So, last night was my last lecture of Med/Surg 1. I can't believe how FAST this semester has flown by. I mean I feel like it literally started yesterday. Maybe because we packed all our clinical hours into the first part of the semester, I don't know, but wow, next week I will be DONE with my first year of nursing school. I'm thrilled but terrified at the same time. I have heard that next semester is the hardest out of everything. I go from taking one class to 2. That will be interesting. I've never taken more than 1 class at a time before since I started at FCC 2 1/2 years ago. Its Med/Surg 2 and Psych. We will have clinical pretty much every weekend the entire semester, so I better enjoy having my weekends to myself while I still can! We do half the semester clinical wise in Med/Surg 2, then the other half Psych. I kind of hope to get Med/Surg 2 out of the way first. I feel like that is going to be far more challenging to me. We start taking 2 patients next semester and I'm kind of worried about that. Mostly how I'm going to prioritize their care and such. We shall see. So far I have had REALLY wonderful clinical instructors, hopefully that trend continues. We also get to go to the OR next semester. I'm sort of leery about that. I can watch trauma shows on Discovery Health without a problem, but when its a REAL person, right in your face that's getting cut open, I imagine its quite different LOL!
OK so on to disease factoid of the week. Now remember, I am just writing this to enlighten the general populace, so if you are a health care person reading this, I know this is going to seem way oversimplified, but please bear with me and remember my audience, ok? Yesterday, we covered the liver, gallbladder, and spleen. We spent a LOT of time discussing cirrhosis and liver failure, so I am going to talk about that. I also took care of a liver patient this semester, so it was cool learning how everything fits together. So, what do you need to know about cirrhosis of the liver? Well mainly that the liver does A LOT of things in your body. There's really not a system of the body that the liver doesn't do SOMETHING for. It plays a big role in protien and carbohydrate metabolism, stores carbohydrates, stores iron and copper and many of your fat soluble vitamins, detoxifies your blood (most medications you take are metabolized in your liver, and Tylenol can really do a number on it. The MAX dosage of Tylenol a day is 4 grams. So be careful when you have a cold with aches and a fever. A LOT of cold medicines have Tylenol in them, so if your taking a cold med AND Tylenol for pain or a fever, you are getting a double dose right there.), makes bile which you need to be able to break down the fats that you eat, helps with the breakdown of old red blood cells, makes clotting factors, and makes a protien that is found in your bloodstream called albumin. Albumin helps keep the water contained in your blood in your blood vessels instead of leaking out into your body. So you can see that if your liver is screwed up, well, everything goes wrong.
So cirrhosis. The number one cause of cirrhosis is alcohol abuse. The number 2 cause is chronic hepatitis from infection with Hep B or Hep C, with Hep C really being the worst. As far as alcoholism is concerned, scientists don't know whether it is the actual alcohol or the malnutrition that results from being an alcoholic that causes cirrhosis. They are still looking in to that relationship. Cirrhosis happens when your liver cells (called hepatocytes) and the cells that make up the many vessels in your liver die and try to regenerate. Your liver CAN regenerate. That is why they can take liver transplants from living donors. You could lose part of your liver and it will grow back. Neat huh? Anyway, the different cells in your liver come together in a VERY organized structure. In cirrhosis, when the cells regenerate, they do so in a very unorganized way, essentially making your liver not able to function properly anymore. There are A LOT of complications and signs and symptoms of this disease, but I only really want to tell you about a few of the major ones that I saw with the patient I took care of. Her disease was caused by a combination of alcohol abuse AND Hep C.
1) Jaundice: This is a yellowing of the skin and the sclera (whites) of the eyes because of a build up of bilirubin. Bilirubin is a waste product from the breakdown of red blood cells. There are 3 types of jaundice, but I'm not going to get into that here. That's a little complicated for our purposes :) Your red blood cells have a lifespan of about 120 days. After that, they are broken down. Normally, the liver takes in the bilirubin and breaks it down into less toxic substances that are then excreted from your body in the urine and feces. If your liver isn't working, obviously you can't break the bilirubin down, and it deposits in your skin, giving it that yellow color. So the patient I took care of had end-stage liver disease, so she was pretty jaundiced. I noticed it most in the whites of her eyes. They were quite yellow.
