Femoral Nails and a Hepatectomy, too!

Last Wednesday, I had my OR experience. It was awesome, and I would like OR nursing. All about the gadgets and the gloves and the tools. Not so much with the sick folks peeing on me and whatnot. But then, I would have just done the surg tech program at the comm college if I wanted to pass instruments and listen to surgeons measure their various appendages all day.

Seriously, ortho surgeons are not right. The things they did to this man's leg! How can they sleep at night?! What were they thinking?

Femoral nails are horrific going in, and even worse coming back out because they didn't get the right size. And as out there in measurement land as these ortho surgeons are, it was freaky to have the vendor of the nail in the OR, too, in his little bunny suit and red hair cover, putting in his two cents about drill bit selection and how fast to bore out the inside of the femur before hammering the nail into it. I hope he didn't take it personally when I asked him to stop talking to me about the procedure - I just couldn't stand to listen to him talking about this man's femur like it was the shelf that his product happened to housed on.

Seeing metal tools holding open the rib cage and all into the diaphragm gives me a new appreciation for why patients don't want to cough and deep breath post-op. I saw golfballs of colon cancer in a liver, and the term "right extended formal hepatectomy" doesn't begin to give you a sense of the sound that half a person's liver makes when it falls into the white plastic bucket before heading off to Pathology. Don't you need to double bag that, or something?!

My clinical instructor told me yesterday that she loves the way I present meds to her before I pull them, that she thinks I would be good at ICU or ED nursing, and that I have an excellent bedside manner. After my 84 on the first Med-Surg exam and 86 on the first Pharm exam, I was a little surprised to get such a positive evaluation. I mean, I think that I'm doing really well in clinicals, too, but I thought I aced that Pharm test! The one thing she said I needed to work on was the DAR progress note at the end of the shift. I just don't get those things! Data, Action, Response - it seems the format makes you state and re-state and then reiterate again, and I don't see the overall goal. It's definitely NOT to communicate about the highlights of the shift - at least not the highlights of a nursing student's shift, since I have six hours to do nothing but hang out with the patient and try to figure out how to work in questions on the Gordon's pattern that I need to do this week or set the goals for my teaching plan paper due next week. I'm doing 3/4 of what the NA's do, and 1/3 of what the nurses do, for only one patient all day long. Of course, my shift notes will be different. If I was only seeing the patient the amount that the nurses see their patients, then it would probably be easier to summarize my shift with them in a sentence or two.

Lest she think I would get cocky about all this comraderie and praise, I told her about getting schooled by the friend of my patient on Tuesday. I'll just cut and paste from my evaluation paragraph of my write-up*:

"What is your name?" "It's Kati, ma'am, I'm sorry that I didn't introduce myself to you before." “You know, Kati, you should never ever bathe a patient without gloves on**.” I had assumed that my role in bathing Ms. O would be similar to last week, bringing her the basin of water and linens, taking things away as she was done, helping her get dressed again. But as I tried to hand her the wet soapy washcloth, she made no indication that she was going to take it, and I realized that she intended that I bathe her. I had never given a complete bed bath to a patient before, but was feeling pretty good about my technique, until the friend’s comment. I flushed, agreed, stammered out a reply. I finished the foot I was washing, then stepped out to get a pair of gloves before I helped Ms. O apply deodorant, powder and lotion. I heard Ms. O admonish her friend quietly and the friend replied, “She’s got to learn sometime!” True enough.

*The write-ups are the reason there's been so little posting. I'm creeping, week by week, towards a 20 page document. Last week, I had 13 meds to discuss, since this week we started having to include the PRN meds in our write-ups (each week, there's a new little tidbit!). I spent at least a page and a half trying to reason out the results of the CBCs and hepatic function panels, and then the rest was nursing diagnoses (make the list of all that apply, then pick 2 priority ones and tell why they're important), outcomes, and at least 5 interventions for each of the 2 priority diagnoses, with rationales and references. I'm really grateful for the Fundamentals instructor - those brainstorming exercises she made us do every week about interventions are really coming in handy now, even though they were useless to me on exam days.

**Okay, the gloves. Seriously. I failed the G-tube feeding eval for this, remember?! Telling my evaluator with total aplomb that I wouldn't need gloves, since I'm only touching the tube, water, and Ensure. Also had to repeat the IV push eval, I believe, for not putting on gloves. Now, I've failed Bed Bath, too.