The Chest X-ray

Today was our chest x-ray lecture.  It was truly a captivating 3 hour lecture given by Dr. Wallace T. Miller, Jr.  He is an expert in his field and an amazing teacher.  It's pretty awesome when the lecturer is also the same guy who wrote the book about chest x-rays that I have on my shelf. 

We looked at many slides of-- well, you guessed it-- chest x-rays.  His tip for the novice reader is to ask yourself these 4 questions.

1.  Is it normal or abnormal?
2.  Is there a problem with the heart or the lungs?
3.  Is the problem diffuse, focal or multi-focal?
4.  Is the pattern alveolar or interstitial?


I know that I was mesmerized and so was the class.  There is so much to learn and I came away wanting to learn a lot more.  It also didn't hurt that he enjoyed cold-calling students for their 'expert' opinion about the films.  Yikes!

Here's an article about the Miller duo- Father and Son

SimMan

Today was our SimMan practicum.  Admittedly, I was nervous and did not know what to expect.  The professors were vague at best.  Also, this was my first experience with a SimMan.  We did work with mannequins in nursing school but never an 'intelligent' SimMan.

They divided us into groups of 4 but one of our group members couldn't make it because of car trouble.  The room was large and along the wall was Mr. Hottie himself- Sim.  He was connected to a speaker in the room next to ours.  Another professor was speaking for him, in other words, playing the role of the patient and observing us through a one way piece of glass.  Two adjunct clinical faculty members were grading us in the room and our professor was assisting us with obtaining the lab results, EKG results, etc when we asked for them.

The setting was in an ED and we were his NP's.  We were given info about him ie: age, presenting complaint, past medical/past surgical history.  Then, it was our turn to elicit the history of present illness, conduct a review of systems, a physical exam, order labs, drugs, oxygen, etc.  We interpreted the labs and proceeded accordingly.  In the end, our case scenario was a pt with a NSTEMI (non-ST segment elevation myocardial infarction).

It was pretty straight forward and we received high marks as a group.  Although, I was trying to complicate things by also ruling out a pneumonia.  I thought that our professors would give us 2 issues that we had to address-- but it ended up being simpler than that.  In the end, I was glad that I explored the possible pneumonia/resp infection because SimMan did have a temp, coarse breath sounds and a high WBC count so it did fit the clinical picture but the chest x-ray was normal.

Overall, I did like the SimMan practicum.  I thought that it was helpful in understanding my own strengths/weaknesses.


Have you ever used a SimMan?  Did you find the experience helpful or a waste of time?


Image by John McLellan

Christiana Hospital

It's official-- my first clinical rotation beginning in January will be at Christiana Hospital! I received an email from the Delaware Board of Nursing that my nursing license by endorsement was approved. Yay!  I was worried that it would not be approved in time.  

I'm very excited because I wanted this rotation for several reasons.  I will be working alongside a NP in their Neuro/Trauma ICU.  According to the clinical faculty, this is an excellent rotation.  The clinical coordinator had only glowing things to say about the NP who will be my preceptor.  Also, I'm especially excited about this patient population.

My first job as a registered nurse in an ICU was at University Medical Center- Brackenridge in Austin, Texas.  I worked in their neuro/trauma unit and really enjoyed it.  I learned so much in that unit because as you can imagine, the acuity was incredibly high.  The patient population consisted of traumatic brain injuries, brain aneurysms, strokes, multiple fractures, and the list goes on.  I'm ready to dive back into this setting to see what the job is like from the nurse practitioner perspective.