Ok, that title is for my brother, Chris. So without further ado...
"Code Brown" was something my clinical instructor last semester jokingly referred to as when a patient has a case of diarrhea. Chris was very upset that I never experienced one myself, and it's only fitting that on my last day of pediatric clinicals, when I was just HOURS away from making it through two full clinical rotations without having a "code brown," that I'd have one...not once, not twice, but THREE times! Clearly, after some cleanup and a couple handwashings later, I texted him to let him know the big news. He was very excited for me.
On to my patient for the week: He was an 8 year old, precious little boy with "high-risk ALL" or acute lymphoblastic leukemia. Actually, he was the little boy who held my hand while playing mini-golf on the computer that I mentioned in my last post. ALL is the most common type of cancer in children, and while cancer is cancer, and little can really address the hurt, confusion, sadness, and the downright unpleasantness of being diagnosed and treated, ALL actually has a very good prognosis when caught early in children.
My little boy wasn't actually coming in due to his cancer, but had gotten sick as a result of his cancer leaving him neutropenic (essentially, without immunity). He came in with neutropenic fever, vomitting, and...diarrhea. Initially they thought he had the flu, but after testing, they discovered that he tested positive for C. diff, a particularly virile bacteria which can cause severe diarrhea. So, if I'm being honest, I knew what I was getting myself into, although I had hoped to avoid said "code brown."
He turned out to be quite the handful, and didn't really want to spend any minute alone, especially since he wasn't allowed to leave his room (think virile bacteria on a floor where almost every single patient is neutropenic and at a high risk for infection). So I spent time blowing bubbles - he was very impressed with how big I could make mine, playing Candyland (I won the first game, despite his cheating. He won the second...probably because of his cheating), and playing ball in his room - a makeshift game that used his emesis (vomit) basin as the basket. Don't worry, it was clean! He won the ball game too, 25 to 23 :)
It was a fun morning though, I always enjoy a good morning getting to step back and act like a kid for a couple hours. Of course, what I've learned in nursing so far, is that the morning will be going slow - you've given your meds, your totally on top of your charting, patient is content - and then all of a sudden everything happens at once. In my case, it was a firedrill occurring at the exact moment that he says, "I just dookied all over myself" - hilarious...except that he wasn't kidding. Several minutes, and one more code brown later, we got him all cleaned up, in a new gown and pants, back to his game of Candyland, and the floor taken care of. The perks of nursing ;)
It was a fun last day, and I have to admit, it really was fitting that it had some code browns. Plus, my patient was adorable, and the source of a major ego-boost. He most have told me, "you're purrrdy" and, "you're nice" at least 50 times throughout the day. And I got a hug!
So now I'm officially done at 5 Childrens. The 7 weeks of clinicals absolutely flew by. I really wish they'd make our peds rotation longer than half a semester. I've been so enthralled by the different ages and cases that I've had, that I feel like I could easily do another half of a semester (heck, a full semester) and still feel like I'd barely scratched the surface. Nothing's set in stone in my mind, but peds is definitely something I'm leaning towards for my future practice. And now, when we get back from spring break, on to our psych/mental health rotation, where stories are sure to abound!
Until next time!
PS - Went home last weekend to surprise my mom/aunts for their birthdays, and was talking to them and Jonathan about food aversions in kids, and how to get past them, and my aunt (who is a nurse) started crying because she was so happy I'd chosen the nursing profession. It was pretty funny, but I'm glad that she's proud of me! Jonathan was a little confused, but I just had to explain that crying outbursts are quite typical of the women in my family (no offense (mom)!).
Friday, February 26, 2010
Friday, February 12, 2010
hello again!
So not too much has changed in the world of Chapel Hill or Carrington Hall...
We've successfully trekked through more exams, both Psych and Pediatric nursing. Now that those are behind us I think we can relax a little bit more. As of now the three of us are planning on a date/chick flick night on Sunday. We are considering "Dear John" and "Valentine's Day." Any suggestions?? I just know that I'm looking forward to the break.
I'm also starting a countdown with my roommate to SB'10 because we're going on a cruise (my first) and it will be sooo warm!!!
