Plan of Care

navigating through nursing school

Ending Yet Another Hiatus (I Hope)

Yes, I know, I know, I suck at blogging. I’m not sure I actually have any readers anymore, so it likely doesn’t actually matter, but — my summer classes kicked my ass pretty thoroughly. (Organic chemistry? Hell.)

I’m going to give it a third, fourth, something like that go, though. I occasionally even have things to say! Up and coming: a rant/statement on how I much prefer “patient” to “client” in healthcare despite the intention of empowerment behind “client.” But it’s a messy and hard thing to talk about.

But I do have Thoughts on it, and those are thoughts that want to be written down. And where else to do it but here?

Ad Thursday

Somebody suggested to me at one point over the past week that I post a vintage medical ad every Thursday, because of how I have so many actually completely relevant to nursing school things to post that I don’t post any of them. I thought it was a good idea. Unfortunately I can’t remember whose idea it was; I’m assuming a classmate.

Anyway, here’s this week’s:
Catarrh: Consumption, Asthma, Bronchitis, Deafness, Cured AT HOME! Trial, Consultation & Advice!
Free 16 pp. Pamphlet
Address DBMW CASE, 1321 Arch street, Philadelphia, PA
Order only from this office
Dr. Case’s Carbolate of Tar Inhalants

Tar. It cures basically everything.

And because that one’s tiny, and because this is the one I keep referencing and never actually displaying, a bonus: the original Thorazine print that got me into collecting these in the first place.

for prompt control of
SENILE AGITATION
THORAZINE*
(chlorpromazine USP)
‘Thorazine’ can control the agitated, belligerent senile and help the patient to live a composed and useful life.

Well I … guess that’s true. Kinda. On the ‘prompt control’ part. The ‘useful life’ part? Probably not. Thorazine is not all that forgiving.

ad lib.

I’ve been gone a long time, I know. Things have been nuts, and I wasn’t sure for a little while of the safety of my place in school, for various entirely non-academic reasons that were really pretty scary. As a result, my blogging kind of shut down, as I couldn’t find myself thinking positively or even able to think about it at all. Now, though, as the semester is coming to an end and I at least know I can stay where I am in nursing school, all I have to contribute is this ridiculous old advertisement.

Old Pepsi advertisementA ready, popular supply
To medical demand —

Pepsi-Cola when forced fluids are indicated.

In your fluid requirements taken by mouth,
Pepsi is pleasing and refreshing to the patient.
Pepsi-Cola is unexcelled in quality. Today’s
Pepsi, reduced in calories, is light, never too sweet.

Rx: Pepsi ad libitum

And I thought all those old Thorazine ads were something else, but this really takes the cake. I collect vintage ads, so I know that in the 1950s Thorazine was supposed to fix everything under the sun and was a great idea to give to the tempestuous older adult. But I had no idea that Pepsi was so wonderful for fluid volume depletion! I didn’t know it wasn’t too sweet, either, because my diabetic patients often complain about it! Pepsi is the answer to medical demand?! I’ve got to start talking to the places where I do my clinicals. Nobody uses this method! I wonder how they missed it?

Seriously, though, I have a wonderful vintage ad collection, and should really consider posting some of the medical ones more often just to look back on them. This one, though, really is the most ridiculous I’ve ever seen, which is why I was suddenly spurned to post it. It beats out all the former uses for Lysol, too.

I feel like I write about roads more than about school these days

So I was all set to write about yesterday morning’s pre-first-day-of-clinical mishap (because my life is a series of anecdotes about mishaps; I’ve yet to have anything notable to say about any of my actual classes except for a couple of amusing quotes from professors) as soon as I got a chance to write anything at all when this past hour happened and dictated that I write this down first before I forget it.

Last night, it snowed. This is something of no consequence to where I live. I live in a place where serious winter weather happens as often as it doesn’t in Florida, and to about that extreme. Between December and February the average outdoor temperature is 9º Fahrenheit. It snows daily. Today when I went outside at 10:15 the large bank thermometer was reading 15º. It snowed about four inches, and to someplace where everything is always open, regardless of the ridiculous blizzard or whatever, I didn’t even think to check my student e-mail before leaving. Who closes a school when there’s only four inches of snow? This is a school that was still going for the first two days into a disastrous ice storm a few years ago that left several entire counties without power and left me fleeing to my parents’ 150 miles south for about four days. (If that identifies my school to you just from that one statement, I’m not actually surprised in the slightest.) It literally had not occurred to me at all that school might be closed. Snow hasn’t equated to “day off” in my head since high school. This college never closes. Snow meant “I have to be ready to leave earlier than usual because I have to sweep snow off my car, isn’t that a pain”. I complained about the having-to-sweep-off-the-car issue, got ready to go and went outside.

