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November 18th post

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1 November 18th post on Fri Nov 18, 2011 12:25 pm

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My patient yesterday had a total hip replacement on Tueasday. One of his scheduled meds was Lovenox. This anticoagulant is a low-molecular weight Heparin. Lovenox inhibits factor Xa and thrombin. According to the article I read, researchers evaluated the pathway efficacy using patient data forms and financial databases. Before instituting Lovenox, the average length of stay after a total knee or total hip replacement was 4.41 days. After instituting Lovenox, the stay average fell to 3.24 for total hip and 2.98 for total knee. Survey results showed high patient satisfaction rates, and the survey showed no increase in complication rates or readmissions. Key elements contributing to the success of any new pathway of treatment include preoperative patient education, standardized orders derived from evidence-based medicine, and team coordination. Quality of care, patient satisfaction, and patient saftey are the primary goals.

"Success of Clinical Pathways for Total Joint Arthroplasty in a Community Hospital"
FL Walter, N Bass, G Bock 2007

The Other Side of the Stethoscope...

Having the heart of a teacher and the hopes of being a nurse, this book captured my undivided attention after the first page. This is a difficult read. It isn't difficult in words or length, but in that it reaches down into your own fears and makes you take a look at how fragile life really is. It made me think of something that happened yesterday, and so I will relate it to you. I don't know the wisdom in doing so, but therein lies the danger of asking for one's opinion.
At 0800 my patient was scheduled for Lovenox. Good! I thought. One that I know a little about. I had given a Lovenox shot last winter, and I did remember how that needle closes itself off with one final push on the plunger. I also know that it is a low-molecular type of Heparin, interferes with factor Xa, watch for bleeding, and so on. Ms. Williams went with me. I had told her about the med and she seemed satisfied with my answer. I went into the room with my head full of thoughts. My thoughts were so loud it is a wonder my patient could not hear them. My thoughts were as follows...put on gloves, ask for two identifiers, check identifiers on armband, give multi-vitamin first, I have already spoken with him enough to know that he is intelligent so don't insult him by asking if he knows what a vitamin is, tell him about Lovenox (not too much, not too little...but what will Ms. Williams see as too much??? too little???), prep the site, not too close to umbilicus...go for muffin top, go straight in...it is subQ but there is plenty of meat in muffin top, and close off that needle, put it in sharps container, and for God's sake don't make any mistakes Kim, you are being watched. Your whole future rides on doing well in nursing, and on, and on... We come out and I'm thinking I did ok. A very thoughful Ms. Williams told me that my whole personality changed when I went in that room. She said I acted too stiff and that she feels I need to be more relaxed so my patient will be more relaxed. Don't get me wrong, she was just being honest with me. A trait I find so little of these days. And she was right. I went in that room so tense that if you could have harnessed the energy in my back and neck muscles you could have lit up New York city for several hours. I wasn't thinking of how my patient was feeling at that moment, I was thinking of how hard I have worked to get here, how much time I put into studying (and how it feels like it doesn't help sometimes), and how exhausted I am. We all have problems, and we all carry a weight around with us. But as Marcus wrote in his book, the nurse is there for the patient. When we walk in that door, it isn't about us...it's about them. I will try to drop my overwheming thoughts at the door before I enter a patient's room. And honestly, when it's just me and my patient, I seem to do just fine. I'll bet you, the reader, if you know me at all would find it funny that I was at a loss of words or ease with this patient or with anyone at any time for that matter! However, the ominous feeling of being watched and graded is terrifying. I am only human, or at least, that's what my husband keeps telling me. And Ms. Williams, if you are reading this, thank you for your honesty. I prefer honesty over southern ideas of charm any time.

2 Re: November 18th post on Fri Nov 18, 2011 12:44 pm

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Kim you always strive to succeed at everything you do. You have become a wonderful friend and I am honored to know that we have taken on this journey at the same time. As we strive to become nurses we get so wrapped up in what we need to do and should do that sometimes we become our own enemy. I have been told many times by people that I study too much. What is too much? What if I over look something, what if I don't remember exactly what I need too? It drives me in sane sometimes. You know how it is too study for hours on end everyday, feel like you don't get to spend time with your family, put your life on hold for every test and then to get a grade that shocks you is devastating. When I do made a decent grade at times I wonder did I just get lucky this time or did I really know it. Don't beat yourself up. I am almost one hundred precent certain that your patient did not pick up on your stiffness, only Ms. Williams because she knows that you are normally not that way. You are going to make a wonderful, caring, nurse one day as I hope and pray I will also. You were only trying to do your best. We have just got to look toward MAY!! I love you.

3 Re: Clinical experience on Sat Nov 19, 2011 5:59 pm

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I totally agree with u Kim! Even the easiest medication given is so intimidating with an instuctor by your side. You are very smart and will be an excellent nurse because you do care. You have sacrificed your time and studied; which will benefit you tremendously when you practice as an RN in the near future!! Very Happy

4 Re: November 18th post on Mon Nov 21, 2011 4:28 pm

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Kim, I love that you shared your story with us. Honestly all of us have had those moments because we do not want to mess up. And with an instructor hovering over us and knowing that if we do anything wrong, we will get that dreaded "U" makes for an unexplained feeling that we have all experienced. We do not want to do wrong, we all strive for perfectionism. But I have to keep telling myself that I am a student nurse and one day we will look back and laugh thinking about our times as a student nurse and how scared we were to give a beta blocker or even Lovenox. But I agree with you, I rather have honesty than sugar coating my flaws. It is just constructive criticism it does not mean they don't think we will make a great nurse one day. Thank you for sharing your "flaws" but I want you to know you are not alone in how you feel when you walk into a patient's room for medications, interventions, assessment and working an IV pump, we do not know what and how things work but one day through experiences we will. Smile

5 Re: November 18th post on Mon Nov 21, 2011 5:47 pm

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Kim I can totally relate to how you feel.I can also get so caught up in doing everything just so that I forget the easiest step, to just be myself.

6 Re: November 18th post on Mon Nov 21, 2011 6:28 pm

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Kim, an almost identical situation happened to me on Thursday. It was my first actual day on the floor from doing the other rotations. I felt so behind with charting and so on. As I went in to do my assessment with Ms. Stelzner by my side, I tensed up, although it was just a simple assessment. Luckily my patient was very understanding and joked with me to relax! everything would be okay. He had a great sense of humor which put my mind at ease somewhat. I think no matter how far along we get in nursing school that nervousness never goes away with people constantly looking over your shoulder, which is appreciated very much so but can be intimidating at times! We all need to be confident in what we know, and what has brought us this far! Trust me, you are not the only one!! Smile

7 Evidence Based Research on Tue Nov 22, 2011 12:33 am

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Wow, I can see where I Lovenox would play its role in prevention of post operative complications. To me I find it interesting and newly gained knowledge that with that, a patient’s hospital stay is decreased as I am sure their healthcare cost is as well.

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