Thanksgiving post and pics to come, I promise. Been a crazy busy but good week at school I don't want to write much, but don't want to forget my experiences. Thus bullets!

• Leadership is over and I think I got 100% in the class. woot. Also didn't pass their ATI practice test - the first time this whole program. What does that tell us about the class?
• Tuesday in outpatient dialysis. Pretty boring on the whole, but I have a better understanding of renal function and got to help set-up dialysis, blood draws, and talked about transplants.
• Wed/Thur two GREAT clinical days. Cared for two kiddos both days.
• First an 11 month old, hepatoblastoma, here for fever and neutropenia (FN). Tiny kid, was twin-twin transfusion in utero (both survived, he's the small one). Had necrotizing enterocolitis, has a J-tube in place. Been vomiting up all his feeds until today, when he kept down a lot of PO as well as gavage overnight. Yea!
  
• Second a 19 year old guy with ALL (a leukemia) also in for FN. Really skinny and malnourished as well. Had him eating more by the second day and doing a lot better
• Basic care for both: give antibiotics, pain meds (dronabinol for one, or as my nurse said "the ganja pill"), get food down, measure pee and poop, vitals, and gown-up every entrance since both were on droplet isolation.
  
• Also got to see a lumbar puncture - it's like maple syrup dripping out of a tree!
• Worked with the same great nurse as last time. She and my instructor are so encouraging and I had many chances to shine. I feel like I got the adult equivelent of gold star stickers all day.
• It snowed today! White out conditions made my preceptor late - she lives in the mtns and it took her 3.5 hours to get here.
• I got to work with a non-floor nurse for a couple hours (more gold stars) and do more independent care. I felt like I took the lead!
• Kids get the coolest stuff. Marshmallow shooters that act as incentive spirometers. "Beads of Courage" that they collect for a necklace - a different colored bead for each type of procedure like transfusions, chemo treatment, etc. My nurse said while I was in my clinical conference she went in the OR to help place a broviac in a teddy bear! They let the little girl scrub-in and help the surgeon place a central line in the teddy's chest along with a bag of fluid so she can flush and draw blood from her own toy. I told my preceptor that if the do one next week to make sure I get to assist.
  
• The snow was swirly outside the windows. When I walked out to my car at the end of my shift I could see it was the perfect picture-book crystals that sparkle like glitter in the parking lights.
  
• There are Christmas decorations all over the hospital and I love it! We gave one of our kids a stocking of cherry candy canes because he hates peppermint ones. A singer came to the floor and serenaded us with carols.
• I'm dead tired after three shifts in a row (8, 12, 12) but I'm on a high from it going so well. My back is pinched and I have so much homework that tomorrow won't be a day off at all.
  

• But I came home to this:

• Ben is so fantastic. He had decorations up, dinner hot on the stove, and Christmas swing music playing when I walked in the door. I love my man. I'm getting so excited for break and for the holiday. One week to go!
  

Remember way back when Amanda and I got fabric to make kitties? And then she made hers in a reasonable time-frame? Well I finally finished mine. Behold!


The little guy's purple nose is hard to see. I'll probably replace it with some peach felt. Otherwise I like them very much!

.flickr-photo { border: solid 2px #000000; }.flickr-yourcomment { }.flickr-frame { text-align: left; padding: 3px; }.flickr-caption { font-size: 0.8em; margin-top: 0px; }

I had the pleasure of seeing Andy perform as Mies Gloriosous in A Funny Thing Happened on the Way to the Forum last weekend. It was a great show - the perfect part for him I think. It was a whirlwind trip but a lot of fun seeing all my mom’s side of the family. I put up some more pictures on flickr.

But then we ate them without taking pictures. So you get Demolly pictures!

Here is my 2 ounces of yarn spun on my drop spindle. I counted roughly 76 to 78 yards of single ply yarn. It is recommended that you unwind your yarn onto a chair back if you don't own a niddy-noddy. They don't mention that you should choose a chair back which is not wider at the top than in the middle. Luckily I was able to stretch my yarn over the upper corners after I discovered my error. That's Jem cowering all guilty-like because I caught her on the table, licking my bowl of chicken soup while I was away from the table. She knows that was wrong, but she can't stop herself!

After two soaks in the sink I hung my skein to dry. The wash and dry is supposed to set the twist. Sadly there isn't much I can do with 78 yards. Next time I'm at Fancy Tiger I'll check for more roving from this sheep.

Bestest. phone call. ever. I won 4 free burritos from Chipotle in their weekly drawing. YEA!!!! No cooking tonight!!

(I'm cheating on this post. We have to respond to questions in an online discussion group for class. Instead of writing a post about my week here, I'm just copying my response to the group. Mwa haha, I'm so clever).

* Describe your patient assignment this week. What was the child's diagnosis, treatment, nursing challenges?
I cared for a three year old girl with neuroblastoma. She was here for a 4 day course of chemotherapy, I cared for her on the third and fourth day. The first day she was very quiet, sleeping a lot, not feeling well. Her father was at the bedside and I get the feeling he wasn’t thrilled about that. Not involved in care. The second day her mother came in the afternoon and the girl perked up immensely. Suddenly she was all about playing and talking. Very fun and sweet.
With her chemotherapy her I&O’s are extremely important. her kidneys get blasted so you want to keep fluids going through her. We had her on D5W + ½ NS + 20 mEq KCL round the clock. We weighed her diapers and measured emesis to make sure her output was at least 45 m/hr per orders. Otherwise you replace ml per ml. She also has a strict regimen of fluids and electrolytes after her chemo, which was during the night shift so I didn’t really get to see that.

* What was your most significant thing learned during week #2? (In other words, an "aha" moment!)
First to answer some of the group’s questions, the oncology patients are here for various amounts of time. Like I said, my girl was here for a specific course and many are like that. In for a week at a time every month or two. Another child I cared for was here since he was diagnosed 9 days ago. My nurse also had a patient in the BMT (bone marrow transplant) unit so I got to shadow the care there. It was an 11 year old girl with aplastic anemia (her marrow stopped making all types of cells). She had a 10 day course of chemo, then go a transplant of stem cells from cord blood, and now was waiting for her body to respond. It can take just a week or two to work, but she’s been here in isolation for 34 days now with no response. They talked another a kid who took 120 days for his body to start producing. They also had a 18 month old kid who had been the hospital since birth. So the length of stay on our unit can vary quite a bit.
I’m not sure I had an aha moment, but obviously I’m already learning a lot about oncology care. I got tons of practice giving IV medications (working with the tubes, doing calculations). I also had some variety with my little 3 year old – getting assessments while she sleeps and getting assessments while she’s talking and jumping and playing with my steth (including banging the bell with it in my ears – OUCH!). You have to make special accommodations to get the information you need. You have to be creative and flexible.