(I am so sorry for being so behind... I have a lot of catching up to do!!)
Last day of clinical for the term, and I had a rather mild patient. This client was one of those who, despite looking "awful" on paper, was really not so bad in person. Just a lot of stuff going on with her, a large medical history, but the actual process of the day was great.
So, it was just a very low-key, relaxing almost sort of a day.
I had my evaluation with my instructor today, who had a lot of good things to say. She liked how organized I was with my nursing process, making sure all my Ts are crossed and Is are dotted. She also liked how clean I was... I think she meant she liked how I have such a focus on staying clean and organized....
It was good to hear those things, as well as have her offer to be a good reference for me someday when I am applying for a job.
Besides that, and a particularly lengthy post-conference, not much else to report. (That... and I sort of don't remember much else....)
Saturday, December 17, 2011
Dec. 8, 2011
0800 is too early for an exam.... Seriously.... that time of the morning comes about way to early anymore. But, being that it was a Community Health exam, it really wasn't so bad. Once again, I studied from the study guide, and it didn't really help. At all. Well, a few things helped. But overall, basically a common-sense, don't be dumb kind of a test.
Theory was so intense this afternoon, though. It was med/surg, and we had a TON of catching up to do, since we were cut short last week because the professor wasn't feeling well, and cut short today because of the exam being moved into lecture time. And even more because the professor needed to end early to make another doctor's appointment. So, it was the world-record of lecture with a ton of material in a very short amount of time. I think we had 40 pages of notes to go through--and that was just the outline.
But, we did, and it was good. LAST LECTURE OF THIS TERM!! Of this year, even!! HOOORAAYYYYY!!!!!!!!!!
Clinical in the morning. I don't think I mentioned it, but I turned in that database/concept map/care plan/teaching plan last Saturday, along with my surgical experience write-up. I am really hoping she has it done, so I can know where I'm at!!
Dec. 7, 2011
Pearl Harbor Day. A date which will live in infamy. But apparently not as much as we think--not really much on the news or anything about it being Pearl Harbor Day... Have we already forgotten?
So, there was that Pharm exam and quiz today. I feel I did pretty well, although there were a few questions I was really kicking myself over afterwards. I hate feeling like that. Luckily, the professor pushed the quiz until the end of class-which gave all of us more time to study for it. I feel bad saying that, but it's true--I mean, I was sort of half-way, kind-of paying attention through most of the lecture. But I did read through the notes relevant for the quiz a few times, too.
In any case, I am VERY happy that the exam scheduled for this afternoon was postponed until tomorrow morning. I would not have been able to function very well if it was actually on for this afternoon.
But, what we did do this afternoon was make up points on that completely botched med/surg exam from last week. I am grateful our professor is letting us do this. As it turns out, I got a 75%, which, by this program's standards, is failing. (76% is the lowest you can get and still pass). So, I was able to make back half of the points I missed, which bumped me up to an 88%. Very nice--my grade isn't so damaged now!!
So, there was that Pharm exam and quiz today. I feel I did pretty well, although there were a few questions I was really kicking myself over afterwards. I hate feeling like that. Luckily, the professor pushed the quiz until the end of class-which gave all of us more time to study for it. I feel bad saying that, but it's true--I mean, I was sort of half-way, kind-of paying attention through most of the lecture. But I did read through the notes relevant for the quiz a few times, too.
In any case, I am VERY happy that the exam scheduled for this afternoon was postponed until tomorrow morning. I would not have been able to function very well if it was actually on for this afternoon.
But, what we did do this afternoon was make up points on that completely botched med/surg exam from last week. I am grateful our professor is letting us do this. As it turns out, I got a 75%, which, by this program's standards, is failing. (76% is the lowest you can get and still pass). So, I was able to make back half of the points I missed, which bumped me up to an 88%. Very nice--my grade isn't so damaged now!!
Dec. 6, 2011
So yes, I did have a different patient today. My patient from last week got sent home a few days ago. Today I was assigned a fairly old little lady, who had some interesting cares. She had a pacemaker placed recently, as well as an ostomy bag. Didn't know about the ostomy until I got into her room. Wow. I was really unprepared for that. I did wound and dressing checks on those, administered meds (using a Pyxis for the first time!!), and then spent the rest of my day answering call lights and typing up some more for my paper. Not much else I could work on, though.
I was happy to be done with this experience; I feel a bit robbed, though, because it wasn't actually long-term care. Oh well--I imagine it's fairly similar, just the clientelle move through rehab faster.
Pharm quiz AND exam tomorrow. Yuck. Study, study, and study some more. It's all memorization, but still--it's tough material. And, it's being taught from the perspective of a medical doctor / PhD, not from a nursing perspective. Basically--it's being taught at a level much higher than what we need to know. Still good to know, but I don't feel I'm getting all the nursing implications.
I was happy to be done with this experience; I feel a bit robbed, though, because it wasn't actually long-term care. Oh well--I imagine it's fairly similar, just the clientelle move through rehab faster.
Pharm quiz AND exam tomorrow. Yuck. Study, study, and study some more. It's all memorization, but still--it's tough material. And, it's being taught from the perspective of a medical doctor / PhD, not from a nursing perspective. Basically--it's being taught at a level much higher than what we need to know. Still good to know, but I don't feel I'm getting all the nursing implications.
Dec. 5, 2011
A day of quizzes and tests. I am really looking forward to finishing up this term.
Today we had our last quiz in Community health. It's such a shame that I spend time studying for this class, when the study guides and the notes aren't all that useful. The test questions themselves are really mostly common-sense type stuff applied to the nursing field. Oh well....
And this afternoon, we had our on-campus lab final. I really studied hard for this last night, not really knowing what to study, since there really was a lot of reading/videos to go along with the material. Turns out, the questions were more general, procedural things, and nothing very specific. This is nice, because with the professor we have, I would have anticipated it being much more nit-picky and precise. So, 100% on that one!!
