Sunday, October 28, 2012

Erica Glenn
10/22/12
Emergency Room 

Learning Experience Journal 
1. Assessment of the Environment
  • Personnel- Kateleen and I observed a women named Jennifer. She was not the nicest lady in the world, and she barely acknowledged us, even when we were trying to ask questions. There were 3 other women in the ER at the time, and one woman who was in her residency (I think) and she was a college student observing/ helping for her last hours that she needed. 
  • Services Provided- The ER provides emergency care to patients that are ill or have just been in a car accident (trauma) or something along those lines. They draw blood and then send it to the lab to be tested. They also insert catheters into patients. They also check vital signs and help the patient in anyway they can to find out what is wrong. They preform many tasks along these lines in the ER. 
  • Equipment- There are many pieces of equipment in the ER including, vials, IV's, catheters, thermometers, computers, ultrasound machines, xray screens, sinks, needles, tourniquets, and many other supplies and equipment. 
  • Technology Utilized- Kateleen and I saw a pregnant woman come in, and she got an ultrasound, and had her temperature taken, and they put some things on her chest so they could monitor her heart rate. We also saw a catheter put in, and blood drawn with needles and IV's. 
2. Observation
  • Health Care Professionals- When we first walked in, all of the women were sitting around talking because there were no emergencies going on at the time. But then later, when patients came in, they became rushed and running around. They all seemed nice and professional, but Monday wasn't there, and that is who Marcela and Dorian suggested we observe. 
  • Teaming Skills- All of the heath care professionals seemed to work well in teams. When the pregnant woman came in, three or four doctors had to work together to help her. It was pretty crowded in the room with all of the people in there, but they were all working together, so it went smoothly.
  • Communication Skills- All of the doctors know what to do and how to communicate it in an affective manner. When they were working with a patient, they spoke in a manner that they would understand, and were very nice to the patient. 
  • Safety Procedures- When taking blood or touching the patient at all, everybody was wearing gloves. Also, when taking blood, when the needle was taken out, it had the cap put back on it and disposed of in the sharps container. There was also multiple trash containers for different waste disposal types. Also, the sink had to be turned on with your foot, so your contaminated hands didn't touch it. 
  • Therapeutic/Diagnostic Procedures- Kateleen and I saw an old woman get a catheter put in, as well as a lot of blood drawn (one from IV, and another from the hand). Also, there was a pregnant patient who came in, and we saw an ultrasound, her temperature taken, and more. There was also another patient who came in and threw up, and we saw him get some meds.
3. Knowledge
  • New Information Learned- I learned that when putting a catheter in, the patient should be laying as far back as possible. I also learned that there is like a portable little machine that is just like a little only sound ultrasound machine that listens to the heartbeat of the baby. I also learned that some people come into the ER for very minor things. 
  • Medical Terminology- When Kateleen and I were in the ER, there was not a lot of medical terminology used.. But there was a few. IV= Intravenous Therapy.
  • Skills Learned- I learned to stand out of the way when the nurses are running around trying to help a patient. I also learned the steps on how to put in a catheter. I also learned that if you come into the ER with abdominal pain and you throw up, you cannot drink any water. 
4. Evaluation
  • Personal Experience- I enjoyed going to the ER, but i definitely do not want a career in that field. I would not be able to handle the trauma or disgusting aspects of the ER. (Vomit, etc.) 
  • Educational Value- I did learn some valuable information while i was in the ER, and I enjoyed my time seeing new things and seeing the difference between a real life ER and the TV show's ER. 
  • Professional Value- I got some professional value experience while i was in the ER by observing the health care professionals and such. I also know that i do not want my professional career to have anything to do with the ER. 
Learning Report
1. What were your responsibilities or duties this week?
  • This week , when the pregnant woman came in with shortness of breath and chest pain, one of the doctors asked me to go get the thermometer. I left the room and was like frantically looking for the thermometer and i was like asking the person behind the desk and she said it was on the wall. I was like looking everywhere for that thermometer and i kept saying "Where is the thermometer?!?!" and finally she pointed to a wall very far away and i like ran over and got it and ran back to the room and gave it to the doctor. That was pretty much the only thing i was asked to do this week. 
2. What new knowledge or skill did you learn this week?
  • I learned that in the ER, they keep a thermometer in a special place on the wall for some reason instead of one in each individual room.. I also learned the steps on how to put a catheter in. I was also talking to another older student in college and i learned how not difficult it is to become an ER nurse. 
3. What was the best thing that happened at the ER this week?
  • The best thing that happened in the ER this week was the pregnant woman coming into the ER with chest pains and shortness of breath, because she was the only actual emergency we saw the whole time. 
4. What was the worst thing that happened in the ER this week?
  • The worst thing that happened in the ER this week was the fact that when we first got there, it was really quiet and we had nothing to do but talk to the women, who were talking amongst themselves, so it was pretty hard to interject into the conversation. 
5. The "worst" was not really a personal mistake, so there was no way to correct it.
6. This week was fair because neither Kateleen or I got to do like anything, and we were just standing there not knowing what to do for a pretty long time. It was fairly awkward because the person we were observing had another college student that she was trying to teach, so we didn't get any of her attention, and she kept leaving without us. 

