Day Two

20/5/14
Firstly today I can proudly say that I figured out how to get to the ward without getting lost or taking long sidetracks. Also I have a swipe card which allows me access to most door I've come across, so I feel like the real deal.
Shift began as usual and working with same two nurses from last night. I am now at the level of writing my own shift plan for timing of meds, obs, and other things that need to be addressed. On hearing that we were receiving a patient from another hospital we hopped to and switched rooms around so the new patient would be in a side room. Patients from hospitals outside the DHB have to be put under contact isolation precautions until their swabs are clear of MRSA. Contact isolation is wearing gowns and gloves, but not face masks etc as per full isolation. But as we all know there are a few problems with contact isolation. 1) many nurses ignore the precautions, as seen on my previous placement, and 2) the gowns the have are reused, put on inside out, and left hanging by the door, so no real infection control in in place. And they wonder why they have hospital bugs. We washed down the room as this particular ward doesn't usually have a care assistant, so nurses do most of the cleaning and washing. Honestly it is quite nice to make sure the place is clean and pleasant enough for a new patient. There's nothing worse than arriving in a new room with the last patient's rubbish still in the drawer.
I observed a cannula removal and abdominal dressing change, taking as many mental notes as possible while staring at a woman's crotch and still trying to look decent. Our new arrival was still to arrive a few hours later which luckily gave time for me to watch a naso-gastric tube being removed. Any part of having a NSG is uncomfortable, but this removal was made worse by the tube being rather long. The technique I was taught is to measure from the ear to the tip of the nose to the bottom of the sternum. Our patient was short and sensitive, and if not for her discomfort it would have been bizarrely comical as the RN kept pulling hand over hand at the seemingly endless tube. But I was able to hold the patients hand to comfort and to her credit she recovered quickly.
A first for me! I prepared and administered medications charted for a couple of patients. The medication room is complex but after I found my way round the hundreds of bottles and boxes, and recited the 5 Rights of Medication to my preceptor (right medication, right route, right dose, right time, right patient *Phew!*) I was allowed to start. A bit nervous after being so hands-off last year, I read and re-read charts, double checked expiries, and did my calculations several times over before taking them bedside and running the old identification spiel. So no big deal after all, though still exciting to have this new level of responsibility.
Finally our new admission arrived and oh, the paperwork. Such fun! Luckily I was able to toodle off and check her obs and blood sugar.
Later, after emptying catheters I put the contents, and the cardboard containers it gets collected in, into the macerator which is supposed to breakdown the cardboard and send the whole lot away, no mess, no fuss. However, this machine was apparently malfunctioning and halfway through the cycle water began bubbling out the seal. Imagine, if you will, a top-loading washing machine for urine, bowel motions, and cardboard. Then imagine the horror of it leaking mid-spin. Oh God! I've broken their machine. I'm literally in the shit. It was one of those times (and I've had many) where instead of doing the sensible thing and telling others so they can help with the aftermath, I panicked and desperately cleaned it up before anyone could walk in the room. I cleaned, bleached, and sanitised the floor, four wall and ceiling faster than you could believe. That room was the cleanest it had been in years. Thinking I had used the machine incorrectly and not sealed the lid right I left it at that. I have subsequently been told that its broken and it was broken before I even used, and I am happy to tell you there is now a sign on it if any other unfortunate like me comes along.
Another first! The night ended on a high with my first ever injection performed on a real human person! I performed a subcutaneous injection on a lovely lady who knew it was my first time and said she was happy to be a guinea pig. (subcuts use a 20mm long very thin needle into a fatty area like the stomach or thigh). All went well, steady hands, correct technique and the patient said she didn't feel a thing. Success!!