I spent the rest of the evening trying to finish up what I could from Long-Term Care, since I have that again in the morning. I just know my patient got sent home, and that I will end up having a new patient tomorrow. I'm bummed out by this, because I really, really wanted to finish up what I could from the information packet. And, after having gone through what I could, I was able to highlight in the packet what still needed to be done---and it isn't as much as I thought I was missing.
Early morning tomorrow!
Today we had our last quiz in Community health. It's such a shame that I spend time studying for this class, when the study guides and the notes aren't all that useful. The test questions themselves are really mostly common-sense type stuff applied to the nursing field. Oh well....
And this afternoon, we had our on-campus lab final. I really studied hard for this last night, not really knowing what to study, since there really was a lot of reading/videos to go along with the material. Turns out, the questions were more general, procedural things, and nothing very specific. This is nice, because with the professor we have, I would have anticipated it being much more nit-picky and precise. So, 100% on that one!!
I spent the rest of the evening trying to finish up what I could from Long-Term Care, since I have that again in the morning. I just know my patient got sent home, and that I will end up having a new patient tomorrow. I'm bummed out by this, because I really, really wanted to finish up what I could from the information packet. And, after having gone through what I could, I was able to highlight in the packet what still needed to be done---and it isn't as much as I thought I was missing.
Early morning tomorrow!
Dec. 3, 2011
So I am shamefully behind... like, really very badly behind.... I am attempting to catch up now...
After an amazing surgery experience yesterday, I am still blown away. And I could not have had a better patient for the day than the one I had today. He was so sweet and so talkative and fun to work with. He was very into his geneology, and shared with me many stories that he had to tell about his Scottish heritage. And, I was able to share some of my heritage, since I go back to the Royal Stewarts myself, so it was fun.
Something that made the day even more fun was how BUSY he was! It was truly one thing after another, with everyone wanting a piece of him--blood draws, echocardiogram, Doppler studies of the legs, cardiac cath lab, and the doctors and nurses who needed to do assessments.... and then there was little, ol' me who needed to give him as many of his usual meds and the newly ordered meds before the cath lab came to get him. I ended up having to have them wait while I pushed this one med into his IV, which had to be pushed over three minutes. It was a crazy busy morning!
When we got to the cath lab, I went to the observation room, and my patient waved at me. He had said that he used to be in the military, jumping out of planes, but the thought of the cardiac catheterization scared him very much. So, I think it was nice for him to have a familiar face there for moral support. Then, they strapped down his arm, in case they would use it for the access to his heart, and as he tried to wave at me again with that arm, the nurses in the room yelled at him. I felt kind of bad that he was getting in trouble, haha!
His procedure went fine, and his heart vasculature was very healthy--always a plus. By that time, though, one of my group-mates showed up to see the procedure--that was already finished. Luckily for us, though, the cardiologist talked us through the entire procedure, showing us what he saw and what he didn't see on the videos that were taken. Very cool, and I am very grateful that he took the time to do that for us.
After that, I spent the rest of my day finishing my assessment and helping out where I could. A busy morning made the day go by pretty quickly, and truly, my patient was so pleasant, that certainly helped, too.
It was snowing as I left the building, with a thin layer sticking. Winter is on it's way!!
After an amazing surgery experience yesterday, I am still blown away. And I could not have had a better patient for the day than the one I had today. He was so sweet and so talkative and fun to work with. He was very into his geneology, and shared with me many stories that he had to tell about his Scottish heritage. And, I was able to share some of my heritage, since I go back to the Royal Stewarts myself, so it was fun.
Something that made the day even more fun was how BUSY he was! It was truly one thing after another, with everyone wanting a piece of him--blood draws, echocardiogram, Doppler studies of the legs, cardiac cath lab, and the doctors and nurses who needed to do assessments.... and then there was little, ol' me who needed to give him as many of his usual meds and the newly ordered meds before the cath lab came to get him. I ended up having to have them wait while I pushed this one med into his IV, which had to be pushed over three minutes. It was a crazy busy morning!
When we got to the cath lab, I went to the observation room, and my patient waved at me. He had said that he used to be in the military, jumping out of planes, but the thought of the cardiac catheterization scared him very much. So, I think it was nice for him to have a familiar face there for moral support. Then, they strapped down his arm, in case they would use it for the access to his heart, and as he tried to wave at me again with that arm, the nurses in the room yelled at him. I felt kind of bad that he was getting in trouble, haha!
His procedure went fine, and his heart vasculature was very healthy--always a plus. By that time, though, one of my group-mates showed up to see the procedure--that was already finished. Luckily for us, though, the cardiologist talked us through the entire procedure, showing us what he saw and what he didn't see on the videos that were taken. Very cool, and I am very grateful that he took the time to do that for us.
After that, I spent the rest of my day finishing my assessment and helping out where I could. A busy morning made the day go by pretty quickly, and truly, my patient was so pleasant, that certainly helped, too.
It was snowing as I left the building, with a thin layer sticking. Winter is on it's way!!
Friday, December 2, 2011
Dec. 2, 2011
Is it just me, or has this week gone by incredibly fast? It feels like it has...
Anyways, so I was up at 0200. WIDE AWAKE. I hate getting sick, I really do. Luckily, I was able to go back to sleep until 0500 when my alarm went off. Surgery this morning, and I have to be there at 0630! The instructors have told us to have a good meal, so I made myself egg burritoes this morning. Not only is it perfectly delicious, but it is also very filling and sticks with me for most of the day. So that is great.
I met my friend outside the building so we could walk in together, and it was about, oh, 10 degrees out. Yup, cold. And I don't like it!!
