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notthereyet0 3,357 Views

Joined: Jul 16, '08; Posts: 158 (15% Liked) ; Likes: 29

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  • Sep 17 '09

    Yes, as long as you have passed one semester of nursing school, you can register and sit for the STNA test. I personally went through the classes and was told that by the DON of the program. Two of my classmates just registered and took the STNA test 2 weeks ago without taking the training classes. We are in our third semester (just started) so all you have to do is find a testing agency and register for the test. This link should help you locate an Ohio testing place. http://www.hdmaster.com/testing/cnat..._STNA_Home.htm

    Good luck!

  • Sep 1 '09

    In peds we had to double check everything. Even OTC meds.

  • Jun 30 '09

    You have to be very creative sometimes....Do you have a list of nursing diagnosis, sometimes just looking through them can be a lot of help. I just finished nursing school in May and Passed NCLEX in June, if you are early in the program they just want to see that you can critically think.

    If a patient is old, confused, and alone in a new enviroment, what could be a problem?

    She could have a UTI.....Old people can become confused due to a UTI....Or could have had a stroke or many other things....just 2 biggies
    -------------------------------------------------------------------
    Risk for injury related to unfamiliar enviroment---re-orient frequently--keep free from clutter etc

    Impaired communication related to disorientation and confusion

    risk for skin breakdown r/t incontinence manifested by patient's change in mental status

    Risk for falls

    risk for impaired nutrition r/t change in patient's mental status

    Well I hope this helps!!!!!

    GOODLUCK....nursing school can be very tricky and annoying, but it will be worth it

  • May 31 '09

    ok, first off think of your care plan as capturing this patient's nursing problems at one moment in time--like a photograph captures a picture of something happening and preserving that one moment in history. so, don't be concerned about followup info. your care plan is about this 88-year old's nursing problems and what you're gonna do about them as of that point in time where you entered his life. our job as nurses is to assist patients in responding to their diseases and conditions and helping them achieve their activities of daily living. in putting together the care plan we begin by collecting data and then sifting out the data that is abnormal. that abnormal data is what becomes the basis for the care plan. the data we are most interested in concerns the following:

    • prior health history (review of systems) - this is an 88-year old man who fell (what was he doing that brought on the fall?) and fractured his left acetabulum (part of the pelvic bone that articulates with the head of the femur). he also has been a diabetic for 20 years and has a history of htn, hyperlipidemia, calcification of iliac, carotid and vertebral arteries, and had cancer of the prostate. he is hard of hearing and needs hearing aids to hear. his wife has dementia and he is her primary caretaker.
    • physical signs and symptoms of disease or illness - i can't believe that in the 5 hours you spent care for this man that you didn't learn anything about his current condition other than he had weak pedal pulses. broken bones produce pain because of muscle spasm at the site of the break. you mention he is on oxycodon for pain but there is no assessment of pain. assessment and description of pain includes the following:
      • where the pain is located
      • how long it lasts
      • how often it occurs
        • a description of it (sharp, dull, stabbing, aching, burning, throbbing)
      • have the patient rank the pain on a scale of 0 to 10 with 0 being no pain and 10 being the worst pain
      • what triggers the pain
      • what relieves the pain
      • observe their physical responses
        • behavioral: changing body position, moaning, sighing, grimacing, withdrawal, crying, restlessness, muscle twitching, irritability, immobility
        • sympathetic response: pallor, elevated b/p, dilated pupils, skeletal muscle tension, dyspnea, tachycardia, diaphoresis
        • parasympathetic response: pallor, decreased b/p, bradycardia, nausea and vomiting, weakness, dizziness, loss of consciousness
    you mention the doctor's concern about this patient's heart and i see he is on a number of heart medications. did he have any edema in the affected leg? what does "his rhythm and rate were ok" mean? did you talk with him about his heart problems? he doesn't think he has a heart problem and his vital signs seem to indicate that his medications are controlling his heart rate and blood pressure. if the doctors aren't stating he has an immediate heart problem i wouldn't force one on him. they are probably worried that his fall came about as a result of syncope which could be related to a heart condition which is why they are bugging him about checking out his cardiac status. what about his prostate and urination? what's this he says about having neuropathy in his feet? is this a complication of his diabetes? i'm curious about how he came to fall and wonder if this neuropathy in his feet had anything to do with his falling.
    • assessing their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming) - this is big for someone who is ordered to have no weight bearing on the affected leg for 24 days. imagine not being able to stand on one of your legs for 3 weeks and you are 88 years old. how will you get up from a sitting position? how will you get up and down stairs? how will you stand and keep your balance? how would you put on and take off a pair of pants? another question i have is how will his wife get cared for while he is on restricted weight bearing? did you talk about this with him?
    • reviewing the pathophysiology, signs and symptoms and complications of their medical condition - you need this information to formulate the etiologies for some of your nursing diagnostic statements. i will tell you now that "calcification in his peripheral arteries" is not the same as calcification of iliac, carotid and vertebral arteries. peripheral vascular disease wasn't even mentioned as one of his medical diagnoses! calcification of iliac, carotid and vertebral arteries is something that was seen on an x-ray and means nothing without physical examination correlation and symptoms to accompany them. see:
    • reviewing the signs, symptoms and side effects of the medications/treatments that have been ordered and that the patient is taking - ace inhibitor, betablockers, antiarhythmics, antianginal (chest pain is indicative of coronary artery disease), antilipidemic (indicative of high cholesterol), oxycodon for pain (where's the pain?), and, again, why the order for no weight bearing on the affected leg for 24 days?
    after collecting information i am ready to diagnose. based on what you have (and haven't) posted. . .
    • impaired physical mobility r/t pain and order for no weight bearing on injured leg aeb [need evidence]
    • acute pain r/t trauma and muscle spasm aeb [description of pain]
    • deficient knowledge, fracture, treatment and discharge needs r/t lack of information aeb [need evidence]
    • risk for ineffective tissue perfusion, peripheral r/t immobilization of affected limb
    • risk for falls r/t history of previous fall, age of 88, need to use assistive device to ambulate, anemia, hard of hearing, neuropathy in feet, risk of blood sugar changes, and taking the following medications: ace inhibitors and narcotics for pain.