Experiene Record
  • Technology Observed: 
    • IV
    • Thermometer
    • Computer
    • XRay machine screen
    • Needles
    • Catheter
    • Etc.
  • Diagnostic Procedures Observed
    • Inserting a Catheter
    • Listing to an ultrasound machine
    • Temperature taken
    • Nurse asking questions to see what was wrong with the patient
  • Therapeutic Procedures Observed
    • The catheter was inserted to help the patient, so i guess that could be considered as a therapeutic procedure.
    • No other therapeutic things occurred while we were in the ER 
  • Diseases/disorders Observed
    • There was one patient with abdominal pains and was throwing up with stomach-bug- like symptoms
    • There was another patient who came in with shortness of breath, dizziness  and chest pains. 
  • Medical Terminology encountered
    • IV- Intravenous Therapy
    • Cultures- Bloos cultures
    • There were not very many other med terms that i encountered
Experience Journal
This week i was in the ER with Kateleen. When we fist got to the ER section, we had a woman joking with us that it cost $2.50 to get into the ER, and we all had a little laugh. Then we both entered into the ER and walked up to the desk where there were a bunch of women sitting around, and we introduced ourselves, and someone told us to go observe Jennifer, so we found her and introduced ourselves to her. THen she went into a patients room, so we followed, and the college student girl came in with us too. Then Jennifer put a catheter into an old woman, took blood and then took some more blood. After that, Jennifer went into another patient's room where the guy had just thrown up, and she was asking him a whole bunch of questions and stuff. Then she left that room, and like had to go somewhere, so she ditched us. So Kateleen and I asked to observe someone else, and so we did. Then a patient came in with shortness of breath and was about to throw up and she was really dizzy and pregnant. So her whole room got very crowed full of people, and kateleen and i were just trying to stay out of the way. Then one of the doctors asked me to go get the thermometer, so i was frantically searching for it, and found it and ran back to the room. The doctor was asking the girl tons of questions while the other doctors were putting all sorts of stuff on the patient. Then they did an ultrasound to listen to the babies heart beat, and everything was okay. Then it was time to go, so Kateleen and I left the room and thanked the pople for letting us observe. Then we left, and made our way back to the cafeteria. 



 