Anyways, we found our way in and made our way up to the surgical waiting room and put in a call to the coordinator. She walked in a few minutes later and took us to the locker room, where we had to change into the hospital's scrubs (yay for no student uniforms!). We then met her in the lounge area, where she told us a bit about our patients and what the order of the day was going to be. Then, she escorted us downstairs to the preoperative area, asking us about our interests and our previous majors. I told her I was a sociology major with an interest in hearts and expressed my hope that I would get to see a heart. By then, we had arrived at the holding area, and she introduced us to the nurses who we would be with for the day.
We each then sat down and started taking notes on the stuff we needed to have prepared for the assignment (i.e. labs, client history, etc.) and spoke with our nurses a bit. My friend's patient arrived, and I just continued asking questions about the preoperative process, and my nurse was very friendly and willing to answer any questions I had. 20 minutes after the expected arrival time, my patient still wasn't there, and she wasn't answering her cell phone or her home phone. Then we heard she called in the day before and seemed apprehensive about the surgery--the feeling was that she might cancel.
So, I called the coordinator to see what she thought, and she said she would look for plan B and then come find me. A few minutes later, she arrived and said her plan B was to have me go see an aortic valve replacement--A HEART!! The only downside was that I would miss out on the pre-op and post-op care, because the pre-op was already done and the post-op was done in the ICU setting (not a PACU, like our assignment tells us). At that point, I really didn't care--I was going to see a heart!!!
Just as we were leaving, my original patient arrived, so we made a modification to plan B -- I go see the heart, and the coordinator would pull me out when my original patient was done, so I could do the PACU care. Sounded good to me!
Off we went to a completely different area. The cardiovascular surgery area is separate; it has three operating rooms dedicated to just these patients, and an ICU attached, so if a patient needs to be taken to surgery, there will be an OR available and close to the room. What a great idea, huh?
I got in the operating room, and met the circulating nurses and the scrub techs, who were hard at work in their sterile field, setting up a LOT of instruments. The cardiopulmonary perfusionist was there also, setting up the heart-lung bypass machine. There was also an anesthesiologist and CRNA, monitoring the patient. The anesthesiologist was also looking at the trans-esophageal echocardiogram (TEE) and taking images that would be useful for the surgery. I was told ahead of time that the surgeon doesn't like people talking during the case, so any questions I had should be asked now.
The coordinator came in with me and showed me around, literally holding my hand to guide me through so I wouldn't enter the sterile field around the patient. We made our way over to the anesthesiologist, who was kind enough to show us some of the images he had taken and tell us what we were looking at. Very cool--and I was able to see the difference on the post-procedure TEE.
Right about that time, the surgeon came in, and I was able to meet him and his first assist, as well as thank him for letting me come in on such short notice. While he and his first assist were putting on the sterile gown and gloves, there was a time-out procedure to make sure everything was ready to go, with the right patient, and to verify the procedure.
Then, everybody got in place to begin. I took my place on the right side of the patient, kind of behind the surgeon to his left, several feet back from the table. Yeah, I didn't explain that very well, but you can figure it out. I had a pretty good view of what was going on, so I saw the incisions through the skin, subcutaenous layers, right down to the bone. Electrocautery was used to cauterize the little blood vessels to reduce the amount of blood lost as well as reduce the amount of blood in the surgical field. And yes, it does smell funny. Not funny "haha" but funny "weird". But burning hair still smells worse.
Anyways, then the surgeon got out the bone saw. It was like a little power tool, hand-held deal--not nearly as big as I'd imagined (obviously based on movies, right?). What I thought was interesting was that they deflated the lungs before cutting the bone, so they had less of a chance of cutting one. Kind of a good idea, although you just know that somebody learned it the hard way.... Yeah....
So, the process of cutting through the bone was actually a lot faster than I expected. As in, less than 30 seconds. Then, they put a sterile towel over the site, put in the retractor to hold open the sternum, and cut a hole in the towel. This was cool, because the towel could soak up blood while also acting as padding between the metal retractor and the patient's tissues (which would probably get more sore without the padding).
Then, a lot of time was spent putting sutures in the fascial layer (the muscle layer that lays over the ribcage). This actually helped keep all the subcutaneous fatty tissue back up away from the surgical area. The ends of the sutures were actually kind of clipped onto little ridges or something on the retractor, so the tissue was absolutely stable. These sutures would then be later used to close up that particular layer of tissue.
So, more tissue, more electrocautery, and I'm still back behind the surgeon. And then I saw it. The heart, beating within the open chest cavity. There are not words enough to describe how amazing that truly was for me. There's the thing that pumps blood through our bodies, that is essentially the engine that keeps us going. No bigger than your fist, and yet it is so important. I had the perfect view of it, coming from the patient's right side.
Alright, so enough marveling, for now anyways. The surgeon then moved more in front of me, blocking my view, to insert the cannulae for bypass. Although I did see a lot of squirting blood. Yup, splashed quite a bit, although I guess that's to be expected from a muscle designed to pump blood throughout the body! Then, they put in these cannulae, and the one was at least an inch in diameter... huge... and at this point the nurse was holding the tubing with the open end upward (obviously) until it was connected to the pump, but as the heart was beating, you could see the blood moving up in the tube. It actually looked kind of funny, but it was still pretty neat at the same time.
Okay, so when bypass was initiated, the lungs were deflated again and the anesthesiologist left. I then moved to where he had been standing, and the nurse put out a step-stool for me to stand on. I was standing basically at the patient's head, looking down into the chest. And it was awesome. The heart was still beating in the cavity with these huge tubes coming out of the chest, and you could see the blood moving through them. Then, they put ice around to heart to cool it down and keep it cool.
