Week 4 Blog #2

Week 4 January 25-31
Friday, January 29, 2016
4p-8p 4 Hours Interned
Saturday, January 30, 2016
2p-10p 8 Hours Interned
Sunday, January 31, 2016
2p-10p 8 Hours Interned


Objective #2:
2. Will verbally demonstrate knowledge of tests included in a CMP and CBC/diff including                  abnormalities, what disease process they might indicate and possible signs and symptoms            that the patient might demonstrate given these values.

       As indicated in my last post, the CMP test, tests 14 different types of components of your            blood as part of an individual’s routine blood-work in their physical. These 14 components            give the doctor info about an individuals kidney and liver function, electrolyte and acid/base          levels, and blood sugar and blood protein    levels. The following will describe a bit about the        14 components and what those blood samples indicate.

1.  Albumin – Protein made by the liver. Important for tissue growth and healing. Keeps the blood from leaking out of blood vessels. Related to liver function.

2. Blood Urea Nitrogen (BUN) – Measure the amount of nitrogen in your blood that comes from the waste product known as urea. Urea is made in the liver. This test is related to kidney function. Kidneys filter the blood and waste (urea) from one’s body. If there is an excess amount of urea in your blood stream, your kidneys are not proper functioning.

3. Calcium – Calcium in your blood shows the level of calcium that is not being stored in the bones. Calcium is a test to check for problems related to the parathyroid glands or kidneys.

4. Carbon Dioxide (Bicarbonate) – A gaseous waste product from metabolism. Blood carries bicarbonate to an individuals lungs to be expelled via exhalation. Test is performed to evaluate kidney function, metabolic conditions, and lung diseases.

5. Chloride – Most important electrolyte measured in the blood. It helps keep the amount of fluid inside and outside of our cells balanced, thus, maintaining a proper blood volume, blood pressure, and pH of body fluids. Test related to kidney and adrenal gland functions.

6. Creatinine – A waste product in our blood and urine. Creatine is broken down into creatinine (waste) via metabolism and cleared from the body through the blood and urine. Test is performed to evaluate kidney function.

7. Glucose – Blood sugar. Insulin is produced to maintain glucose levels in the blood. Test is performed to see how well an individuals pancreas can produce insulin.

8. Potassium – Electrolyte and mineral. Helps maintain water amount inside and outside of cells. Important to how nerves and muscles work. Test performed to determine kidney and adrenal gland functions.

9. Sodium – Electrolyte and mineral. Maintains fluid amount in and out of cell. Importnt in how nerved and muscles work. Test performed to check water and electrolyte balance in body and kidney and adrenal gland functioning.

10. Total Bilirubin – Found in bile when the liver breaks down old red blood cells and is removed via feces. Test performed to determine liver function.

11. Total Protein – Amount of protein in blood. Two componenets: Albumin and Globulin. Test performed to determine liver and kidney function.

12. Alanine Aminotransferase (ALT) – Enzyme in the blood. Mainly found in the liver. Test performed to determine and liver damage.

13. Alkaline Phosphatase (ALP) – Enzyme in the blood. Mainly found in the liver. Test performed to check for liver disease or damage.

14. Aspartate Aminotransferase (AST) – Enzyme in the blood. Mainly found in red blood cells, liver, heart, muscle tissue, pancreas, and kidneys. Test performed to check for liver damage or disease.

I know this was a lot to through at you and seemed very vague…. Due to the time constraint of this internship, I had to break down my objectives into components to keep up with my biweekly blogs. If I dumped all the info on you guys in one blog, I wouldn’t have anything else to post! So this was a rough breakdown as to why these components to the CMP test are important and what they are tested for. Next week I will go into better detail of each component of the CMP test, their values norms, abnormal values, and what the abnormal values can indicate related to the disease process.

Week 4 Blog #1

Week 4 January 25-31
Monday, January 25, 2016
4p-8p 4 Hours Interned

Objective #2:
2. Will verbally demonstrate knowledge of tests included in a CMP and CBC/diff including                  abnormalities, what disease process they might indicate and possible signs and symptoms            that the patient might demonstrate given these values.

