IDalove2 1,415 Views
Joined May 6, '12.
Posts: 10 (20% Liked)
First of all, the explanation above about the way that pneumonia relates to the WBC count and etc is a really really good one. And the advice to 'look it up' should be followed. But I have to tell you that lots of experienced Nurses have the same problem relating lab values to the Pt's condition, to what lab values should have to do with each other, what nursing interventions they should lead to--well, it's hard for lots of us.
The problem starts with the way we don't know how to organise all those numbers. It turns into mumbo-jumbo real quick; just look at all the numbers jammed together that you put on your original post. To start with, you don't need all those numbers--just some of them.
Here's how I show 'baby nurses' how to do it:
1. Draw a straight line across a sheet of paper horizontally. On the top of that line draw two short vertical lines. (Make three spaces on the first line.)
Then on the bottom, draw three short verticals (make four spaces).
Along the top of the line, use the three spaces to fill in the Sodium, Chloride and Glucose. Along the bottom, Potassium, Bun, Creatinine and CO2.
Look what you've got: Above the line-an IVFluid (see it? Na Cl Dextrose, like D5 1/2 NS). Below the line you've got a report on your Pt's kidneys.
Let's put your Pt's lab values in this form:
Na 133 I Cl 100 I Gl 142 (little low on saline-needs electrolytes)
K 5.3 I BUN 40 Cr 1.5 I CO2 22 (kidneys stressed, moderately dehydrated)
The Pt needs saline and fluid; maybe 1/2 NS at 75 to 125/hr. Does he have a good IV site? Has the Dr seen these labs? Is the IV order appropriate? If he's not eating & drinking you need to see that these things are done. If he's taking PO well, move the water pitch off his over-bed table and put juices there.
See how looking at the labs should suggest nursing action?
2. Do a similar 'formatting' of the CBC: (You'll see the Drs doing this in the progress notes, BTW--that's how I learned it)
Again, draw a line but this time put two 'wedges' on either end of it. Like this:
And put the WBCs in the left wedge and the PLT in the right wedge and the HGB above the line in the middle, and the HCT below it. (For our purposes, we don't need to know the 'differential' of the WBCs. For general information--its basically an set of percentages (so it should add up to 100) of how young or old the WBCs are. This indicates how hard the body is working churning out WhiteBloodCells.)
So this is what we get for your Pt:
So your guy has a slight elevation of his WBCs but as NeneRN said, you're not surprised by this cause his diagnosis is of an infection. Infact, for a Pt with pneumonia--that's kind of low WBCs. So maybe his infection is low level, or somewhat chronic. You'd relate this to other things you see--is his temp WNL? What's his heart rate? What's his O2 sat? Does he have a productive cough? What do his lungs SOUND like? Etc, etc.
Then with this effective grasp of the data, you can plan Nursing Care. You want to make sure that his mild anemia does not get worse (probably he'd get a unit of blood if his Coronary Artery Disease is bad and his HGB went below 9.0). You want O2 Sats as high as possible because the fewer-than-normal RBCs have to carry their maximum amount of Oxygen to his heart.
So the labs play a part in making a science-based plan of care for your Pt, IF YOU CAN USE IT. And now you CAN!!! WAY TO GO!!!!
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.
as a new(ish) nurse, i still like to browse through the "student nurse" section of allnurses.com from time to time. what constantly strikes me is that i see the same questions and concerns over and over again. "i'm failing, and i don't know why" "i feel nervous in clinicals" and "i don't have time to do anything other than schoolwork" are all common themes. while there are some great answers from some wonderfully knowledgable and patient nurses (rip daytonite) out there, i thought a go-to guide with every tip and secret i can think of, plus some more that i've only read about, would be an excellent resource for student nurses to have.
beginning at the beginning: tips for pre-nursing students
#1 get a job! the very first tip that i give to anyone who is even considering nursing school is to get a job in the healthcare field. you can be a cna, a patient care assistant, a unit clerk, or even a patient transporter with little to no experience needed. be sure to mention on your job application that you are considering going to nursing school, hr people love that.
there are many reasons that this is the first thing i tell people who ask me about becoming a nurse. first and foremost is that no matter what you may think you know about being a nurse, there is nothing like observing what nurses do from day-to-day in the real world rather than on tv to help you decide if it's really for you. consider it an anthropological study. every different field from banking to food service has it's own culture, it's own set of unspoken rules. the sooner you learn what they are, the more likely you are to be successful down the road as a nursing student and as a nurse.
other great reasons to get a healthcare job before nursing school? um, let me see... professional contacts, possible tuition assistance, and oh let's not forget having a paycheck while in school. don't tell me you don't have the time either. you can work per diem most places by just putting in a couple of shifts per month.