Once the heart was stopped, the surgeon began cutting into the aorta. He cut it about.... hmm... maybe a half inch or so away from the heart, not too close but not too far from the aortic valve. Then, he looked around with a little dental-type mirror to see what he was up against, and then started cutting away the valve. Now, when I saw it on echocardiogram, the anesthesiologist said it was bicuspid (which means there are two leaflets; the aortic valve is suppose to have three leaflets) and that there was a lot of calcification on it. It wasn't able to open as well as it should, is basically why they were replacing it.
So, after cutting away what he could with scissors, the surgeon then gripped the remaining tissue with a huge pair of tweezers and took a scalpel to cut away the rest. Then, lots of rinsing with what I assume was normal saline delivered in what looked like turkey basters. The surgeon then tried out some valve sizes. The companies that provide valves send out little models that are the size of a particular valve. One company had a test thing that had how big the valve actually is on one end and then on the other end how it would seat, with the attachment material on it also. So, the surgeon played around with 19-mm and 21-mm valves from both companies, and decided which was best.
The next part was probably the most tedious part--putting the sutures in place. The sutures are pledgeted, meaning they have little pledgets on them, which are used to absorb some blood but also to protect the wound. The surgeon used 14 sutures in a 21-mm or so area. It was very meticulous work to put them all in just right so the pledget is in place and you have both ends of the suture coming up (don't worry, I have a picture to show what I'm talking about). What was good, though, was there was a suture keeper device to keep them all separated and in order--because the ordering of it is very important.
Right, so once all those were in place, the surgeon then started attaching the valve to the ends of the sutures already attached to the heart. In order--remember how I said that was important? If they get out of order, things aren't going to line up right. So, that was a little less meticulous, but still meticulous work for the surgeon.
When all the sutures were through the valve, it was put into place, the sutures pulled tied, and then the knotting began! Lots and lots of knotting. At least 30 minutes' worth. But, it's very important to make sure the valve is in the right place and is secure. Especially considering the high volumes and pressures the aortic valve has to endure.
Once that was done, and having checked meticulously throughout for any problems or errors in suturing, he began closing the aorta. Again, more sewing. But that is one artery you do NOT want leaking. Once the aorta was just about closed, I was asked to move, as the anesthesiologist was back to prepare for weaning off bypass. It was over before I knew it, actually, and closure began shortly thereafter. I actually missed the retractor coming off for how many things were happening so quickly.
The first layer to close is obviously the sternum. I have never seen a bigger suture-needle in my life. That thing was a friggin' beast! I mean, of course it has to be to thread wire through bone... but still... you know... it was intimidating....
It took two people--the surgeon and the first assist--to tighten up the wires simultaneously to the point where it was a good closure. Then, the wires were twisted and then cut with a large pair of wire cutters.
Then, the fascia was closed, using the sutures already in place, followed by the subcutaneous layer of tissue (which is mostly fatty tissues). The surgeon didn't really finish doing this layer, and left the OR. He let the first assist finish the subcutaneous sutures, and finish up on the subcuticular stitch (sewn under the skin to close the skin). The surgeon came back in a few minutes after he left to do his dictation. And, just as everything was wrapping up around 1030, the coordinator came back in to get me, because my original patient was done with surgery. Perfect timing.
As we were leaving, the first assist began joking around, saying that she was surprised I didn't faint--because they like getting students in who get woozy and pass out. She said she tried to make it gory for me so I would. Not so!! I am too tough for that!! But, I am happy I didn't pass out--I was sort of in that I-have-a-headcold-and-feel-foggy state, so I was swaying a bit (sure felt like I was, anyways).
Seriously, today was meant to be. I had been so wanting to see a heart, and circumstances lined up so perfectly for me to see one today--from start to finish even. I am so grateful for the way this worked out! And, I was just so excited to share that I had to get caught up on my blog to be able to write this ridiculously long entry about an AMAZING day!!
I should probably tell about the rest of my day... so PACU was interesting. My patient was a fairly old lady (pushing 100!), still working part-time, and just a vibrant little thing!! Basically, I just helped get vital signs per the orders and watched the nurse go about her routine. It's one-on-one care, which makes sense, and while we were waiting for orders to come down for admission, it was pretty much just a waiting game. So, I was able to get a lot of my write-up done then and just waiting to be dismissed.
Then, I came home, and set to work on homework, but got side-tracked by my desire to update my blog. So, I will resume homework directly.
All in all, it was an amazing day, and I feel very blessed and happy to have seen what I saw. : )
DISCLAIMER: I do not own any of the images provided in this entry; I used Google to find them and added them here. I give full credit to their rightful owners and thank them in advance for letting me borrow them!
Anyways, so I was up at 0200. WIDE AWAKE. I hate getting sick, I really do. Luckily, I was able to go back to sleep until 0500 when my alarm went off. Surgery this morning, and I have to be there at 0630! The instructors have told us to have a good meal, so I made myself egg burritoes this morning. Not only is it perfectly delicious, but it is also very filling and sticks with me for most of the day. So that is great.
I met my friend outside the building so we could walk in together, and it was about, oh, 10 degrees out. Yup, cold. And I don't like it!!
Anyways, we found our way in and made our way up to the surgical waiting room and put in a call to the coordinator. She walked in a few minutes later and took us to the locker room, where we had to change into the hospital's scrubs (yay for no student uniforms!). We then met her in the lounge area, where she told us a bit about our patients and what the order of the day was going to be. Then, she escorted us downstairs to the preoperative area, asking us about our interests and our previous majors. I told her I was a sociology major with an interest in hearts and expressed my hope that I would get to see a heart. By then, we had arrived at the holding area, and she introduced us to the nurses who we would be with for the day.