The major road I live on was, miraculously, plowed. I’ve had to go to school on days when said road had not been even slightly plowed and today it was mostly clear; this indicated the rest of the drive would be smooth sailing. And it was! Until I got to school, where in trying to turn down the road that led to the parking garage, my car slid up and down a few times in a giant slush-drift. I switched it into the lowest possible gear and rocked back and forth a little bit, discovered there was no way I was getting into the garage as it involved going up a hill that was covered in about 3 inches of dirty snow, attempted to drive around the school on roads that were also not plowed (on school property) and realized that it seemed that the parking lots were not only not plowed (they clearly had smooth, white snow in them) but that the parking lots were entirely empty.

That was when I realized perhaps not checking my e-mail before I left had been a major oversight.

It simply hadn’t occurred to me that the school that is open when no one has plowed the major interstate that 50% of students at least use to get there might have closed when all the highways and expressways were clear.

So I drove all the way around to the main parking lot, which had a few cars in it (likely all maintenance staff, I figured, and later found out I was mostly correct – a couple may have been teachers) and was still basically covered in pristine snow, found a spot I could pull close enough to the building to that I would be able to get Internet signal, pulled out my trusty 9.1″ computer, prayed I would actually get wireless signal and opened my email, propping the computer up against the steering wheel.

Where I found not one but four emails, the first of which was sent at 5:31 am, indicating that the school would be closed until noon because they didn’t have plow service before then (my reaction: what? You’re open when the roads aren’t even plowed yet because you always have plow service). My one class today was scheduled to end at noon. The clock on my car read 10:44.

Putting away the computer, I realized there was no way I was going to be able to easily get out of where I had pulled the car in. Just because that section of the lot had a clear access road didn’t mean the rest of it wasn’t, well, snow. And I had ended up about halfway in the snowdrift created by the plow that cleared the access road. Switching the car between its lowest gear and reverse about five times, slowly rocking back and forth until I could reverse the car and drive in a circle to make it back to the access road, where another car pulled in just as I was trying to pull out, so I had to reverse back into the snowdrift for a second and force my way out of it again.

While doing that, my low fuel light came on.

at least I got the WordPress app for Android

Which is what I’m currently using as my computer is still packed away in a bag from having been visiting with my parents. I knew if I didn’t update about this now I would never do it ever – this day was quite something.

After departing for the 3 hour drive home at 6am, I was tired when I finally got to my apartment, but as the semester is about to begin there were some things I had to get done right away: be sure the order for my new glasses was in, get my clinical assignment and pick up my textbooks.

The glasses went off without a hitch, but when I got to the clinical assignment part I found a problem: I was given evening shift. Which wouldn’t be a problem if it weren’t for that pesky 4pm language class! I had forgotten the golden rule of “leave your whole clinical day open, you don’t really know your times until it’s begun.”

So there was some frantic switching around of classes until I got into a different sign language section – that has left me with a Wednesday from Hell even longer than last semester’s (no breaks between some pretty intensive courses and labs, 10am to 5pm – in that time I usually have three meals, being a six-meal-a-day person) but at least I got in at all and the books were the same so I hadn’t wasted that prepack order and won’t be losing the credits.

Just as I thought everything had worked out okay, I bit into the snack I had purchased in the bookstore and heard the horrible crack of one of my back molars breaking.

I spit the piece out. It’s in my refrigerator, just in case.

The dentist (who I have spoken to, I’m not an idiot I swear I called him – funny, I’ve been hiding from dentists for three years and now I keep needing one, I had a bunch of work done earlier this month) isn’t open until Monday.

School opens Monday.

This semester is going to be wonderful.

and grades are in

N.B.: The names and organization of my classes have the potentiality of outing my identity, here, because I’m not sure what other programs run like ours. If you figure out which school I go to please don’t tell anyone or think anything of it!

