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daisyfleur70 5,959 Views

Joined Apr 10, '07. Posts: 164 (10% Liked) Likes: 24

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  • Feb 7 '13

    Wow congratulations!!!!! i did check BON today and i passed!!!!!

  • Feb 4 '13

    NCLEX questions are quite specific with regards to drug calc. Verbiage will include...."round to nearest whole number," or "2 decimal places." Good luck, relax and stay positive!

  • Jan 4 '13

    Quote from daisyfleur70
    Good call, I'm on my phone... I'll get in my laptop
    Cool beans

  • Dec 19 '12

    Also - you need to look at the dosing of the opiates given for SC pts: most are very tolerant and need much bigger doses than someone who is opiate-naive.

    With the higher doses of opiates, you have more histamine release so that is why it is routine to give benadryl with the opiates.

  • Dec 19 '12

    I take care of sickle cell pts on dialysis.

    Opiates cause histamine release and benadryl relieves this.

    A peripheral blood smear isn't going to show much except whether the pt has sickle cell disease or not. It does NOT indicate crisis.

    SC pts get started on narcotics early in life, usually tylenol with codeine for pain. the time they are adults, they are very narcotic-tolerant and may require high doses for adequate pain control.

    Of course along with meds should come education:

    1. Stay away from sick contacts.
    2. Stay hydrated.
    3. Try to reduce the amount of stress you are under.
    4. Make sure you follow-up with your hematologist regularly.
    5. Take meds as directed.

  • Dec 16 '12

    If you look and act the most professional you will probably get the job. Do some research on the hospital and ask some intelligent questions. Dress conservatively and show maturity and flexibility. Good luck.

  • Dec 16 '12

    Remember the interview panel's names and dress NICE but not ridiculous. dont wear too much makeup...
    KNOW the mission, vision, values of the organization AND department.
    Think of a situation where you had use critical thinking, talk about experience.
    Know the answer to this question: "why do you want to work in the ED?"
    They will ask you a specific medication and what it does/contraindications/what to do pre and post admin and outcomes...(think ER meds: nitro, pressors, pain meds, etc..
    Know how to answer conflict resolution questions
    They may ask "what would you do if you learned that a fellow RN was diverting narcotics
    Think of a sick patient that you had - know their dx, what you did, what you should have done, what their outcome was (nursing process question.)
    If they ask you how you're doing, be honest. Tell them you're nervous because you really want this job. On my interview they said "good, because I dont think we'd hire someone who said they weren't nervous in a stressful situation."
    Bring a list of legit questions to ask them...and YES, bring the list with you, it's OK to look prepared. QUestions to ask have to be relative to the job. for example: when can i be trained in trauma, when can i get my CEN, what are the goals of the department, how long is residency, what are your expectations of me after residency... DONT ask questions like "what are benefits like"...thats HR stuff

  • Nov 7 '12

    I appreciate what you are trying to say but it does get tiring hearing this. I graduate next semester. I'm not changing career paths. I go to a great school, am getting my BSN, I am lucky to have several personal contacts that have already told me to come see them as soon as I'm ready or about a month before I graduate, and yes I still am concerned but I have a lot of opportunities. I get the point you are trying to make but I just don't see the point. Anyone hear that is smart is going to have a plan and anyone dumb that doesn't have a plan are just going to look at this and say "well no not me." These may be students like the ones going to a local school by me. They have the largest intake of nursing students and graduate about 50% of them. They tell them they are teh best program in our state and gurantee them that they will have jobs and this and that and then surprise they arent getting hired. More hospitals by me are not hiring ASN's, I mean some are but the majority are moving towards BSN. But my point is these students aren't going to amke any changes after reading this either. Everybody is already too vested in where ever they are right now.

  • Nov 7 '12

    Also, if she has a history of miscarriage, high blood pressure (may or may not be an isolated incident) and complaints of dizziness (the reason for her fall) did you ask about vision disturbances? Did she have any prenatal records in her chart where you could trend her blood pressure from prenatal visits? I'd be wondering about pre-eclampsia/eclampsia.

    Edit: Did her blood pressure improve after her anxiety subsided?