Because there is a lot of info to this objective I have broken down components of it to explain over the next few weeks. I will First start with the CMP test and a little background on it.

What is a CMP test?
A CMP test is known as a Comprehensive Metabolic Panel (CMP). It’s a test ordered by your doctor that tests 14 different components. The CMP test measures particular values in an individual’s blood. These blood values show the current status of someone’s kidney and liver function, electrolyte and acid/base balance, and your blood sugar and protein levels. It is a common test to check conditions such as diabetes and liver and kidney diseases. CMP tests can also be ordered to monitor known problems such as hypertension, drug therapies, and cholesterol-lowering drugs.

When is a CMP test ordered?
An individual’s doctor will order a CMP test as part of routine blood work. Typically once a year as part of a routine physical. The doctor can order it again depending of the abnormal values to follow up on them and compare at a later date (after treatment etc.)

How is a CMP test performed?
A doctor will order a CMP test and ask an individual to fast for 10-12 hours prior to the test. The tests consist of drawing blood by inserting a needle into a vein in the individuals arm.

What components are being measured from a CMP test?
There are 14 components to a CMP test. The 14 components are:
1. Albumin
2. Blood Urea Nitrogen (BUN)
3. Calcium
4. Carbon Dioxide (Bicarbonate)
5. Chloride
6. Creatinine
7. Glucose
8. Potassium
9. Sodium
10. Total Bilirubin
11. Total Protein
12. Alanine Aminotransferase (ALT)
13. Alkaline Phosphatase (ALP)
14. Aspartate Aminotransferase (AST)
I will explain later what the normal range of these values are, abnormal values, and the disease process that may be related to the abnormal value.

Week 3 Blog #2

Week 3 January 18-24
Tuesday, January 19, 2016 
5p-9p 4 Hours Interned

As I said in my last blog I would share my experience with my first insulin injection which was performed last week as indicated in Week #2 Blog #2. I explained how nervous I was and how nice the Sister was in saying she didn’t even feel a thing! I was completely nerve wrecked because I had never done it before, was trying to remember all the proper steps and techniques without flipping through my notebook (didn’t want to look like I was following the instructions as if I were putting together a table from Ikea lol!), and was trying to maintain my cool so that the Sister didn’t see how nervous I was! I wouldn’t want someone about to poke me with a needle looking nervous! But all in all I passed with flying colors! One thing I neglected to mention when I initially posted about me giving the Sister her insulin injection was that I gave her TWO! Not that I gave her two cause one was accidental, but because she required two administrations! Was saving that good stuff for this post! For the sake of making this easier for me and HIPPA, I’m going to refer to the Sister as Sister A when talking about her.

