Monday, August 27, 2007

Start of semester anxiety

Someday I'll look back on this and laugh.
There are two types of problems. The first is the unsurmountable problem. These are relatively rare and seem to be exclusively those bearing on one's personal health or lack thereof (or death)--the sorts of problems that require an act of God. All other problems are the type that can be solved with money. What problem, anywhere, can't be solved with the right amount of cash?

Today I had a problem and my problem's price turned out to be $110. That's $110 more than I wanted to spend today, but my problem is solved. What sort of problem? Just some silly beginning-of-semester issues involving a non-existent "user guide" and seemingly dysfunctional website for one of my classes. Still, I have a tendency to panic and I felt sure that my nursing career had ended before it had even started.

Another, less pressing problem is mastering dosage calculation. My nursing instructor sent home a four page flier and explained that if we mastered the skills contained therein, we needn't buy the $55 textbook on dimensional analysis. There are four skills and I have mastered three of them, but the mastery of IV drip calculation.

We monitor the flow rate by counting the drops as they fall into the drip chamber. Not all manufacturers make equal sized tubing. Each package contains a printed label stating its calibrated size. This is written as drops per mL (gtt/mL). It takes 10,15,20, or 60 drops to fill a 1-mL container. Most physicians order IV fluids on the basis of volume with a corresponding time. (e.g. 125mL/hr. In order to deliver fluids at this rate you must calculate the gtt/min, so you can count them as they drop into the drip chamber.

What the F have I gotten myself into? I don't ever recall seeing a nurse staring at an IV bag, counting drips for a full minute. I asked Jon about this and he says he never counts drips. He tells physicians that he has three speeds: fast, medium, and slow and they should pick one. That's all very well, but I don't think that will fly with my instructor. That, and even though the calculation follows a similar format to the ones I've already mastered, I keep getting the wrong answers. This material will not be covered in class (although we will be tested on it).

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