Postgraduate Adult Nursing 2014

Good luck all the best with the applications I hope you get where you want. i am currently a PgDip student and on placement! I even have time to start a blog. Using this to shamelessly promote myself :P

http://nursingexperiences.wordpress.com/2014/01/13/reflect-reflect-reflect/

Happy to answer any questions xxx

I'll be starting the PgDip Adult Nursing at Kings in September…..Good luck to all those applying.

Hi Lizzie, I love your blog, theres not many out there so its good to have your blog as a reference.

Is there any way you could let me know what your time table is like, as in when you go on placement etc. And also any books you think may be helpful I want to get a head start especially with anatomy and physiology. Any help would be greatly appreciated.

Thanks

It's never too early to get started familiarising yourself with the common drugs. At the end of the day you will be administering the drugs to teh patients and some patients will ask what does this drug and that drug do and why they are taking it and you will need to explain it to them, as well as explaining for example if they become hypotensive, why they cannot continue taking their anti-hypertensive drugs. Common painkillers (analgesics) include: paracetamol, ibuprofen, codeine, codeine phosphate and tcontrolled drugs oramorph, oxynorm, oxycodeine and tramadol are also painkillers, which are kept in tightly controlled cupboard. There are several laxatives to be aware of, movicol and lactulose that are liquids and senna that is a tablet. Antiemetics (antisickness) are metoclopraminde and odensetron.


However what I think so far that is the hardest is the multi-tasking and the constant interruption. We have several bariatric patients that are completely immobile so this increases their risk of developing pressure ulcers, they require all round care in terms of washing once a day and changing the bed sheets, you need at least two people to do this. At the same time, someone in the other bed may be pressing the call button because they have had diarrhoea and was too late or unable to mobilise to the commode/toilet without the risk of falling. At least they are able to notigy you, some people are completely unable to indicate whether they have opened their bowels so they risk lying in their own faeces, which also increases the risk of infection. Then you may have a patient who needs to go down for surgery or a contrast CT scan, you have to ensure they are nil by mouth (NBM) no eating and drinking for about 8 hours prior, depending on the procedure about 20mins before you need to have done all the pre-op asssesments. You could be changing a wound dressing, a wound they had after an operation, they needs to be checked and clean to ensure they are healing properly but it takes time to prepare the aseptic technique; cleaning the trolley getting all the gauzes, sterile packs, dressings etc After that dont forget to reposition your bariatric patient who is immobile in bed and grab/wait until a HCA is free to help you roll the patient over to a new position. If you lie in one position all the time the area of skin in contact with the bed will receive poor circulation due to the pressure applied and eventually deteriorates and turns into a moister lesion and into a ulcer. Once you repositioned you have to document that you did that otherwise it would have suggested you had neglect your patient.

Also if the patient has diarrhoea you have to asses it using the bristol stool chart and document that, put them on a stool chart and document that. The medication rounds are 12pm and 6 pm during the day shifts. If they have IV medications it takes time to mix and prepare the medication and it also requires another nurse to countersign that because they have to cross check anything you just did ie checking its the right dose of IV medication and the expiry date. In return you might be interrupted to check another nurse their controlled drug or IV medication that they are about to give to a patient.Also the drug cupboard only has one set of key and only one nurse will have it at one time, when not in use its always locked. So the nurse that needs the medication needs to run around trying to find who has the key in their pocket. Whoever used it last will keep it on them until another nurse needs it for their patient who is in pain and requires one of the 'on demand' analgesics. analgesic such as oramorph can been taken outside the medication round, whenever the patient is in pain, but cannot exceed 4 hours between each intake. If that fails you have to bleep the doctor who prescribed it explain that their patient is still in pain and see if they prescribe something stronger. Sometimes the doctor is busy and you dont know who long you have to tell the patient to wait. I dread having the explain to a patient in tears with pain that as a nurse I cannot do anything for them but I have told the doctor who will be coming soon. The doctor may be receiving other calls or might have forgotten. So I have to ensure that I give some time for the doctor to arrive but not take too long that they might have forgotten my call.


At the mean time another patient may have vomitted due to a side effect of the oramorph, a pain killer because 40% of patients who take it, feel nausea or vomitting, so I have to administer an anti-emetic to stop the effects of the painkiller, when the painkiller was originally taken for the surgical wound. Then document that in the patient folder. Then don't forget it's now been four hours since I've last repositioned my bariatric patient, need to reposition them again, and grab a passing HCA to help me to do so. Meal time rolls in a there is a patient who is has had a stoke so cannot feed herself independently and I need to feed her. This ensure that I know for sure how much they had had and how well their appetite is. All patients activities such as appetite, mobility, bowel elimination, urine output, changes of the care plan must be documented each day.


Then I need to remember if the doctor has come to review the patient who was crying out in pain earlier on. Of course not everyday is like this but as a student nurse there was not much I can do to help, in terms of IV, medication, and its not nice to watch my patients suffer. Also the hospital food are microwaved from pre-prepared packs. If the patient is hungry is virtually impossible to get more food outside meal times because the kitchen staff lock the kitchen to prevent food being stolen. Food is actually rationed in hospitals, so imagine telling your patient who is hungry to wait till dinner time or get their relatives to bring them more food the next time they visit.


Some patients are very particular, they want only sweeteners no sugar and plenty of milk in the tea, or they only want hot milk but the the tea trolleys that go round only serve cold milk and the microwave is back in the kitchen which is always being guarded by staff and I end up pleaing them to microwave a glass of hot milk especially for my patient, really depends on who is on duty to perform who is willing to perform such a special request. I could easily save my own skin, saving time to finish all the paperwork early by telling l my patient they only serve tea of coffee and give them an ultimatum but how can I form a good rapport? I'll be the one caring for the patient for the entire day not the kitchen staff. Then you might be called by the porters to collect another patient who is in recovery suite after an operation, you have to be away from the ward for 15/20 minutes.......

just had a crazy day and letting off some steam. Hopes it useful anyway feel free to ask questions !

Wow! you provided with me such brilliant insight!! thank you so so much! I will defo get a A-Level biology book and start brushing up on my anatomy! I will also research the basic drugs, what you have listed has been so helpful! I currently work within mental health but have joined an agency and will start doing some work on medical wards and nursing homes so hopefully that will help!

Blowing of steam here is a good idea, it gives you a way to vent and it also gives us an idea of how it all works! Im so nervous but so excited at the same time.

Just another question when do you get your holidays I know you only get 6 or 7 weeks, but I'm just wondering when they are?

Again thanks a lot for replying and keep up the good work with your blog, its sooooo helpful!