We each then sat down and started taking notes on the stuff we needed to have prepared for the assignment (i.e. labs, client history, etc.) and spoke with our nurses a bit. My friend's patient arrived, and I just continued asking questions about the preoperative process, and my nurse was very friendly and willing to answer any questions I had. 20 minutes after the expected arrival time, my patient still wasn't there, and she wasn't answering her cell phone or her home phone. Then we heard she called in the day before and seemed apprehensive about the surgery--the feeling was that she might cancel.
So, I called the coordinator to see what she thought, and she said she would look for plan B and then come find me. A few minutes later, she arrived and said her plan B was to have me go see an aortic valve replacement--A HEART!! The only downside was that I would miss out on the pre-op and post-op care, because the pre-op was already done and the post-op was done in the ICU setting (not a PACU, like our assignment tells us). At that point, I really didn't care--I was going to see a heart!!!
Just as we were leaving, my original patient arrived, so we made a modification to plan B -- I go see the heart, and the coordinator would pull me out when my original patient was done, so I could do the PACU care. Sounded good to me!
Off we went to a completely different area. The cardiovascular surgery area is separate; it has three operating rooms dedicated to just these patients, and an ICU attached, so if a patient needs to be taken to surgery, there will be an OR available and close to the room. What a great idea, huh?
I got in the operating room, and met the circulating nurses and the scrub techs, who were hard at work in their sterile field, setting up a LOT of instruments. The cardiopulmonary perfusionist was there also, setting up the heart-lung bypass machine. There was also an anesthesiologist and CRNA, monitoring the patient. The anesthesiologist was also looking at the trans-esophageal echocardiogram (TEE) and taking images that would be useful for the surgery. I was told ahead of time that the surgeon doesn't like people talking during the case, so any questions I had should be asked now.
The coordinator came in with me and showed me around, literally holding my hand to guide me through so I wouldn't enter the sterile field around the patient. We made our way over to the anesthesiologist, who was kind enough to show us some of the images he had taken and tell us what we were looking at. Very cool--and I was able to see the difference on the post-procedure TEE.
Right about that time, the surgeon came in, and I was able to meet him and his first assist, as well as thank him for letting me come in on such short notice. While he and his first assist were putting on the sterile gown and gloves, there was a time-out procedure to make sure everything was ready to go, with the right patient, and to verify the procedure.
Then, everybody got in place to begin. I took my place on the right side of the patient, kind of behind the surgeon to his left, several feet back from the table. Yeah, I didn't explain that very well, but you can figure it out. I had a pretty good view of what was going on, so I saw the incisions through the skin, subcutaenous layers, right down to the bone. Electrocautery was used to cauterize the little blood vessels to reduce the amount of blood lost as well as reduce the amount of blood in the surgical field. And yes, it does smell funny. Not funny "haha" but funny "weird". But burning hair still smells worse.
Anyways, then the surgeon got out the bone saw. It was like a little power tool, hand-held deal--not nearly as big as I'd imagined (obviously based on movies, right?). What I thought was interesting was that they deflated the lungs before cutting the bone, so they had less of a chance of cutting one. Kind of a good idea, although you just know that somebody learned it the hard way.... Yeah....
 |
| I'm not sure this is exactly it, but it looks pretty close.. |
So, the process of cutting through the bone was actually a lot faster than I expected. As in, less than 30 seconds. Then, they put a sterile towel over the site, put in the retractor to hold open the sternum, and cut a hole in the towel. This was cool, because the towel could soak up blood while also acting as padding between the metal retractor and the patient's tissues (which would probably get more sore without the padding).
 |
| This is the sternal retractor, and you can kind of see the little cylindrical things on the top where sutures could kind of be hooked? Yeah, that comes next in your reading... |
Then, a lot of time was spent putting sutures in the fascial layer (the muscle layer that lays over the ribcage). This actually helped keep all the subcutaneous fatty tissue back up away from the surgical area. The ends of the sutures were actually kind of clipped onto little ridges or something on the retractor, so the tissue was absolutely stable. These sutures would then be later used to close up that particular layer of tissue.
So, more tissue, more electrocautery, and I'm still back behind the surgeon. And then I saw it. The heart, beating within the open chest cavity. There are not words enough to describe how amazing that truly was for me. There's the thing that pumps blood through our bodies, that is essentially the engine that keeps us going. No bigger than your fist, and yet it is so important. I had the perfect view of it, coming from the patient's right side.
Alright, so enough marveling, for now anyways. The surgeon then moved more in front of me, blocking my view, to insert the cannulae for bypass. Although I did see a lot of squirting blood. Yup, splashed quite a bit, although I guess that's to be expected from a muscle designed to pump blood throughout the body! Then, they put in these cannulae, and the one was at least an inch in diameter... huge... and at this point the nurse was holding the tubing with the open end upward (obviously) until it was connected to the pump, but as the heart was beating, you could see the blood moving up in the tube. It actually looked kind of funny, but it was still pretty neat at the same time.
Okay, so when bypass was initiated, the lungs were deflated again and the anesthesiologist left. I then moved to where he had been standing, and the nurse put out a step-stool for me to stand on. I was standing basically at the patient's head, looking down into the chest. And it was awesome. The heart was still beating in the cavity with these huge tubes coming out of the chest, and you could see the blood moving through them. Then, they put ice around to heart to cool it down and keep it cool.
Once the heart was stopped, the surgeon began cutting into the aorta. He cut it about.... hmm... maybe a half inch or so away from the heart, not too close but not too far from the aortic valve. Then, he looked around with a little dental-type mirror to see what he was up against, and then started cutting away the valve. Now, when I saw it on echocardiogram, the anesthesiologist said it was bicuspid (which means there are two leaflets; the aortic valve is suppose to have three leaflets) and that there was a lot of calcification on it. It wasn't able to open as well as it should, is basically why they were replacing it.
