Date: Thursday, October 12, 2017

Location: Kaiser Permanente Westside Medical Center

Department: Medical Imaging
Total Hours: 4

First thing in the morning I met my instructor, Dina Newton in the lobby. She started the
day showing me the MRI machine. She explained the function of the machine, what kinds of
scans are used and she explained the procedures of taking the MRI scan. I learned that it does
not use radiation, but magnets and hydrogen to scan patients. The hydrogen is used because
each tissue in the body has a different concentration of hydrogen; this allows the scan to show
up with different shades signifying the variety of tissues. While we were in the room, a patient
came in to have an MRI done. He laid down and was given earplugs. His body looked like it was
cradled all around; this was so he wouldn't move. Even a small movement of the foot can alter
the results of an MRI scan. I saw the procedures taken to complete the scan. As the machine
was working, we could see the image appearing on the computer screen. With the scroll of a
mouse we were able to see a three dimensional image of his body inside, and at multiple levels.
On one axis we were able to go superficial and deep, whereas on the other axis we could go
inferior and superior throughout the inside of his abdominal cavity.
Dina took me on a tour of the floor and showed me the different machines and
technology they use for imagining. In the nuclear medicine area I learned that patients are
injected with or ingest radioisotopes. Because these have a half-life and will eventually decay, it
is very important that the patient is there for their scheduled appointment. If they are too late,
say multiple hours or a day then there will not be enough of the tracer left to perform the scan.
And vice versa, professionals do not want the patient to have an overload of radioactive
material, so they schedule the scan for the radioisotope to be at a sufficient level. This ,method
is used to scan multiple parts of the body including the gallbladder, bones and muscles to see
which is causing a patient the pain, and can track a GI tract bleed. As Dina explained the CAT
Scan she pointed out that there are two machines; one to use for scheduled appointments and
a second that is always kept open for emergencies. She explained that if a patient is suspected
to have had a stroke, they have an open machine to perform a CT scan to search for a stroke.
We spent the majority of the rest of my time there in the x-ray area, which contains x-ray
machines and a fluoroscopy room. I was able to watch a live x-ray, where the patient ingested
fluid that was able to be seen in the live x-ray. I could see the fluid moving through the patient
and move from the small to large intestine. I also was able to see multiple x-rays of different
bones. These included a wrist, abdomen, and spine. The spine was interesting because it was
taken searching for scoliosis, a curvature of the spine which was visible. I found it interesting
that more than just bones were visible in the x-rays. I saw an odd shape in one patient’s
stomach and it turned out to be an air bubble and the patient just needed to burp!
Overall, this experience was educational and called upon my memories and lessons
from chemistry, biology, and anatomy. I enjoyed that I was able to relate my school subjects to a
real world setting, in a hospital!
Date: Monday, October 16, 2017
Location: Kaiser Permanente Westside Medical Center
Department: Orthopedics
Total Hours: 8

I began the day shadowing a Physician Assistant named Ian Clemons. This orthopedics
clinic at Kaiser Permanente specializes in knees and hips. A handful of the patients we visited
with were receiving a cortisone shot in the knees to relieve pain brought by arthritis. I learned
that over time the more shots a patient receives, the less effective they become. The first shot
may last for several months relieving the pain, however as a patient receives more injections
they may only last a few weeks or have no effect at all. I learned the procedure for a cortisone
injection into the knee. Pain and temperature are received through the same receptors. Before
injecting, Ian made the skin cold so the nerves feel the cold instead of the pain from the
injection. Other patients included those still deciding on total knee or hip replacement, as well as
patients coming for post total knee or hip replacement checkups. While some patients were
considering their option of joint replacement, I learned that they must have their teeth checked
and clean before surgery. This is because bacteria in the mouth and teeth may cause an
infection in the new joint.
I was amazed at the technology that was used for documenting each visit. Ian used a
medical application on a smartphone that would record his voice and turn it into words onto the
computer. It had a vast medical vocabulary that could understand and document each visit with
the patients.
One patient described their pain as small pieces moving around and the pain is only
relieved when those pieces seem to fall into place. Movement helped to relieve the pain, such
as golf, swimming, and swinging their leg on the x-ray table. Their pain was worse at night and
in the cold, sometimes they could barely lift their foot to the brake pedal of their car. This patient
had osteoarthritis and tore their cartilage; however their primary care doctor concluded that it
was a pulled muscle. This patient scheduled a total knee replacement for treatment.
After lunch, and for the second half of the day, I shadowed a registered nurse named
Dot who also worked in the clinic. She explained her job duties as a nurse in a clinic, which was
new to me, because I was familiar with nurses in the hospital setting. The nursing role in this
clinic included telephone advice, and seeing patients. Patients who may have just gotten home
after surgery may call and ask about the steps they need to take to care for themselves. Dot will
go over the checklist the patients received and help them transition from the hospital to their
home. I also asked Dot about her experiences in other places and I learned what path she took
to get into nursing. This experience gave me insight to different roles each professional takes in
the healthcare field. I learned about orthopedics and was able to relate my healthcare learning
to real world situations.
Date: Saturday January 20, 2018
Location: Tuality Community Hospital
Department: Medical-Surgical
Total Hours: 12

