Wednesday, April 20, 2011

Cranial Nerves I through XII intact.

        I just finished up my last officially scheduled clinical this past week in the ICU on the neurological floor. I also finished my last preassessment ever! (just have to finish the post part of it, which is why I am procrastinating and doing this instead). I only have spring term in Tonga and then Fall semester left till I am officially working as a nurse! Crazy, huh? I will be working out my own schedule with my nurse preceptor   in a yet to be determined location, but I am hoping ICU.
My ICU Clinical group at Red Robin together.

It has been a wonderful semester, in which I have learned and been able to experience many, many interesting things. I thought I would share just a few through a neurological assessment  perspective.

CN I- Olfactory(Smell). There are many strange and usually unpleasant smells in the hospital, but the trick is to somehow become immune or at least not let your patients know it makes you a bit squeamish! It also works to just recognize them for what they. It can often be a clue to gastrointestinal progress. There are times when doctors can even diagnose certain illnesses by ones ability to smell!
More often than not though it is taking in deeply the smells that surround you in order to recognize or conjure fond memories. It is the smell of a summer rain, or freshly washed clothes, the sizzling of bacon, or your winter mittens that conjure up the sensations of life. Although the end of your nose might be over looked, this is an important sense given to man for his joy,
"D&C 59:18Yea, all things which come of the earth, in the season thereof, are made for the benefit and the use of man, both to please the eye and to gladden the heart;

 19Yea, for food and for raiment, for taste and for smell, to strengthen the body and to enliven the soul."
CNII- IV, VI- Optic, Occulomotor, Trochlear, Abducens-

All of these nerves help you see all that is around you. since there are four you know it must be important. It is your vision that helps you gain understanding of the world around you. It is that first glance when you walk into a patients room that can tell you so much in your assessment. While this visual interpretation helps me see what is going on with my patients I have learned that it is still my perspective. I need to see what they see. I remember at Primary Children's hospital they had several of the ceiling tiles painted, but nothing really on the walls. I learned that these bright paintings were placed in just the right position for the kids to be able to see them from their perspective of being on their backs being taken from one place in the hospital to the next in their hospital beds. Seeing is not glancing in someone's direction, but the act of looking is what will really help us understand what is going on around us. That may even include taking the extra effort to see what is on the periphery of what patients are going through that may seem minor to us, but it is important to them and that is what matters.

CN V- Trigeminal-  Butterfly kisses, tears streaming down, your cheek, sunshine on your face. This nerve helps me remember that close human touch. I always remember this one when I go to visit my first patient I ever had in Art City and how she always kisses my cheek when I see her. It is a simple act of love but I feel it there and in my heart. 

CN VII- Facial- Have you ever just felt the goodness of a smile on your face and how it just some how brightens your whole countenance. Try it now and even the fake smile might even make you chuckle a bit :) I have learned the importance of this nerve from a friend who is recently recovering from Bell's Palsy. He handles this trial like a champ... or should I say more like a pirate? He makes his crooked grin into a jovial pirate greeting and always has an optimistic outlook about it. He never seems to be discouraged by it and continues to have a warm, inviting smile.

CN IIX- Vestibulochoclear- Beep...Beep...Beep...Beep. In the hospital I would say Nurses have a very keen sense of distinguishing which beeping IV pump is theirs and not in another patient's room. I have still have yet to master this skilled hearing.  What I have learned is to listen to people. I have learned that effective communication really means being willing to listen. It doesn't mean putting in your opinion or viewpoint, but rather empathizing. Obviously I am still working on this, but from listening to people's stories in the community who are suffering from mental illnesses I learned that people really do want to tell their story. They just need someone to listen, someone to understand where they came from and then help them see the potential in themselves. It is not about judging, but accepting and validating what people are experiencing. It doesn't help us or those around us to criticize or demean one another no matter how sugar coated it may sound. It also doesn't matter if our patients are in a coma or not neurological all there they still can hear us! It is their room that we are stepping into, we need to respect them and their space. Positive, uplifting, patient centered communication.
A funny story to go with that is when a fellow nursing student went in a patient's room to give him is sequential compression devices that help squeeze the blood in your legs to prevent from getting clots in them. Anyways they are usually called SCDs for short she accidently said, "I am here to give you your STDs!" Whoops :)

CN IX & XII- Glossopharyngeal and hypoglossal. - Tongue and other apparatuses! Swallow your pride and invite yourself to do a humbling work. Learning the healer's art means serving His children.

2For in many things we aoffend all. If any man boffend not incword, the same is a dperfect man, and able also to bridle the whole body.
3Behold, we put bits in the horses’ mouths, that they may obey us; and we turn about their whole body.
4Behold also the ships, which though they be so great, and aredriven of fierce winds, yet are they turned about with a very small helm, whithersoever the agovernor listeth.
5Even so the tongue is a little member, and aboasteth great things. Behold, how great a bmatter a little fire kindleth!
6And the atongue is a fire, a world of iniquity: so is the tongue among our members, that it defileth the whole body, and setteth on fire the course of nature; and it is set on fire of hell.
7For every kind of beasts, and of birds, and of serpents, and of things in the sea, is tamed, and hath been tamed of mankind:
8But the atongue can no man tame; it is an bunruly evil, full of deadly poison.
9Therewith bless we God, even the Father; and therewith acursewe men, which are made after the bsimilitude of God.
10Out of the same amouth proceedeth blessing and cursing. My brethren, these things ought not so to be.

- James 3 :2-10

"Angels speak by the power of the Holy Ghost; wherefore, they speak the words of Christ. Wherefore, I said unto you, bfeast upon the cwords of Christ; for behold, the words of Christ will dtell you all things what ye should do."
~ 2Nephi 32:2-3

- We speak nice words when we take the time to reflect upon what it really means to speak uplifting words. 

CN X Vagus- Use your gut instinct. If something doesn't seem right, no matter your position have the courage to speak up. It is better to be mistaken for a moment than be wrong with repercussions. This happened a lot in the ER as a volunteer I would have the opportunity to talk to patients for a long periods of time and was able to assess situations such as suicide ideation and a pending heart attack. Although I was just a volunteer I recognized these potential problems and was able to help.
I am also very thankful for the promptings of the spirit that teach me what I should be looking for or what I should do.

CNXI- Accessory- If things don't go quite the way you expected you have to learn from it and shrug it off your shoulders. You just have to realize that you did the best that you could. If the testing center monitor doesn't say "Awesome" next to your score, you get a mean nurse, you squirt yourself with morphine while trying to draw it up, or you blow a vein trying to put an IV in, it is can all be counted as a round of experience thankfully!

I am still alive through the 3 hour lectures, endless tests, ATI, lab pass offs, Sam lab, projects, waking up at 4:30 am, doing preassessments, etc.! I have loved nursing school and all the opportunities I have had while being in the program. I am so thankful God answered numerous fervent prayers and knew what he was doing with His timing. I love the people that are in my semester and it has been a perfect fit. Although I felt that I was losing my mind I am still intact CNI-XII

1 comment:

  1. Congratulations! I'm so happy for you. And I love the section on the tongue- something PJ and I have been working on. Thank you!