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| The normal aortic valve has three leaflets, but the bicuspid aortic valve has only two--almost like there should have been three but it didn't cleave or something... I have it on good authority that people can live symptom-free for many, many years with a bicuspid aortic valve, although they usually tend to notice it in their 30s or 40s |
So, after cutting away what he could with scissors, the surgeon then gripped the remaining tissue with a huge pair of tweezers and took a scalpel to cut away the rest. Then, lots of rinsing with what I assume was normal saline delivered in what looked like turkey basters. The surgeon then tried out some valve sizes. The companies that provide valves send out little models that are the size of a particular valve. One company had a test thing that had how big the valve actually is on one end and then on the other end how it would seat, with the attachment material on it also. So, the surgeon played around with 19-mm and 21-mm valves from both companies, and decided which was best.
The next part was probably the most tedious part--putting the sutures in place. The sutures are pledgeted, meaning they have little pledgets on them, which are used to absorb some blood but also to protect the wound. The surgeon used 14 sutures in a 21-mm or so area. It was very meticulous work to put them all in just right so the pledget is in place and you have both ends of the suture coming up (don't worry, I have a picture to show what I'm talking about). What was good, though, was there was a suture keeper device to keep them all separated and in order--because the ordering of it is very important.
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| See the white thingies? Those are pledgets. |
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| If you look kind of around the hole, you can see where the pledgets are. Look also how the sutures have both ends coming off. That's important for later. |
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| And here's the suture organizer. For one suture, each end goes on each side of the blue. This helps number them , keep them in order, and keeps the ends from tangling. |
Right, so once all those were in place, the surgeon then started attaching the valve to the ends of the sutures already attached to the heart. In order--remember how I said that was important? If they get out of order, things aren't going to line up right. So, that was a little less meticulous, but still meticulous work for the surgeon.
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| So here you see all those sutures sewn through that valve, and now they will just slide it down into place. |
When all the sutures were through the valve, it was put into place, the sutures pulled tied, and then the knotting began! Lots and lots of knotting. At least 30 minutes' worth. But, it's very important to make sure the valve is in the right place and is secure. Especially considering the high volumes and pressures the aortic valve has to endure.
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| And here's the valve in place, "pulled down" the sutures. From here, the surgeon will begin knotting everything up to tie it in place. Very cool stuff. |
Once that was done, and having checked meticulously throughout for any problems or errors in suturing, he began closing the aorta. Again, more sewing. But that is one artery you do NOT want leaking. Once the aorta was just about closed, I was asked to move, as the anesthesiologist was back to prepare for weaning off bypass. It was over before I knew it, actually, and closure began shortly thereafter. I actually missed the retractor coming off for how many things were happening so quickly.
The first layer to close is obviously the sternum. I have never seen a bigger suture-needle in my life. That thing was a friggin' beast! I mean, of course it has to be to thread wire through bone... but still... you know... it was intimidating....
It took two people--the surgeon and the first assist--to tighten up the wires simultaneously to the point where it was a good closure. Then, the wires were twisted and then cut with a large pair of wire cutters.
Then, the fascia was closed, using the sutures already in place, followed by the subcutaneous layer of tissue (which is mostly fatty tissues). The surgeon didn't really finish doing this layer, and left the OR. He let the first assist finish the subcutaneous sutures, and finish up on the subcuticular stitch (sewn under the skin to close the skin). The surgeon came back in a few minutes after he left to do his dictation. And, just as everything was wrapping up around 1030, the coordinator came back in to get me, because my original patient was done with surgery. Perfect timing.
As we were leaving, the first assist began joking around, saying that she was surprised I didn't faint--because they like getting students in who get woozy and pass out. She said she tried to make it gory for me so I would. Not so!! I am too tough for that!! But, I am happy I didn't pass out--I was sort of in that I-have-a-headcold-and-feel-foggy state, so I was swaying a bit (sure felt like I was, anyways).
Seriously, today was meant to be. I had been so wanting to see a heart, and circumstances lined up so perfectly for me to see one today--from start to finish even. I am so grateful for the way this worked out! And, I was just so excited to share that I had to get caught up on my blog to be able to write this ridiculously long entry about an AMAZING day!!
I should probably tell about the rest of my day... so PACU was interesting. My patient was a fairly old lady (pushing 100!), still working part-time, and just a vibrant little thing!! Basically, I just helped get vital signs per the orders and watched the nurse go about her routine. It's one-on-one care, which makes sense, and while we were waiting for orders to come down for admission, it was pretty much just a waiting game. So, I was able to get a lot of my write-up done then and just waiting to be dismissed.
Then, I came home, and set to work on homework, but got side-tracked by my desire to update my blog. So, I will resume homework directly.
All in all, it was an amazing day, and I feel very blessed and happy to have seen what I saw. : )
DISCLAIMER: I do not own any of the images provided in this entry; I used Google to find them and added them here. I give full credit to their rightful owners and thank them in advance for letting me borrow them!
Dec. 1, 2011
Neuromusclar disease = not my friend. Well, the exam anyways. Good grief. I'm not sure if it's because I'm a bit sleep deprived or I didn't study as hard as I usually do or some unknown reason... but Myasthenia Gravis, Multiple Sclerosis, and Amyotrophic Lateral Sclerosis all started running together.... And none of the questions throughout the test "helped" to determine any answers for any other questions. I think what's hard is how similar some of the presentations are and then the abbreviations, at least for MS and MG, are similar enough to help throw people off.
It seems like the whole class didn't do as well as we wanted to--and the professor could tell that we had two Pharmacology quizzes the day before. I'm not sure when grades are going to be posted, but I'm almost afraid to see what it looks like...
It was another early day. The professor had to leave earlier than her already-scheduled early day to get to some more medical tests, so we did the evaluations for our clinical instructors and then were able to leave. I came home and rested up in anticipation for the surgical experience I would be having the next day.
