Tag Archives: SJCME

Apr8

I’m Baaaaaaack!

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Wow, I can’t believe I haven’t posted since August.  If I had waited much longer, I would be posting as a newly graduated nurse practitioner!  I have recently finished my second clinical rotation.  I start my third and final clinical rotation on May 1st and will be completed by the first week of August.  It really hasn’t started to sink in, yet.  I don’t think it will until I have those three little letters behind my name!

I have received a lot of messages and comments from you guys– thank you very much!  I did want to address a few things.  Several have asked, so I will clarify:  I am currently enrolled in the FNP program at Saint Joseph’s College of Maine.  Many have also asked if I would post or e-mail a concept map.  Unfortunately, I cannot do that due to the rules of academic integrity.  Actually SJCME recently lost a few students due to just that.

However, I will share how I set up my concept maps, which is COMPLETELY different than other concept maps that I have seen online and otherwise.  I can’t do spider-web concept maps with lines all over the place– so if that’s your style, I am no help there!  There is no room for spider-web concept maps in the person that is moderately OCD.  They’re messy, ugly, and I hate them :) .  Seriously, it goes it against my entire BEING!!  I need straight lines, symmetry, and color coordination.  I ended up with an A, so it works.

I’m going to post an example template.  Bear in mind, I used to use the dabbleboard program, which was clean with pretty lines.  They’ve since shut down.  I recommend Lucidchart, which is what I used to make this example in about 6 minutes.  It’s not pretty, but it’s just to show you how I set up mine.  I set up my concept maps using color– I use green lettering (for example) to show that the case study demonstrated this positive finding.  I use yellow arrows to correlate two concepts, so it doesn’t get too ugly.

Lucidchart lets you use shapes, colors, funky arrows, text, etc.  It takes some playing around with.  And hey– if you like spider webs, they have a great tool for that too.  You can click on this to open it in a new page and enlarge it.  My concept maps have always been quite large (obviously, the one below is a very quick one… mine get HUGE.  I spent way too much time on them).

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Anyway, I’ll post again later with updates and clinical tips!  Hope you’re all doing well :)

Jul16

Health Assessment

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Random tips for completing the history assessment during the patient interview.

Interviewing

Apologize immediately when wait has been long. Sit down, don’t look at watch or act hurried.

Balance of empathy, listening, and structure.

Active listening, documenting during the interview.

Sit down, lean forward, state: “The nurse mentioned that you’re having this problem. Tell me the story.” Actively listen while giving patient one minute to speak.

“I’m sorry that I have to do this, but I have to make notes while we’re talking so that future providers know…”

Patients are the best experts on the terms of their own culture—ask them about it.  Variations include ethnicity, economic status, religion, age and gender.

If history is not taken well, data may be skewed or incomplete.

Don’t make assumptions about patients, such as “I’m sure you’re not a smoker.”

Be sure to ask patient if it is okay to speak with family member in room. Focus on patient, not family member. Be sure to have family member leave room temporarily at some point.

Warn patient when you’re about to ask of sensitive questions.

“That’s big news” is not negative or positive, it allows patient to process big information such as pregnancy, cancer.  No value is attached to the event/diagnosis/etc.

Don’t talk about your self. Don’t try to relate with life events such as deaths, etc.

Take time for self-reflection. What are you anxious about?

Review chart before going in room, establish if you have seen patient before.

Don’t introduce yourself and shake hands if you’ve met this patient before.

Be aware of how you dress; be professional.

Be aware of “failure of the therapeutic relationship.” Litigious, threatening, noncompliant people are examples of patients to avoid involvement with.

Avoid marginalizing patient based on narcotics, drug use, etc, etc.

If you must document on electronic record, have the patient sit next to you and explain “I must carefully document everything we discuss so that during future visits, we’re able to identify changes to body systems over time.”

 

Interview Environment

Place patient in front of wall to bounce sound off of—increases hearing.

Do not sit directly in front of patient as it is confrontational.

Have blankets in exam room if it is a cold environment.

 

Symptom Analysis

During the interview, you are completing a ROS; sometimes you have several complaints that are uncovered when the visit lasts for only 30 minutes.  To help address symptoms, use:

7 attributes of a symptom: location, quality, quantity or severity, timing, setting, remitting/exacerbating factors, and associated manifestation’s.

