I felt like I did good for a patient today.

10/10 neuropathic foot pain, and refusing all pain meds except neu.ron.tin.  Says that he doesn’t want to feel stoned.  I’ve been arguing with him over this for 3 visits…today, I finally thought of Lido.derm patches!  Brought them up, and he agreed immediately upon hearing what they were.  Hopefully by tomorrow, he’ll be out of pain.

Cancer patients can be so rewarding.

When you find yourself stealing your wife’s fentanyl patches, you know there’s a problem…

So, after 5 weeks, I’m finally done with orientation/preceptorship.  I had my first day alone yesterday(Friday), and I think it went pretty well.  Saw three patients, spent about an hour on the phone, got all my paperwork done…overall it went well.  Once I got started, I was fine, however, making that first phone call was a little nerve wracking.  I know that will get better.

Monday I have another three patients on my schedule–including a wound vac that I’m covisiting on, a daily wound visit, and a pain management case.  Should be interesting.

So, remember how my first patient died?

8 days in the field, and already I’ve had a second unexpected death.

Jeez.  Even my preceptor says I have a black cloud now.

A quick note to my patients:

If we’re going to fill a mediset(pill box) for you, you have to take them in order.  Taking whatever day’s and time’s meds whenever you feel like it doesn’t work so well…

Had a mixed day today, with half of the day spent doing visits and half in the classroom.  We started off early this morning (7am, new preceptor) with 12 flights of steps to go up.  Yikes-I was half dead by the 10th floor. Rock climbing is not so good for cardiac endurance.  Next time should be easier.  The second and third patient weren’t too remarkable–a hickman blood draw and a general nursing visit.

The afternoon started off a bit slower, with someone reading  us slides on SBAR reporting, then a chat regarding the private pay aide service we run.  After that we moved into the diabetes education, which I was thinking would be dull–3 hours on a topic I feel I know pretty well.  However, once we got into it I found myself quite interested.  The CDE was very knowledgable, and though I knew about half of what we talked about, the other half was new to me.  Example: alcohol is a hypoglycemic agent, because when the body runs out of sugar, usually the liver will take over and push some glucose out.  However, when you’re drinking, the liver is processing the alcohol, and apparently it can only do one thing at a time(single minded liver).  So, hypoglycemia!  Also learned how to use an insulin pen, which I’ve always wanted to do.

After the talk on diabetes, I went out with the CDE to a patient’s house where she had scheduled some diabetic teaching to do.  There, we met with an older gentleman who, though fairly knowledgable about his diabetes, was still having some new troubles with high blood sugars and a skin infection that wasn’t clearing up.  Chatted with him for about an hour, left the house with a new plan of care and some numbers–I now know who to call for education, that’s for sure.

10 hour day today–100 miles put on between two cars, and I only saw 4 patients! Hopefully a shorted day tomorrow.  Classroom training all day.

Every day, the visits get easier and easier to do.  See, I have a fair amount of social anxiety, to put it mildly, and sitting down and chatting with my patients can be really hard for me.  The technical nursing stuff?  No problem.  Answering questions they ask me–piece of cake.  Small talk about the weather: oh god, kill me now.  As I posted previously, my first visit was incredibly ackward.   However, things are getting smoother.  Today I ran two visits, and both went quite well–I got everything covered with a minimum of long silences.

And then, after my two visits, the drama started.  First, we saw a patient who had an absolutely warring family–his child said that the patient’s wife was abusive, hysterical, and controlling.  The patient’s wife said their son was abusive, hysterical, and controlling.  The wife says he has a month left to live.  The son says the wife is cancelling appointments.  And on, and on, and on.  The planned 30-minute visit took us two hours to sort everything out.

Taking two hours at that house made us late to our next patient, a hospice patient with horrible pain on a CADD pump.  This patient is a medical provider, and has thrice called in his own prescriptions–including one for Ativan.  Trying to tell him, “No, X, you can’t do that,” has gotten us nowhere.  All we can do is call his attending whenever he does it and update that doctor, but it’s starting to get a little frustrating.

Drama, drama, drama.  Tomorrow I see three patients, including one whom I remember from the ICU.  Should be interesting…

So, the first patient I saw yesterday, who I went out to see this morning?  He died overnight.

I think I have a black cloud.  2 days and already someone’s died.

:/

So I saw my first patient today, and it was…ackward.  Not with the physical nursing tasks; my nursing skills aren’t the question.  But the communication was, well, ackward.  I don’t know how to ask questions off of a form without seeming like I’m reading a form.  My preceptor can work it all into a conversation, but I don’t really have that yet.  It will come, I’m sure.

One problem was that I didn’t really get a good chance to prepare: I had time for a brief look-through just before we went in, but that’s it.  Luckily, I know the names of my patients for tomorrow (one is a person we saw today, one is new) so I can look them up.  I also am having problems–well, not problems, I’m just slow–with the computer program, the electronic charting, so I practiced that some more tonight.  Knowing what J, my preceptor, wants me to chart on helps.  In classroom orientation, we were doing the entire 25 page assessment–apparently it’s a little redundant and the forms we actually fill out(electronically) are much shorter.  So that helps.

I’m scheduled to see one patient tomorrow, but I’ll probably ask to do two, since I’ve got the advance info on them both.  Hopefully it goes a little smoother tomorrow.