Friday, March 22, 2013

Emergency Room 3-18-13 & 3-20-13

Learning Report:

What were your responsibilities this week?
I talked, observed, and worked with a variety of health workers in the ER this week. I worked with two ER nurses, a firefighter, two EMT technicians and a doctor. One of my responsibilities was to give blankets to a child patient before he had his IV taken. I observed a variety of patients from different ethnic backgrounds, each with a different diagnosis
 What new knowledge or skill did you learn this week?
While talking to an ER nurse, I learned that she had an associate's degree in nursing. We talked about the importance of getting a BSN for nurses, and how that degree may become a requirement for nurses in the future. We also talked about colleges and universities. Some skills I observed in the ER were mainly how a health care professional took vital signs, started an IV, diagnosed a toothache, and assessing the patient.
 What was the best thing that happened at the unpaid work-based learning site this week?
The best thing that happened in the ER was observing different conditions of patients and how the ER professionals dealt with it. All the employees were fantastic and answered all my questions. They were even funny, too. I also saw an sad but interesting case with a 20 year old patient. The right side of her throat and face was in terrible pain and she was not able to open her mouth and swallow. After the ER nurse took the initial assessment, I learned that she was an ardent smoker (she smoked half a packet a day) and that she had five kids. After the doctor came to take a look, he finally said that her right molar tooth was impacted, infected badly, and she had a cavity. The MD informed her that she needed a surgeon to fix this problem, but sadly she did not have insurance.
The patient's tooth was impacted, therefore she experienced a lot of pain
 
 What was the worst thing that happened at the unpaid work-based learning site this week?
 At first, the ER seemed to be slow, but as we started talking to the ER nurses, we started learning a lot. One mistake I made was knocking on the door of a patient and asking the nurse inside if I could observe, but to my surprise she said that she was in the middle of taking the patient to the bathroom. It was slightly awkward.
 This week was: Good
The ER had enthusiastic and funny employees, which made my experience fun. They explained what they were doing and the various equipments they used. I also found the conditions of patients to be interesting and liked talking to some of them.

Experience Record:

Technology Observed: Enovate Computer - Looks like a television screen; used to conduct an assessment of the patient, Chromofare D-300 light, Ohmeda vacuum - measures pressure, oxygen tubes, Executone™ patient assistance caller, Slit Lamp - used for the eye.
Diagnostic Procedures Observed: CAT scan , MRI, X-ray, taking an IV, injection of potassium, taking vital signs such as breathing, blood pressure, pulse, etc. The blood pressure for a patient I observed was 116/75, pulse was 92 bpm, and her oxygen saturation was 98.
Therapeutic procedures observed: Therapy was not conducted this week at the ER.
Diseases/ Disorders Observed: 20 year old woman had impacted and infected tooth. She was in severe pain and could not move her mouth, therefore she was crying. Another elderly Hispanic patient had abdominal pains that morning. She felt nausea, had vomiting, had a fever about 100 degrees, and her white blood cell count was elevated. Later, the nurse gave her a potassium injection, which was a low medication. Another patient has respiratory problems. She had a high blood pressure, diabetes, and cholesterol.
Medical Terminology: While assessing a patient in their room, I heard the word 'ovarian cysts'. This refers to  cystic tumor (usually benign) in the ovary.

                                                       Experience Journal:

    When I first entered the Emergency Room I saw a long hallway with patient rooms on the left side. The ER was pretty quiet, and behind the huge counter/desk sat various employees. These employees were either writing information, looking at charts, or talking to another employee. Generally, the ER treats patients who cannot go to a primary physician. The patient rooms are medium sized. Each room includes a white bed with bars on the side, some wall pictures, a section of the wall that had various types of technology, and a computer. This computer seemed interesting to me because it looked like a television screen. Technology I observed in various rooms were Enovate™ Computers, Chromofare D-300 lights, Ohmeda vacuums, oxygen tubes, Executone™ patient assistance callers, Slit Lamps, Alaris PC heart monitors, and more.
    I mostly heard the assessment of patients and what their condition was. While observing a lady with a impacted tooth, I listened as she told the ER nurse her medical information. I mostly talked to ER nurses while in this department. The first ER nurse gave me details on the patient we had previously seen and we talked about her career. In the ER, there are usually 3 nurses and one charge nurse. They deal with patients as well as students, and they give treatment, education, draw blood, and more. One characteristic that the nurse said was important was being able to think on your feet. While visiting an elderly patient who needed her IV taken, 3-6 employees worked cooperatively to help the patient. These employees were 2 nurses, 2 EMTs, a firefighter, and a doctor. They used both informal and formal language to give directions and to calm the patient down. Safety procedures that I observed were using hand sanitizer, wearing gloves when touching a patient, placing pillows on either side of a bed so a patient will not fall down, cleaning skin with alcohol, and throwing a used needle in a specific container. In the ER I saw a patient with a severe tooth impaction, a lady with abdominal pain, an elderly woman who felt nauseated, a lady who had diabetes, respiratory problems, high cholesterol, and lastly a young boy whose stomach hurt while at school. 
    I learned that employees use different ways of speaking when talking to a specific age group. When talking to an adult, the employee uses common language to help the patient understand what is being said. When talking to a kid, however, the employee softens their voice to help calm the child down and make him/ her feel comfortable. A medical terminology term I came across while at the ER was 'ovarian cysts'. It means that ovarian cysts refers to a cystic tumor in the ovary. Skills I saw were an EMT student start an IV on an elderly lady. Although he messed up at first, I did get to see which vein he was trying to get on the elderly woman's hand. 
    Overall, I would rate my ER experience to be very good. I really liked how the employees were funny and at the same time very informative. Professionally, this will help me in the future if I go into the medical field and I end up working in the ER. I would be more familiar with the setting. Educationally, this is benefit me if I am asked questions about this particular department in college or other schools. Personally, this benefited me because now I know much more about the ER than I did before coming here.