So what did I do…

·      I referred to Sister A’s MAR. Her MAR said at 8pm to administer 5 units of Humulin R insulin (fast- acting insulin) and a predetermined amount of NPH (long-acting insulin) based on her given blood sugar amount at that time. This predetermined amount is known as a sliding scale. According to http://dtc.ucsf.edu/ , “The term “sliding scale” refers to the progressive increase in the pre-meal or nighttime insulin dose, based on pre-defined blood glucose ranges. Sliding scale insulin regimens approximate daily insulin requirements.”. What this means is that once her blood glucose level is determined, we refer to a chart made by her doctor and give her the amount of NPH insulin that matches to her blood glucose level.
·       I gathered my supplies. My supplies consisted of the two types of insulin, two insulin 100-U needles, alcohol prep pads, glucometer, glucometer strips, lancet, gloves, and Band-Aids (just incase she began to bleed!). FYI the glucometer is a small medial device that is used to approximate the concentration of glucose in the blood. The glucometer strip goes into the glucometer and what comes into contact with a small drop of blood. We obtain the blood by pricking the Sister’s fingertip with the lancet.
·       Washed my hands and applied gloves.
·       Asked Sister A which finger she would like to have pricked by the lancet. Once she picked the finger I wiped it with an alcohol prep pad for 30 seconds in a circular motion. I then let it dry for another 30 seconds. Note: when letting the area dry, do not blow the area because that will unsterilized the area!
·       Once the area was dry, I got the lancet and pricked Sister A’s finger :( had to squeeze the sides of her finger to get a drop of blood to come out.
·       I then placed the glucometer strip in the glucometer, let it boot up, and touched the strip to the Sister’s drop of blood. Waited 5 seconds, read her blood glucose level, removed the strip and disposed it in the biohazard container, recorded her blood glucose level in the mar, and referred to her sliding scale. Her sliding scale indicated to administer 4 units based on her given blood glucose level.
·       I then began to prepare for the injection. I got her NPH insulin, removed the cap, and wiped the top of the insulin bottle with an alcohol prep pad for 30 seconds. While it was drying I grabbed one of the insulin needles, drew the plunger back to 4 units, waited until the insulin bottle’s top was dry (20 more seconds), put the needle into the insulin bottle, pushed the 4 units of air into the bottle (air against air), flipped the bottle on top of the needle, pulled the plunger back to 4 units to withdraw the insulin from the bottle, and then removed the insulin bottle from the needle. I checked to make sure there wasn’t any air bubbles (which there wasn’t), recapped the needle, marked it so I knew which insulin it was, and then returned the insulin to its proper storing place.
·       After I was done preparing for the NPH insulin injection, I did the same steps as above but for Sister A’s Humulin R insulin. The only difference here was she needed 5 units of this insulin vs the 4 units from the NPH.
·       Now I was done preparing for the injections and had to administer them! I went to Sister A and explained I would be giving her two insulin injections. The NPH of 4 units based on her blood glucose levels and the 5 units of Humulin R insulin. I asked her if she had a personal preference to which sites she would like to have them administered, noting that they could not both be administered at the same site. She said she would like to have one on the posterior part of her upper right arm and one in her abdomen. No personal preference to where which insulin went to.
·       I chose to administer the Humulin R insulin in her abdomen because it was a fast acting insulin and the abdomen is the fastest absorption site. Decided this because it would correct her elevated blood glucose level to normal.
·       To her lower right quadrant, 2 inches away from her navel, I wiped the area with an alcohol prep pad in a circular motion from inward to outward and let it dry for 30 seconds. While the area was drying I grabbed the labeled Humulin R insulin syringe and uncapped it.
·       Once the area was dry I pinched up the skin area to be injected with my left hand and with my right hand quickly pushed in the needle into her skin at a 45-degree angle and pushed the plunger to administer the insulin! Released the pinched skin from my left hand and waited 5 seconds to make sure all the insulin was disposed from the syringe. These five seconds seemed like they took forever! There was that awkward moment of me just sitting there counting to 5 holding a needle in someone!
·       When the five seconds were up I withdrew the needle at the same angle in which it went in and there was no blood to apply a Band-Aid to, pushed the safety over the exposed needle, and disposed it into the sharps container…. and I WAS DONE!
·       Asked Sister A if she had any pain of discomfort during the procedure and she said she didn’t feel a thing! Hope the next one would be just as good! (Not to put any pressure on me or anything right?!)
·       I then got ready to administer the NPH to the posterior area of her upper arm. Followed the same steps as above but to the posterior area of her upper arm rather than her abdomen. Another success!

This was definitely a nerve wrecking experience for me but I couldn’t have done it without how assuring the nurses were and what a good sport Sister A was! I don’t know if she was just saying she didn’t feel a thing because she knew how nervous I was, but all in all I felt good about the overall experience. I did not make her bleed after the injections and feel very confident in my administration technique. It was awesome! Since my first experience last week, I have done this 2 other times and am becoming more and more confident and fluid in my administration technique.   

