I’m writing this entry for myself, as I often forget my tips from previous tests to use in my next test. It’ll be great if you find them helpful for you, too .

To get good grades:

• When I study, study to get 100%…of course I never finish my studying to be confident that I could get 100%, this is just to motivate myself, KEEP STUDYING)
• When I’m about to take the exam, imagine that I’m gonna get only 85% and still feel ok with that —> relax –> less anxiety, better grade.

So, the idea is to convince yourself that it’s ok to get a lower grade than you expected, RELAX ^^…

(Don’t be too relax that you on the exam like me once , I got bad grade for that one for being too anxious at first, and too relaxed at last. I find out I got 100% any time I did not want it badly, wish I could be calm and got luck more often.)

Don’t change my answer if I:

• have no idea about the topic
• don’t have a really good reason for the change

Change my answer if I:

• recognize I misunderstood the question and find the other choice correct
• find a part of my first choice is wrong

If I think all options given are wrong and can’t choose one:

• choose the one that even if it’s wrong, it’ll do the least harm.

If I think all problems given can be right to be serious:

• Choose the one that is most acute and require immediate attention (usually mental status involved)

If I have no idea about the topic:

• Eliminate those answers that can be in the same group (lab tests for the same purpose, same group of disease…), look for common points

Will add more if I can think of something else . Do you have any tip that can help me? Please share them .

My mood is down now, you should not read, because I’m gonna whine a lot in this entry, and my whining will probably make you sick haha.

What was my impression? Oh, my feeling was not good, it’s gonna be worse than mom-baby clinical. The instructor looked serious. She rarely smiled. The facility did not look that great: small, and well…not a warm and welcomed place. There are tons of paperwork that need to be filled out while on the floor: care plan, patient profile, med, psycho- social assessment…. can’t believe it. The assignment are not clear, and as my med-surg clinical last semester, there will be a lot to prepare before the day.

I was on Labor and Delivery Unit. I expected to observe a vaginal birth, but there was none going on. The unit was slower than usual. There was only about 4 clients in the morning, and one of them did not want to have students. I was hanging around for a while, and then helped Kim prepare for a C-section of twin.

I observed tubal ligation with spinal anesthesia. The doctor gave me a quiz. Unfortunately, I forgot what 5% solution mean, so I got it wrong. Now I would remember for life, hopefully, that 5% solution means there is 5 g of drug in every 100 mL solution. He also taught me a way to calculate the dosage quickly. The surgeon made a short cut at the client’s umbilical area. I imagined after the incision healed, no one would notice any scar on the client, as it would be hidden with the umbilical skinfold. “That’s nice,” I thought. After pulling the tube out on one side, the surgeon tied it 3 times, cut it off, and did the same to the other side. I guessed the woman would have a lot of pain after all this pulling.

I also went into a ultrasound session. The parents came to have their fetus checked because they suspected their son was arrhythmic. The doctor said he was fine. He just turned around a lot. It was interesting for me to look at the ultrasound monitor. I could not tell one thing from the other, as everything was just black and white. Then while the doctor was explaining what was on the screen to the parents, I could see the fetal heart beating. That was eciting.

After lunch, I went to my third C-section. The client had twin. The same anesthestist gave the client an epidural anesthesia. Spinal and epidural anesthesia procedures looked the same for me. I could not tell which one is which by observing only. I took care of baby B and gave her medications. I did not have a chance to do her first bath, as her temperature was still low when I left.

Although there was not much going on in the early morning, it was another good day for me toward the end. So far, I haven’t done any Foley Catheter insertion, and haven’t seen hearing test, and vaginal birth. I hope I’ll have a chance next week.

Hic hic, hôm nay lại có dịp đi chơi mà N lại ko tham gia được, tiếc quá đi thôi. Thứ hai là quiz, 2 tuần liên tiếp có 3 exams, pharmacology, med-surg, maternal…môn nào cũng hay mà khó nuốt, ực ực. Còn cái paper chưa viết, cái project chưa đánh máy,…ko dám nhìn vô cái schedule nữa…

…need to manage time better soon, ko thì bị tẩu hỏa nhập ma mất, …Stress is when you know exactly what to do, but don’t do it. I can, and will do it, yeah!

This week’s clinical day was more as an observation day for me. I followed S.J. to assess a baby, and this time it was not as easy for me to listen to the baby’s breath sounds. This baby’s heart beats were not as strong and clear as other babies I had, so it’s harder to listen to his breath sounds.

Then the mom tried to breastfeed her baby as much as she could before the baby had circumcision. It was difficult at first. A staff lactation nurse was called to assist her. I was there and learned some good information.

Then I collected the data for my project for almost the rest of my time. I learned to understand the information presented in the mom and baby’s charts. There are rich details from the charts.

After lunch, the nurse let me see how she removed the surgical staples from a C-section mom. It looks a little scary and seems to be painful for the mom. Anyway, she was fine after the procedure.

It was not a hands-on day for me, but still a good educational day. I learned a lot about finding information from the charts, and it was great to be able to understand what I read.

Hum, I’m searching resourses for my paper in maternal nursing class. Over the last hour, I found a bunch. This should be a good start.

This week’s clinical was another fantastic day for me. I got to see 2 Cesarean sections. The nurses were very good in explaining things and let me have some hands-on experience.

The first C-section case I saw was carried out because the baby was in a breech position. There was a mistake among the caring team that the mom had twins, until C. greeted the parents saying “babies”, the father corrected the nurse that they were going to have a “baby”. I followed A. while she prepared a lot of paperwork. The mom needed to sign the consents for her surgery, any treatments (if necessary) for her baby and herself, disclosure of information, hepatitis B shot for her baby. Then A. put a gel on the mom’s abdomen, put a monitor on to monitor the baby’s heart beat. She also gave the mom medication that prevents vomiting, and something else that was put in her IV, and shaved her lower abdomen where the doctor would make an incision. Then we went to the operating room to preprare identification bands, other paperwork, and count the surgical items.
 

