delrepublica1776 6,284 Views
Joined May 8, '10.
Posts: 210 (6% Liked)
I understand it's intimidating to have pt's ask you questions that you are still learning yourself. I felt the exact same way. I didn't want to seem incompetent or let the pt's know I didn't know something. We are all perfectionists in some way. As time goes on, the amount of knowledge you posses will grow exponentially and you will be able to offer all types of descriptions and definitions. As for me, it happens all time that I can't answer something. For example, my weaknesses are in Hematology/ oncology. I took me freakin forever to remember what was b-cells, t-cells, immunoglobulins, humoral immunity...wait, t-cells fight what... and b-cells are made where...i hated it! And sure, I know the different types of brain cancer, how to interpret a CBC, or how to care for pt's with sickle cell, but if a pt threw different questions at me about gliomas, I wouldn't be able to answer all of them. But, that's ok. Actually, pt's like the fact that you can't answer everything. It shows humility. but I try to answer as much as I can within my scope of practice. The first time I had to discharge a pt and go over the discharge instructions/ meds, I was sweating. I was worried he was gonna leave and tell everyone I didn't know what I was talking about. But, as my career progressed, I was able to answer almost anything b/c I was always learning. I wouldn't have been able to give all that insulin info when I was in school either. I barely knew that stuff when I worked in the ER. In ER, the pt wasn't there long enough to see the effects of steroids or stress. We put them on an insulin drip and zipped them to the floor. Once I was in ICU, I got to see a different perspective...how things played out over time.
It's great you brought up the nutrition topic. I think a lot of nurses take nutrition for granted. Best person to ask about dietary is a registered nutritionist. They LOVE when nurses are curious about their field b/c some nurses blow it off. Nutrition is more than just giving a pt an 1800 cal ada diet. There's a whole science behind it (obviously). I constantly asked the nutritionist random questions. Next time you come across a pt with tube feeding, read dietary's primary assessment note. They calculate calories, protein intake, free water, dietary requirement, recommendation to switch tube feeding, vitamin supplementation, etc. Did you know that Propofol (diprivan) on vented pt's is counted as caloric intake and the tube feeds are sometimes lowered until they are extubated? That pt's with decub ulcers are given Vitamin C/ Zinc supplementation to promote wound healing? That tube feeds containing Omega-3 fatty acids may increase the survival rate in pt's with ARDS by possibly eliminating free radicals due to it's antioxidant potential? That giving tube feeds can somewhat combat 3rd spacing by providing proteins, which is involved in oncotic/ hydrostatic pressure (albumins?) That too much protein in liver failure pt's can raise ammonia levels? That Omega-3 is contraindicated in pt's with intracranial hemorrhages b/c it is a natural anticoagulant? And that grapefruit is contraindicated with certain medication b/c it can change the therapeutic drug levels? Nutrition is VERY important, especially with so many people taking herbal supplements. I find it fascinating, But, I didn't know one thing about nutrition in ER. Not one. Didn't care b/c everyone was NPO and there was more important things to do. But as time went on, I learned. Still to this day, I randomly ask staff questions...even hypotheticals. Nutrition, speech, physical therapy, RT's....anything. And if there is something I don't know, I have to find out, or it bothers me. Just like Esme12 said, "As you gain experience, you will gain knowledge." And in time you will be able to answer all their questions until they have nothing more to ask. If you consult ancillary staff, make sure you get their input. Always be curious....
Do you ever have moments where you wish you didn't have any student loans?
Having multiple student loans can be scary. For those who have multiple loans, have you thought about consolidating?
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The other day my instructor asked us to anonymously answer some questions about the class. A few days later she opens class with, "It has come to my attention that there have been many off topic questions that I have entertained during lecture and stories from your fellow classmates that I have allowed to go on too long. Should these things come up in the future, I will ask that the individual come talk to me about it during break."
During the lecture that day she cut off some of the worst offenders with. "Great question! lets talk about it on break. Moving on..."
After wasting hours of my life hearing about their extended family members, it is over. Sorry if this post is silly, but i am extatic.
Cardiac tamponade occurs when there is such a build-up of excess fluid in the pericardial sac that cardiac output diminishes and the decrease results in hypotension which left untreated can lead to cardiogenic shock and even death.
Pericarditis (an infection) can generate this kind of fluid accumulation in the pericardial sac.
Pericarditis is a cause. Tamponade is the possible effect.
But tamponade can also result from trauma, malignancy, tuberculosis and other conditions, each of which would produce its own distinct clinical findings.
Here is an excellent link that speaks of both conditions in wonderful detail.
Pericarditis and Cardiac Tamponade: eMedicine Emergency Medicine
Hope this helps.
Thank you all so much for your words of encouragement. And I really appreciate your honesty, ThatGuy & CrunchRN.
