GamerGirL337 4,942 Views
Joined: Feb 26, '11;
Posts: 138 (17% Liked)
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Congratulations to you! Just like you, I applied to a critical care fellowship and landed the job that I truly wanted. I did not apply to any other positions and felt pretty confident I was going to be offered a position. I was nervous, anxious and scared but at the same time excited!
Working in the cardiac unit, I knew that at any given moment someone can code at anytime. Which was terrifying to me because I didn't know if I would be able to "handle" it if it were my own patient. But I'll tell you, what an adrenaline rush it is when you are in that position. I've been in the ccu for 5 years now and absolutely love it.
My advice to you is to know your meds, ACLS, and heart rhythms (or at least know what is not normal sinus rhythm on tele). If you don't know something look it up, ask questions! Instincts also is key, if you feel something is wrong most likely it is and notify someone.
In time it will come to you as if you are a seasoned RN. Good luck to you!
Congrats! I started in Peds ICU as a new grad. I learned so much in that first year, and continue to.
My advice is to never be afraid to ask a question or for help. Just be open to your co-workers ideas and LEARN!
It's going to be scary, but it will get better and a year from now you won't believe how far you've come!
She knew what she wanted.
She'd watched her husband of 52 years die on a vent, and followed his wishes to remain a full code. But she knew that was not what she wanted for herself.
So, she wrote a Living Will, had it notarized, gave it to her personal physician, told all her friends and family what she did not want. She wasn't eligible for a DNR, as she was a healthy 89-year-old, but she knew what she wanted.
"I do not wish my heart to be restarted through usage of any chemical, mechanical or physical intervention..."
Of her 6 children, one fought against her mother's decision, and it was this child, this one desenting voice, who found her mother collapsed on the kitchen floor.
"I do not want any external device to be used to maintain my respiration if my body is incapable of sustaining it on its own."
The daughter told EMS her mother was a full code, and they intubated her on the floor of her kitchen. Once at the ER, her heart stopped, CPR was performed, and her heart was shocked back into a beat. Under the hands of those trying to follow the daughter's wishes, the woman's ribs cracked and broke.
"I wish to die a peaceful, natural death."
She was then sent to ICU, where her heart tried to stop 3 more times. Each time, the broken ribs jabbed and ripped into the fragile muscle and skin as CPR was performed. Electricity coursed across her body and her frail heart was restarted a 4th time. By this time, the other children were there, but the act had been done, over and over. No DNR was written, and the Living Will fluttered impotently at the front of the chart.
"I do not wish artificial means of nutrition to be used, such as nasogastric tubes or a PEG tube."
Her swallowing ability was lost in the storm in her brain that had left her with no voice, no sight, no movement. A scan showed she still had brain activity; she was aware of what was being done to her. Including the PEG tube sank down into her stomach, and the trach in her throat.
"I wish nature to take its course, with only medication to prevent pain and suffering."
The daughter who wanted the mother to remain a full code also refused to allow narcotics to be given, stating she did not want her mother sedated, since she would "wake up" when the correct medical procedures were performed. Her nurses begged the doctor to write a DNR, and he said, "the family can't get it together, and I'm not getting into the middle of it."
"Allow me the dignity we give to beloved pets. Let me die in peace."
I met her one Tuesday night, and spent that night pouring Jevity into her tube, only to suction it back out. Her legs were cool and mottled, her bowel sounds were non-existant, and her blue eyes stared blindly at a ceiling she could no longer see. The MD refused to terminate feedings, but I held them since there was no digestion taking place. The woman was turned and repositioned every 2 hours, and each time, she moaned and gurgled as her lungs slowly filled with fluid. I whispered my apologies as I did the very things to her she tried so hard to prevent.
Suctioning improved her lung function, but would make her body tremble. Over the next 2 nights, she slowly died, all while the daughter demanded more interventions, and maintained that her mother wanted to be a full code. We had read the Living Will. We knew better.
"Thank you in advance for helping me in the last moments of my life to have a gentle, peaceful passing."
She had another stroke, and went back to the ICU, where she was coded until there was not enough surviving heart tissue to maintain a beat. Finally her heart was broken.
And so was mine.
I just graduated in December, took boards Wednesday (and Passed!). We began our 2 year ADN program with around 98 and graduated with 56. My school has a 98% 1st time NCLEX pass rate. We lost more than 42 but we gained several retakers throughout the 2 years. I couldn't be prouder of myself to have made it through while working full time and taking 3 prereq's with my Nursing courses that first year. I thought I wouldn't survive, but guess what.... I DID! And finished with a 3.4 GPA! IN YO FACE, Nursing School!!!!
this i don't understand: "
> 35pound/2.2pound= 16pound.
there is no way to multiply 16 pounds x 16 kilograms to have a result of milliliters. :d
first convert to kg. 35lbs/2.2lbs/kg = 15.9 kg (we had to round to one decimal place for pedi doses, if your program permits you to round up then use 16 kg). then multiply kg x dose (mg/kg/day). kg will "cancel out" so the result will be mg/day
15.9kg (or 16 kg) x 50mg/kg/day = ___mg/day max
15.9kg (or 16 kg) x 25 mg/kg/day = ____5 mg/day min
(i'm sure you are capable of multiplying 16 x 50 and/or 16 x 25)
cannot answer in milliliters as you did not give that information (vial contains x mg/ y ml). only dose range of 25-50 mg/kg/day so can only answer the minimum & maximum amount of mg per day for a 35lb child. are you sure the question isn't what is the acceptable dose range for a child of this size?