I shadowed a med-surge nurse named Amity for a full day shift at the hospital. I arrived,
checked in with security, and headed up to the fifth floor. There I met with Amity and we
gathered with the other day shift nurses in the break room and awaited our assignments. Amity
was assigned four patients that day. The first, had recently gotten a nephrectomy, (their kidney
was removed), the second had a total hip replacement, the third had a urinary tract infection
(UTI) as well as pneumonia, and the fourth patient came in for abdominal pain and the CT scan
showed they had pancreatitis. Amity went around to the other nurses gathering their notes on
her patients. During this the night shift nurse made rounds and introduced the patients to their
day shift nurse, Amity.
Amity explained a regular day as we made rounds and she performed her tasks; she
explained that she usually gets three to four patients, but occasionally five. While administering
the patient’s morning meds, the second patient denied a medication, so it wasn’t administered.
The machine which holds the medication is connected to the computers and has each patient
and their medications in its system. If a patient refuses a medication, then the machine offers an
option for returns, and a drawer opens for it to be returned. In contrast, when it was time for the
patient’s meds, Amity logged into the computer, selected the patient, selected the medications
that are due, and the machine unlocked and opened the correct drawer and flipped open the lid
to each section of medication needed.
Science is all around the hospital and I could understand why a strong foundation in
science was important. I learned that a phlebotomist comes around to the patients and draws
blood to run tests to check on the patient. One test is the check the potassium level in the
patients. If the patient is diabetic then the blood sugar must be taken before they eat so the
nurses can get a good reading.
I learned the many sacrifices and hard work that it takes to become a nurse. Medications
may be scheduled for 9:00 AM but they may not get administered quite yet. That is a time to aim
for but there’s no telling that it is accurate every time. Prioritizing is an essential skill. During the
morning rounds we became derailed from schedule with patient needs and tasks must be
ordered by importance. When we deviated from schedule, Amity tried her hardest to get all the
meds administered by 10:00 because they are due again at 12. Another factor that may put a
nurse behind is charting. Amity explained that she tries to chart as she goes, but it can often be
difficult.
By about 11:00 AM the first patient was discharged with their education including
precautions to watch for at home, prescriptions, as well as a scheduled follow up appointment.
The second patient asked for a chaplain to come and speak with them. The chaplain’s role in
the hospital is to give spiritual support to patients in the hospital who are not able to attend their
regular religious services. The third patient was not eating, had no appetite, and would only
drink liquids such as juice and water, although it was almost noon and thus lunch time. This
patient had diabetes and had very high blood sugar. The fourth patient had a very high level of
pain with an IV of morphine. After consulting with the doctor, Amity switched the medication to
Oxycodone to see if it would relieve the pain. I learned that different painkillers work differently
for each patient and by switching painkillers it may resolve the problem of pain. Since the
medication was through an IV, Amity went to check on the patient’s pain level about 30 minutes
after the medication was given. If it would have been given orally, then Amity would have
checked in about an hour later because the medication would take longer to begin working.
In order to keep track of tasks that needed to be completed, Amity wrote a list and
checked them off once they had been completed. At about 4:00 PM a new patient was admitted
and Amity had four patients once again. This new admit had hypoxia and acute respiratory
failure. Amity continued to check in with her patients. The second patient had voided urine, and
to confirm that their bladder was emptying Amity took a bladder scan. The patient was doing
well, eating, and had a good attitude. The third patient was still not eating at this time, which
now it was almost near dinner time. They would still drink liquids and had a protein shake and
water. Their blood pressure had decreased from before and the patient was still receiving
insulin. They had to urinate often because of the medication Lasix which drains excess fluid
from around the lungs and organs. The fourth patient reported that the Oxycodone pain killer
was working much better because the pain was gone and they were feeling much better.
Date: Saturday February 3, 2018
Location: Tuality Community Hospital
Department: Medical-Surgical
Total Hours: 12

