Alert & Oriented :: N30040 :: Clinical Journal Entry #27

Today was our second day at the nursing home. We began the morning at 0700, and I found my patient wide awake, sitting in her chair beside her already-made bed, ready to start her day. She was in her 80s with Parkinson's disease, fall risk, diabetes, arthritis, hypertension, and osteoporosis. Nothing unusual. She could walk with a walker and seemed to be as independent as nursing home residents come.

Today was "case study patient" day because my instructor wanted to find us all patients that were actually alert and oriented, able to answer our questions and participate in data sharing. After this week, we may or may not have a patient who can talk, feed himself/herself, walk, etc., and papers take time, so we appreciated her thoughtfulness in letting us get the paper data done the first week.  (And before spring break!)

I completed a head-to-toe assessment and gathered information for my case study paper before my patient seemed to be aggravated by all of the questions, so I left to get my remaining data out of her chart.

The hallways were insane.

The words "Joint Commission" could be heard in every direction. Yep, JCAHO was here.

Not only that, but the nursing home was planning a big open house for the afternoon to showcase their kidney dialysis center, now open to out-patients. So we had banquet prep going on (meat carving, huge bouquets, tablecloths...) , a mob of business suits and clipboards standing over every shoulder and peering into every room, and a massive wave of nurses and support staff on the edge of panic attacks, making sure everything was done with extra care and left in extra pristine condition.

Thankfully, our instructor helped us steer clear of JCAHO since we're not licenced or employees of the Center anyways, and unfortunately for me, my patient was very independent and did not require any nursing treatments or interventions. She did not want to participate in any of the Center’s planned daily activities (Movie Matinee, Reminiscing Hour, and Wheelchair Exercise? Come on!) and turned down every other idea I could come up with, so I spent the rest of my time answering other patients’ call lights, working on my case study, and learning how to flush a PICC line with saline and heparin.

That's pretty much it.

Wait, that is it.

Told you this rotation is boring.

Oh, and for the journal that my instructor is requiring us to keep, I chose to visit a website as this week's "requirement." I went to Parkinson.org to learn more about my patient's disease (after all, she seemed to be pretty healthy for being in her 80s). I was surprised to find that in addition to, or maybe instead of, her osteoporosis and arthritis, this disease could be the contributor to her history of falling and a good reason she was in the nursing home. For all of you curious minds, according to the website, Parkinson’s disease is diagnosed by having four main motor symptoms: shaking/tremors, bradykinesia, stiff arms, legs, or trunk, and postural instability. Throughout the course of the day, my patient seemed to suffer from depression and anxiety, and those are also symptoms of Parkinson’s disease. Parkinson’s can also cause things like decreased reflexes, loss of facial expression, dandruff, and muffled speech, but my patient did not exhibit any of those symptoms. I learned that the average age of diagnosis is 62, but if diagnosed before age 50, the disease progresses slower. I was surprised to find out that 10% of Parkinson’s disease patients are under 40.

And with that, I can now begin my case study paper that will suck up the next month and a half of my life.  :)

Next week is spring break, and I am not looking forward to the following several weeks at the nursing home simply because how long and boring they are. These days are hard enough for me physically, and when they're boring and seem to go on forever, I come home a complete wreck. All I can think of is, if we took all of the coherent patients today, that means we get the dementia floor and the other fun stuff next time...

As I've said before, I love older people. They're amazing sources of knowledge and perspective and have great stories. But I'm burnt out, tired, and not into the kind of nursing that involves lifting people up in bed, feeding them, cleaning up their incontinence for ten hours straight without a single needle, line, IV, wound, test, etc.  Plus, the Center is full of aides who do those sorts of tasks much better, faster, and probably safer than we nursing students.  Oh, and these patients are literally on dozens of meds, so our instructor only has time to pass meds with two students per day.  The point? Unless it's our one day to pass meds, we don't even do that. Not complaining, just wanting to be spending my time learning things and keeping busy.

And for the record, I don't care if my next patient is in a coma - we are going to Movie Matinee at 1:30 in the dining room!!