Sunday, October 21, 2012

Erica Glenn
10/21/12
Laboratory

Experience Record

  • Technology Observed:
    • Cobas #2501
    • Cobas 601
    • Cobas 6000
    • Freezers and refrigerators
    • Computers
    • Microscopes
  • Diagnostic Procedures Observed:
    • Testing to see electrolyte levels
    • Testing to see potassium, iron, chlorine, and many other elements levels in the blood.
    • Many tests to see what is wrong with the blood
    • Some tests were using Cerebral Spinal Fluids
  • Therapeutic Procedures Observed
    • There is no treatment in the laboratory, just diagnostics.
    • But she did show me and explain how to draw blood form an adult patient and an infant patient.
  • Diseases/ Disorders Observed
    • Some of the blood had too low or too high levels of some things.
    • One person had electrolytes too high.
    • One person had a low white blood cell count which could mean a variety of things with the immune system.
  • Medical Terminology/ Abbreviations Encountered:
    • K- Potassium
    • Cl- Chlorine
    • Many other elements
    • CSF- Cerebral Spinal Fluid
    • H2O- Water
    • Scope- Microscope
    • Several more
Learning Report
  • What were your responsibilities or duties this week?
    • The woman who I was observing let me count the containers and organize them in order. With those containers, i had to fill them up with the correct nimber or vials in the correct spots. With those vials, I put in drops of different fluids so they could be put in the machine and tested. When everything was in the machine and ready, she let me start all of the tests on the computer. 
  • What new knowledge or skill did you learn this week? 
    • I learned how precise you have to be in this job, because the slightest mistake could mess all of the tests up. Also, i learned that chemistry is a HUGE part of this job, and you need to know literally all of the elements on the periodic table. 
  • What was the best thing that happened at the unpaid work-based learning site this week? 
    • The best thing that happened was i actually got to do work by myself. She was putting a lot of responsibility in my hands to preform these tasks perfectly. I really liked the fact that i got to be very hands-on. 
  • If the "worst" was a mistake, how was it corrected?
    • I made one mistake when i was putting the vials in the containers, but when i was filling the vials with fluids, i realized the mistake and i told her and then we both fixed it. 
  • This week was...?
    • Good- i really enjoyed all of the hands-on stuff i got to do, and i really liked the fact that she was taking her time to show me around and explain all of the stuff to me and was keeping me involved. 
Experience Journal Summary
This week, I was in the Laboratory. When i walked in, I walked up to the first woman I saw and introduced myself. She was busy, so she brought me over to another woman in the lab, so i then introduced myself again. She was very nice and began to talk to me about what i was interested in and everything while she was finishing the tests she was running. Then she took me around the lab and explained all of the different types of vials with the different colored tops, as well as explaining all of the functions of all of the rooms. She then took me into the stock room and showed me all of the stuff in there and what everything was used for. She then explained to me how blood was drawn from an adult and from an infant. Then we went back to work and she made me put on gloves and start working. She told me what to do, so i counted out all of the containers and put them in order. Then i put all of the vials in the correct spots in the containers, and then I filled all of the vials with the certain fluids that she was giving me. Then we put the containers in the machine, and she let me start up the tests on the computer. Then it was time to go, so i let her sign my paper, and i thanked her for  her time and effort to teach me. Then i left, and met everyone else in the cafeteria. 

