Tag: 19AbbyH

Today was my last day shadowing Shannon Clark at Southwest Wake Dialysis. I started out doing the normal rounds on the patients with Shannon Clark. I got to see the different parts of the machine and the different levels that are monitored by the machine and how Mrs. Clark reads each level and then decides what the patient needs to do. She explained to me that they sometimes listen and other times do not, and it is their life so they ultimately have control over what they want to do and understand the consequences.

I also got to learn more about the transportation many of the patients require to take them home after dialysis and how the drivers can be a pain sometimes. The drivers only make minimum wage so the do not have sympathy for dialysis patients who already have to sit through dialysis for 4 hours for 3 days a week. After they have dialysis, the needles need to be taken out and then need to apply constant pressure for 15 minutes to the area after their 4 hours is up. They then also have to weigh themselves again at the end of their treatment, so this whole process takes a while and the transportation drivers arrive right at the time they get off dialysis so they become impatient and leave.

I also got to see how Shannon Clark deals with dementia in patients. They often cannot remember where they are or anything in their past, which is why Mrs. Clark says she hates dementia.

I also got to see how the dietician, social worker, and nurse practitioner all work together to discuss what to do for certain patients. They are all equally important but handle and specialize in different things and thus it is very important that they all talk to each other because care is multifaceted. They also talked to me about how they became a professional in their field, and it was very interesting to listen to.

Overall, dialysis was very interesting and cool. I absorbed so much while I was shadowing Shannon Clark and am very thankful for this opportunity!

Today I was back at Southwest Wake Dialysis and White Oak Dialysis Center shadowing Shannon Clark, a nurse practitioner. I arrived and got to see an ambulance arrive (at the same time as I arrived) and they went in because a patient was having irregular fast heart rate due to him missing dialysis one day and then coming in today and they took off too much fluid so his heart was “freaking out”. The paramedics put him on a stretcher and he was very irritated because he wanted to leave, saying that he felt fine, since he had to take care of is 5 year old daughter. Mrs. Clark explained that there was no way they would let him get into a car. She also explained that sometimes patients have the same issue but they do not have the irregular heart rate so they are less of a concern.

I got to see Mrs. Clark make her regular rounds and check on patients. Mrs. Clark also explained that, since she learned that I was also shadowing a pediatrician, she likes adults because they know their body and are able to tell the nurse and doctors what is wrong with them, whereas with kids you have to guess sometimes.

I also learned that Mrs. Clark does not like to prescribe many medicines since they mess patients up sometimes. She also talked about nurses lying about things that the messed up and how big of a deal it is since it messes with all the patients.

I then got to visit the White Oak Dialysis center with Shannon and it was very new and nice. Afterwards, I left. Overall, today was very fun and I learned and got to see more things associated with dialysis and how the cardiovascular and nephrology is related.

Today was my last day shadowing Dr. Wu at her Knightdale Pediatrics location. I got to see and experience all of the same things I did yesterday and last week but also got to shadow a nurse for a little bit and see how they draw blood and give shots. I also got to see the nurse complete a newborn check because the hospital had done the check at 7hrs when they are supposed to wait until 24 hours. Another baby was coming in later for the same problem but the hospital had done the blood test at 23 hours and 58 minutes (just 2 minutes short of the deadline) and thus Dr. Wu said the situation was annoying but the state requires it to be at or after 24 hours even if it does not make a difference.

I also got to experience the vision test with two 3 year olds that were not super cooperative but that is understandable due to their age. I then got to see a family with a dad who was African and a mom who was Thaiwanese. The mom was going to take their son out of the country to Taiwan so the dad was very nervous about sending his son away with his mother. I also got to see how different families could take different lengths of time based on how many questions they have and their circumstances.

