Student Nursing Diagnosis & Another Night of Firsts

I have to share. Going over my notes from a recent Med-Surg lecture I realized I mistakenly typed a wrong word and started an involuntary self giggle session.

My instructor mentioned the NANDA nursing diagnosis, "Risk for Infection" but I typed, "Risk for Information."

I found it funny because I thought it would make a great nursing diagnosis to be applied to the overloaded mental status of a typical nursing student. Okay. Its either a sad commentary on my state of mind or it really is funny. I'll let you decide. If you have some related to's feel free to leave them in the comment section. Who knows. Maybe we can collaborate on a new NANDA diagnosis.. HA!

No OB clinical this week (translation: one less care plan to turn in this week :-)

Med-Surg & a night of firsts
Disclaimer: For those of you with tons of experience you may roll your eyes in boredom so bear with me.

It is fair to say that I have spent too much time in class and not enough time in a clinical setting developing new skills. I know this is a weakness of mine and I only hope to get as much experience in the next few weeks, months, years that I can stand.

My strategy for this rotation has been to choose patients that have multiple diagnoses (especially diabetics). Its not that I'm sadistic... I just want to give injections, start IVs, etc.

Last night I had a diabetic patient BUT as it turns out he did not require insulin. Thats right. I pick the one insulin dependent diabetic patient whose blood sugar levels just so happened to be WNL (within normal limits). Fine! ;-)

Aside from the injection disappointment I did get to hang 1000 mL of procainamide. For those of you unaware procainamide is an antidysrhythmic that comes in a bottle... not a typical bag. Since a bottle is rigid it cannot collapse like a plastic bag as it empties its contents, hence... the release valve! Every so often the (student) nurse must open a little release valve found right above the drip chamber to allow air into the bottle thereby eliminating a potential vacuum. I know this is silly but hey... it was news to me.

Too Fat the IV pusher
The subtitle can easily be misconstrued but I'll let it stand... lol. I performed my first IV push last night. It also felt good to have the answer to my instructor's question ready to fire as soon as she asked:

"Now Mr. Student Nurse... how fast are you supposed to administer this drug?"

"2mL of famotidine mixed with 5 to 10mL of normal saline is to be infused over 2 minutes."

"Very good. Now quit standing around and get going."

I could see she had a knowing twinkle in her eye.

The Night of 'the Ugly'
In the world of (student) nursing there are clinical tasks that can be categorized, "The Good, the Bad, & the Ugly." Last night I had to perform what most would consider 'the Ugly'.

During report I was informed that a stool sample would need to be 'obtained' for lab (hemoccult) ... and the patient was not expected to have a bowel movement during the shift.

With a grin on her face & a giggle in her voice my instructor added, "If you haven't guessed this means you are going to have to go in after IT."

• 1630 student nurse accompanied by fellow male student nurse into pt's room to find pt laying in recently poured out pitcher contents (water)
• 1645 pt resting comfortably after gown and linens changed by student nurses & a fresh pitcher of ice water on side table
• 1646 pt responds to student nurse request for stool sample, "You go to hell!"
• 1700 instructor responds to student nurse report of pt refusal stating, "Give him a few hours to forget, try again, and bring a female student nurse with you."

A few hours later I was able to forgive my giggling instructor as her advice paid off. All my patient needed was a female hand to hold as Student Nurse Jellyfinger did his job.

One thing I remember from Foundations was that GI bleeds smell to high hell. Last night that belief was challenged... and I'm a believer!