I can help you with some of them! Sodium - The price of table salt is approximately $1.35 and $1.45 (Na+ 135-145 normal range)
Magnesium - "M" is 1/2 way through the alphabet ... (M is 1.5-2.5 normal range)
Calcium - the weather in California is between 89 and 101 degrees (Ca+ 8.9-10.1 normal range)
Potassium - Kermit the frog is about 4 years old (K+ 3.5-5.5 normal range)
Red Blood cells - about "5", then multiply by 3 and you get about "15" for Hemoglobin, multiply by another 3 and you get about "45" for Hematocrit
Hope these help a little bit!
I have found the Made Incredibly Easy series to be very helpful. I am lucky that our college library has many of the books available to checkout. I highly recommend the Dosage Calculation Made Incredibly Easy. I also have to say the Mary Ann Hogan's Reviews and Rationale Series is great also. It makes arrows out from things deemed highly important to know. I hope this helps.
I have the same Pharm book, and I think the same med surge book! This is the drug we get in our bundle http://www.amazon.com/Nursing-Refere...7&sr=1-3-fkmr1 and comes in very handy!
If you have ATI there's a lot of sections on there for pharm and med/surg that are helpful. You can go to quia.com and search for quizzes from other instructors for practice and a drug guide book would only be helpful for referring to specific drugs as to what classes they belong to for pharm or common ones used in med/surg. If you find yourself struggling the companion CDs are very very helpful. The drug guide book that was required for my class that I use is http://www.amazon.com/Nursing2012-Ha...3025201&sr=1-1 if you aren't required to get one and all the hospitals here use the same one also.
It sounds like you are having trouble with exam questions. Since I was (and am) a professional nursing tutor (BSN, RN), I will advise you to do what I tell my students to do: Get yourself a book called "Test for Success: Test Taking Techniques for Beginning Nursing Students by Nugent and Vitale. It will teach you how to answer test questions. Since most students suffer from test anxiety, this is what I tell them:
1. When you get your test paper, cover the answer choices with a piece of paper (your answer sheet) and just focus on the question. Look for key words or key phrases that will tell you what the question is asking about. Look for phrases like, "the nurse should NOT" and be sure you are answering what the question is asking. Once you have figured out what the question wants, unveil the answer choices. One of the mistakes often made is that a student will see an answer choice, remember something about it from the 19 chapters they just read and select it without identifying what the question is looking for. Avoid that trap and I guarantee you that your grades will rise
Attached are 12 Word documents which I made when I took pharmacology. All the information was based on the ATI study guide since that constituted the final exam in our class.
They are formatted as 3x5 cards and were printed on individual 3x5 cards.
Have at 'em if you think they'll help... they certainly worked for me.
Again, they are entirely my own creation based on the information out of the ATI book. I make no promises as to their accuracy (though I rocked pharm so they couldn't be too bad).
Feedback is welcome.
Hello, our school isnt picky on how you get the assessment done as long as you get all the information, i seem to do this a different way then head to toe, for example i am on a respiratory unit in clinicals for this rotation so,
the first thing i do is do a visual scan of everything in the room, bed position, O2, IV, do they have glassess or dentures on their side table? then as i am doing the visual scan i introduce myself, take vitals and check orientation i ask them to tell me their name, if they know where they are, what time/date/or month it is, and if they know why they are here.
then being on respiratory i check their lung sounds at the front, from there since my stethoscope is already on their chest i then check apical and heart sounds. right after i then check bowel sounds and THEN palpate abdomen.
from there i move to feet to check pedal pulses & cap refill, while doing that ask them questions, (are you having any trouble breathing? do you have any pain? how did you sleep last night? do you have any dizziness/lightheadedness?) then i check holmans sign and if negative ask them if they can lift their right leg and then left.
Then move to upper extremeties and do the same thing as with lower. here i will also ask them to move their shoulders to their ears and squeeze my hands.
Then from there I check their mucous membranes, perrla, conjuctiva, palpate lymph nodes around ears and down neck.
Then just do another visual scan to see if there was anything i missed or i needed to fix.
Your assessment may end up changing depending on your patient or patients problem or deficit. That is the one thing I have learned is you may have to adjust your assessment to pts needs so never rely on being able to go head to toe or even being able to do a full assessment all at once (i had a pt that needed frequent rests, so my assessment had to be broken down into 3 different parts)
I hope this helped and i hope i did not miss anything either lol good luck
He didn't die helplessly. He had the choice to go against a tradition he respected, but he upheld that tradition. I'm sure he knew he was likely to die without the transfusion and I'm sure he made his decision with that knowledge. It's sad when anyone dies, but he did what many people don't get to do; he died with his sense of tradition and morality intact. Honoring his wishes allowed him to finish life in the best way possible for him.
