December 6, 2014 ~ Adult Health 2
Caution: Much detail is included in this post about my experiences as a student nurse.
I have to admit that this semester was my favorite clinical but not my favorite theory class. The first day of theory class was canceled and we were to just participate in a discussion online so things started off with us feeling behind. Then throughout the semester we had group projects on topics, which was good because it helped us learn a lot about the subject we were presenting on but then we had our classmates teach the subject rather then the professor. Having our classmates teach the subject instead of the professor was hard because we weren't sure if our classmates were teaching the important information or if things were left out that were important and such. I read the textbook and I LOVED all of the information that I learned because I like Med-surg but it was hard feeling like I didn't get much guidance on the material I was reading and the whole class felt like this. I felt bad for the teacher though because she is a really nice person and when she taught Adult Health 1 she was an amazing teacher and I learned so much but this semester she taught differently or the lack of teaching was the issue. It was an issue for the whole class and many of the classmates met with her one on one with their issues. She even canceled a class later in the semester because of a one on one discussion she had with a classmate before class was so frustrating. I still learned a lot and it was still an overall good semester there was just frustration as a class with the lecture portion of the class.
For the clinical aspect I was at San Martin on the IMC floor and I rotated twice to the ICU and 3 times to the ER. I LOVED THE ER. I begged to go back as much as I could. In a team huddle before my first clinical day in the ER I told all of the ER nurses that I was there to learn and was happy to do any IV's, Catheters or anything they wanted and that opened up a lot of opportunities. My first day in the ER I did 2 blood draws, 3 IVs, a couple of IM injections and watched a girls dog bites get stitched up. By the last rotation I had in the ER I felt confident in my ability to start an IV (at least in the AC) without making a mess. I still remember this one poor guy that I started an IV on successfully but when I went to take out the catheter and screw on the tubing the gauze that I put below the hub got caught in the tubing. I didn't notice this of course and went to flush the IV and blood went everywhere because the tubing was screwed on all the way. I made such a mess and apologized and cleaned him up but now I know not to put gauze underneath the hub when I am about the screw on the tubing.
My first day in ICU changed my life. I had a wonderful nurse that I was following that was educating me every step of the way. We had one patient that was on a vent and we were in the room when he starting fighting the vent. He was mouthing "I can't breathe", his pulse elevated up to 120, and if his hands weren't tied down with restraints I bet he would have pulled the tube out. We had to calm him down and educate him that the tube was helping him breath and he had to stop fighting it and let it help him. I felt so bad because he was so worried, in pain and just wanted help. I thought at that moment, I never want to be an ICU nurse. The thought that the patients are so fragile scares me. That if something goes wrong with the vent they die, and really any little mistake can cause a code. I got a little more comfortable in the ICU as the day went along and I helped the nurse with IV pumps, assessment and suctioning trachs. But then I experienced my first code.
The gentleman was in his 60's he had just had a selective open heart surgery to fix a bulging artery. He selected to do the surgery to prevent an aneurysm which would result in an emergency surgery and possible death. So he selected to do the surgery to prevent death but after surgery things just went downhill. In the code everyone was strongly calm and everything went very smoothly. Everyone knew what their role was and everyone knew what they were doing. The doctor was there, the pharmacist, respiratory therapists and all the nurses on the floor. The respiratory therapists were doing the ambue bag and chest compressions. The doctor was advising everything. The pharmacist would give medications and watch the timer for when the next medication could be given. The patient had coded the night before and the heart surgeon happened to be on the floor and the heart surgery cracked open his chest to get the heart pumping manually without the ribs blocking it. Since the chest was already cracked it looked like the people doing chest compressions were doing them on a pillow, there was nothing blocking them from the heart except for a dressing. With every chest compression blood would squirt out of the top of the dressing by his head and therefore I got masks and put them on people while they were at work.
I wanted to step in and do chest compression but there was already 3 nurses/respiratory therapists switching off and I didn't want to interrupt. I tried to help as much as I could without getting in the way. After putting masks on everyone I could I helped hand my nurse drugs from the pharmacist that way she didn't have to walk across the room to get it. They got a blood transfusion going considering the blood loss. After about 7 minutes of CPR and drugs the doctor said stop the compressions. When they stopped the compressions the heart rate and the blood pressure plummeted. The doctor said to continue. After about another 5 minutes of CPR the doctor said to stop and they got an ultrasound of the heart. The heart was flooded with blood and wasn't pumping properly and so they stopped CPR and announced him dead. The code was a total of about 10-15 minutes.
It was unreal to hear that he was dead. Everyone was so calm and did exactly what they were supposed to, there was no chaos at all but yet he still died. I was so very calm during the whole thing also, it was odd to me of how calm I was. Reflecting back on the experience I didn't know if I was calm because I was in shock or if it was because we clearly did everything we could and it was clearly his time to pass. I think another thing that might have made me calm is that after he passed away we cleaned up all the blood, cleaned the room up and tried to make him look as presentable to the family as we possibly could. But while we were cleaning him up the nurse pointed out some mottling or discoloration of his skin that had taken place during the code the night before. The nurse informed me that we almost lost him the night before and when he coded he started to mottle but they were able to get his heart pumping and working again. Unfortunately we couldn't remove the trach and the arterial line because the doctors that put them in had to remove those but we cleaned up the body and removed all of the other IVs. One thing that was neat was to see the nurses making the room nice for the family, set aside tissues and calling the hospital Chaplin so he could be there for the family. By helping the nurses do that it made it an easier experience for the family and I think in turn made it easier for me.
After we cleaned him up and stepped out of the room I was talking to my nurse about the situation and I mentioned how calm and organized everyone. She mentioned that the night before when he coded everything was chaotic and it wasn't very organized so this time around it was organized. I am appreciative that my first code I experienced was so organized and not chaotic. I think it would have hit me a lot harder if everyone was scrambling and chaotic and we lost the patient. I feel bad that the experience didn't make me cry and that the experience didn't hit me as hard as I thought it would be but maybe it didn't hit me as hard as I thought because I knew we did everything, I knew it was his time to pass and I know that there is life after death and that families can be together forever. I am so very thankful for the gospel that is in my life and the comfort that it brings me. Other then my great grandma passing away when I was in 4th grade, and Lucas's grandfather passing away I haven't experienced death but I know that as I experience loved ones passing away I will have the comfort of knowing that families can be together forever.
I almost forgot to mention a funny story from our clinical group. We always eat lunch as a clinical group and this one day at lunch Kritcha bought a donut and was saying how she was trying to eat healthy and us being nurses said that if she was trying to eat healthy she probably shouldn't eat the donut. She bought the donut and of course she was going to eat it, which we all understood but then she proceeded to put 4 cubes of BUTTER on her donut. We thought she was joking around because she didn't even spread the butter around but left them as cubes. But then she said, I really like butter and took a huge bite. She ate the whole thing, butter and all.