Week 3 Blog #1

Week 3 January 18-24
Monday, January 18, 2016
4p-8p 4 Hours Interned

Objective #1:
1. Will demonstrate proper technique and knowledge of possible anatomical sites to use for the          administration of insulin

Here are the steps to insulin administration from 
https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000660.htm 
It is a straight copy and paste because you can't really rewrite directions to something in your own words. But this is the website I obtained my information and took notes on in regards to insulin administration. I know in last weeks blog I explained how I already gave an insulin injection! So for this post, it will be the instructions on how to administer insulin from the website listed above. My next post this week will be on how I administered it! There are additional steps in this instruction guide that I did not take because they were not needed and are good to know for future instances, but my next blog will explain my experience :)

Giving an insulin injection

To give an insulin injection, you need to fill the right syringe with the right amount of medicine, decide where to give the injection, and know how to give the injection.

Getting Ready

• Your health care provider will teach you all of these steps, watch you practice, and answer your questions. You may take notes to remember the details.
• Know the name and dose of each medicine to give. The type of insulin should match the type of syringe: U-100 or U-500. Because U-500 syringes may be difficult to find, your health care provider may give you instructions for using U-500 insulin with U-100 syringes.
• Some types of insulin can be mixed with each other in one syringe, but not all. Consult with your provider or pharmacist about this.
• Always use the same brands and types of supplies. DO NOT use expired insulin.
• Insulin should be given at room temperature. If you had it in the refrigerator or cooler bag, take it out 30 minutes before the injection. Once you have started using a vial of insulin, it can be kept at room temperature for a month.
• Gather your supplies: insulin, needles, syringes, alcohol wipes, and a container for used needles and syringes.                                                                                                                                                                                                                                                            Filling the Syringe - One Type of Insulin
• Wash your hands with soap and water. Dry them well.

• Check the insulin bottle label. Make sure it is the right insulin. Make sure it is not expired.
• The insulin should not have any clumps on the sides of the bottle. If it does, throw it out and get another bottle.
• Intermediate-acting insulin is cloudy, and must be rolled between your hands to mix it. DO NOT shake the bottle. This can make the insulin clump.
• Clear insulin does not need to be mixed.
• If the insulin vial has a plastic cover, take it off. Wipe the top of the bottle with an alcohol wipe. Let it dry. DO NOT blow on it.
• Know the dose of insulin you want. Take the cap off the needle, being careful not to touch the needle to keep it sterile. Pull back the plunger of the syringe to put as much air in the syringe as the dose of medicine you want.
• Put the needle into and through the rubber top of the insulin bottle. Push the plunger so the air goes into the bottle. 
• Keep the needle in the bottle and turn the bottle upside down.
• With the tip of the needle in the liquid, pull back on the plunger to get the right dose of insulin into the syringe.
• Check the syringe for air bubbles. If there are bubbles, hold both the bottle and syringe in one hand, and tap the syringe with your other hand. The bubbles will float to the top. Push the bubbles back into the insulin bottle, then pull back to get the right dose.
• When there are no bubbles, take the syringe out of the bottle. Put the syringe down carefully so the needle does not touch anything.