And, of course, I start having cold/flu symptoms. I'm not sure what the cause is, but whenever I get sick, my pupils dilate. Noticeably. My brother gets chatty, and I look like I'm on drugs; mom always could tell when we were sick. I took some DayQuil to get me through the rest of the day. Because I didn't know what procedure I would be seeing until my instructor contacted me, I opted to work some on the long-term care paperwork, and got through most of the medication information stuff. That stuff is hard to get through, because there is so much pertinent information for all the drugs.
At around 1900, I decided it was getting late enough to hear from the instructor. So I called her to find out what I would be seeing tomorrow so I could do adequate preparation for it. No answer. She called back around 2000, and said she didn't receive the call from the coordinator, so she didn't know what we were doing. Then, she called back at 2100 or so to say she checked her e-mail, and found out there was a laparoscopic cholecystectomy and a lap-band placement, and that I would have my choice.
My initial thought was to take the lap band, since that might be more interesting and it would be something nobody else in our clinical group had seen. But, I remembered my friend (who was also going to surgery in with me) said something about kind of not wanting to see a lap-chole because everybody else had seen one. So, I opted to take that so she could have something different and perhaps more interesting. That being said, I finished up the medication sheet for the long-term care paperwork, took some NyQuil, and went to sleep. Early morning tomorrow!!
It seems like the whole class didn't do as well as we wanted to--and the professor could tell that we had two Pharmacology quizzes the day before. I'm not sure when grades are going to be posted, but I'm almost afraid to see what it looks like...
It was another early day. The professor had to leave earlier than her already-scheduled early day to get to some more medical tests, so we did the evaluations for our clinical instructors and then were able to leave. I came home and rested up in anticipation for the surgical experience I would be having the next day.
And, of course, I start having cold/flu symptoms. I'm not sure what the cause is, but whenever I get sick, my pupils dilate. Noticeably. My brother gets chatty, and I look like I'm on drugs; mom always could tell when we were sick. I took some DayQuil to get me through the rest of the day. Because I didn't know what procedure I would be seeing until my instructor contacted me, I opted to work some on the long-term care paperwork, and got through most of the medication information stuff. That stuff is hard to get through, because there is so much pertinent information for all the drugs.
At around 1900, I decided it was getting late enough to hear from the instructor. So I called her to find out what I would be seeing tomorrow so I could do adequate preparation for it. No answer. She called back around 2000, and said she didn't receive the call from the coordinator, so she didn't know what we were doing. Then, she called back at 2100 or so to say she checked her e-mail, and found out there was a laparoscopic cholecystectomy and a lap-band placement, and that I would have my choice.
My initial thought was to take the lap band, since that might be more interesting and it would be something nobody else in our clinical group had seen. But, I remembered my friend (who was also going to surgery in with me) said something about kind of not wanting to see a lap-chole because everybody else had seen one. So, I opted to take that so she could have something different and perhaps more interesting. That being said, I finished up the medication sheet for the long-term care paperwork, took some NyQuil, and went to sleep. Early morning tomorrow!!
Nov. 30, 2011
So, I stayed up way later than I should have last night, worrying about how much of that long-term care packet I got done. I started working on it to see how MUCH I was missing, and by the time I was finishing up, it was midnight. And I still hadn't started studying for the two pharmacology quizzes for today. So, I picked up the Pharm book and started in reading and going over drugs. Thankfully, I am already familiar with most of them, but it was good to get a little deeper into what they do, how they interact, etc.
By the time my alarm went off, I think I got about 3-4 hours of sleep, and had to be up to finish studying. I got to school and took the quizzes, and thought I would head home. But, I felt it would be disrespectful to the professor to leave in the middle of class, so I opted to stay through lecture, but leave to go sleep and miss the afternoon class. I know, I am awful. It would be the only class I have missed so far.
Luckily for me, though, the professor cancelled class this afternoon due to illness, so I was able to go home and nap, guilt-free! And then try to study for the last exam in the week. Blech. Too much happening, haha! So much to do.
But, the light is at the end of the tunnel!! Only a few more weeks and I will be home enjoying time with my loved ones :)
By the time my alarm went off, I think I got about 3-4 hours of sleep, and had to be up to finish studying. I got to school and took the quizzes, and thought I would head home. But, I felt it would be disrespectful to the professor to leave in the middle of class, so I opted to stay through lecture, but leave to go sleep and miss the afternoon class. I know, I am awful. It would be the only class I have missed so far.
Luckily for me, though, the professor cancelled class this afternoon due to illness, so I was able to go home and nap, guilt-free! And then try to study for the last exam in the week. Blech. Too much happening, haha! So much to do.
But, the light is at the end of the tunnel!! Only a few more weeks and I will be home enjoying time with my loved ones :)
Nov. 29, 2011
So, long-term care was not long-term care at all. It was a rehab unit in a facility that also houses long-term care residents... Oh well....
I showed up and was wearing my uniform, as the instructions from the instructor said. Only problem was--I was wearing my community uniform (black pants and the school polo shirt), when I think they meant scrubs. Oops. At least I wasn't the only one--two others were wearing their community uniforms.
In any case, we began the day with helping the nursing staff take vitals and sitting with the patients during breakfast. Then, we met and went over the expectations. Yes, another 12-page assingment. How many pages do you think I can turn this one into? Yeah... Awesome....
I got to meet with my patient finally, and from the start, I knew it was going to be tough to get through a bazilliion pages of questions. The standard program gets three days for this--we get two. Two days to work with elderly patients who are tired and have a tiring schedule already--and then we add this crazy-long questionnaire.
Thankfully, the gentleman I was working with was very pleasant and was very willing to share so much with me. I felt like I got a lot of information, but looking back at the packet, it really doesn't feel like that much. And, he felt he was going to be discharged later this week, so I may or may not see him next week to finish with all the questions.