Since I've last talked to everyone I've had three more patient in the pediatrics floor. I think I've already talked about my adolescent, so I'll move on to the others.
My second week on the floor I had a 9 month old little girl who was born with a congenital anomaly, one that created a connection between her esophagus and her trachea. She is now suffering with feeding problems and struggles with normal growth rates. However, she was a doll baby! She was so peaceful and calm. Her mother was there the night I went to get my assignment and seemed very involved. However, her mom had to leave unexpectedly the day I was actually caring for her baby. When she got back I was able to talk with her for a little bit. I could tell that she and her daughter were very close and shared a loving relationship...something we've all learned is one of the most important parts of growing up healthily and to full potential.
My third week was a much more overwhelming. We got our assignments the morning of, because of the snow, and caught up on our patient and their stories on the fly. So I guess we were acting more like real nurses! I had 4 year old boy who knows the staff by name and the hospital is considered his second home (at least according to the unit staff...). He has a very rare mitochondrial disease, it's actually amazing that he is still alive. He stays in a room by himself most of the time, so he treats it like his kingdom. He wanted to help me out when I was giving some of his medicines, which surprised me! But he was funny about it! He really kept me on my toes, especially the time he started hitting at my hands. I just thought he wanted to give some high fives so I played some games with him. No. That wasn't the case. He just kept hitting my hands, then arms, then he hit me in the face. "Pause." That's what went through my mind in a split-second. Then I had to pull out the firm-tone-don't-mess attitude. Face hitting is not acceptable, he's just lacking the consistent discipline to actually know that. And when I figured that out, it made me kind of sad.
Funny story from this day: I went to take lunch for about 15 min and came back to the nursing station. The secretary looked at me and asked if I still had his room. I said yes and she just laughed. "Well whenever I can smell it from here....I know it's your boy." GREAT. So, I changed my first dirty diaper ever... gross.
This past week I tried to get a school aged kid, because that's the age group I haven't had yet, but that didn't happen. I got another little girl, 2 months old (adjusted for her prematurity), who was suffering from Short Bowel Syndrome after having about 25% of her intestines removed from chronic NEC. Soooo, I was dealing with GI problems in a little girl again, but I did get to practice some new skills with a great nurse! She went through everything step by step and explained why things were done the way they were. She was also always open for questions. That's really the first time I've seen this from the floor nurses. Anywho, I learned all about TPN (total parenteral nutrition...basically food that's infused into your blood stream) and central lines and changing lines and GI issues. I learned a lot, but it was kind of a slow day because she didn't require much care...just monitoring and loving.
Sad part of this day: The very first thing I did was carry my little baby down to x-ray / fluoroscopy so they could give a barium enema and look at her bowels. I can see why parents are emotionally unprepared for watching things like this. It was hard for me to see her suffering, and I only knew her for one day! Basically, they infuse this chalky white substance into her bowels through her little bum and then take multiple screens of it to check out the status of her GI tract. They had my poor little baby strapped to this wooden plank and restrained (that's the least invasive way to put it). I understand why it's necessary (so she won't squirm and mess up the process) but seeing / hearing her like that was crushing.
Ahhh so it's busy around here but I just try to take it all one day at a time.
We've successfully trekked through more exams, both Psych and Pediatric nursing. Now that those are behind us I think we can relax a little bit more. As of now the three of us are planning on a date/chick flick night on Sunday. We are considering "Dear John" and "Valentine's Day." Any suggestions?? I just know that I'm looking forward to the break.
I'm also starting a countdown with my roommate to SB'10 because we're going on a cruise (my first) and it will be sooo warm!!!
Since I've last talked to everyone I've had three more patient in the pediatrics floor. I think I've already talked about my adolescent, so I'll move on to the others.
My second week on the floor I had a 9 month old little girl who was born with a congenital anomaly, one that created a connection between her esophagus and her trachea. She is now suffering with feeding problems and struggles with normal growth rates. However, she was a doll baby! She was so peaceful and calm. Her mother was there the night I went to get my assignment and seemed very involved. However, her mom had to leave unexpectedly the day I was actually caring for her baby. When she got back I was able to talk with her for a little bit. I could tell that she and her daughter were very close and shared a loving relationship...something we've all learned is one of the most important parts of growing up healthily and to full potential.