One way to differentiate viral from bacterial illness is to obtain CBC with differential.  If the lymphocyte count is elevated, the organism is likely viral.

 

Tavistock Principles

Rights: People have a right to health and health care.

Balance: Health of the population should be balanced with the health of individuals.

Comprehensiveness: Ease suffering, minimize disability, prevent disease, promote health.

Cooperation: Essential among patients, providers, and the system.

Improvement: Serious responsibility

Safety: Do no harm to patient or self.

Openness: Being open, honest, trustworthy is vital in health care. Don’t keep errors to yourself, may result in poor outcomes. (Lido & epi in Rocephin IM accident).

 

Sexuality

Must confront patient regarding sexual advances/jokes. Don’t assume that it’s okay, because a problem may come up again in the future.

Reflect on your own behavior.

Jul14

“You can swallow a quarter, as long as….

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…as long as it gives you dimes and a nickel on the way out” –Physician guest speaker at SJCME.

ImageJust had my skills workshop on campus in Maine!  Here are a few highlights. A quarter is about the biggest foreign object that a child can safely pass… but that’s pushing it.

Xylocaine with epi has been shown in studies to be nearly as safe as plain xylocaine… however, my instructor strongly urges us not to use it unless absolutely necessary due to the risk of necrosis, especially on fingertips and toes. 2% lidocaine is perfect for adults, no more than 1% for children.  A tourniquet can be left on for approx 10 minutes or less to suppress bleeding in lieu of epi.  Too much xylocaine can be toxic– 3mL is generally sufficient.  This is VERY important in children!

Pig feet are an awesome learning tool for suturing. 6.0 thread is just about the tiniest needle imaginable and should be reserved for areas such as the face.  Your sutures should be spaced apart by approximating the distance from the former suture by 1/2 the width of your previous sutures.

Punch biopsies look like you literally used a hole puncher… but you don’t. It’s this very unsophisticated (yet effective) looking tool that you twist into the skin (using local anesthetic). You need just the tiniest amount of subcutaneous fat (very tiny) for the pathologist to estimate wound depth.  Any deeper and you’re going to have increased bleeding that may require stitching. The wound is closed with silver nitrate. If it requires suturing, you have to adjust the wound to make elliptical shape for closure.

If you have MDConsult, 5 Minute Consult, Ferri’s advisor, etc be sure to check their sites for instructional videos. I know 5 minute consult has excellent ones to review procedures :)  Practice, practice, practice.

I learned much more in class and will add as I go along… for now, I’m spending my vacation in Maine with my nose in textbooks!

Jul8

Ooops!

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I just got back from Colorado. It was beautiful!  It was a short business trip, courtesy of Family Heritage. We snuck away from the group with a few friends for half a day to visit Mt. Evans.  It’s a 14,000 ft mountain that you can literally drive up.  It’s a 30 minute drive from ground to top.  It was 101 in Denver, and 50 degrees on the top of the mountain! It was amazing! Beautiful sights!  Of course, I was doing pathophysiology and pharmacology during his meetings and any chance I got. We just returned home a few days ago and then I’m off to Maine in 2 days! Busy, busy.

Pathophysiology is nearly done… I’m just a few critical thinking questions away. Hallelujah!!  I’ve never been so excited to move on to the next course :)  I found a preceptor and hope to start this September for clinicals. I just have a few MAJOR, CRAZY goals to hit to make that happen!  Pharmacology is underway, and health assessment will be started when I travel to Maine this week.  I’m doing a workshop for suturing, I&Ds, x-ray interpretation, etc.  I’m such a nerd… I’m more excited about a edu-vacation than I was when I went to Colorado without any forced learning :)  I think it’s nice sometimes to just have a break away from work, other people having fun, and feeling like you’re letting your loved ones down because you’re buried in a book!  In Maine… I won’t have to excuse myself for studying  :)  And what better place to celebrate with a few drinks for finishing pathophysiology?

Anyways,

I’m back on hiatus for another 2 weeks. Other students… feel free to let us know how your program is going & any helpful hints that you’ve found!  When I’m back from Maine, I hope to share a lot of what I’ve learned in the skills workshop and health assessment!!

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