Acute Care Clinicals: Week 1

This week we started the acute care portion of our clinical rotation. Seven other students and I have been placed on the floor of a hospital where people receive care for problems related to end stage liver failure, most are on transplant lists and some have just received new livers. Most everyone there with light skin is bright yellow with jaundice and swollen with ascites. We were all soooo nervous on our first day, but once we got to the hospital and saw what it was like on the floor, I think we all started to calm down a little. I really love the fact that all of my classmates readily admit how scared they are -there are no tough guys in the group. It's really nice to know that when you are feeling really doubtful about your preparedness for these situations, there are seven other people around you to reassure you that, "girl, I'm crapping my pants too..."
On day #2 we were assigned a patient who we had perform a general assessment on. My patient was having a liver biopsy performed on another floor when I got there at 8:00, so I didn't get to work with him until about 11:00. When I finally got to meet him, I found him to be a really nice guy which made it a lot easier for me to do the assessment...!
Aside from working with my patient, I helped another classmate wash hers up . This guy had two chest tubes, three JP drains, a "mercedes" incision (use your imagination) AND these things they wrap around their calves and hook up to a machine that squeezes their legs (I think to help prevent deep vein thrombosis). He had just received a new liver the day before. He was acting a little strange because liver failure can cause neurological problems and I guess he wasn't feeling the effects of his new organ yet. He also had an IV and bandages on both arms. Oh! and don't forget the catheter and butt tube! I mean there was barely an inch of skin that we could actually clean before running into a tube... I also drained a catheter bag (is this getting too disgusting?) and helped a nurse draw blood off of a PICC line. I also saw a craaaaaazy dressing change on this lady's abdomen (the nurse could fit her hand up to the knuckles into the wound).
Next week, we'll start passing meds (just pills, I guess) and the following week we'll be ready for injections!!! This is too fast!

Long Term Care

Last week I started the clinical portion of school at a long term care facility (read: nursing home). We'll only go a total of four days to our designated facility before my group and I head into acute care on an organ transplant floor.

Each student has been paired up with a resident at the nursing home who we'll work and write a clinical paper about at the end of our four days. I was happy when my resident immediately reminded me of my 94 year old grandmother. She's pretty funny and feisty and while I thought she was at least in her late 80's to early 90's, I found out on the second day that she was only 69! That's just a few years older than my mom, dad and aunts and uncles. Why do people age so differently, I wonder.


Being at this home has been a saddening experience to say the least. And not because we're working with elder patients, some of which have dementia or can't talk or feed themselves, and all of whom are incontinent... it's the fact that there is about one burnt out CNA (certified nurse assistant) per 8 residents who's lack of patience or desire to take the time to be a little more caring is all too evident. "Fortunately" for me, I'm at one of the "better" homes where residents just get left on the toilet for 30-45 minutes and rushed in and out of the shower as they cry for the CNA to be careful because they have dementia and are afraid they're going to fall or get hurt. I've heard horror stories from other students who are at different homes who've told me of a resident having her own urine wiped on her by a laughing CNA who left this incontinent person in her bed for three hours and then scolded her for peeing in it... Or others who've told me that the residents in the home where they've been placed are wheeled into the hallways where they spend their whole day staring at the back of the person in the wheelchair in front of them... And we've only been at these places for TWO days! Imagine spending years living or working in one of these homes.

So what have I learned? 1) I don't want myself or anyone I know to ever have to live in a nursing home 2) CNA's need to be paid more and their patient load needs to be drastically reduced.
I can't stop thinking about my resident who's only been at this home for one month but who's already developing a pressure ulcer on her butt from sitting in her wheelchair all day, everyday. It's entirely possible that she could end up dying from an infection resulting from that sore. It makes me feel guilty knowing that once I put in my last day with her on Thursday, I'll go on to something else, but she'll be right there until the end of her days.