That being said, it's a difficult tradition for me to understand. If I ever need blood, I sure won't turn it down.
Unless the aide posts identifying information of the client, I don't see how her posts can be a violation of Facebook policy, nor HIPAA. IMHO, you have no basis to complain about the other aide unless her behavior was endangering the client and what you posted does not seem to do so.
Also, those of us working in healthcare are human too and as such, we complain, whine, rant, and more. I don't see the big deal here.
This is a quick list of some iPod applications that I have installed and find helpful that I want to share with you.
I am a new graduate, so the following may or may not be helpful to you. So for what it's worth, here's my list:
Micromedex Drug Information ($free)
A wealth of drug information you can look up either alphabetically or by class. Lists dosing, contraindications, adverse effects, mechanism of action, administration, toxicology, clinical teaching, etc. Excellent reference, highly recommended.
Huge list of formulas, scales, etc. from O2 gradient and ratio to mean arterial pressure to Wells SCore for DVT and PE.
Great information to read up on covering diseases, conditions, medications, etc. A surprisingly enormous amount of information at your fingertips for zero dollars.
MD ezLabs ($free)
A-Z list of normal lab values with additional information and references. Great free resource.
RH Medical Labs ($1.99)
Resident Helper Medical Labs is different from MD ezLabs in that it displays normal lab values for specific gender and age groups arranged into different lab value charts. What I recently discovered is that if you touch directly on a value, for example, BUN, a pop up screen comes up describing the lab and the clinical significance of it.
Physical Exam Essentials ($2.99)
An (almost) complete reference list for doing head to toe examinations. Has pictures and briefly describes maneuvers such as abdominal palpation, checking capillary refill time, and gives reminders on what to look for when doing mental status checks, etc. I had read in a couple old reviews that the abdominal quadrants were mislabeled (backwards) but that has since been fixed it seems. I just downloaded this app and I think it is really going to help improve my patient assessments. It is lacking a musculoskeletal exam however.
Nursing Essentials ($5.99)
Not sure about this one yet. I just got it today, and while there is quite a lot of material to read up on, it does seem very basic in some regards. It's like the developers tried to cover too much material so what they did cover is very limited. However, there is still a lot of good information here. You can brush up on different fluids like colloid solutions and what they are used for, read up on how to properly give injections, there are common lab values, ECG strips explained, conditions such as pneumothoraxes for instance are briefly described with reminders on what to look for during an assessment, there are some medical calculators, and even some spanish translations. You can also bookmark sections for quick referral if you want. I already have a medical calculator and a medical spanish translator, so some of what is in this app I don't necessarily need. But overall, I'd say it is useful reference material if you are just starting out like me.
Instant ECG ($0.99)
Superb learning material for studying ECGs. Very descriptive, shows waveforms, has videos so you can see what the different rhythms will look like on the cardiac monitor, and even has exams you can take. Excellent if you want to study the heart.
I think this app is really cool. You can see what different x-rays look like so you can become familiar with what the MD is looking at. You can search by category but you need to know what you are looking for to bring up results. Just messing around with the app, if I find a certain category that I want to explore, I just type in a single vowel in the search area and it will bring up a list of results. You can zoom in on them but not very much. If you click on labels it explains what you are seeing. Neat.
NCLEX-RN Quiz Cards ($2.99)
Over 3,800 NCLEX questions with rationale for 3 bucks. Even though I already passed the NCLEX, I downloaded this app just to keep me on my toes. Of all the NCLEX apps out there that I was checking out, I think this one gives you the most questions for the least amount of money. At least, that's what I found when I was researching this topic. Maybe that has changed by the time you read this, or maybe not. Anyway, I recommend this app for any nursing student.
Pedi Safe ($0.99)
A quickly referenced list of ICU, OR, and ER medications for pediatric patients. Separated by weight. I don't really know why I downloaded this app to tell you the truth. I guess I thought it would be a handy reference someday, but for now, I don't work in peds, and don't really plan to either. Anyway, it doesn't seem like a whole lot of information, but I suppose it could be useful.
I really like this app. It's mainly written for laypersons who want to look up their symptoms. You can look up specific diseases/conditions, or look up your symptoms such as abdominal pain or throwing up. Then it will bring up a list of possible reasons for the symptoms, with descriptions, symptoms, tests, treatments, images, videos, and links to other medical websites. If you feel that you need to be seen by a physician, you can click on the "providers" tab which will bring up another list of hospitals, urgent care clinics, pharmacies, etc. in your area. If you then click on the address of your chosen medical institution, it will bring up a map of your area and you can then get driving directions. Way cool.
Medical Spanish ($free)
This free version is good if you don't need the audio portion to speak the translations for you. If you can read it and say the translations correctly, then this one is all you need. The paid version for $6.99 will speak the translations for you.
Convert Units for Free ($free)
Great free unit conversion app.
Hope this helps!
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