The blood draw was interesting because the little girl that was getting her blood drawn had an artery that stopped giving the little tube blood so the nurse let it trickle for a while and then told them that it should be enough for allergy testing, which is what they were using it for. I also got to learn and see how different vaccines require different needles and different target locations on a child’s body. I also saw how the nurse prepared the blood drawing items and vaccines before she went in.

I also got to see how Dr. Wu (as well as the other nurses) distracts kids who have a hard time at the doctors. Some of the parents are helpful and some are not with this process.

I also learned that the state requires certain things like a vision test even if the kids are uncooperative and no results come out of it (typical of 3 year olds during a vision test).

Overall, I really enjoyed my time with Dr. Wu and the nurses at Knightdale Pediatrics. I learned and saw so much and it definitely opened my eyes to the field!

 

 

Today I shadowed Christine Wu at her Knightdale Pediatrics office. I started out the morning by meeting Lori, Dr. Wu’s assistant doctor in the office. Then I got to go with a nurse, which was different to rooms to see what a nurse typically does. She went into the rooms and asked similar questions that Dr. Wu asks and did tests like the strep test and blood draw (finger prick) to test for things like strep throat and mono. I also got to see how babies (and young toddlers) are weighed, using a baby scale. The nurse then sends Dr. Wu a note through their system to let her know what kinds of tests she took, what the parents are saying, and the results of those tests (if they are available at that time). The nurses also check vitals when they go into the rooms and after they bring the patient back from the waiting room. Dr. Wu then goes into the room and asks the same questions and figures out what to do for treatment, or for a physical she just makes sure they are growing and everything else looks normal.

I also got to see a family that had an infant and did not like vaccines. Dr. Wu explained to me that while parents have the ultimate say for vaccines, many of their judgements are flawed based on the internet or their friends. She also told me that because she works in a private practice she can refuse patients who do not get immunizations required by them by certain dates and thus she told this family that if their daughter did not get the immunizations by 2 yo they would have to find a new practice.

I also got to experience the lab today, which was very cool and I got to see how blood is tested for hemoglobin and wbc levels.

I also got to see babies being weighed and their heads being measured for a 2 day old baby and a 4 day old baby. Dr. Wu also told me that all babies when they are born have jaundice, which I thought was interesting.

Today I met Shannon Clark at her Wake Nephrology office on Bush Street. It was a very relaxed business day in which I got to experience the business side of her nephrology practice. Mrs. Clark explained that in order for them to keep their practice private, they must have all of the stuff together and make sure that everyone on their team can succeed and is happy. They spent 6 long hours in a meeting discussing how best to divide nephrology/dialysis centers among the 16 women who work for them, in terms of the number of patients at each center. Mrs. Clark also explained to me that some times the patients and work shifts become uneven and then people get angry. She said that, for instance, a nurse practitioner had much fewer patients and went on vacation for more than the allotted 30 days a year and thus someone else had to cover the load that she was not covering.

Mrs. Clark also explained to me that one nurse practitioner practicing under another practice lied about giving medicines to a patient that never received them and told me that they mess up all the time because we are all human but they need to own up to their mistakes because, in her job, it has dangerous repercussions !

I got to speak with Lori, the desk manager, and she showed me the complex excel sheet that has all of the shifts for each person as well as the requested and then granted vacation days. She was very good at her job and could change things in the spreadsheet easily and efficiently.

Overall, today was uneventful but I learned how complex and tedious organizing a private practice is. I also learned that nurse practitioners do not see patients ever day.

Today I shadowed Shannon Clark at her Southwest Dialysis location. I got to see what dialysis was like and met some very nice patients. Unfortunately, I was unable to take photos but I have a picture of the basics of kidney dialysis below.

I got to do 2 shifts with Mrs. Clark and got to meet many patients. They were all very positive and very sweet! They told me their stories and Mrs. Clark helped to explain all the different parts of the dialysis machine and what, exactly, it was doing. I was very interested. She also told me a sad and unfortunate story about a patient that had his port covered under a blanket and the needle ended up coming out of the arm. He bled to death very quickly and died. She told me that they now have a rule that makes the patients show their faces and their access ports at all times to avoid this!