Saturday, March 2, 2013

L&D 2-25-13 &2-27-13

Learning Report:

What were your responsibilities this week?
On the both rotation days, I initially went to the L&D, however there were not any patients and the health care professionals advised me to go to Nursery. Nevertheless, I had the chance to work with three registered nurses and a neonatologist. I saw about five babies in the Nursery on Monday, and maybe three babies on Wednesday. I got to see how the nurse examines the newborn baby.

What new knowledge or skill did you learn this week?
I learned so much by seeing all the wonderful babies in the Nursery. I truly saw how little and susceptible these infants were. By working with a neonatologist and a RN, I learned how to do a newborn examination. In this examination, the baby's posture, reflexes, vital signs, and behavior are noted in order to diagnose any problems with the baby.

What was the best thing that happened at the unpaid work-based learning site this week?
The best part of the Nursery was seeing the babies and having the chance to actually hold a baby boy. They were very cute to watch, especially when the RN was examining them. I also found the the infant examination to be interesting. My partner and I also had the chance

What was the worst thing that happened at the unpaid work-based learning site this week?
Nothing bad happened at the Nursery during my rotations. All of the employees were very nice and informative. However, my partner and I did get a bit uncomfortable when she held the baby and it started crying. In the bright side, it stopped crying afterwards when the neonatologist arrived and stuck a pacifier in the infant's mouth.

This week was: Good
I enjoyed this department very much because the RNs I worked with were very informative and answered all my questions. I could really tell that they enjoyed teaching students. I also liked talking to a neonatologist because he informed me on a few good medical schools that I could look into.

This is how the nursery fairly looked like

Experience Record: 

Technology Observed: EKG, AK-NICU, Infant Warmer System, Incubator, Heartstand XL, AED Purposes, Pysxis Supply Station, Pyxsis MedStation 3500, Wellch Allyn thermometer, Alaris PC
Diagnostic procedures Observed: Neonatologists diagnose a baby with any problem by first doing an infant examination. This is similar to the physical examination an individual receives at the pediatrician. In this examination the health care professional checks the baby's posture, reflexes, vital signs, and behavior.
Therapeutic procedures observed: I did not see any treatment, but I did see a baby getting her first Hepatitis vaccine.
Diseases/disorders observed: In the NICU, one baby had been born prematurely and was underweight.
Medical terminology encountered: Vernix- skin cells that baby's don't shed, this looks like a white skin and it is usually found underneath the armpits or other folds of skin.

Experience Record: 

    When I first entered this department, I saw two rooms: the NICU, which was for sick babies, and the nursery, which was for healthy babies. On both my clinical days there were 4-5 babies in the Nursery and only 1-2 in the NICU at any given time. In this area, health care professionals, babies, and students like me are only allowed. Registered Nurses and one Neonatologist mainly work in this department. The babies each had their own crib and the newborns were placed in a radiant heat warmer to warm up their body to the correct temperature. The normal temperature for this warmer is 36.5°C (97.7°F).
    All of the health care professionals here are very social and informative. They must communicate well when talking to each other regarding the baby's condition and information. Furthermore, they must also know how to collaborate and work together as a team. Some safety procedures I observed was washing your hands and putting on gloves before touching a baby. The main reason for this is to avoid getting germs on the baby. Since their immune system is not fully developed, their body is susceptible to sicknesses. 
    I saw a neonatologist doing a infant examination on the baby. I learned that the certain postions a baby is in can indicate whether he/she has a physical problem. I also learned about the Mongolian spot that is a dark coloring usually found in specific areas on a baby's body. Usually this spot will fade as the baby's skin grows. However, it is imperative that the RN or doctor write on the chart indicating that such a dark coloring is a Mongolian spot. If not, people might begin to think it is bruising on the baby and this can lead to trouble.
    Overall, my experience was very enjoyable. Holding an infant was definitely a great experience. I would definitely love to visit the Nursery some other time and talk to the employees and see the babies. I really enjoyed working with the RNs and the neonatologist because they were social, funny, yet informative. Personally, this will help me in the future if  I am ever interested in pursuing a career in the Nursing field. Educationally, this will help me if I am in Nursing school because I have already been exposed to the general idea of what an RN or neonatologist does. And professionally, this will help me if I ever become a RN and work in the Nursery/NICU department of a hospital.