  • Nov 7 '12

    I think your progress note needs more info ab the fall. What caused her to fall? Did she land on her hands, her belly??
    Any bleeding? Did you get fetal heart tones to see how the baby is doing? Blood work to see if mom is Rh negative and may need a Rhogam shot??
    Is she reporting pain?

  • Oct 3 '12

    I'm in my last semester and still feel like an idiot most of the time....

  • Jul 21 '12

    I am an RN. I was a CNA before I was an RN. I appreciate every single CNA I work with, because I know how hard you work. The two roles really cannot be compared, though. When the **** hits the fan, it's the RN who is ultimately responsible for notifying the doctor, family, etc... and that is incredibly stressful. When it looks like we are sitting around not helping witht he 'physical work' you describe, we are usually studying the charts to learn more about the patients just in case something should happen. It really is all about teamwork and communication and doing what is necessary to care for the patients. Some days I miss being able to say "I will tell your RN", like I could when I was a CNA. Until you have experienced the role of an RN, please do not try to compare who works harder.

  • May 24 '12

    If you aren't any good at time management, be good at time management before you get there. Don't be afraid to ask questions. Become a sponge and absorb anything and everything and get your foot in the door of as many patients as you can. Volunteer yourself to do any procedure they'll let you do. Learn your drugs. Learn how to do a focused assessment. Know your cardiac rhythms.

    That's a good start. Every day is a new learning experience, even when after you're an RN.

  • May 9 '12

    Hope this helps....this is what I used to learn the differnce and now I am a pro at it. Let me know if it helps

    Normal pH pH (7.35-7.45)
    < 7.35 Acidosis
    > 7.45 Alkalosis
    7.40 is the exact normal
    7.35-7.45 Compensated
    < 7.35 or > 7.45 Uncompensated
    CO2 (35-45) normal CO2 in artery
    HCO3 (22-26) normal Bicarbonate in artery
    Respiratory Acidosis CO2 > 45
    Respiratory Alkalosis CO2 < 35
    Metabolic Acidosis HCO3 <22
    Metabolic Alkalosis HCO3 > 26
    pH and HCO3 are cousins they go in the same direction for Acidosis and Alkalosis
    But CO2 is an outsider it goes the opposite direction for Acidosis and Alkalosis
    Abnormal pH and CO2 in opposite directions respiratory problem
    Abnormal pH and HCO3 in the same direction metabolic problem
    HCO3 and CO2 in the same direction trying to compensate for abnormal pH
    HCO3 and CO2 in opposite directions both imbalances (mixed)
    What are some causes of low PaO2? Hypoxic Hypoxia--there’s just not enough of a supply of O2 ( COPD, pneumonia, ARDS, suffocation)
    What are some causes of low PaO2? Anemic Hypoxia There’s plenty of O2—but not enough HGB to carry it to the tissues
    What are some causes of low PaO2? Stagnant Hypoxia There may be enough O2 coming in and enough HGB to carry it--but the circulation is stagnant due to a decreased Cardiac Output. The O2 is not being adequately carried to the tissues.
    What are some causes of low PaO2? Histotoxic Hypoxia Poisoning like Carbon Monoxide or Cyanide. Either the blood can’t carry the O2 or the cells can’t receive the O2 from the blood.
    What is saturation? SaO2 (oxygen saturation) measures the percent of oxygen bound to hemoglobin. This tells weather the patient has HYPOXIA (decreased O2 in the tissues).
    Normal SaO2 ? Greater that 95%
    In Carbon Monoxide Poisoning the HGB is saturated with Carbon Monoxide. Although the patient is hypoxemic because there is no room on the HGB for O2 to be carried—the Saturation looks good because it can’t distinguish between the two.
    What does the PaO2 mean? The O2 tells us if the patient has HYPOXEMIA (decreased oxygen in the blood).
    Normal PaO2 = 80-100. (Hypoxemia = PaO2<80)
    What does it do? PaO2 assesses Perfusion (gas exchange).
    What does it do? PaCo2 asseses the adequacy of Ventilation (breathing pattern).
    What does it do? The PaO2 is very important in determining your patient’s oxygen status and needs
    Decreased pH with Decreased HCO3 ACIDOSIS.
    Increased pH with Increased HCO3 ALKALOSIS.
    Decreased pH with Increased CO2 ACIDOSIS.
    Increased pH with Decreased CO2 ALKALOSIS.
    If it is 7.35-7.45 (normal) is COMPENSATED
    If the CO2 is <35 or >45-- RESPIRATORY.
    If the HCO3 is <22 or >26-- METABOLIC.
    If the pH is <7.35 or >7.45 is UNCOMPENSATED.
    Carbon Dioxide is an Acid
    Increasing your respiratory rate(hyperventilation) you "blow off" CO2 decreasing your acid. Giving you ALKALOSIS
    Decreasing your respiratory rate (hypoventilation) you retain CO2(acid) therefore increasing your CO2 giving you ACIDOSIS
    Hydrogen or HCO3 is Bicarbonate or Basic or a base
    If you have excess H+ and decreased HCO3(base):decrease in pH Acidosis; the kidneys will try to adjust to this by excreting H+ and retaining HCO3
    When H+(acid) decreases and you hace increased HCO3(base) Alkalosis;Kidneys excrete HCO3(base), retains H+
    Respiratory AcidosisH<7.35;CO2>45 Causes HypoventilationDepression of respiratory center (sedatives, narcotics,drug overdose, mi,Spinal cord injuryChest wall disorders(pnuemo)Disorders of lung(COPD, CHF, pneum, aspiration
    S/S of Respiratory Acidosis Muscle twichingTachycardiadysrythmiasdiaphorisispalpitati onsserum electrolyte abnomalitiesCNS depression
    Treatment of respiratory acidosis physically stimulate pt to breatheVigorous chest PTC & DB, Spirometerrespiratory treatmentsreversal of sedativesantibiotics for infectionsdiuretics for oveload
    Respiratory Alkalosis: pH > 7.45 CO2 < 35 Alveolar HyperventilationPsychogenic(fear,pain,anxiety)CNS stimulation(brain injury, ETOH, brain tumorHypoxiaventilator rate too fast
    S/S of respiratory alkalosis HeadacheVertigoTinnitusElectrolyte abnormalitiesParesthesias
    Treatment for Alkalosis Sedatives or analgesicsCorrection of HypoxiaAntipyretics for fevertreat for hyperthyroidismbreathe into a paper bag