2) Ascites: This is basically a fancy term for build up of fluid in the belly. Patients with ascites are those patients that look 7 months pregnant but aren't. The skin of the abdomen becomes stretched and shiny, and if the fluid buildup is bad enough, the skin can actually start to weep fluid. You can have a build up of fluid anywhere in the body, and that is called edema, but when its massive and in the abdomen, its ascites. There are MANY reasons a person could have edema or ascites, but I am just going to discuss why people with cirrhosis get both edema and ascites here. Normally your body maintains a VERY strict fluid balance and there are many mechanisms within the body that keep your fluid balance where it's supposed to be. So without getting into a lot of complicated concepts, the reason people with cirrhosis have problems with fluid balance are 3. 1) The liver is not making albumin anymore. Remember I said albumin was the protien that keeps the water in your blood inside your blood vessels and not out in your body? Well if you don't have enough of that albumin, the water is going to leave your blood vessels and enter your tissues, causing swelling 2) Malfunctioning of the capillaries in your liver: Remember from bio that the capillaries are the smallest blood vessels in your body? Well the liver has them too and they are called sinusoids. Capillaries are permeable, because they work in the tissues releasing nutrients and oxygen and taking up waste products. Now normally, the openings in the capillaries are NOT big enough to let albumin through, because it is a pretty big molecule. In cirrhosis, the sinusoids are no longer normal, and they allow the albumin to escape. So now we have low albumin because the liver can't make it anymore, and even LOWER albumin in circulation of the liver, because it is being lost. Water is going to follow the albumin out, so we get fluid in the tissues. THIS part is important for the actual ascites because of the location of the liver. If you are losing water from the capillaries of the liver, where is it going to go? Think about the area where your liver is located. There is a good bit of space inside your belly, so the fluid is going to build up there, but you might get swelling elsewhere too, and finally 3) Aldosterone: Aldosterone is a hormone that is made in your adrenal glands, and it tells the kidneys to retain sodium. In the human body, water follows sodium. The liver is the organ that breaks aldosterone down. So now you have high levels of aldosterone telling the kidneys to conserve all this sodium, and you retain water. That is why salty foods make you bloated! Because water follows sodium. I found it kind of strange that my patient didn't really have ascites, since she was end-stage. She did have edema down her legs and feet though. You can imagine why ascites would be bad though? First, having all that fluid in your belly makes it difficult to breathe. Second, you run into a lot of problems because of fluid overload that are too complicated to get into here. Third, all that fluid is nice and warm, and contains nutrients, a perfect breeding ground for bacteria, and you wind up with an infection called peritonitis, which can be fatal.
3) Hepatic Encephalopathy: This is a really end-stage complication, and eventually IS fatal. It's a neurological condition that starts as more of a psychiatric problem (confusion, agitation, mood disturbances) and ends with coma and death. People with this also have a characteristic "hand flapping" tremor called asterixis. My patient definitely had this. She was in the beginning phases of it. She had the confusion, she would often forget where she was, what she was saying, or forget words for things, had flights of ideas, and definitely had mood disturbances. One minute she was in a good mood talking to me, the next she was crying, and the next she was yelling at me because she didn't get any toast on her breakfast tray. She had that tremor too. Its only really noticeable when the person puts their hands out in front of them. So here's its cause. When your body breaks down proteins, one of the waste products is ammonia. A lot of that is done by the bacteria that live in your large intestine. I am sure that you know that ammonia is VERY toxic. Well guess what breaks down ammonia? If you guessed the liver, pat yourself on the back! It converts the ammonia into urea, which is excreted by your kidneys in your urine. So if your liver is not breaking down the ammonia, it starts building up in the blood, and ammonia can cross over your bloodstream into your brain. Most chemicals can't do this because the barrier between your blood and brain is so tight (the blood brain barrier) but ammonia can, and it is also quite toxic to your brain. So that is what causes hepatic encephalopathy. The treatment for it is lactulose, which is essentially a laxative. The special property of lactulose is that it binds up the ammonia in your large intestine, and then you eliminate it. My patient was on this, and I am guess that that was why her condition wasn't worse, although after a while, there isn't anything else that can be done.