   Filling the Syringe - Two Types of Insulin

• Never mix two types of insulin in one syringe unless you are told to do this. You will also be told which insulin to draw up first. Always do it in that order.
• Your doctor will tell you how much of each insulin you will need. Add these two numbers together. This is the amount of insulin you should have in the syringe before injecting it.
• Wash your hands with soap and water. Dry them well.
• Check the insulin bottle label. Make sure it is the right insulin.
• The insulin should not have any clumps on the sides of the bottle. If it does, throw it out and get another bottle.
• Intermediate-acting insulin is cloudy, and must be rolled between your hands to mix it. DO NOT shake the bottle. This can make the insulin clump.
• Clear insulin does not need to be mixed.
• If the vial has a plastic cover, take it off. Wipe the top of the bottle with an alcohol wipe. Let it dry. DO NOT blow on it.
• Know the dose of each insulin you want. Take the cap off the needle, being careful not to touch the needle to keep it sterile. Pull back the plunger of the syringe to put as much air in the syringe as the dose of the longer-acting insulin.
• Put the needle into the rubber top of that insulin bottle. Push the plunger so the air goes into the bottle. Remove the needle from the bottle.
• Put the air in the short-acting insulin bottle the same way as the previous two steps above.
• Keep the needle in the short-acting bottle and turn the bottle upside down.
• With the tip of the needle in the liquid, pull back on the plunger to get the right dose of insulin into the syringe.
• Check the syringe for air bubbles. If there are bubbles, hold both the bottle and syringe in one hand, and tap the syringe with your other hand. The bubbles will float to the top. Push the bubbles back into the insulin bottle, then pull back to get the right dose.
• When there are no bubbles, take the syringe out of the bottle. Look at it again to make sure you have the right dose.
• Put the needle into the rubber top of the longer-acting insulin bottle.
• Turn the bottle upside down. With the tip of the needle in the liquid, slowly pull back on the plunger to exactly the right dose of long-acting insulin. DO NOT draw extra insulin in the syringe, since you should not push the mixed insulin back into the bottle.
• Check the syringe for air bubbles. If there are bubbles, hold both the bottle and syringe in one hand, and tap the syringe with your other hand. The bubbles will float to the top. Remove the needle from the bottle before you push out the air.
• Make sure you have the right total dose of insulin. Put the syringe down carefully so the needle does not touch anything.

   Giving the Injection

Choose where to give the injection. Keep a chart of places you have used, so you do not put the insulin in the same place all the time. Ask your doctor for a chart.

• Keep your shots 1 inch away from scars and 2 inches away from your navel.
• DO NOT put a shot in a spot that is bruised, swollen, or tender.

The site you choose for the injection should be clean and dry. If your skin is visibly dirty, clean it with soap and water. DO NOT use an alcohol wipe on your injection site.

The insulin needs to go into the fat layer under the skin.

• Pinch the skin and put the needle in at a 45º angle.
• If your tissues are thick enough, you may be able to inject straight up and down (90º angle). Check with your health care provider before doing this.
• Push the needle all the way into the skin. Let go of the pinched skin. Inject the insulin slowly and steadily until it is all in.
• Leave the syringe in place for 5 seconds after injecting.

Pull the needle out at the same angle it went in. Put the syringe down. There is no need to recap it. If insulin tends to leak from your injection site, press the injection site for a few seconds after the injection. If this happens often, check with your health care provider.

Place the needle and syringe in a safe hard container. Close the container, and keep it safely away from children and animals. Never reuse needles or syringes.

WOAH! Lots of stuff right?! I can assure you my next post wont be this long, but this is all information I need to know for my field. Next post will explain the steps I took and my experience :)

Week 2 Blog #2

Week 2 January 11-17
Sunday, January 17, 2016 
2p-10p 8 Hours Interned

Today was a good day! Got to do the medication administration for the entire shift. There was a lot of double checks and comparisons to be done between the med carts medications and medication administration record (MAR). On the med cart there are little bins for each Sister that have rolls of pills in little packages for them. SLC receives the pill roll of medications for the entire week for each Sister. Each pill packet has certain medications in it with the date, name of medication, and the dosage. You then have to compare the information on this packets against the MAR to make sure it is the right med and then administer it during the allotted time frame to take it. It was a lot of double checking and back and forth. Certain medications could only be given as long as the Sister's pulse was above a certain range, blood pressure was in a certain range, systolic pressure above or below this range, diastolic pressure above or below that range, on an empty stomach, and so forth! Working as a CNA and watching the nurses administer the medications looked like a walk in the park! They just "popped pills" and handed them out! Didn't seem to difficult! But all these checks makes it very time consuming! I didn't realize all this! Obviously this is important because if the wrong med is given under abnormal circumstances, given to the wrong Sister and have an adverse reaction with another one of their meds, etc. this can be life threatening! So if there was a difference between the MAR and the pills in the packets (thank God there wasn't on my first med pass), we have to refer to a doctors order to triple check it! If we have the wrong medication compared to the doctor's order, we have to contact the pharmacy which delivers the medications (Grane pharmacy) and have them bring over a "stat" medication, fax over the doctor's order so they can check it, and have it changed! Its a lot of book work and checking! It's almost overwhelming! But everyone there has assured me that in time when I become more familiar with the medications and the Sister's, it will get easier. Just going to take practice! They were so nice! Any question I had they answered it and explained why. Didn't make it seem like I was inconveniencing them and was more that willing to help! Also, after researching insulin and how to administer it (that blog will be next week), I got the chance to do my first insulin injection! It was kind of scary, never poked anyone with a needle before, my hands were shaky drawing up the insulin, trying to remember the steps because there is a proper and sterile technique to it.... it was nerve wrecking! But got through it! The Sister told me she didn't even feel a thing! I don't know if she said that just because she was being nice and knew I was nervous, but it was very sweet of her :) It was a good day!