My third week was a much more overwhelming. We got our assignments the morning of, because of the snow, and caught up on our patient and their stories on the fly. So I guess we were acting more like real nurses! I had 4 year old boy who knows the staff by name and the hospital is considered his second home (at least according to the unit staff...). He has a very rare mitochondrial disease, it's actually amazing that he is still alive. He stays in a room by himself most of the time, so he treats it like his kingdom. He wanted to help me out when I was giving some of his medicines, which surprised me! But he was funny about it! He really kept me on my toes, especially the time he started hitting at my hands. I just thought he wanted to give some high fives so I played some games with him. No. That wasn't the case. He just kept hitting my hands, then arms, then he hit me in the face. "Pause." That's what went through my mind in a split-second. Then I had to pull out the firm-tone-don't-mess attitude. Face hitting is not acceptable, he's just lacking the consistent discipline to actually know that. And when I figured that out, it made me kind of sad.
Funny story from this day: I went to take lunch for about 15 min and came back to the nursing station. The secretary looked at me and asked if I still had his room. I said yes and she just laughed. "Well whenever I can smell it from here....I know it's your boy." GREAT. So, I changed my first dirty diaper ever... gross.
This past week I tried to get a school aged kid, because that's the age group I haven't had yet, but that didn't happen. I got another little girl, 2 months old (adjusted for her prematurity), who was suffering from Short Bowel Syndrome after having about 25% of her intestines removed from chronic NEC. Soooo, I was dealing with GI problems in a little girl again, but I did get to practice some new skills with a great nurse! She went through everything step by step and explained why things were done the way they were. She was also always open for questions. That's really the first time I've seen this from the floor nurses. Anywho, I learned all about TPN (total parenteral nutrition...basically food that's infused into your blood stream) and central lines and changing lines and GI issues. I learned a lot, but it was kind of a slow day because she didn't require much care...just monitoring and loving.
Sad part of this day: The very first thing I did was carry my little baby down to x-ray / fluoroscopy so they could give a barium enema and look at her bowels. I can see why parents are emotionally unprepared for watching things like this. It was hard for me to see her suffering, and I only knew her for one day! Basically, they infuse this chalky white substance into her bowels through her little bum and then take multiple screens of it to check out the status of her GI tract. They had my poor little baby strapped to this wooden plank and restrained (that's the least invasive way to put it). I understand why it's necessary (so she won't squirm and mess up the process) but seeing / hearing her like that was crushing.
Ahhh so it's busy around here but I just try to take it all one day at a time.
Friday, February 5, 2010
I'm Up!
Mmk, well it's my turn to do the blog this week! I haven't had one experience that has really stood out more than others, so I'll just talk about what's been going on so far...
Like Mary Kelly, I'm working on the hematology/oncology floor at the UNC Children's Hospital. We get cancer patients, patients with blood disorders, and those with pulmonary diseases. We've been there three weeks, and I've had a precious 2 year old with aplastic anemia, a super friendly 19 year old with cystic fibrosis, and a VERY independent 9 year old, also with cystic fibrosis.
Quick recaps for those girls:
My 2 year old: I was nervous going into that week - it was our first one, and all I could think was, "I've never done an assessment on a 2 year old!" She has aplastic anemia, which means her white blood cells, red blood cells and platelets are all severely depleted. I walked into her room, and she'd graduated from a crib, so she was sleeping in an adult-sized bed, totally horizontal. I took her vitals, and was totally confused as to why she wasn't waking up while I was moving her arms to take her blood pressure and temperature. I found out a few minutes later, that in preparation for the platelets she was to receive that day, they gave her benadryl - and it had knocked her OUT! A good thing too, because she was NPO (couldn't eat) until 12 when she went to have a bone marrow biopsy, and was an UNHAPPY camper when she awoke at 11 and wasn't allowed to eat! She's waiting for a bone marrow transplant. Unfortunately, she was back in this past Tuesday - they thought she had appendicitis and a perforated bowel. I watched them put in a NG (nasogastric) tube so they could give her the contrast they needed to before they did a CT scan. That was definitely the most traumatizing thing I've watched yet...but it had to be done I suppose. It was sad to watch though.