    - - - - - - - - - - - - - - -

    the problems with your diagnoses are as follows:
    ineffective tissue perfusion r/t calcification in his peripheral arteries aeb o2 was a bit low and weak pedal pulses.
    • the place or organ of the ineffective tissue perfusion needs to be identified in the title. i presume you meant ineffective tissue perfusion, peripheral. this diagnosis specifically refers to the tissues not getting enough oxygen.
    • the r/t, or etiology, must tell the most rational reason why the tissues aren't getting enough oxygen. do we know? what is preventing the oxygen from getting to the tissues? how does calcification in his peripheral arteries have anything to do with oxygen getting to the tissues? i'm not getting the connection. blood is the substance that carries oxygen and how the oxygen gets transported to the cells of the body. calcium has no connection with it.
    • the aeb items are your evidence of the ineffective tissue perfusion, peripheral. think of them as your proof that the ineffective tissue perfusion, peripheral exists. if the tissues of the feet and legs are not getting enough oxygen what will you see? pale, cyanotic or other skin discolorations, temperature changes in the skin, weak pulses, bruits over the arteries if you listen to them with your stethoscope, edema, there may be no hair or shiny skin. however, o2 was a bit low is a measure of the patient's respiratory status and has nothing to do with the oxygenation of the tissues.
    impaired physical mobility r/t pain and musculoskeletal impairment aeb left acetabulum fracture, opioid pain meds, and history of falls.
    • as i mentioned above, the aeb items are your evidence of his impaired physical mobility (limitation in independent, purposeful physical movement of the body or of one or more extremities). all of your aeb items fail as evidence that would support or prove impaired physical mobility.
      • left acetabulum fracture is a medical diagnosis and does not even come anywhere near describing physical movement.
      • opioid pain meds are a medical treatment for pain ordered by the physician.
      • history of falls is an anticipated (potential) nursing problem that has its own risk factors (a total of 9 for this patent) and needs to stand as it's own diagnosis with goals and nursing interventions. it cannot be a symptom of another nursing diagnosis, impaired physical mobility.

  • May 20 '09

    I have Lab Notes (the spiral book) I also have a PDA but much prefer this little book.

    Fits in my pocket perfect and it has what I think you're looking for. It will say for whatever lab what is the most likely cause(s) for an increase/decrease.

    I can flip back and forth for different things (which is why I prefer this for labs rather than the PDA) and it's working well on my last 6 weeks of 12 hour clinicals before graduation

    Feels great to be able to answer questions that my instructor may throw at me.

    HTH

  • May 19 '09



    i think it's mosbys, we have davis on our pda's, i like the book better.

  • Apr 11 '09

    employers look for people who have:

    • initiative - autonomy
    • dynamism - energy
    • positive outlook
    • responsibility
    • orientation to the client and co-workers (ability to provide customer service)
    • learning capacity
    • productivity
    • high adaptability - flexibility
    • leadership
    • team work
    • tolerance to pressure
    • analytic ability
    • professional development
    i interviewed and hired a lot of new grads and nurses. i also did a lot of yearly evaluations on which goals had to be written for the next year's evaluation (you are never going to get away from having to write personal goals on these things-ha! ha!). the following goals would be appropriate for a student nurse:
    • (1) complete your program of nursing
    • (2) become employed after graduation. mention the kind of nursing you want to specialize in.
    • (3) in your first year or two after graduation you plan on honing the skills you learned in school. after that you plan to focus on specializing more seriously in that field you mentioned above. you would like to become a certified nurse in that field and will be joining the national association of nurses for this specialty. see http://www.discovernursing.com/nursing-careers for the list of nursing specialties and the links to the national association connected with that specialty. you see yourself eventually being a role model and leader for other new nurses who want to go into the same kind of nursing, how to do take care of these patients and how they can also become specialized in this area of nursing.

  • Mar 30 '09

    We use to have a teacher on our psych unit for the adolescents also.

