Tuesday, July 27, 2004

Nurse C.

My practical exam went beautifully. I was assigned to assess the respiratory system which is a lot more than listening to someone breathe. Honest! You have to percuss (my nemesis) a person's back and front, do several voice tests, listen to all lobes of the lung (and know where the darn lobes are) and map out diaphragmatic excursion. Diaphragmatic excursion involves percussing down a patient's back with their lungs inflated and deflated to map out how much your lungs expand during inhalation. The idea is to listen to percussion sounds change from "resonance" to "dullness" as you shift from inflated lung to plain old viscera. The average excursion is 3-5 cm. If you're an athlete, you'll have a larger excursion because your diaphragm and lungs do a better job of taking in and expelling air. In fact, students have engaged in some low-level excursion competition i.e. my lung expansion is bigger than yours. My big break was that my partner was a male so percussing and palpating his front was a great deal easier sans boobs.

So I performed the exam with minimal prompting (I forgot to do tactile fremitus! Who wouldn't?!) and the professor testing us said "Very well done, Nurse C." I glowed. Truly.
We're still not done with genitalia and today we watched a video of the genital and rectal exam. One hour of penises and rectums and vulvas and vaginas and cervixes (cervices?) on the big screen. Wonderful! During the rectal portion of the video ("insert your finger into the rectum, ask the patient to bear down so that you may insert your finger further into the rectum...), a photographer came in to take some promotional pictures for the school. Imagine: 100 sour-faced, cringing, crossed-legged, squinting nursing students. Choose this nursing school! I don't know who made the decision to have the photographer come at that moment but they clearly want to cut down on next year's class size.

We're now in the midst of lectures on first aid. I like the first aid lectures because they make me fell very nursey and knowledgeable (never place an amputated body part on ice, always flush chemical burned eyes for 30 minutes, never use burn cream, never remove an impaled object unless it is obstructing an airway, always wear gloves...).
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