Week 2 Blog #1

Week 2 January 11-17
Friday, January 15, 2016 
4p-8p 4 Hours Interned


Objective #1:
1. Will demonstrate proper technique and knowledge of possible anatomical sites to use for the          administration of insulin

Probably should explain why insulin is important and give some background about it before spitting out the steps to insulin administration. I would want to know what I am administering and why before doing it! If not, people would be giving out random drugs for no apparent reason! Will be explaining some insulin deficient disease (Type 1 Diabetes and Type 2 Diabetes), some terminology associated with these diseases, the needles used to administer insulin, and the anatomical sites where we allowed to administer insulin and why.

Insulin is a hormone made in the body by beta cells found in the pancreas. It's main function is to use ingested glucose (sugar) as energy or store it for later use. All cells of the body need energy and get this energy from glucose. But glucose can not go directly into the cell. This is where insulin comes into play! When there is an increase in one's blood sugar levels, insulin is released from the pancreas into the bloodstream and attaches to cells. This signals the cells to absorb the sugar from the blood stream and can be used for energy. If there is too much sugar in the bloodstream, insulin will store the excess glucose in the liver and release it when your blood sugar is low and you need more energy. Moral of story, insulin helps your body maintain its blood sugar levels. This little dude is kind of important :)

So what happens when we don't have insulin? A person can become hyperglycemic or hypoglycemic. Hyperglycemia is when an individual has too much sugar in their blood stream. And hypoglycemia is when an individual has too little sugar in their blood stream. There are two circumstances when someone will need insulin. Type 1 diabetes and Type 2 diabetes.
Type 1 Diabetes - This group of individuals are not able to make insulin because the beta cells of their pancreas are damage or destroyed.
Type 2 Diabetes - This group if individuals' cells are resistant to insulin.
So what do we do for these people? The people with Type 1 Diabetes have to have insulin injections to help their bodies process glucose and prevent hyperglycemia. The people with type 2 diabetes pancreas still produces insulin, but the cells are resistant to insulin, thus, are inefficient at regulating glucose AND the other cells for storage are inefficient at absorbing glucose.

In essence, insulin is a very important hormone that is needed in the body. If an individual has either Type 1 Diabetes or Type 2 Diabetes they will need to have insulin administered to maintain proper levels of sugar in their blood stream to prevent hyperglycemia or hypoglycemia. There are different types of insulin such as rapid, slow, intermediate, and long acting insulins. The following is a description of their functions:

• Rapid-acting insulin: It starts working approximately 15 minutes after injection and peaks at approximately 1 hour but continues to work for two to four hours. This is usually taken before a meal and in addition to a long-acting insulin.
• Short-acting insulin: It starts working approximately 30 minutes after injection and peaks at approximately 2 to 3 hours but will continue to work for three to six hours. It is usually given before a meal and in addition to a long-acting insulin.
• Intermediate-acting insulin: It starts working approximately 2 to 4 hours after injection and peaks approximately 4 to 12 hours later and continues to work for 12-18 hours. It is usually taken twice a day and in addition to a rapid- or short-acting insulin. 
• Long-acting insulin: It starts working after several hours after injection and works for approximately 24 hours. If necessary, it is often used in combination with rapid- or short-acting insulin.