Well, the semester ended back on the 22nd with my make-up clinical and then I proceeded to wait approximately forever to actually receive my grades. (“Approximately forever” = “a week,” but I felt like I was the last person of anyone I knew still in school who hadn’t gotten grades – well, of people at other schools, anyway! People in my program had to wait just as long.)

The good news is unlike quite a few other people (which is normal), I get to stay in the program, having worked myself to the bone to save grades that were low in the beginning of the semester from staying low. I still wasn’t sure if I’d actually manage to pass everything, despite trying – I wasn’t ever sure until I actually got my grades. Starting out nursing school recovering from a summer where I was seriously ill didn’t go too well. My initial microbiology test grades, for instance, were a 50 and a 58. Once I started to feel fully like myself and really work at it, combined with getting the right help in the right places, I got two 94s and an 81 on the final. This combined with lab grades left me with a frustrating 79 as a final grade. She gave me a C, of course, because while I could hope, improvement over a semester isn’t really grounds for rounding up an entire point.

Anatomy & Physiology I was where I was totally in the dark. My lab grades were pretty bad, largely because of issues with hand tremor that have, thankfully, also been resolved. (My medication for it was wearing off just as the lab started, and nobody ever noticed the tremor because when it came to things like giving injections in clinicals, my hands moved smoothly and without any problems. I knew it was there but wasn’t aware of how much it had an effect on what I was doing.) My final exam grade was a 93. My exam-exam grades were all over the 70 and 80 spectrum, and we had an abstract-writing (as opposed to abstract writing) assignment that I got a 25/25 on that of course I couldn’t recall the actual grade computation value of.

Turned out the final and the lab grade canceled each other out, leaving me with a C. I never got the actual number.

Nursing I? Nursing I was a headache and a half, because I was doing fantastically well with the exception of one exam. And then I was sick for a quiz. Boyfriend called me in, which I was never even aware of due to the fact that I had a migraine and had just never really made it out of bed – I don’t actually remember that morning at all, so I didn’t know he’d called me in. I only figured out after he must have, because I went to check postings to see if I was eligible for a makeup.

My name was on the list, but of course by the time I thought to look, the quiz makeup had already passed. So my comfortable B (which had even been a comfortable A until that one exam!) vanished, becoming an uncertain B instead.

And the final was absolutely horrid. I had real trouble with the final, and I still don’t know why. There were a lot of questions I found hard to understand despite having done NCLEX questions to prepare. Part of the problem was likely tiredness and nerves; my microbiology final, which I had to get a B on to pass the course, was immediately after. I had ten minutes between tests.

I got a C on that final. But it was enough, leaving me with a B in the class – a B I barely scraped by, but a B nonetheless.

Now, issues with my previous program screwing things up and refusing to fix them (I have documentation of how many times I asked them to fix this problem, and none of my emails or phone calls were even responded to let alone handled) my previously-good GPA tanked over the summer, and this semester did not really bring it up. I think it maybe brought it down a little bit, and I need it higher to actually be a candidate for BSN programs. I’ve heard admissions looks at the difficulty of the courses and the school you went to for your ADN and not just raw GPA and the fact you passed the NCLEX (I don’t know if they look at NCLEX scores) but I can’t be sure of that. I have enough problems figuring out how to get in all the electives the BSN programs want you to have!

So who knows what’s going to happen with that, but that’s a year and a half away, and while I obviously need to think some about pre-reqs because of all the additional electives, clearly my actual focus point has to be on passing what’s required for my degree and passing the NCLEX. I’d just rather not have to stay in school longer to take additional electives when I’ve already gotten my ADN; it seems like a pain and I think the nonmatriculated course prices are higher.

But I’ve only got three semesters and 1 summer left, and in that summer I’m having maxilofacial surgery so I don’t know how much of it will be left for school! Hopefully it all works out. Right now I’ve got about five days to enjoy winter break before I’ve got to have a bunch of dental work done, and that’s worrisome enough.

it’s almost over!

Quick update: I have managed to pull my disastrous grade up at the last minute, after today’s exam. (I actually had two exams today; now I’m finally done with hourly lecture exams and only have the four finals and two clinical shifts left to go.) I am very, very tired. I hope that I’ll ever get the ability to recount events from my first semester again.