My 19 year old: Because we were so close in age, I went into it thinking, "This could either be really good...or really really bad." Luckily...it was really good! She was a sweetheart and--apart from when I had to be the nurse, and do her assessment, take vitals, give meds, etc--we had a fun time just talking and hanging out, watching food network and talking about boys, makeup, school, and plans for the future. Cystic fibrosis has touched my family, so working with a patient with CF was a special experience. As my patient, staff nurse and I discussed, CF is a disease that sort of flies under the radar. It receives far less awareness than other chronic illness (like cancer), and is one disease that still faces no cure. At the same time, the life expectancy for patients has risen dramatically in the last few decades due to great advancements in treatment/therapy, which is really encouraging.
My 9 year old: Like I said, VERY independent! She wanted to open her own meds, she wanted to push her own IV pole, and wouldn't let me help her tooooo much! She is actually a cancer survivor, and has a complex history, but despite her fairly recent diagnosis of CF, she knew what she was doing! She was very bright, and ready to get out of the hospital - which she did at 12! Which left me a very bored student nurse for the rest of the day :) So what did I do? Various oddjobs that people asked me to - weighed some dirty diapers, took some temperatures, met some new patients, talked with a girl recently diagnosed with non-Hodgkin's lymphoma, played mini-golf on the computer with a 7 year old boy with ALL (a type of leukemia) while he held my hand, witnessed a girl with CF give her number to a boy with CF two rooms down by yelling it out to the secretary standing in the hallway, and tried on some spongebob masks to appease another patient!
Working in peds has been great so far. I love how different each week has turned out to be - from playing with babies, to talking about life with patients practically my own age. We've only got 3 more days left on that unit, but I'm hoping that they'll be just as enlightening!
I've got to agree with MK though - God is good! And one of the benefits of a career that has you in the hospital often is that you can't help but feel acutely blessed for your own personal good health.
So: babies are cute, nursing is fun [albeit challenging], and God is good!
Like Mary Kelly, I'm working on the hematology/oncology floor at the UNC Children's Hospital. We get cancer patients, patients with blood disorders, and those with pulmonary diseases. We've been there three weeks, and I've had a precious 2 year old with aplastic anemia, a super friendly 19 year old with cystic fibrosis, and a VERY independent 9 year old, also with cystic fibrosis.
Quick recaps for those girls:
My 2 year old: I was nervous going into that week - it was our first one, and all I could think was, "I've never done an assessment on a 2 year old!" She has aplastic anemia, which means her white blood cells, red blood cells and platelets are all severely depleted. I walked into her room, and she'd graduated from a crib, so she was sleeping in an adult-sized bed, totally horizontal. I took her vitals, and was totally confused as to why she wasn't waking up while I was moving her arms to take her blood pressure and temperature. I found out a few minutes later, that in preparation for the platelets she was to receive that day, they gave her benadryl - and it had knocked her OUT! A good thing too, because she was NPO (couldn't eat) until 12 when she went to have a bone marrow biopsy, and was an UNHAPPY camper when she awoke at 11 and wasn't allowed to eat! She's waiting for a bone marrow transplant. Unfortunately, she was back in this past Tuesday - they thought she had appendicitis and a perforated bowel. I watched them put in a NG (nasogastric) tube so they could give her the contrast they needed to before they did a CT scan. That was definitely the most traumatizing thing I've watched yet...but it had to be done I suppose. It was sad to watch though.
My 19 year old: Because we were so close in age, I went into it thinking, "This could either be really good...or really really bad." Luckily...it was really good! She was a sweetheart and--apart from when I had to be the nurse, and do her assessment, take vitals, give meds, etc--we had a fun time just talking and hanging out, watching food network and talking about boys, makeup, school, and plans for the future. Cystic fibrosis has touched my family, so working with a patient with CF was a special experience. As my patient, staff nurse and I discussed, CF is a disease that sort of flies under the radar. It receives far less awareness than other chronic illness (like cancer), and is one disease that still faces no cure. At the same time, the life expectancy for patients has risen dramatically in the last few decades due to great advancements in treatment/therapy, which is really encouraging.
