Shifts 6, 7 and 8

I completed three more shifts since my last post. A lot of what I have done is the same. I have done lots of g-tube assessments, helped with g-tube teaching, and helped with wound vac dressing changes. Things have been pretty routine and I feel like I have gotten pretty good at these three things. Last shift I got to see a patient with a suspected deep tissue injury and was able to identify it as such correctly. Also, last shift I had the opportunity to independently see two patients. The first was an ankle wound and I was able to identify the proper course of treatment, apply the dressing and give the parents instructions with one two additional comments to the parents by my preceptor. Also, I had the opportunity to independently change a wound vac dressing and reapply the wound vac with my preceptor only handing me supplies. It was a very straight forward dressing change, but it felt very good to be able to do it independently.

Shift #5

Pretty normal shift this time. I saw a lot of the same things I have in previous shifts: g-tube assessments, dressing changes, parent teaching about g-tubes. My preceptor and I did spend some extra time charting, and I feel like I'm starting to learn the lingo and be more effective at charting. Seeing as I am doing my preceptorship in a "specialty area", I do feel like learning to chart will be a valuable skill that I take away from this experience.

Shift #6

I was supposed to teach the community g-tube class tonight, but we didn't have any parents scheduled to attend so that didn't happen. Other than that, it was a pretty normal shift doing g-tube assessments and a few dressing changes in the clinic.

Shift #4

Assisted with a wound vac change. Learned how to clean and pack the wound, apply the vac, and ensure there is proper suction. Treated an open surgical wound from an amputation that was not healing properly. Learned the benefits of hyperbaric  treatment to help a wound heal (it provides a super dose of oxygen that can help a wound that has stalled).

Shift #3

1-      Assisted with a wound vac change. Learned that you don’t use wound vacs just to clean out a wound. We use them to enhance blood flow to the tissues. For a wound to heal we need a moist wound bed (not too wet or too dry), nutrients and oxygen.  Performed a dressing changed on a stage 2 pressure sore (toe), and learned that collegen can be used to aid as a scaffold and aid creation of granulation tissue (which is what happens when a wound is healing). 

Assisted my preceptor to clean a stage four sacral pressure ulcer. I learned that children with spina bifida, particularly those in wheelchairs, are at increased risk for pressure ulcers because they can’t feel sensation, and in adolescents they are often responsible for their own hygiene, and the pressure sore might not get caught until it’s extended into the entire tissue. I also learned that pressure sores are only stageable if you can see the wound base. A white wound base is covered in slough, and is thus unstageable. I also learned about the use of fluid airbeds for patients with pressure ulcers. The material inside the bed makes it so that the patient is basically floating, and there isn’t pressure on the bony prominences. It has it’s disadvantages however, in that it makes turning the patient difficult (if not impossible), but the patient still needs to be turned/repositioned every few hours.

Shift #2

  Performed several wound dressing changes, and saw my first stage four pressure ulcer. Also learned that when an IV infiltrates, particularly if lipids or certain medications were running through the IV line, that wound team follows them because of the risk of cellulitis. Did some measurements on a little boy who had cellulitus in his foot due to an IV infiltration. We signed off on this patient because the cellulitis is resolving and he doesn’t need our services anymore.Saw several patients in the outpatient clinic. Performed a dressing change on an ear wound, a G-tube assessment  (it was leaking, and we gave the mom some cream to help with skin breakdown), and assisted with packing, cleaning, and dressing a wound formed because of a peri-anal cyst.

Shift #1

My first shift for preceptorship. I spent a lot of the day observing and orienting to what my preceptor does. I did perform g-tube cleaning and a dressing change. I also assisted in a g-tube teaching session with parents of a child with a newly placed g-tube. I learned a lot about why gastronomy tubes are placed- poor nutritional intake, failure to thrive, short gut syndrome, how they are placed (PEGS are placed endoscopically, while buttons are placed in the OR and require an incision), and emergency treatment if the tube comes out (try to replace, then try a catheter a size smaller than the tube the child normally has, then if that doesn’t work go to the ER.

So far I feel like this is going to be a good experience for me, even if it isn’t the exact experience I had hoped for.