Oh well--it was an interesting day. Definitely not what I would have thought of as long-term care nursing, but very cool to hear the stories some of these folks have to tell.
I showed up and was wearing my uniform, as the instructions from the instructor said. Only problem was--I was wearing my community uniform (black pants and the school polo shirt), when I think they meant scrubs. Oops. At least I wasn't the only one--two others were wearing their community uniforms.
In any case, we began the day with helping the nursing staff take vitals and sitting with the patients during breakfast. Then, we met and went over the expectations. Yes, another 12-page assingment. How many pages do you think I can turn this one into? Yeah... Awesome....
I got to meet with my patient finally, and from the start, I knew it was going to be tough to get through a bazilliion pages of questions. The standard program gets three days for this--we get two. Two days to work with elderly patients who are tired and have a tiring schedule already--and then we add this crazy-long questionnaire.
Thankfully, the gentleman I was working with was very pleasant and was very willing to share so much with me. I felt like I got a lot of information, but looking back at the packet, it really doesn't feel like that much. And, he felt he was going to be discharged later this week, so I may or may not see him next week to finish with all the questions.
Oh well--it was an interesting day. Definitely not what I would have thought of as long-term care nursing, but very cool to hear the stories some of these folks have to tell.
Nov. 28, 2011
Today was a short day all the way around. We had another IRAT/GRAT in Community. If I haven't said wat these are, they are individual readiness assessment tests and group readiness assessment tests, or something along those lines. We take a 5-point, 20-question quiz individually, and then as a group and get scored on both. Today, for the first time, I got a 5/5! The questions are tough, and even though I studied from the study guide, I feel it didn't help very much.
Class ended early, which was nice. I was able to go home and rest and then practice some on my sterile glove technique, which I had to get checked-off on this afternoon. Not for points, but it was something I had to pass.
I plan on spending the rest of the afternoon not doing much of anything! Well, I suppose I will prepare for long-term care clinical tomorrow, but that's about it.
Class ended early, which was nice. I was able to go home and rest and then practice some on my sterile glove technique, which I had to get checked-off on this afternoon. Not for points, but it was something I had to pass.
I plan on spending the rest of the afternoon not doing much of anything! Well, I suppose I will prepare for long-term care clinical tomorrow, but that's about it.
Nov. 26-27, 2011
Well, I put in way too much time on that Database / Concept Map / Care Plan / Teaching Plan, but luckily for me, it's almost done. Just a few more things to finish up, which is wonderful. I spent all day Saturday on it (taking frequent breaks, of course), and it looks like the final page count on the database, care plan, and teaching plan will be 23 pages, and the concept map will probably be another page on top of that. Good grief, I doubled the page count from the original assignment. The sad thing is--I don't think I did MORE than what was expected of us.
Sunday, I spent most of the day doing a whole lot of nothing, with a little bit of studying at the end of the day. It was a nice, relaxing way to spend the last of my Thanksgiving vacation. As much as I am not liking the idea of going back to school in the morning, I will be happy to have a routine back again.
Sunday, I spent most of the day doing a whole lot of nothing, with a little bit of studying at the end of the day. It was a nice, relaxing way to spend the last of my Thanksgiving vacation. As much as I am not liking the idea of going back to school in the morning, I will be happy to have a routine back again.
Nov. 25, 2011
Black Friday shopping was a success!! And I survived, obviously... you know, since I'm writing this...
Anyways, I got to Best Buy last night at around 2230, and there was probably already at least 500 people in line. Crazy, right? So, I hung out for an hour and a half and was surprised to find the thing I came in for was still there!! Hooray, so I picked it up and was out of there by 0030. Then, I proceeded to Kohl's and didn't get what I originally came for but got something at a better deal than from the other place I had planned to go--WIN! But, the sad part was I didn't have a cart carrying these particularly heavy items, so two hours later, when I finally got through the line, my arms were jelly and sore. Then, off to Toys R' Us to buy a gift for my niece, and after that to the car dealer for a $15 oil change. I finished off the evening with a few more stops and waiting for stores to open, and got home, unpacked the car, showered, and was in bed by 0700.
But, my body didn't want me to sleep that much, because I was up about 5 hours later ready to get going on some homework. And boy am I glad I got started on that beast. It started out as a 12-page assignment, basically a template to fill a bunch of information into. Yeah, with all the information I gathered, I added many more pages, and I'm STILL not done. But anyways, It was a good day (morning?), and now my schedule is a bit off.
Oh well, hooray for good deals and getting to sleep in tomorrow!!
Anyways, I got to Best Buy last night at around 2230, and there was probably already at least 500 people in line. Crazy, right? So, I hung out for an hour and a half and was surprised to find the thing I came in for was still there!! Hooray, so I picked it up and was out of there by 0030. Then, I proceeded to Kohl's and didn't get what I originally came for but got something at a better deal than from the other place I had planned to go--WIN! But, the sad part was I didn't have a cart carrying these particularly heavy items, so two hours later, when I finally got through the line, my arms were jelly and sore. Then, off to Toys R' Us to buy a gift for my niece, and after that to the car dealer for a $15 oil change. I finished off the evening with a few more stops and waiting for stores to open, and got home, unpacked the car, showered, and was in bed by 0700.
But, my body didn't want me to sleep that much, because I was up about 5 hours later ready to get going on some homework. And boy am I glad I got started on that beast. It started out as a 12-page assignment, basically a template to fill a bunch of information into. Yeah, with all the information I gathered, I added many more pages, and I'm STILL not done. But anyways, It was a good day (morning?), and now my schedule is a bit off.
Oh well, hooray for good deals and getting to sleep in tomorrow!!
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