Info obtained from http://www.endocrineweb.com/conditions/type-1-diabetes/what-insulin 

Insulin needs to be administered in particular sites due to its absorption rate. It needs to be injected into subcutaneous tissue (the irregular connective tissue right under the skin containing primarily fat cells). The most common sites of the injection of insulin are the posterior part of the upper arm, anterior and lateral part of the thigh, buttocks, and abdomen (two inch radius from navel). The abdomen is the fastest absorbing site. You also have to rotate sites.

Insulin is also measured in a special type of measurement. It is measure in units and not mL or grams like other medications. Because of this and the desired tissue level insulin has to be administered to, insulin injections are given with a particular type of syringe made to measure units, of a certain length, and thickness (gauge). 

Possible syringes to use for the administration of insulin are:

Syringes come in different sizes based on the amount of units desired to administer:
• Each line on a 100-unit syringe marks 2 units of insulin. 
• Each line on a 50-unit or 30-unit syringe marks 1 unit of insulin.
• Use a 30-unit syringe if you take 30 units of insulin or less. 
• Use a 50-unit syringe if you take 50 units of insulin or less. 
• Use a syringe that shows 1/2-unit marks if you need 1/2 a unit of insulin.

The needles come in different lengths and thickness. Side note, the thinner the needle, the higher its gauge. Seems backwards but I didn't design them! For example, a 31-gauge needle is thinner than a 28-gauge needle. And has to be one of the following:
• The standard needle is 1/2-inch long. 
• Needles also come in 5/16-inch and 3/16-inch lengths. 
• The 3/16-inch length is often used for children
• A gauge between 28-31.

Info obtained from http://clinicians.org/images/upload/Insulin_Handout_3.pdf

Week 1 Blog #2

Week 1 January 4-10
Saturday, January 9, 2016 
4p-8p 4 Hours Interned

On the weekends Sue Bland is not at work and should probably describe the shifts at SCN which are:
6a-2p
2p-10p
10p-6a
Based on my class schedule and availability, I will be interning during 6a-2p and 2p-10p shifts on weekends and half shifts (4p-8p) after class during the week or on weekends. Sue Bland works Monday-Friday 8a-4p so anytime our times overlap we will be touching base on my progress towards achieving my objectives, ask questions, and plan the next plan of action towards achieving my objectives. During the time that I am there and not with Sue, I will be under the supervision and guidance of other nurses who have also been more than willing in helping me! So far so good, everyone has been great!

So back to my time on Saturday, January 9, 2016. This day was more hands on activity with the Sisters. Similar type work to which I have done in the past as a CNA at other facilities. Getting familiarized with the Sisters, their routines, watching, following, and learning what the staff did for the Sisters, etc.. We served the Sisters supper, administered supper time meds (nurses pulled the meds  from the medcart and then I was able to physically give them under the nurses supervision to the Sister's. Never able to do this before!), gave baths, helped the Sisters to bed, and administered bedtime meds. After that, we had some down time in which I asked questions about things I had observed, how to do certain tasks, and other general questions. Since I have been at SCN, I have only interned half shifts (4p-8p) so it is a bit difficult to learning how to fully administer (pull from med cart, check the medication administration record, chart, etc.) during this small time frame. I was told that as soon as a did a full 8 hour shift, either during 6a-2p or 2p-10p we would go into greater depth then. Cant wait!

On a side note, it was interesting that the Sisters called dinner time "supper time". They start their day with breakfast at 8am, have "dinner" at 12pm, and "supper" at 5pm. I just found it funny lol! They have "dinner" at what most others would call lunch. I guess supper and dinner can be used interchangeably, so that's not too out of the norm, but found it funny them calling lunch "dinner".