So wow. This was long! Thanks for reading, and I hope it was educational :)
Thursday, December 2, 2010
Monday, November 29, 2010
Bit of a rant
Ok, so here's the deal. I am jobless right now. I have been jobless since last New Year's Eve when the temp agency I was working for so kindly let me know the position was over. With no notice. On New Years. THANKS GUYS! If you ever need a temp job, stay far away from Sparks Personnel Services. Anyway, with that out of the way.........
As a nursing student, you can apply for your CNA after you complete your first semester. Which I have. After that, you can work as a nurse's assistant pretty much anywhere. Here's the rub though. To work in a HOSPITAL as a CNA, I am finding, you have to have experience. Nursing homes usually not so much. BUT many (if not most) nursing homes require you to have a GNA (Geriatric Nursing Assistant) which requires you to take an additional test and whatnot. But here's the REAL kicker. With my program, I can't APPLY for a GNA. Yes, that's right, I would have to take an additional 6-12 month course, WITH more clinical time to learn skills that I have already been taught and have used umpteen million times already. Its MADDENING! Same thing for anything clerical. EVERYONE wants 1-2 years of experience in a doctor's office. WELL HOW THE FRIKITY FRAK do you get the experience when NO ONE WILL HIRE YOU? Bottom line is, I need a job. I'd LIKE to get a job somewhat healthcare related, but that doesn't seem to be in the cards for me.
Who knows, I might be unemployed until graduation. My primary field is insurance, and God knows THAT isn't hiring right now. Plus I've been out of the industry so long...................so yeah. Huge vent. But at least you were warned!
As a nursing student, you can apply for your CNA after you complete your first semester. Which I have. After that, you can work as a nurse's assistant pretty much anywhere. Here's the rub though. To work in a HOSPITAL as a CNA, I am finding, you have to have experience. Nursing homes usually not so much. BUT many (if not most) nursing homes require you to have a GNA (Geriatric Nursing Assistant) which requires you to take an additional test and whatnot. But here's the REAL kicker. With my program, I can't APPLY for a GNA. Yes, that's right, I would have to take an additional 6-12 month course, WITH more clinical time to learn skills that I have already been taught and have used umpteen million times already. Its MADDENING! Same thing for anything clerical. EVERYONE wants 1-2 years of experience in a doctor's office. WELL HOW THE FRIKITY FRAK do you get the experience when NO ONE WILL HIRE YOU? Bottom line is, I need a job. I'd LIKE to get a job somewhat healthcare related, but that doesn't seem to be in the cards for me.
Who knows, I might be unemployed until graduation. My primary field is insurance, and God knows THAT isn't hiring right now. Plus I've been out of the industry so long...................so yeah. Huge vent. But at least you were warned!
Wednesday, November 24, 2010
Thanksgiving break, weird dreams and such
Well normally I would have lecture tonight and be able to come back here and post scintillating information about whatever diseases we learned about that night, but alas, that is not to be! Its the day before Thanksgiving, so no class tonight! Whee!!!!!!!! And clinicals are over for this semester too, so my weekends are my own once again until the end of Jan.
Anyway, what I really wanted to post up about tonight is this really crazy dream I had last night. I dreamed that I was in the hospital, during clinical. I was on the same unit that I have been on all semester, except that it wasn't that unit. You know how in dreams you might be at your friend's house but the actual building around you is NOT your friend's house? That type of deal. I was also with my same instructor from this semester, as well as all of the same group members I was with. Anyway, I was in my patient's room getting ready for the day. Now in real life, we are assigned to one patient for both Saturday and Sunday, and we are expected to attend to all of their needs, including bathing, helping them eat, helping them walk around, etc, and we also administer medications one of those days. In this dream the patient that I had in the beginning was a woman I had never seen before, and she was what we in the nursing community call a "walkie-talkie". A "walkie-talkie" is a patient that is alert and oriented (ie not confused), can walk around without worry that they will fall on you, and is independant with all their self care needs (ie bathing, eating, toileting). Basically a nursing student's dream patient.