Part of how I haven’t been blogging enough, though, is that I also haven’t been reading enough. I never feel inspired to share when I’m not looking at the things other people are sharing. Little minutiae? I have Dreamwidth, Livejournal and Tumblr accounts for that in addition to Twitter. Thinking about having my nursing-related tweets actually ported in as entries, but I think that drives a lot of people crazy (I know it does on the sites where I do my more personal, semi-private writing; I’m one of the people who doesn’t like it because it feels largely like it’s all half an IM conversation) … not sure if it would drive people crazy when all the tweets were 100% related to blog content: moments relating to school or nursing-related links. I do a lot of “I liked this article on nursinglink or scrubsmag or medscape or something like that” tweeting.

This paragraph is running away with me. The point is now that I’ve done two major exams in one day and gotten 90s on both of them, I’m treating myself to a tiny break and just … reading other blogs. I’ve already come across a post I can’t resist linking:

you’re a bad, bad nurse, on when nurses call in sick.

Not that I can think of anything intelligent to say on it, because I’m tired. But it’s a good post. I agree with everything in it.

And now I should probably do a little bit more reading and then go to bed, because I’ve got to get up at 5am to get to clinical tomorrow on time. In the snow. Without my GPS for the first time (I still get lost too easily trying to find this hospital; it is not close by). Who hates winter? That’s right. Me.

So, I haven’t posted in a long time. And I had a whole long post that I handwrote explaining why.

But it was a lot of whinging about nothing, and talking about how I have a physical disability and mental illness that makes it hard to do anything that isn’t school, including blogging. And I was afraid to go into detail because of potential backlash saying these disabilities should prevent me from being a nurse. They can’t and they won’t – I have chronic depression, OCD and a series of weird physical problems including optic neuropathy and complicated migraine. They are all kicking my ass right now. But this is a particularly bad time for all four, because the wintery season is the worst in the world for me, and none of these things are stopping me from doing the things I need to do.

They’re stopping me from doing the things I want to do, which is why I have no life. I’m having a lot of problems with one hard science course in particular having to do with how confusing the fill-in-the-blank-only testing format is, and major test anxiety on my part that hits anytime something isn’t multiple choice (my classes that have NCLEX format exams? wonderful! I do fantastically, even with write-ins. This class? Bad bad bad news.) and am therefore spending every spare moment that is not in classes or clinical studying for this course and attempting to best the anxiety and memory difficulties caused by the anxiety.

So it’s hard to post about things, from my ridiculous commute to clinical to how awesome my nursing lab is to how much the sliding filament theory is a bummer to recite when life, grades and the weather have me down, but I’m still here. Hibernating under a pile of textbooks, maybe, but still here.

It’s dumb to say “I’ll update my school blog when finals are over,” but until this one class is gone and gone forever that’s what it looks like I’ll be doing.

what, subconscious

Lots of things to update on that I keep running out of time to comment on (and this week, considering the paper, presentation, exam, CPR recert and all the other homework, isn’t really the time) but this is another one of those ‘I should note it so I don’t forget it and I have time right now‘ sorts of things.

I had a nightmare last night that I showed up to clinical this Thursday late, with no paperwork, no ID (this is actually a problem for real, as I don’t have any photo ID right now) of any kind, wearing some weird pyjama getup instead of my scrubs, and without a stethoscope.

Then my boyfriend and one of his former classmates showed up attempting to convince the hospital that they were students for some energywork class that didn’t exist. So a classmate of mine (who isn’t real) and I literally pushed them out the door, just to ask them to come back in and help us move a patient.

I have no idea.

tricky test question

I literally just had the test and am in a lecture, but couldn’t possibly wait to share this question as I was afraid I would forget it. It’s one of the most cleverly written exam questions I’ve ever encountered.

#. Which procedure is correct to follow when listening to breath sounds?
A. Auscultate the anterior chest at 6 different points.
B. Use the zig-zag pattern to listen, comparing sounds from right to left.
C. Ask the patient to take a deep breath and hold it in so you can listen.
D. Instruct the patient to breathe slowly and deeply in and out through the nose.

If I didn’t know before that my instructor wrote NCLEX questions (not examples, but the actual NCLEX) I would definitely know it now. I’m very impressed by the sneakiness of this question’s wording! If not reading carefully you’d definitely be screwed on this one.