All industries are experiencing a downturn right now, including my current field, and I need to jump in with both feet with a (flexible) plan and just do the best I can.
i sold my insurance agency dec of 03. after 4 months of settling the new owner in. i started looking at my options. if i didn’t have health insurance my profits would be eaten up to quickly. my husband and i are older i was 45 and he was 50 it is really hard to find affordable health insurance. i knew i wanted to go into nursing so i started at local nursing home in may of 2004 as a na-r, i needed health benefits and they had a full time opening on the noc shift with benefits. i do not sleep well at night so i thought it wouldn’t hurt to give it a try. na-r is very hard work. i knew that my body would not tolerate this for long. i enjoyed the residents and liked this kind of work.
i started the lpn program in aug of 2004. my hubby was not happy about me wanting to go to college. he thought it was too much for me to handle. i had signed up and promised i wouldn’t go if he said no… i missed the 1st week of school because he couldn’t make up his mind, monday morning i told him that he better tell me if i could go or not and he wouldn’t say anything so i took that as a yes and went to college…. i went to my 1st class and it was nursing 1 the instructor took attendance and afterwards she asked me to pick up my books and step out into the hall she said that i couldn’t start a week late that they have already taken a test and i missed the lecture. so i didn’t say a word and went to the councilors’ office and asked if there any of the programs in this college that the student guide didn’t applied to. he said no, so i turned right around and went back to the class. sat down asked if i could have the power point. and she handed it to me. after the lecture she said i would need to take the test tomorrow. i said fine. i took the 1st test and the second test on the same day… i failed the first test because they take 10% off for taking it late. i got an 80% (a c ) on the second one. so i just plugged away… continued on.
at midterm my instructor pulled me aside and told me i was at a high d… i asked her if she was kicking me out. she said no because i had perfect attendance. i told her that it’s not over until the fat lady sings and this fat lady hasn’t sung yet!!! i paid for this and i was going to go to the end even if i failed it… i would just take it over if i had to.
the second semester i took 3 classes online a&p ii, psycho social, & med terminology that helped with the sleep issue. i could do them on my own time.
our school has open enrollment and i took 18- 21 credits a semester i graduated with a 3.5 gpa in three semesters partly because when i was a student there 27 years ago i was a straight a’s at that time. i believe during the lpn i had a 3.0
i continued taking my co required pre- req. classed so that my work load would be lighter later in the rn program. i worked 5 nights a week as the charge nurse on the night shift. and 3 day shifts. i was accepted into the part time program. so my rn program was 3 semesters long. i only had the core classes left…. thank god. those classes were the hardest classes i have ever had.
organization was one of the keys to my success i bought a large day planner. everything about school and personal life was in it. i knew when my tests were and when projects were due. if future papers were on the agenda i kept a list of ideas or things i would like to research. i always kept in mind what my future practice would entail. (geriatrics) it was the hardest thing i have ever done. i had many struggles though it
i worked for local nursing home full time. i work 10 shifts per 2 week period. and usually work 1 to 2 - 12 hour shifts if someone called in. i graduated with a 3.12 i didn’t get any time off. with school and work it was 12 days straight until my weekend off. i told the “kids” the other students that this is just a short blip in my life and i will get through it. i graduated in may of 2007. took the nclex the same day my 1st granddaughter was born…(i knew she was in labor but she and my husband did not want me to postpone it) well i took the test and made it back to my daughters side to have my hand in on the delivery. (another story some day.) i found i had passed the nclex the next day.
that’s my story.... yes keep going don't stop... it is so easy to let life get in the way. and you know what… what other people think is unimportant. the rewards are great. i finally have job satisfaction!!
Absolutely, here is my set-up in my backyard!
First, there is no nursing shortage. There are at least 500,000 surplus nurses that have left, due to various reasons, many d/t lousy conditions. There are estimated 170, 000 postions, many undesirable, poor paying, part time, w/no benefits, or in places with a high COL.
Second, there are a large number of people seeking nursing degrees.
Third, nursing like medicine can have only a limited number of students per class. The students require a "hands on, supervising instructor"...unlike accounting where you can add a few extra seats with no problem. There are also limited openings d/t number of local hospitals that permit students. You cannot have 50 nursing students in OB rotation, w/only one or two hospitals hosting them. If it is a small area, with fewer birthes, you will have 4-8 students trying to observe one or two birthes...they cannot participate well as weel as it is hard on staff and patients - who wants 4 extra strangers watching you give birth. Plus your school may be "sharing" facilities with several other schools at the same time.
There are liability issues, with insurance of the school and the facility bearing a burden. Nursing students increase the liability of the school and facility.
Colleges rarely pay instructors adequately. They can invariably get paid more for fewer ours and less education, as a practicing nurse. While med schools offer Attendings certain advantages in return for teaching, nursing does not.
Nursing classes are more expensive to run, with labs and dissections involved, rather than pure academic classes. There are only so many cadavers around. And while med school can charge big bucks, nursing school cannot.
And it really should not be any easier to get into nursing school, because of the fictious shortage. There is a shortage of primary care MDs... do you see Johns Hopkins lowering their standards or opening extra postions, while sacrifing quality of instruction (same number of patients for more MDs to learn with)?
Somewhere beautiful, with a low population of rich people who pay their own hospital bills in full, and whose residents are polite and civil.
Wait... you said somewhere in America....
You'll be too busy on the floor to talk about anything that isn't relevant to nursing, don't worry about it.
Ummm I'd cut the attitude before you start your classes or the teachers and your *dumb* classmates will eat you for breakfast.
And just one *dumb* community college student to another it's "I speak very articulately" not "I speak very articulate".
I don't know where you're living but hospitals here in kansas are doing loan foregivness programsin return for working 2 years for them (and getting paid as well.) grads here all have jobs months in advance to graduation. Like 96% of seniors have jobs waiting fior them... It is worth everything to be a nurse. PLUS if nursing is your passion, you will do what it takes.
Wowie those are great scores. Congrats! What's your secret? LoL..
I got into Vanderbilt with the same verbal score ( and lower math-lol) ,GPA is figured in as well-hth! *I love NOLA!
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