The area for dialysis was one big communal area with many chairs, patients, RNs, NPs, and the desk ladies. It was very cold in order to avoid dilation of the veins which is detrimental during dialysis, so the patients had thick blankets.

The dialysis access port was, not going to lie, a little scary. It is installed by vascular method and by surgery. The port is then set up by injecting a needle (preferably one that is 16 gage or 17 gage for starter patients) into the port and setting up the system. The blood then got pumped out and filtered through the artificial kidney and then pumped back into the persons vein. It is all mostly set up using the “graft method” but it can also be set up by going into the veins in the neck (which is uncomfortable and not the “best” option available).

Mrs. Clark also talked about needle sizes with me. She said that because patients are coming in so frequently (3 times a week, either first shift or second shift) the size of the needle plays a significant role in their contentment. Patients generally like smaller needles! Mrs. Clark favors giving smaller needles but going for a longer time, which is not only better for the patient but also better for the heath of their access port!

Overall I had a very fun time today and learned a lot first hand about kidney dialysis and also about sustaining both the patients life-span and happiness. For example, an 85 year old patient may not want to go through dialysis even if it extends their life-span because it is not fun and dying peacefully at home may be better for them!

 

 

Today I shadowed Dr. Christine Wu at Knightdale Pediatrics. I got to see and experience what a typical day in the life of a Pediatrician is like. I got to sit in on sick visits and well visits and hear what kinds of questions Dr. Wu asked the parents. I also got to see the complex system Dr. Wu and the nurses and other people at her office use to communicate about patients with each other. It was very interesting to see her send orders for medications and make notes on patients. She also let me know that if a parent has a concern they must address it in their notes even if there is nothing specifically wrong with their child.

There were 4 newborns checkups that I witnessed and it was very interesting to see the difference in the parent’s stress when it was their first child versus their second. Most of them had a lot of questions and Dr. Wu had tremendous patience and thoroughly answered each of their questions.

I also got to see the lab where the nurses take blood, urine, and saliva samples and test them for certain viruses and diseases. I thought that was very cool to see. I also got to see where they put all the vaccines (most in a large refrigerator and the rest in a large freezer)!

Dr. Wu also used a large cabinet that was locked and had things like formula and food for impoverished families that could not afford formula. The WIC (women infant and children) program only covers Gerber formula, which Dr. Wu told me was not favored by families these days. She would give them free boxes of formula powder (the favorable type).

There was this really nice lady, who had 10 kids, and told me to keep it up and that she’d hope to see me in the future. That honestly touched me.

Today I shadowed Shannon Clark, a nurse practitioner, at Wake Nephrology. I got to experience a typical day in the life of a nurse practitioner doing nephrology. I got to sit in on check ins with patients and learn the different things Mrs. Clark checks for at each visit. She monitors their weight, diet, potassium levels, phosphorus levels, uric acid, and other things in a patient’s body to help them with their journey with CKD (chronic kidney disease). She showed me the significance of different percentages of creatinine in a patient’s body and how they signal different stages of CKD. When a patient is at the 5 -6% range they are due for dialysis. Dialysis can be administered different ways and at different times of the day. Most people start out doing it in their stomach and at night for 5-6 days a week. However, if you do it in your stomach, you cannot take a bath or swim because of the risk of infection.

It was also cool to see how Mrs. Clark interacted with different doctors and was able to send notes and notify other doctors in other specialities of problems they should look out for with the patient.

Mrs. Clark also let me know that a lot of patients talk to her about all sorts of life-related problems that are not medical related. She said that as patients get older there are less people they can talk to so they enjoy going to see their doctor to chit-chat. She also explained that she enjoys the community feel of her job due to this sort of thing.

Mrs. Clark gave me patient handouts which helped explain some of the things she did and her field of study.