Bruits & Thrills/ Special Needs School

This Friday on the PCU, my original patient was discharged before I got up to the floor. (It is very common on the PCU floor and I guess that is a good thing!) I was able to take care of a patient that had kidney disease and was on dialysis. This patient also had a catheterization to put stents into the heart. Upon assessment of the patient's pulses, I felt a really strong pulse coming from the right arm that was very different from the left arm (you assess pulses on both extremities for similarities and they should have the same rhythm). When I was assessing the radial pulse (on the lower part of the arm) it was beating so fast and strong. It was like electrical I kept saying. I went to the nurse and told her about it and she said that that patient might just have a really strong pulse. Finally when I was charting on the computers I saw that the patient was positive for a bruit and positive for a thrill. A bruit is a sound you hear using the bell (smaller side) of the stethoscope and you will hear a "shh" sound and a thrill is what you palpate. The reason this patient had this was because of the AV (arteriovenous) fistula (used for his hemodialysis). What I was hearing and feeling was the blood from the arteries going into the veins. It was AWESOME. I have never felt anything like it before. It was the highlight of my night.

Also, this Monday I had clinical at a special needs school. A group of 6 nursing students were able to assist special needs teachers for the day. I was able to help out with the middle school aged children. The classroom I was in had about 6 children, all who have different needs. Many were autistic and the child that I followed throughout the day had seizures. This clinical was definitely worthwhile.

As for my pharmacology and med- surg test I did well. Thank you for all the prayers and encouragement! It means so much to me!