Then the mother was brought to the room. An anesthesiologist gave her epidural anesthetic. I was there to observe the whole process since the physician made the first cut until the incision was sutured. The baby did not cry much when she got out, but in the end, she was healthy. During and after the C-section, we counted the surgical items 3 more times.

Then the mother was brought back to her room. We checked her vital signs every 15 minutes. I was allowed to check her bleeding by pushing and cupped her fundus. There was moderate bleeding immediately after surgery, and on my second check, there was no obvious bleeding.

I have heard before about instances when a wrong patient was brought for a procedure by mistake, or surgical item was forgotten in the patient body. That’s very bad. Observing the nurses check on the patient’s name and her reason for being here several time, and the time out (when the patient’s identity was check for the last time right before the surgery), and the counting for 4 times made me feel that it’s safe for the clients here.

Then I switch with M. to care for a newborn. I was taught to bathe her, hold her like a football to shampoo her hair under the running water. Then bathed the rest of her body trying to remove as much of the vernix as possible. Then I checked her blood sugar 2 times (as far as I remember, she was preterm, so we had to check her blood sugar for 6 times every 15”, then every hour), and did other vital signs. I was so excited that I could listen to the baby’s breath sound this time. The duration of a baby’s breath sounds is extremely short compared to an adult’s breath sounds, so I hardly recognized them at first.

Around noon, I followed nurse C. who was the “baby-catcher”. In this second C-section that I saw, the baby was in transverse position. It was determined to be in breech position until the mother was on the surgical table. This time instead of following the mom, I went after the baby. So C. made sure all the items needed to take good care of the newborn were in good working condition. Right after birth, the nurse and a neonatologist wiped off and assessed the newborn. The father refused to cut the newborn’s cord, so I had the chance to do it. Then back to the patient room, beside doing vital signs, I gave the baby vitamin K and hepatitis B intramuscular injections, and applied the antibiotic eye drops.  

I had a great educational day, and I look forward to the next one.

I often feel so overwhelmed just to think about what I need to learn. It seems that the more I study, the less I know. I felt pretty good after high school, that I knew quite a bit. Now I felt more and more stupid (at least I’m glad to realize that, and be modest).

Socially, I don’t know all the situations in which I should be myself, and when I should follow other people. Also, there are tons of good books that I haven’t read, millions of things I’d like to be knowledgeable about.

I know I was weird (vo duyen) some times. The other times, after I said something, I knew right away that the person would not interpret it the way I wanted, but I was not quick enough to correct myself. I was stressful and so eager to learn to be better as fast as possible. I expected myself to always say and act right, so I became shy and scared to speak up. Probably I need to accept that I’m gonna act weird over time, learn from each of them, and hope that those who are important to me will understand me. Just relax, and be natural.

Well, I guess I should break down the things I need to learn FIRST, and be happy if tomorrow I know more than today ^_^.

Today I had a totally different experience from last week at Neonatal Intensive Care Unit. I had more hands-on experiences with the babies, simple things such as checking their vital signs, and feeding them, but made me feel so good. They are such little cute babies.

First of all, I listened to the shift report with my nurse, B. Listening to the shift report is still a challenge for me, especially with the relatively noisy background with other group reports and all the beeping from the monitors.  Abbreviated medical terms were used. I would need to read and learn a lot more to understand these terms faster. Fortunately, B, my nurse today, was very nice and clear in answering all my questions. She also showed me how to do computerized charting. I like the way it works. Everything can be chosen from a list of descriptive options. That ensured professional medical records for all patients. The nurses could also write their own notes when necessary.

Another nurse showed me how to calculate the medication. I was surprised to see the medication work sheets in the patients’ chart books. On the sheet, the nurses carefully wrote down every calculation which ensured correct dose of the medication to be administered, and had their names signed at the end which showed accountability.

Then I did assessment on the babies. When I put the thermometer in the axillary and hold their arms in place, they grimaced and winged their arms to get rid of the thermometer. Then I checked their blood pressures with the little cuffs, listened to their heart tones, breath & bowel sounds. I could hear their heart beats all over the chest wall and even down their abdominal. That made it hard to listen to their breath sounds and bowel sounds.

I felt great when I could actually practice the mummy restraint (the way we wrap the babies), change the diapers, hold and feed them. They looked small but could be heavy to hold over time. The nurse taught me how to adjust and position my arms with a pillow on the side of the chair’s arm to get more comfort.

Before I left for post conference, I got the chance to observe the insertion of a PICC line. A newborn baby girl was sepsis with E. coli that could damage her brain. To my surprise, the baby looked perfectly healthy. Unfortunately, she had to be treated with strong antibiotics for 3 weeks, and she had 2 more weeks left. Her IV line was infiltrated. She had to received her medication intramuscular on her thighs in the morning. Because her medications were very strong, they had to be given IV (even the old IV line could not stand the antibiotics), so a new one was inserted by a nurse (C.) specialized in IV insertion in the afternoon. I helped change her diaper and feed her, get her ready for the procedure. She screamed loudly and pulled back her extremities hardly whenever C. touch her arms and heels to find good vessels, as if she knew so well what was going to happen to her. Probably she gained the unpleasant experience from the previous procedure. It did look painful when C. inserted the needle and tried to place it into the baby’s vessel. Poor baby!

NICU did not seem like an intensive care unit today. It might be slow (no trauma and running), but I still got busy with baby feeding which took quite some time, and practicing reading the charts to find information for my care plan project. I had a great day with full of hands-on experiences and observation.