So many days on your rotations you feel like a student. There are simple questions that you will get asked by a patient or your preceptor that most times you THINK you know the answer to but aren't really sure. Then you check, verify that you were correct or missing something then relay the info to the patient. Then there are these little moments where you can answer a question with authority and know with confidence. It is these little moments where you actually feel like a practitioner. I think that first moment happened for me last rotation and is happening more and more this rotation. Then you will have a preceptor ask you a simple question like "what is pediatric dosing for Tylenol" I should know this off of the top of my head, but I have very little experience thus far with treating kids (which I will remedy this week). It takes only one little thing like that to remind you that you are a student and that you have so much to learn still.
I think about being done with rotations and is both excites and scares me. Exciting because I look forward to having more of a life and actually having a paycheck. Scary because there are great things that I learn every day that remind me the value that only comes with experience.
For those of you that aren't a PA student, the rest of this may get boring.
So some tidbits for you '11ers.
ALWAYS remove a baby's diaper. We found a gigantic abscess on this baby. She was septic and parents were presenting her as a cough and fever. Not sure if she made it or not.
Things not to miss on a baby's bootie. Petechiae.....could mean meningiococcus. Redness around belly button or umbilical cord (at 2-3 days usually. Pus from cord to) Could mean omphalitis (will kill a baby). A sacral dimple or sacral pit.....could indicate a neural tube defect.
You can give any age Tylenol, but can only start giving Motrin at 6 months.
You can give Zofran during pregnancy.
You can hear fetal heart tones at 12 weeks.
First time mom should feel baby kicking at 20 weeks......veteran mom might feel it sooner.
Later in pregnancy mom should count fetal movement. Baby should move 10 times in 2 hours. All 10 of those times can be right on top of each other, but it should be at least 10 times.
If someone comes in with a really painful sprain or break in their ankle, always palpate the up the leg to the fibular head. If they are tender here, get an x-ray. They may have a maisoneux (sp?) fracture. This fracture is not really treated anyway, it just means that there was enough twisting force that the ligaments between the tibia and fibula have separated and will need a couple of screws put in, even if there is no break in the ankle.
OH and a GREAT one!!!! Totally learn the physical exam for malingering for people with "back pain" aka drug seekers. Here is is in a nut shell. You have them lie flat on their back and you hold the backs of both ankles in your hands. Then you ask them to raise either foot (do one at a time). If they have true pain and are trying to lift their leg, they will push with the other leg in your hand for leverage. If no push, they are full of it. I did it tonight on a known case (she found out that if you get a tooth pulled they give you 6 Lortabs........she's all out of teeth now.....seriously). Anyway, I did it on her and it worked like a charm!! Through all of her moaning and screaming, and carrying on, she put on a show when trying to lift each leg, but absolutely did not try to use the other foot to push off with. I like those small victories. :-)
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