This day was the second of my 24 hour internship at Tuality with Amity. I knew a little
more what to expect this time and couldn’t wait to get back onto the floor. I went through the
same beginning routine as the first 12 hour shift. That day Amity had four patients again. The
first had gastric cancer and a J-tube was placed for feeding. This patient also had cellulitis on
their leg and bradycardia, a slow heart rate. The second patient had already been in the hospital
for almost two weeks. They were in shock when they entered the hospital, and had Parkinson’s
Disease. This patient was alert to self and had moments of good speaking. They had an NG
tube which went through the nose and down into the stomach. This patient also had respiratory
therapy with a vibrator which broke up the mucus in the lungs. The third patient had pneumonia
and hypoxemia. This patient was impulsive, complained a lot of chronic pain, and had been in
the hospital for about a week. This patient was also non-compliant because they had been in
the hospital before as well. This patient demanded to be discharged although was not yet ready.
The fourth patient came about mid-morning because they were a new admit. This patient had
chest pain and hypertension. They had shortness of breath but recovered quickly. The hospital
room was prepared and had oxygen ready to use for the patient.
Amity went around to each patient administering medications, taking vital signs, and
asked the patients if they needed anything. The CNA on duty was very helpful for all the nurses
in assisting the patients with needs that the nurses couldn’t get to. Amity finished taking vitals
and administering all the medications a little later than planned. The third patient put her behind
schedule; Amity wasn’t planning on having such a long conversation about the patient’s
medications. While we were in the room with this patient I could tell that they were confused and
may have had a case of mild amnesia. The patient first refused medications that Amity offered.
Later we were called back into the room with the doctor and the story changed to the patient
saying their medications were late. The patient began to refuse staying in the hospital and
demanded their discharge, although would not agree to physical therapy. It was somewhat
difficult to watch because the patient was confused and didn’t understand the best for their
situation although their daughter was trying to explain the best option was to stay in the hospital
and continue receiving care. The first patient was very kind, sweet and had a positive attitude
although they had cancer and small children. This patient had an infection and therefore was
holding off on chemo treatment. The second patient’s family wanted to have an update of how
their loved one was doing. After Amity called them she checked in on the patient again and
found that the feeding tube had been clogged. After an hour of trying different possible solutions
to unclog the tube, she decided a new one should be put in. unfortunately, the department was
out of the correct size so they began calling other floors in the hospital looking for another NG
feeding tube. After another long period of time, a new feeding tube is found to replace the
clogged one. The feeding tube needed to wait to be inserted because the patient was then
receiving speech therapy as well and working on trying to swallow and clearing the mucus.
 Amity went around to check in on all of her patients again and then worked on catching
up with charting on her four patients. Because of the setbacks, she was behind in charting;
floater nurses and the CNA helped out with caring for her patients until she got caught up.
Amity was able to put the NG tube in the patient with help from another nurse. Since it
was the only size left in the hospital but it was too big, there were some complications. With the
help of tape they were able to solve the problem and the tube was held in place.
Amity continued charting on her patients. The night shift nurses came and she gave
reports of her patients. She still had about 30 minutes of charting to do and stayed after her shift
to finish. This experience showed me that not all days are normal, but I was also able to see
that the nurses work as a team. They support and help each other when they need it. I enjoyed
this experience was glad to see the work that a nurse puts in on a regular basis.