
Friday, November 07, 2008
Sunday, November 02, 2008
Freddy Krueger and a Bee
A Gypsy and a Bum (huh, I guess we were both channeling poverty this year ;-)
Donna Noble with the Doctor's Hand
Juno and Paulie
Dude from Fear and Loathing that I don't know
"The Management" from Carnivale series
Pizza mummies, Graveyard cupcakes, Brian's punch, Deviled Eggs
We had a TON of food, many not pictured.
Mystery Candy Bar Contest. The winner got 8/12.