Student Nurse Clinical: Day 1

Heavy sigh. I was that nursing student. The one who is certain she is called to be a nurse, always ready with the answers… who faints on the first day of clinicals. This is an experience that shouldn’t start with a bang. I guess I’ll start from the beginning, rather than piecing it out and having you attempt cohesion at the end.

My first clinical day was about two weeks ago. I had to work at the restaurant the night before, but I willingly pulled the “I have to leave my house by 5:30 AM tomorrow” card on my manager. He cut me first from the floor, and I was grateful. It still took me a while to wind down, even though I got home around 9:30, but I got to bed about 11 or so and estimated I would get 6 or so hours of sleep.

I woke up at 5 AM before my 5:15 alarm. Dang. I got into my scrubs and grabbed some granola bars. I could feel my adrenaline already pulsing, so I decided to fore go my usual large coffee with cream. It was a rainy and cold morning, so I snagged an umbrella out the door. The drive was a good time to relax and think about the day.

I thought about stopping into the Hubbard & Cravens on my way to Wishard, however, I decided that coffee wasn’t necessary as I was still strung out on adrenaline. I met with my instructor and fellow students in our conference room; I felt a little nervous but it seemed normal. I might have been the only one in the room who did not want to be in pairs, yet everyone else wanted to pair up, so I consented by silence.

We got the KARDEX (paper information) on our patient and report from the nurses. I started feeling a little light headed with waves almost like severe exhaustion, so I shrugged them off and tried to busy myself. We were still waiting for our patient to wake up, so I chatted a little with the nurses. The next few waves came. Shoot, they were a little stronger this time. “I’m not going to vasovagal!” was running through my head. I thought I was thirsty, and I knew another thing I needed was to get the blood back to my heart and head. I tried walking around. I sat down with  my head on the desk. Thinking I might want a juice or soda, I tried to find the vending machines, but I only had a $20 bill. Dang. The water from the fountain tasted terrible. Thanks, Indianapolis.

About 5 minutes later, our patient was waking up, and I wanted to be brave. My partner and I went in to introduce ourselves and asked if we could start our vital sign assessment. I was feeling fine while taking the patient’s pulse and counting respiration rate; my extra energy had something to do. Right in the middle of my 30 second respiration count, a med student came in. The patient was having a procedure done that day and the student needed to complete a pre-procedure interview. All I was doing was standing around. Huge wave and the first sign of blurry vision.  I excused myself to find my instructor. I couldn’t think what it was that was starting the vagal response in me. The patient had some chronic conditions, one of which was renal failure. Dialysis was needed, and the current port for the dialysis tubing was in the patient’s neck. While I hadn’t seen that specific kind (Inter-Jugular or IJ tubes), I had seen ports on others before. I spent the last year giving medications by PEG tube to The Brain! Tubes should not have been a problem.

I finally found my clinical instructor and admitted that I wasn’t doing to well. I told her I had a history of vagal responses, but if I could go get some juice and walk around, I would be fine. Partial humility is always a bad idea. She consented, but right then I felt a huge wave and said, “After I sit down…” I turned to walk towards the welcome desk and chair.

The fuzziness began to clear, but it felt as though I was being woken up. I closed my eyes again not wanting to be bothered with the light and noise.

The THX sound check began ringing in my ears. People were saying my name, but I didn’t recognize their voices. I had no idea what happened. Then I heard a voice I recognized as my clinical instructor’s say, “She was on her way to the chair, when she fell and hit her head on the shredder box, taking the charts down with both of us.”

The first words out of my mouth, “YOU MEAN I DIDN’T EVEN MAKE IT TO THE CHAIR?!?!?”

Nope. I was on the floor against a wall. The right side of my head felt as though I had been hit by a rock. I was tired, dehydrated, and trying to explain my medical history with vagal responses when they would let me. My thought process is one that if I explain I have a history of these and I’ve survived them, then it won’t be a big deal and I can get back to work.

Why do nurses think that medical rules don’t apply to them?? (History = Problem NOT “Oh, she’ll be fine!”)

The staff around me takes my blood pressure. I tell them that I had a typical breakfast for me and, no, I don’t have diabetes. They check my blood glucose anyway. 100 thank you very much! (This is within normal limits) My blood pressure is a little low but not drastically. They ask if I’m ready to sit up. Yes, I’d like to try. I sit in the “fainter’s position” with my head between my knees; I hear an audible gasp. With the way my head is slightly throbbing, I make this supposition:

“I’m going to assume by that sound that there is blood involved.”