Anyways, after all the Sisters bellies were filled, drugged up, tucked into bed, and had questions answered, the rest of the night I tried to organize my objectives. Although I only have 3, there are many "subsections" to them. So to balance them out over the 15 week (16 weeks if you include finals week) semester, I tried to break the objectives up over the allotted time frame. So hopefully if all goes as planned, this is obviously subject to change, but this is a rough breakdown of what to expect from my blogging over the Spring 2016 semester (plus its a good outline for me to keep tract of what I'm suppose to be doing!):

Week 1: Introduction to SCN and duties
Week 2: Background of insulin. What is it? What is it used for? Why? Anatomical sites for                            administration.
Week 3: Steps to proper administration of insulin.
Week 4: CMP test. What is it? What is it used for? When is it taken? What does it evaluate? The                  tests functions?
Week 5: CMP test results. What are the tests range norms?
Week 6: CMP test results. Abnormal values.
Week 7: CMP abnormalities related to the disease process. What do these abnormal values                        indicate?
Week 8: CMP abnormal values. Signs and symptoms the patient may demonstrate.
Week 9: CBC/diff test. What is it? What is it used for? When is it taken? What does it evaluate?                   The tests functions?
Week 10: CBC/diff test results. What are the tests range norms?
Week 11: CBC/diff test results. Abnormal values.
Week 12: CBC/diff abnormalities related to the disease process. What do these abnormal values                  indicate?
Week 13: CBC/diff abnormal values. Signs and symptoms the patient may demonstrate.
Week 14: Pharmacotherapeutics and pharmacodynamics of the first 6 (of 12) most commonly                        prescribed drugs at SCN.
Week 15: Pharmacotherapeutics and pharmacodynamics of the remaining 6 (of 12) most                             commonly prescribed drugs at SCN. Drugs adverse effects.
Week 16 (finals week): Reflection of internship. Drugs adverse effects.

As said in an earlier post, because SCN is not ran by the state I can do particular duties under their supervision. Along with these objectives, I will be getting the opportunity to learn many other skills! So during these blogs in the weeks to come, I may add some other interesting experiences in addition to the objectives listed above! This is going to be an exciting semester!

Week 1 Blog #1

Week 1 January 4-10
Friday, January 8, 2016 
4p-8p 4 Hours Interned

This day I met with Sue Bland and we went over the objectives to be achieved during this internship. I was introduced to the staff, Sister's of Saint Louise Convent (SCN), and was familiarized with how their organization worked. Because Saint Louise Convent is not ran by the state I am able to do duties such as medication administration, take Dr.'s orders, have access the Sisters charts, etc. without being a licensed RN, Nurse Practitioner, Physician Assistant, and so forth. I am currently a certified nursing assistant (CNA) and am aware of these duties. But as a CNA, they are all duties outside of my scope of practice. This is going to be a great opportunity to apply my knowledge and newly learned knowledge to practice! Everyone seemed more than willing to help me with learning their system and in helping me achieve my objectives! I am looking forward to this opportunity!

Spring 2016 Internship

Starting this blog as a requirement to my Spring 2016 Internship for Chatham University. I will be interning a minimum of 120 hours over the course of the semester at Saint Louise Convent under the supervision of Sue Bland RN Manager. I am required to do a biweekly blog based on objectives I am to achieve. I will be posting the dates and hours interned at Saint Louise Convent in my post title to record my progress. My internship started last week and because my internship agreement wasn't finalized until Friday nor did I have a blog set up. I will be blogging an additional two blogs this week to make up for the blogs not written last. Just an explanation as to why the dates to post's title will not be matching that actual post date.

Here are the three objectives I will achieve and be reporting about over the Spring 2016 semester:

1. Will demonstrate proper technique and knowledge of possible anatomical sites to use for the          administration of insulin

2. Will verbally demonstrate knowledge of tests included in a CMP and CBC/diff including                  abnormalities, what disease process they might indicate and possible signs and symptoms            that the patient might demonstrate given these values.

3. After being provided with a list of the 12 most commonly prescribed drugs at our facility, Robin      will be able to verbally demonstrate knowledge of their pharmacotherapeutics,                                pharmacodynamics, and adverse effects.

A lot of info to research, memorize, and apply to practice. But this will all be very beneficial info to know (and am required to) to go into the medical field. This is all info I will be applying to practice in my career. Fun stuff :)