Experience Journal
  • Assessment of the environment:
    • Personnel: There were very few people in the lab. I was observing one woman (I dont remember her name) and she was a phlebotomist. There were two other women working with blood and scanning vials into the computers. And there was one man who was walking around and running tests. Total, there were only 4 employees in the laboratory when i was in there.
    • Services Provided: In the laboratory, they provide diagnostic tests on blood and other fluids for patients. They preform tests, but not really experiments or treatment plans. 
    • Equipment: Everyone was wearing gloves, including me. We also used vials, syringes, and containers to hold the vials. 
    • Technology Utilized: Cobas #2501 (Calibration), Cobas e 601, Cobas 6000, computers, refrigerators, freezer, microscopes, scanners, etc.
  • Observation: 
    • Health Care Professionals: All of the employees were wearing scrubs and tennis shoes, but not all of their scrubs matched. They were also all wearing their ID badges on the top of their scrub tops. Also, everybody was wearing gloves, but not everybody had their hair pulled back. Everyone in the laboratory was very nice and friendly. 
    • Teaming Skills: All of the employees were working together to fix a computer problem, so there was very good teamwork. 
    • Communication Skills: There were no problems communicating with anyone. All of the employees had good communication, and I had good communication with the woman who I was observing. (Even though she had a tough Vietnamese accent.)
    • Safety Procedures: Everyone in the laboratory was wearing gloves. I also saw a fire extinguisher and a fire alarm. Also, every time a syringe was used for anything, it was thrown away. There were several types of trash cans and waste disposal containers that were each classified for what they were used for.
    • Therapeutic/ Diagnostic procedures: There were many diagnostic tests used on the blood and other body fluids to fins out what was wrong, or even if there was anything wrong in the first place. 
  • Knowledge: 
    • New Information Learned: I learned that I need to remember all of the elements on the periodic table. I also need to remember what all of the color-coding of the vials represent.
    • Medical Terminology: K-Potassium, Cl- Chlorine, CSF- Cerebral Spinal Fluid, Scope- Microscope, etc.
    • Skills Learned: I learned that each vial that blood is kept in has a color that all means something. I also learned that the machines they have in the lab are extremely advanced, and can do pretty much anything with all body fluids. 
  • Evaluation: 
    • Personal Experience: I really enjoyed my time in the lab. Although there was no patient contact, i was still very hands-on and i learned a lot. I enjoyed the experience, and I really liked the woman i was observing because she really took the time to teach me new things and teach me all about the lab.
    • Educational Value: I learned a lot of new stuff in the lab including how to draw blood from an adult and an infant, as well as the meaning of all of the color-coding of the vials, and many other things.
    • Professional Value: I learned all about what a phlebotomist does on a daily basis because that is who i was observing. I learned that a career in the laboratory would be very quiet (besides the machines) and possibly very cold. 
Medical Laboratory Questions:
  1. Describe the blood types and their percentage found in the population.
    1. Group A
      Blood has A antigen on red cells, and anti-B antibody in its plasma. 
    2. Group B 
      Blood has B antigen on red cells, and anti-A antibody in its plasma. 
    3. Group AB
      Blood has both A and B antigens on red cells but neither anti-A antibody nor anti B antibody in its plasma. AB blood cannot cause the clumping of red cells of any other groups, and therefore persons with AB blood are called universal recipients. 
    4. Group O 
      Blood has neither A nor B antigens on red cells, and both anti-A antibody and
      anti-B antibody in the plasma. Group O blood cannot be clumped by any human
      blood, and therefore persons with Group O are called universal donors. 
  2. What is the Rh factor?
    1. Most people also have an inherited condition of the red blood cells known as the Rh factor, or antigen D. When the D antigen is present, a person's blood type is designated Rh positive. When antigen D is missing, the blood type is classified Rh negative. In general, Rh negative blood is given to Rh negative patients and Rh positive blood to Rh positive patients.
  3. Describe the diseases that each unit of blood is screened for after donation?
    1. Hepatitis B Surface Antigen (HBsAg), Antibodies to the Hepatitis B Core (Anti-HBc),Antibodies to the Hepatitis C Virus (Anti-HCV), Antibodies to the Human Immunodeficiency Virus, Types 1 and 2 (Anti-HIV-1, -2),Antibodies to Human T-Lymphotropic Virus, Types I and II (Anti-HTLV-I, -II),Syphilis,Nucleic Acid Amplification Testing (NAT),Confirmatory Testing
  4. Explain the differences between a biopsy, smear, fluid tissue samples.
    1. A biopsy is a medical test commonly performed by a surgeon or an interventional radiologist involving sampling of cells or tissues for examination.
    2.  A blood smear is a blood film or peripheral blood smear is a microscope slide made from a drop of blood, that allows the cells to be examined microscopically.
    3. A fluid tissue sample is something that bathes and surrounds the cells of multicellular animals.                                          
  5.  Describe the safety precautions practiced in the laboratory during specimen collection.
    1. Wear gloves, lab coat, and when appropriate, a mask or goggles. Also, use leak-proof containers that specify the transportation of blood. Also label everything correctly and put in a reliable refrigerated area. 
  6. How much must a blood donor weigh?
    1. At least 110 pounds. 
  7. How much blood is collected for each donor unit?
  8. What is the purpose of an anticoagulant?
    1. To prevent blood from coagulating, or clotting.
  9. What is the purpose of staining tissue?

    1. The purpose is to add visual contrast to otherwise transparent objects, so they will be easier to see and study under the microscope.

  10. Define the following:
    1. Retic Count: Reticulocyte Count
    2. Diff: Deifferent
    3. ESR:Erythrocyte Sedimentation Rate
    4. Hgb: Hemoglobin
    5. HbS: Hemoglobin
    6. Hct/Crit: The percentage of red blood cells in the blood
    7. MCV: The mean corpuscular volume
    8. MCH: Mean corpuscular hemoglobin
    9. RBC: Red Blood Cell
    10. Sed rate: Erythrocyte Sedimentation Rate
    11. WBC: White Blood Cell
  11. Distinguish between logging, dehydration, and mounting.
    1. Logging: Logarithm 
    2. Dehydration: Not enough water
    3. Mounting: Putting something up
  12. Explain the educational requirements and licensure differences between a cytologist, histologist, and pathologist.
    1. Cytologist: cytology is that branch of life science, which deals with the study of cells in terms of structure, function and chemistry. 
    2. Histologist: is the study of the microscopic anatomy of cells and tissues of plants and animals.
    3. Pathologist: The study of diseases.
  13. Describe the machine used for cutting tissue into very thin strips.
    1. A Tissue Staining and Processing Machine
  14. Describe the process for processing fresh frozen tissue for cancer diagnosis.
    1. Store in a histology laboratory where everything is labeled and safely sealed. 
  15. Describe the method of preparing exfoliated cells for cancer diagnosis.
    1. Properly exfoliate cells so they can be diagnosed for cancer or not.