I am really enjoying respiratory school right now. I love what we're learning and I absolutely cannot wait to start clinicals. So far the classes haven't been too stressful, probably because I have so much free time to prepare for tests. Pharmacology was supposed to be the hardest class and I was expecting worse. I ended up with an 89% in the class, which requires me to say goodbye to my 4.0 GPA this semester. There are three other courses to be graded, though, including Cardiopulmonary Anatomy & Physiology (we call it CPAP), Theories & Principles of Respiratory Care, and our clinical rotation.
I start my clinicals on March 16th. Like I said, I am beyond excited for my rotation. My instructor, who we just call Callihan, said it was the best hospital to go to our first semester. I was lucky enough to get a spot there. Six people wanted to go, and only four spots were available. Because I was flexible with what days I would go I got a spot. I am on Thursdays and Fridays. It will be a dark drive early in the morning but there seems to be a lot of daylight in the small hospital to keep things cheery and positive during the day. Sharing a car with my mom is kind of inconvenient with this location as she'll have to get to work super early (like two hours) or go in half an hour late. I hope she chooses to go late two days a week, I'd hate for her to sit in the office alone for that long. How boring it would be!
Today in class we just practiced our skills we will use in clinicals. I practiced listening to lung sounds which so far is my least favorite part because I always hear rubbing from clothing and confuse it with crackles. Thankfully hospital gowns are thin. I also practiced with assembling masks and jet nebs, setting up the H tank, and giving nebulizer treatments. We also worked on our PPD, Percussion and Postural Drainage. Mostly it was just percussion which involves cupping your hands and beating on certain areas of the chest and back to loosen secretions from the lungs. They say they have special paddles or vests in the hospitals so we likely won't be doing the method we practiced, but we definitely needed to learn the correct spots to beat.
For my own benefit I'm going to write out a planned patient interaction given the following orders:
Prov q4h
40 VM
IS
PPD
PO
"Hi Mr. Smith, I'm Katie and I'm with respiratory therapy. Your doctor has written some orders for you today including a breathing treatment (then wash hands). First I'm going to check your oxygen and heart rate with this little gadget here, it just slips on your finger like this. I'm going to listen to your lungs next. Just take a deep breath in through your mouth (repeat for 12 spots). Good, next we're going to get you going on your breathing treatment. Have you ever had one before? What it's gonna do is help open up your lungs so you can breathe better. It'll only take about 10 minutes (assemble nebulizer). For the treatment you'll put your teeth on this mouthpiece here and wrap your lips around it. Then you'll take a slow, deep breath and hold it for 5-10 seconds, however long you can. You can breathe normally after that, but every 7 or 8 breaths we're gonna take another deep breath and hold it again. Like I said, it'll take about 10 minutes. (5 minutes into treatment check pulse and oxygen. When treatment is over, check again). Ok Mr. Smith, can you give me a good, deep and forceful cough? This will loosen secretions in your lungs. Good. I'm going to listen to your lungs again, remember deep breaths with your mouth open. If you get lightheaded or don't feel right, just let me know and we'll take a break. Your doctor has ordered some oxygen for you, so we'll get that set up and hopefully improve your oxygen level (set up Venturi mask at 40% FiO2). He's also prescribed some percussion, which will involve using these paddles to loosen up secretions in your lungs, which we want to come out so you can breathe better and also help prevent pneumonia (when treatment is done, have patient cough forcefully three times). One last thing we're gonna do is something with this piece of equipment called an incentive spirometer. It's going to help inflate your lungs so you don't get sick with pneumonia. I'm gonna have you cough for me again. Like the neb treatment put your teeth on the mouthpiece and seal your lips around it. Then you're going to take a slow, deep breath. You'll do that 10 times every hour while you're awake. Do you have any questions for me, do you need anything? It was a pleasure, Mr. Smith, thank you."
I. Cannot. Wait! I just want to grab my scrubs, put on my tattoo cover-up sleeves and my watch, put the stethoscope around my neck and waltz into the hospital tonight. 17 days!