    a pH of less than 7.35 on an ABG would be considered acidosis
    a PH of greater than 7.45 on an ABG would be considered alkalosis
    alkalosis along with a PaCO2 of less than 35 on an ABG would be considered respiratory alkalosis
    acidosis along with a PaCO2 of greater than 45 on an ABG would be considered respiratory acidosis
    acidosis with an HCO3 level of less than 22 would be considered metabolic acidosis
    alkalosis with an HCO3 level of greater than 26 would be considered metabolic alkalosis
    normal PaCO2 range 35-45
    normal HCO3 range 22-26
    normal SpO2 range 95-100

  • May 9 '12

    We're all used to straight As when we get in the program. Look at how many straight A students become straight B and C students! We've got more than 50 forums on allnurses for student nurses because having 1 general one wasn't enough.

    Nursing school is hard. There is a reason why it has that reputation. It makes a straight A student feel good about getting Cs. I get your feeling of fear, I really do. My path is leading me to grad school as well. It's going to kill me to get grades lower than As because I have a touch of OCD and impossibly high standards for myself.

    But, there is a learning curve. I know the first semester will be the hardest because it is the first time in these types of classes. There will be 3 more semesters after that. Life will go on. My school accepts its own alumni into their grad program with a 3.0 GPA. I've shot myself in the foot a bit by transferring in, so my 65ish credits at a 3.87 won't matter. The pressure is on.

    But, I will forgive myself, especially with the first semester, because if there is anything admissions people like to see, it is that you have learned from your experiences. When you write you application letter, or essay, and you are honest about the first semester kicking your butt, and they can see you did better later, they'll know you have grown as a student and a person, and you are committed to excellence.

    They'll forgive that C as much as you should. How do I know that? My first semester back in college I got a C in a&p 1. My school only considers GPA in pre-reqs, and I still had 2 left to go. I think that gave me only about a 3.5. I start my program in the fall.

    Lighten up. Go have a beer