My 9 year old: Like I said, VERY independent! She wanted to open her own meds, she wanted to push her own IV pole, and wouldn't let me help her tooooo much! She is actually a cancer survivor, and has a complex history, but despite her fairly recent diagnosis of CF, she knew what she was doing! She was very bright, and ready to get out of the hospital - which she did at 12! Which left me a very bored student nurse for the rest of the day :) So what did I do? Various oddjobs that people asked me to - weighed some dirty diapers, took some temperatures, met some new patients, talked with a girl recently diagnosed with non-Hodgkin's lymphoma, played mini-golf on the computer with a 7 year old boy with ALL (a type of leukemia) while he held my hand, witnessed a girl with CF give her number to a boy with CF two rooms down by yelling it out to the secretary standing in the hallway, and tried on some spongebob masks to appease another patient!
Working in peds has been great so far. I love how different each week has turned out to be - from playing with babies, to talking about life with patients practically my own age. We've only got 3 more days left on that unit, but I'm hoping that they'll be just as enlightening!
I've got to agree with MK though - God is good! And one of the benefits of a career that has you in the hospital often is that you can't help but feel acutely blessed for your own personal good health.
So: babies are cute, nursing is fun [albeit challenging], and God is good!
Monday, February 1, 2010
Live, love, laugh, LIFE
I never cease to be amazed at the grace the Lord has poured out on me and what an amazing gift that is. To all of my friends and family that don't share my faith, I hope that you can at least recognize that, for me, the Lord is my strength and my assurance in my past, present, and future. With each day and month that passes, I only gain more and more faith in the fact that my past, present, and future all serve some purpose, and I love watching it unfold. However, let me just say, I have my down days just like everyone else. For example, Friday was just one of those days. I was absolutely exhausted (like every other nursing student), I felt like everything I said and did was getting on someone's nerves, I came home to a parking ticket for $100 b/c I parked within 50 feet of a freakin' fire hydrant, and then I had to work which meant I didn't get to go home at all to visit my mom. Days that end in tears. They're wonderful. However, the weekend turned out just fine. Lots of studying and rest accomplished. So, I got the bad day out of the way. The rest of my days since Christmas have been pretty wonderful overall, actually. I am now working on the 5th floor of UNC Memorial, with a focus on oncology and hematology. It's been interesting to adapt my style of nursing to children who are so sick. They're in such an illogical place - 13 year olds with cancer? I don't even know how to touch that, and it brings me to tears just thinking about it. Not all of the cases are so severe, but it is those cases that remind me how amazingly, amazingly blessed I am! I am so grateful to be in the position to be able to help those not so fortunate to have their help. If only my attitude could be that wonderful everyday at 6:00 when that alarm clock goes off. As far as school goes... it felt so wonderful coming back to familiar faces! Katie and I talked about it right away; the feeling of being back amongst students that you know and love is pretty fantastic (as opposed to 400 student lecture halls in regular undergrad)! Speaking of, let me just give a shout out to my 2 fellow bloggers. These girls are BEAUTIFUL- you have no idea how jealous I am of both of them. And, I'm not joking - well not jealous haha but definitely in awe. They are so encouraging, each in their own ways, and they are just going to be (I guess, they already are) the two most kick-ass RNs and women ever! Thank you ladies for the laughs, the inside jokes, and the united venting fronts. And, the sex jokes. Sorry, Katie.. I'm 5... I had to throw that in there : ) While I'm on this light note, I should mention that I am now officially an employee of the YOGURT PUMP. My freshman dream has come true. I'm pretty "pumped" about it for sure though. If you can believe it, I'm this witty all the time. And yes, only if you know me, will that illicit even the slightest smile. So anyway, life is beautiful, even on my most depressing of days, and this blog helps me remember that. So, thank you Erika, for the motivation! For now, I will so adieu (which makes me long for rain drops, and roses and whiskers on kisses), but I promise to be much more faithful from here on out. Keep us in mind this week- we have our first test! Until next time, love to you all! <3 MK
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