Mar 10, 2011, 06:35 am
Last edited Mar 10, 2011, 06:35 am
update #3
There's some truth to your comment.....indeed some subjects are pretty lame but then again most aren't. I remember some subjects I did that I sincerely claim was utter rubbish at that time. However nowadays I am glad that it was there for a purpose.
Nursing is a dynamic profession with specialities in supporting various specialties within medicine itself...however the common bond or pre-requisite is continuous pursuit of knowledge, critical thinking and experience. There are so many things that we still need to learn POST graduation and acknowledging this need, Universities are pushing the theme of self directed learning. I recalled studying a degree in Pharmacology itself....the course material covered indepth understanding of how medicine works...agonistic and antagonistic properties on different receptors for example was one area where almost .ALL students felt was going too far into the principles that we might as well have done Pharmacology itself. However today, armed with that knowledge I can research medications and understand their properties better. I believe that it has congealed my knowledge of other areas better.
For example, we first learned that it was easy to identify medications by the few last letters in their generic names...Bisoprolol, Metoprolol, Sotalol, propanalol and all the "lol" are beta blockers. However armed also with the extended knowledge of how medication bind with receptor sites, you can further research to learn that even though these medications are primarily a beta blocker class, they are NOT all used as for its beta blocking properties. Example - sotalol is used primarily as an anti-arrhythmic - correcting atrial fib or flutters. However because they are NON selective for Beta sites, they are contraindicated for use in asthmatics because salbultamol (aka ventolin) needs to bind and agonise beta receptor sites in the lungs to cause broncho-dilation. This cannot be done if sotalol are bound to the same beta receptor sites to AND Acting in opposite fashion - as an antagonist instead!!...BTW sotalol is a class I beta blocker - non selective in binding sites.
However metoprolol is a class II beta blocker...selective for Beta 1 and as such would not have such adverse effects to contraindicate against Salbultamol. which binds to Beta 2 sites..so you will find that doctors will tend to use class II beta blockers for it negative chronotropic and positive inotropic effects in asthmatics on salbultamol or atrovent. Without this knowledge someone would be scratching their heads as to why doctors do not apply the "general" knowledge of beta blockers contraindicated for asthmatics. As a patient advocate, nurse can query certain medications and withhold them if they believe it may do more harm then good and seek to gain clarification from doctors before proceeding.
I recalled my student days where I picked up long QT twice in different placements. The first was a patient who was tachycardic around 140 bpm.. Though tachy, his ECG trace showed very clear ST segments sufficient to calculate QTc. The second case was in my last placement - patient on new meds. and developed chest pains..ECG done and I interpreted it for the ward...picked up the long QTc (Significant prolongation of 0.52 seconds) and alerted the med. reg. It was NOT an infarct but because the patient had no previous history of long QTs, I reviewed his medications (he wasn't under my care then but I was asked to help with the ECG because in that ward I was the only one who had done a course in ECG interpretation)....and guess what...it was the sotalol..beta blocker used for atrial fribillation....med reg agreed and we withhold that beta blocker and gave a stat dose of glucagon - generally used in beta blocker overdosing...I guess it was cautionary that the med reg ordered the dose as he did not want the patient to develop Ventricular fribillation on his shift...lol. I attribute the knowledge to my University for having given me the fundamentals. Guess what, when I graduated not long after and though I did not get a GNP offer, I got a call from the NUM of that ward with a job offer which I have been in ever since...lol
As you progress through your placements, you will start to appreciate the knowledge Universities are arming you with and they are basically hoping that you will fervently apply your knowledge and skills towards self directed learning ands reflections to become the quality in whatever areas you choose to go into.
Don't loose heart...I think you will do very well....because already you have demonstrated that questioning mind...its a Great start and wishing you all the best.