Double-Helix, BSN 26,438 Views
Joined Apr 5, '11 - from 'New Jersey'.
Double-Helix is a Nurse, Children's Hospital.
Posts: 2,748 (50% Liked)
Have you been able to review the exams with the instructors? I would ask them to sit down with you and go over the exam questions to see if you can identify where/why you're having trouble. Sometimes it's a matter of learning how to read the question and identify what is actually being asked. NCLEX questions often have lots of information- some is important to the answer and some isn't. This may help you decide if you really do have a good understanding of the content or need further review.
I don't think you need to bring evidence with you to have a discussion about this, if your intent is to learn. Bringing "evidence for argument" suggests that you only want to speak with her to prove that you're right, rather than to understand why she says risk for bleeding is not a priority. Try simply having this conversation with the intent to understand. Learn her rationale for not choosing risk for bleeding as a priority diagnosis, THEN, if you still feel inclined, search out evidence in support of your work.
I'll add that in my school, "risk" diagnoses were rarely considered priority over actual diagnoses, unless there were no other actual diagnoses that needed to be addressed, or the patient had significant risk factors and was likely to develop serious complications were appropriate actions not taken to mitigate risk.
anyway, anybody ever call in on a major holiday like thanksgiving, christmas, new years, etc.. ? did they reprimand you? what happened?
NICU is far, far from quiet and peaceful. Maybe at moments it's quiet, but it's also caring for the sickest and most fragile patients you could possibly encounter. It's calculating and titrating micro-doses of medications to maintain blood pressure and heart rate, achieve fluid balance without fluid overload, managing specialized ventilators, and constant observation and assessment to detect life-threatening complications like ventricular hemorrhage and necrotizing enterocolitis. Please don't think NICU is all quiet and peaceful, feeding little babies until they get big enough to go home.
Shookclays, it's fine to have an idea of where you would like to work when you enter school. But keep in mind that the NICU will be a minute part of your nursing education. In fact, most nursing programs only do a one day shadow in the NICU, if any time is spent there at all. And after graduation, NICU positions are highly coveted. Few will hire nurses with no previous experience. It's possible, but depending on your location, it's very possible you may not be able to enter the NICU right after graduation. Your focus during school should be getting a well rounded education, learning how to think, assess, and act like a nurse so that you can pass the NCLEX exam and become licensed. By all means, take advantage of opportunities to network and get a feel for what nursing is like in the NICU, if your school offers them, but also leave yourself open to other areas and opportunities as well. Then, after graduation, if you still feel NICU is where you want to be, search for jobs in that field, with the understanding that you may need to accept a position in another speciality in order to get the experience required for employment in the NICU.
Stories like this tend tend to run rampant in hospitals and schools. Usually they exist to "scare" students or staff into paying close attention to certain issues having the potential to cause harm. Yes, wrong site surgeries do happen, but they are never due to the error of a single person.
Sometimes these wives' tales begin as humor and get perpetuated because it just sounds so crazy it must be true. You know, even though I work in one of the largest children's hospital systems in the country, and even though everyone and their mother knows someone who knows the infamous twins, Lemonjello and Oranjello, I have yet to see their name on a census board.
Tylenol and Enoxaprin are both NSAIDS and with the warfarin and morphine she is high risk for bleeding.
One of the functions of the liver is to help bilirubin bind (conjugate) into something water-soluable so it can be excreted in the urine and stool. Bilirubin is a byproduct of the "heme" part of hemoglobin created when red blood cells are broken down. In infants, immature livers often mean this byproduct can't be conjugated and excreted quickly enough, causing a build up in the blood stream called jaundice. The point of phototherapy is to use light waves to transform the unconjugated (also called indirect) bilirubin in the blood into a water-soluable form so that it can be excreted while bypassing the liver.
So, based on that explanation, you'll see that a blood test to measure hemoglobin or RBC level wouldn't tell you whether phototherapy is indicated, because that level reflects healthy red blood cells, not those that have been broken down. That leaves you with your second choice, plasma bilirubin levels, specifically indirect/unconjugated bilirubin.
It's pretty standard in many hospitals that inpatients be on an H2 blocker to reduce amount/acidity of stomach acid to protect the lining of the stomach and esophagus. Many factors associated with being the hospital- such as stress, lack of regular diet, medications, and vomiting, all create risk of stomach ulcers or bleeding. The pepcid helps mitigate that risk.
Medical management speaks to the plan of care. What equipment is required to care for this patient and ensure survival/recovery? What medications are needed? What tests need to be performed? Etc.
Nursing management speaks to the specific actions that the nurse will take within his/her scope of practice to care for the patient. What will the nurse assess for each shift? What will the nurse to do make sure the patient remains free from injury or complications from hospitalization? Think about nursing diagnoses for this patient when you're answering. In terms of writing the goals, think about your SMART goal criteria.
It depends on the program. 1 is a bare minimum. In my opinion, you need at least several years of ICU experience- and general nursing experience- in order to have the skills and knowledge necessary to be a successful CRNA.
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