  • Mar 30 '09

    We have teachers employed by the public school system who are assigned to our hospital full time to be the link between the kids and whatever school system they attend. They supervise their educations while the kids are in the hospital. They are not nurses. They are regular teachers.

  • Mar 30 '09

    I think that's the most common approach. And you would be surprised how much they get accomplished in that brief period at the bedside or in the classroom. When you eliminate the fluff and the distractions, so much can be done. Years ago I worked in a peds extended care unit where one of our patients was a teenager. She managed to keep up with her classmates until such time as she went for a transplant and then she fell behind. (And she was NOT the most cooperative kid in the world either!)

  • Feb 19 '09

    oncology will be medical patients receiving either surgical or medical treatment for cancer. they may be hospitalized because of a complication related to the cancer treatment or because of the cancer itself causing a medical problem. cancer treatment today is moving toward being treated as a chronic disease. having gone through radiation therapy and chemotherapy myself i can tell you that these modalities of treatment can cure the cancer but leave the patient with other problems. which is why oncology is primarily a medical specialty. you are likely to see patients with just about anything going on and any kind of treatment and device. it would be interesting. oncology nurses are experts in chemotherapy and the cancer treatments and their side effects. lot of ivs and picc lines. they are also very compassionate. their patients think about and face issues of life and death daily. lot of psychosocial issues going on. yes, you would learn and see a lot from working on this kind of unit.

  • Jan 21 '09

    you need to give ceclor to a patient who weighs 31 pounds. the doc order is ceclor 20 mg/kg/day in 3 divided doses. you have ceclor available in 125mg/5ml. how many ml will you administer in each dose?

    by dimensional analysis. . .
    20 mg/1 kg (dose to give) x 31 pounds/day (part of dose to give) x 1 day/3 doses (one dose) x 5 ml/125 mg (dose on hand) x 1 kg/2.2 pounds (conversion factor) = 3.75 ml/dose rounded up to 3.8 ml/dose
    you can also recheck this using another method. 31 pounds converted to kilograms is 31/2.2 pounds, or 14.090909 kg. insert that into your order 20 mg/kg/day in 3 divided doses so you have (20 mg) (14.090909 kg) (one day) which gives you a required dose of 281.818181 mg.
    dose desired: 281.818181 mg
    dose on hand: 125mg/5ml

    calculate using the formula dose desired divided by the dose on hand multiplied by the amount the dose on hand comes in: 281.818181 mg/125mg x 5ml = 11.272727 ml. this is the daily (24 hour) dose. to get one dose, divide this by 3: 11.272727 ml/3 = 3.7575756 ml which you would round off.

  • Jan 7 '09

    1. GRAVITY; Ex: When you are giving a bed bath to a large elderly female lying in bed dont look for scars from a double masectomy, roll her over and retrieve her breasts or from wherever they are.

    2. CONTACT PRECAUTIONS; Ex: You will see many nurses go into the room taking no precautions other than the standard ones. However, your clinical instructor WILL make you gown up as if your patient is an alien and you are about to take them back to the spaceship.

    3. SHIFT CHANGE REPORT; Ex: Really listen to what the nurse tells you about your patient and look at their chart for past surgeries. You do not want to go into your patients room and do a head to toe assessment and ask a double amputee about the strength in his legs.

    4. WE ARE STUPID; Ex: Don't hesitate to ask the nurse, tech, etc. a question because you may look dumb...because we already look dumb....and they were once too.

    5. HIPPA; Ex: Yes you will begin to act like you are in a secret society, only trusting your mother.

    6. OPPOSITE SEX BATH; Ex: Wash the penis last, if he becomes aroused you calmly discontinue and ironically have completed the bath. Seriously, dont keep bathing.

    7. CODE BROWN; Ex: Yes, we have all been there and so will you. This is when you will wonder why there are no gloves available that come up to your elbows. Grab a yellow gown off a door of a patient that is on contact precautions and slip the gloves on over the gown cuffs.

    8. KNOW YOUR HOLES; Ex: Urethra, Vagina, and Anus. We are all diffrent and the urethra is NOT always above the vagina. Enough said.

    9. PUT IT BACK WHERE YOU FOUND IT. Ex: When you are done placing a urinary catheter in an uncircumsised male...put the foreskin back where you found it.

    10. TAMPONS. Ex: You will be greeted with your monthly hello as soon as you put on your white uniform and are at the hospital. Bring them in your bag and bring some for your clinical group.

    Author: Me KP

  • Aug 19 '08

    there are 2 sides to being understanding and "getting over" the way people treat you; what's good for the goose is good for the gander. there in no reason for any professional nurses to be "snappy" or "eating students"--at any time--for any reason. that is just a cute way of saying someone is exhibiting bad behavior. that kind of behavior is never acceptable no matter what the circumstances. having a bad day or being upset over the death of patient that was unsuccessfully coded and taking it out on an innocent person isn't justification for being nasty to someone who has no idea what a nurse just experienced. neither is going home and kicking the dog or beating up one's spouse. remaining calm headed and finding other outlets to release stress is the correct way to handle the stress. expecting people to stand there and take the brunt of someone else's anger and upset is absolutely outrageous and wrong.



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