So, getting back to the dream. I was in this patient's room, and my instructor walks in with a few other students, including one of my friends that was in my group in the dream, but not in the program anymore in real life. My instructor tells me there is a patient on the unit that is dying, and she wants me in there with this patient today because all of my other classmates have already seen someone die. (Which is not the case at all, only one person in my group was actually with someone when they died this semester). I started FREAKING OUT that I did not want to see anyone die, and that I was afraid to touch a dead person. I really am terrified of touching dead people. I am scared I'm going to touch them and they'll pop up and be like, "BLLLAARRRRGGGGHHH" or something. I guess I have watched one too many zombie movies.
In the dream, my friend demonstrates to me how a person screams just before they die, and that made me get even more upset, but my instructor told me it was just something I would have to do.
So I get to the patient's room and the room is HUGE, probably close to 5 regular hospital rooms put together, but its what you would imagine a 1950's hospital room would look like. There are 3 CNA's in there taking care of this woman who is elderly and morbidly, morbidly obese. She was wearing an oxygen mask, breathing very fast. The CNA's keep trying to raise the head of her bed, and end up raising it to the point where the bed is perpendicular to the floor and the woman slides down the bed onto the floor, so they pick her up and put her back in the bed and lower it so she is laying flat on her back. At this point she starts seizing, so they raise the head of the bed to about a 45 degree angle and she takes off her mask, looks at me, and asks me to please pray with her. There is a rosary on her side table and she hands it to me and I start saying the rosary. After a while, it looks like she's not going to die yet, so my instructor has me leave the room. Finally, another of my classmates comes running in the room saying it looks like she's going to die at any minute. I walk back in and instead of this morbidly obese elderly woman in the bed, it is the same woman, but she now she is very thin and fragile looking. There is a priest in the room and everyone is singing, "Amazing Grace." For some reason, only the priest and I know the words because we are the only two Catholics in the room, but I know that's ridiculous because pretty much all Christian denominations sing that song. Anyway, that's how the dream ended. I never actually saw her die.
So now I'm wondering what does this mean? I mean, I know that actually seeing someone die is probably one of my biggest fears. So is having to touch a dead body. Nurses do BOTH of those things on a pretty regular basis, so I'm going to have to get over that. I don't know. Any ideas?
Anyway, what I really wanted to post up about tonight is this really crazy dream I had last night. I dreamed that I was in the hospital, during clinical. I was on the same unit that I have been on all semester, except that it wasn't that unit. You know how in dreams you might be at your friend's house but the actual building around you is NOT your friend's house? That type of deal. I was also with my same instructor from this semester, as well as all of the same group members I was with. Anyway, I was in my patient's room getting ready for the day. Now in real life, we are assigned to one patient for both Saturday and Sunday, and we are expected to attend to all of their needs, including bathing, helping them eat, helping them walk around, etc, and we also administer medications one of those days. In this dream the patient that I had in the beginning was a woman I had never seen before, and she was what we in the nursing community call a "walkie-talkie". A "walkie-talkie" is a patient that is alert and oriented (ie not confused), can walk around without worry that they will fall on you, and is independant with all their self care needs (ie bathing, eating, toileting). Basically a nursing student's dream patient.
So, getting back to the dream. I was in this patient's room, and my instructor walks in with a few other students, including one of my friends that was in my group in the dream, but not in the program anymore in real life. My instructor tells me there is a patient on the unit that is dying, and she wants me in there with this patient today because all of my other classmates have already seen someone die. (Which is not the case at all, only one person in my group was actually with someone when they died this semester). I started FREAKING OUT that I did not want to see anyone die, and that I was afraid to touch a dead person. I really am terrified of touching dead people. I am scared I'm going to touch them and they'll pop up and be like, "BLLLAARRRRGGGGHHH" or something. I guess I have watched one too many zombie movies.
In the dream, my friend demonstrates to me how a person screams just before they die, and that made me get even more upset, but my instructor told me it was just something I would have to do.
