I'm moving to Utah!
Although I had a feeling that I would eventually return, I didn't realize it would be so soon... I have decided, after much prayer and deliberation, that I will be returning this summer! Many reasons factored into this decision... but now that I know I want to pursue my master's degree in midwifery at the University of Utah, it just seems silly to ruin my residency status by staying out here an extra year or so to work. And, on top of that, I don't want to take my boards twice... getting licensed out here only to have to re-take the exam in Utah just seems like a huge inconvenience. There were a few other factors that finally pushed me to make this decision, but I am at peace with this new turn that my life is taking. I know that the Lord is guiding me, and that there is a reason I am meant to return. Many people think I'm jumping ship, that I couldn't handle life out here on the East Coast.... but that's not the case! I do love it out here, and I know that I will miss it once I am back in the Salt Lake Valley, but I feel like I've experienced what the Lord wanted me to while I was here, and now it's time for me to continue on to the next adventure. So... after getting settled in the great city of Baltimore, it looks like I'll be packing up and making the trek out west. But I still have a few more months to enjoy life out here, and I know that I will be making the most of it!!
SO. Aside from that minor development... life has been pretty routine the past week. School is quite time-consuming right now, and there isn't much of an end in sight... I have two exams this Tuesday, and then my first Care Plan for Adult Health due on Wednesday. Needless to say, I'll be spending my "holiday" tomorrow at school. This "Care Plan" that I speak of... it's not anything to be taken lightly. Especially for Adult Health. We take our patient from this past week in clinical, and we have to put together an entire plan of care for that patient based on their priority nursing diagnosis and problems that we are responsible for treating. These "nursing diagnoses" include anything from pain management, ineffective coping, nonadherence to treatment directions, and so on. In past clinicals, this diagnosis is usually quite straightforward... but for the unit that I am working on now, the "general medical-surgical" patients encompass a wide variety of problems. For the first time, I had a female patient who was my age... she was suffering from spastic paresis (temporary periods of unexplained muscle spasms/paralysis of the legs) and gastroparesis (intractable nausea/vomiting), aside from a myriad of other medical diagnoses. She is what the hospital terms a "frequent flyer" -- she is in and out of the hospital often, and comes to know nurses and doctors by name. For the most part, this descriptive term is used to describe those who have multiple health issues and can't help but visit the hospital on a high frequency basis. For some, however, they develop an apparent "addiction" to the hospital environment and the attention that they receive while there that they can't imagine life any where else. So... they concoct these "symptoms" and find ways to return to the hospital. I don't mean to say that they don't have these feelings of pain or sickness, but for many, their bodies are so closely intertwined with their psyche that they work themselves up into a state of illness. It's quite fascinating, to a certain extent. After spending two days with my patient, I watched her very closely and her pattern of behavior, and recognized a very deliberate and manipulative attitude regarding her care and what she wanted done for her while she was in the hospital. I don't want to say that she was exaggerating her stated symptoms, but I have my theories... either way, I have to write up a plan of care for how I must care for her while she was in the hospital, and my priority problem for her was imbalanced nutrition -- she refused to take anything by mouth because it would make her sick, and all her medications were given through IV (which gave me great practice on administering meds via IV push). She also complained of severe abdominal pain, and requested narcotics to treat her symptoms, as they were the only medications strong enough to cover the pain without causing her to be sick... but, after a lengthy course of narcs last year, she was weaned off due to a high tolerance build-up, and had severe withdrawal which caused her to be even more sick, so the physician did not want to go that route again. She threw quite a fit when she couldn't get what she wanted... which made us slightly suspicious that she was drug-seeking. That's the tough thing about pain -- it's completely subjective, and we have to treat it according to how the patient describes it to us. You can have a patient in obvious excruciating pain, and they rate their pain at a 6/10 because they've been in worse pain in the past. Then, you'll have a patient (like mine this past week) who is talking and laughing one second, then reporting her pain as a 10/10 -- the worst pain imaginable -- and requesting strong pain medications. And for many pain medication orders, we are given a range: 2-4mg morphine Q3H, based on pain score. If they are in more pain, we give them more pain medication. There is no assessment that we, as nurses, can perform in order to definitively say how much pain the patient is actually in, so we must go by what they report to us. Surprisingly, most patients under-report the amount of pain that they are experiencing, but there are the select few that, for whatever reason -- be it low-pain threshold or desire for stronger meds -- report higher pain scores in order to be treated. Nurses are constantly put in this difficult position, to judge the situation and care for the patient as they see acceptable and appropriate. This can be a difficult responsibility to have, but I much rather prefer to have this type of relationship with the patients and really understand what it is that they need versus what they want, or what their medical diagnosis may dictate that they may need. In many situations, we are the patient advocates -- we recognize what the patient needs more than the physician, and we are able to relay this information to the appropriate provider. Unfortunately, doctors are too focused on diagnosis and treatment plans that they forget to actually assess the individual from a holistic perspective and take outside factors into account for their current physical and psychological state. Working as a nurse and learning more about the patient's history and lifestyle choices allows me to gain a greater understanding of the person behind the medical problems and usually helps to better serve the patient. It's an interesting and complex dynamic, and I'm appreciating these opportunities to prepare myself for what lies ahead in my future career. Aside from the complicated profile of my patient this week, I was able to attend two very interesting procedures with her: first was a gastric emptying study (which she was unable to complete because she couldn't keep the food down) and then second was an EGD - they put a scope down her esophagus and into her stomach to take a look and see what might be causing the irritation and constant vomiting. In addition to looking around, they injected her pyloric sphincter with BoTox to prevent it from closing -- in essence, the BoTox prevents the muscle from contracting so that the food moves through her stomach more rapidly and has less chance to be regurgitated. It's a newer, more experimental procedure, but she had it done last fall and it seemed to help so she was at Hopkins specifically to have this done again. That's one thing about JHH -- we're able to witness procedures that are still being closely studied and investigated, as those patients who come through the doors of the hospital are usually at their last hope and will try (almost) anything to alleviate their ailments. And I am grateful that it is a teaching hospital, as the physicians are much more willing to explain their procedures while they are performing them. The two doctors (one attending and one resident) that did the EGD for my patient were more than happy to include me in their discussion throughout the procedure, and I appreciated that. It was so fascinating... I was transfixed by the image on the monitor of what the small camera was viewing as it traveled down the GI tract... and once it was in the stomach, I could see the waves of peristalsis move through the muscle wall -- it was fascinating. I am in constant awe of the complex systems that control our bodies and their function... have you ever stopped to really think about how perfectly our body systems must coordinate their efforts in order for us to live? No matter how many times I learn about the various physiological processes that occur in our bodies, it never fails to amaze me... and only serves to further strengthen my testimony of the Lord and how perfectly He has organized this world.
WOW. Another soapbox moment for me! I just get typing and don't realize how much I've written. But I really need to get studying... I have so much to get done over the next 24 hours! Goodness... pray for me. haha. The only thing that keeps me sane is yoga -- my current goal is 30-straight days... I've hit 11 already (not including Sundays) and I feel FANTASTIC. Seriously. It really helps to keep my mind focused and helps reduce my stress. I have really developed a healthy addiction to the "hot yoga" craze out here -- 90 minutes in a 95-degree room... it's quite the workout, let me tell you! I don't think I've ever been in this great of shape, and I absolutely LOVE it! I could just continue on this trend for a while... why stop at 30 days?? :] Anyways, have a great week all! Until next time....
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