“Yes.” I put my right hand up to my head by the area that feels tender. A few drops of crimson. Dang. I can not refuse treatment now (yes, I’ve done that before when no blood was present. Again, nurses don’t follow the rules.)

Some one hands me a small container of orange juice. After a few small sips, I stare at the cup, “This is the WORST orange juice I have ever tasted.” It was more like melted concentrate. I try to be humorous (deflecting, anyone???) and tell my instructor, “Well, Jeni, you have another story.” She smiles.

They ask if I’m ready to get on the wheeled bed to go down to the Emergency Dept. I stand up slowly and make it. Then the tears of embarrassment come at the same time as the urge to expel any contents of my stomach. The Vagus Nerve (Cranial Nerve X) is involved with both your heart and digestive system, thus the blood pressure drop plus the nausea are typical. Someone hands me a small box of tissues, the offended sheets are put in laundry, and I’m wheeled away to the ED.

After the elevator ride, I’m asked the orienting questions by the admitting nurse. What is your name and date of birth? What month is it? Who is the president?

An admitting bracelet is put on my wrist, and I’m taken to the ER triage bays. I make the comment, “Yay, my first hospital bracelet since birth.” A nurse comes to place me on a monitor for heart rate and pulse oximetry. I look at the monitor, my pulse is at 50 which means that earlier it was much lower. (Adult pulse rate should be about 60-100). The resident comes over with a med student and does her assessment. Is my grasp even? Can I follow her finger to the 6 cardinal movements of vision? Am I able to resist her in my arms and legs? Can I tell her what happened? Do I have a history? She looks at my head; two staples are definitely needed. My instructor tells her part of the story. It’s at this point I find out that I was out for a minute or two and that the brief interlude where I felt I wanted to roll over a sleep was prior to me exhibiting signs of a small seizure. I explain that the seizure-like symptoms have occurred before and that I’m unaware of any seizure history except the few symptoms that occur in conjunction with my vagal responses. I think a few more tears fell.

A nurse comes by with supplies for blood draw and IV fluids. My vein that was found so easily a few months prior was not so that day. She had to really search for it before finding a decent draw. Ow. After the samples were taken, 1 litre of saline was put on a fairly fast drip into my system. I’m simultaneously encouraged and discouraged; I can handle a fast drip to replace fluids, yet it’s one more thing that tethers me to the bed. Another nurse came by, this time for a 12-lead ECG (apparently EKG is no longer the correct abbreviation).

Registration comes by. Emergency contact? Who can drive me home? Um… “Put down my parents, and I’ll figure out my life later.”

At this point, I’m alone in the bay as my instructor left to check on the others still on the floor.

I cry from embarrassment. I try to rest, which is impossible with COPD guy coughing behind the curtain on my right, the light above me, and a woman two bays over being on cardiac monitors. And my IV starts bothering me, but there are no signs of infiltration and phlebitis doesn’t happen in 20 minutes.

The resident decides I’m ready for my staples. Since numbing the area would take longer AND hurt more than just putting in the staples without an anesthetic, she irrigates and proceeds. It felt a little weird feeling both go in and pinch the skin together, but in reality, I’ve had mosquito bites be more annoying.

My instructor comes down with my backpack and report on the others. She reminded the other students that my incident was covered under HIPAA, therefore, they had to allow only me to share with others in our classes. I didn’t realize until she said it how relieved I was. I got her phone number before she left.

I texted my mom and The Frau as calling was impossible in the recesses of the ED. A few texts are exchanged with The Frau, and I assure her of a full explanation when I have better cell reception. The resident came over to check on me and see if I could walk around without feeling woozy. I passed the test. Woot. In the mean time, I decided to take a free HIV-antibody test because it was offered, and I figured I should get something for free out of this experience even though I live a low to no risk life. It came back negative. Shocker.

The attending physician comes over to check on me before discharge at 11:30, mind you I collapsed at about 7 AM. I assure him I feel fine and that my recent surge of tears is more from embarrassment (with a slight amount of failure). He validates my emotions and says they’ll do their best to get me out quickly. My discharge papers only list “syncope” as my diagnosis. No care or other instructions related to my staples. Hm.

I finally see the light of day after twisting through the labyrinth of halls to the outside. I call my instructor to let her know I’m out and half hoping she’ll let me return to the floor. Denied and without energy to argue, I consent to her wisdom.

I call The Frau and am put on speaker so her husband can hear as well. I walk back to my car while explaining the situation.

And, yes, I drove myself home. Yet another nursing rule broken.


1 Comment (+add yours?)

  1. philologia
    Nov 28, 2012 @ 12:06:07

    Glad you’re okay. Syncope sucks.



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