So I get to the patient's room and the room is HUGE, probably close to 5 regular hospital rooms put together, but its what you would imagine a 1950's hospital room would look like. There are 3 CNA's in there taking care of this woman who is elderly and morbidly, morbidly obese. She was wearing an oxygen mask, breathing very fast. The CNA's keep trying to raise the head of her bed, and end up raising it to the point where the bed is perpendicular to the floor and the woman slides down the bed onto the floor, so they pick her up and put her back in the bed and lower it so she is laying flat on her back. At this point she starts seizing, so they raise the head of the bed to about a 45 degree angle and she takes off her mask, looks at me, and asks me to please pray with her. There is a rosary on her side table and she hands it to me and I start saying the rosary. After a while, it looks like she's not going to die yet, so my instructor has me leave the room. Finally, another of my classmates comes running in the room saying it looks like she's going to die at any minute. I walk back in and instead of this morbidly obese elderly woman in the bed, it is the same woman, but she now she is very thin and fragile looking. There is a priest in the room and everyone is singing, "Amazing Grace." For some reason, only the priest and I know the words because we are the only two Catholics in the room, but I know that's ridiculous because pretty much all Christian denominations sing that song. Anyway, that's how the dream ended. I never actually saw her die.
So now I'm wondering what does this mean? I mean, I know that actually seeing someone die is probably one of my biggest fears. So is having to touch a dead body. Nurses do BOTH of those things on a pretty regular basis, so I'm going to have to get over that. I don't know. Any ideas?
Monday, November 22, 2010
Hello world!
Good evening, my name is Sashimistat, and this is my first foray into blogging. So I am guessing your first question is why I don't put my real name or picture up here. Well, there's a good answer for that. I am a nursing student. And I am going to be writing about what its like to be in nursing school. See, we have these fancy laws nowadays called privacy laws, and while I would NEVER mention anyone by name, its safer if I don't use my own name either, capice?
So, a little about me. I live on the east coast. I'll give ya a hint but just one. We do have winter where I live, but its not like negative three hundred below in winter here either. I like it here on the east coast, but I'm not sure I want to stay in this state forever. I've been here all my life. I'd like to go either south or west one day. I am married, no children (human children, that is). I do have 2 dogs and 2 cats. I love, LOVE sushi/sashimi hence the name. Unfortuantely right now we are too broke to enjoy either, but thems the breaks right?
I am a nursing student. I go to a community college and when I finish I will have an Associates and be able to sit for my NCLEX-RN (the licensing exam for RNs). I already have a Bachelors from another school in an ENTIRELY different discipline. It took me 2 years of classes before I could even apply for the program I am in now, but I did, and I got in. I am almost through with my first year of 2. It has NOT been easy at all, and my self confidence has been sorely tested along the way, but I have managed to maintain a 4.0 this whole time. Go ahead, talk behind my back, I don't care LOL! I worked hard for those grades and I am proud of them! I have done things in the past year that I never thought I would EVER be able to do. Namely give shots. I have a HUGE needle issue and used to not be able to even WATCH someone else get a shot, but now I give 'em like a champ. Clinicals are over for this semester, and I have heard that next semester is the hardest yet, so strap yourselves in and get ready for the ride!
So, a little about me. I live on the east coast. I'll give ya a hint but just one. We do have winter where I live, but its not like negative three hundred below in winter here either. I like it here on the east coast, but I'm not sure I want to stay in this state forever. I've been here all my life. I'd like to go either south or west one day. I am married, no children (human children, that is). I do have 2 dogs and 2 cats. I love, LOVE sushi/sashimi hence the name. Unfortuantely right now we are too broke to enjoy either, but thems the breaks right?
I am a nursing student. I go to a community college and when I finish I will have an Associates and be able to sit for my NCLEX-RN (the licensing exam for RNs). I already have a Bachelors from another school in an ENTIRELY different discipline. It took me 2 years of classes before I could even apply for the program I am in now, but I did, and I got in. I am almost through with my first year of 2. It has NOT been easy at all, and my self confidence has been sorely tested along the way, but I have managed to maintain a 4.0 this whole time. Go ahead, talk behind my back, I don't care LOL! I worked hard for those grades and I am proud of them! I have done things in the past year that I never thought I would EVER be able to do. Namely give shots. I have a HUGE needle issue and used to not be able to even WATCH someone else get a shot, but now I give 'em like a champ. Clinicals are over for this semester, and I have heard that next semester is the hardest yet, so strap yourselves in and get ready for the ride!
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