#2 get your pre-requisites done before you start actual nursing courses. the requirements vary from school to school, but even if your school will allow you to take microbiology, etc. while you are matriculated as a nursing student, it's just not a good idea. your grades in one course or the other will suffer. believe me and the others on this website when we say nursing school will dominate your life. (i will give you some good ways to keep it from doing so later on, but for now, just believe us)
on to the meaty part: academic tips for student nurses
#1 go to class, and pay attention while there. it sounds so very simple, yet for so many reasons, just doesn't happen. let's go over some big time distractors, and what to do about them:
the cell phone. if you really can't sit in a lecture hall for two hours without texting or updating your facebook status, then for heaven's sake leave the phone in your car! if you need your phone with you for emergencies (and by emergency i mean actual blood, tears and vomit do not count) then leave it in your bag on vibrate. you will hear it.
friends. you've gotta have them, but you don't have to sit with them during class. if your friends tend to goof off and talk during lecture, do one of two things. either sit somewhere without them, or get them all to sit in the very front row of the lecture hall with you. no one goofs off in the front row.
sleep. i have a friend who failed her third semester of nursing school because she just couldn't stay awake during class. she was working full time night shift, so it was a tough situation. but everyone has obstacles they must overcome to be successful. if you can't stay awake during classes, here are some suggestions: try and switch to a class that better reflects your sleep schedule. my friend requested evening classes, but was told there was no space. you know what? the lecture classes were so big that no one would have noticed an extra face in the crowd once or twice. she could have easily gone to the evening lecture if she fell asleep during the day one to find out what she missed. another good option is tape recording the lectures. actually this is a good idea even if you aren't a sleepy head. record the lecture and play it back in your car, on your headphones while working out, etc.
in my experience, 50-75% of the material covered on exams is covered ad nauseam in lecture.
#2 don't do the reading. okay, i don't really mean that. what i mean is if you have time to read 500+ pages a week, by all means do so, but if you don't here are some tips:
what you really need to get out of the reading are the nursing responsibilities. while it's great to know the in depth pathophysiology of the diseases you are studying, you are going to nursing school, not medical school. the things you will be tested on are the nursing diagnosis(s) associated with the disease, the nursing interventions, and the patient education required. get some little tiny post it notes and label the pages in the reading that cover these, and refer to them prn.
get some nclex review books now. "but i'm not even close to graduating yet" trust me. they're like cliff's notes for nursing. "but i don't have the money to buy extra books right now" buy them used on ebay, borrow them from someone at work (see #1 in pre-nursing section) who's already passed nclex, or just go to barnes & noble and sit and read them there. once i discovered these wonderful books, i rarely even brought my actual textbooks to nursing school anymore. they're much lighter to carry around and they cut out all but the most important things that a nurse needs to know for each disease process. they are, in short, a godsend.
#3 do nclex questions. there are tons of resources for them online, and most of the review books that you will be getting anyway (see #2) come with cd's that have thousands of them. don't believe your teachers when they say they write all of their own questions. they are getting their questions, or at least the basic formats for them from these very same resources. nursing school questions are unlike anything you've ever experienced before. i hear from people all the time that they aced their pre-requisites and are barely maintaining a c average in nursing. it's because the questions are different, and the very best way to know how to answer them is practice. answer a set number of questions, then go back and review the rationales for the ones you got wrong. figure out why you got it wrong, go back and study the material again if you need to. repeat. plan on doing 100+ questions a week during your first year of nursing school, and increase it during your final semesters. by the time the nclex rolls around, you should be doing at least 500 practice questions a week.
wading in: survival tips for clinicals
#1 be a goody two shoes. not in a brown nosing, teacher's pet sort of way, but in a way that shows that you are a professional who knows how to behave in a professional setting sort of way. i hated going to clinical when i was in nursing school. i was out of my element, i didn't know where things were, i didn't know who people were, and i wasn't familiar with the facility's documentation system. and i'm just not a morning person in general. but i treated it like a job. i showed up at least 15 minutes early every morning to get my assignment and ask the night nurse (if i could find him or her) how the patient's night went, what was new, and get report. and you know what? because my instructor knew that i could be counted on to do these things, by the end of the semester not only was i getting the choice assignments, i was also the one sent to help out other students with things they were unfamiliar with when the instructor was too busy. i also usually had my care plans and other paperwork done before i even left for the day, because i was able to use the time in the morning to get it started.
#2 be nosy. find out what is going on on the floor that day. are there any bedside procedures like a tee, or a picc line placement being done? even if it's not on your patient, ask if you can observe (check with your school's policy, and get the patient's permission of course). be nice to the floor nurses, tell them you are interested in learning just about anything, and if they invite you to help them out or watch them do something like an iv start, or a dressing change for god's sake don't say "i've already done/seen that." even if you have.
#3 if you have down time, try and help out your fellow students. not only is it just the right thing to do, you may find that you learn something, or see something you hadn't seen before just by going in a room to help another student do a bed bath. and next time you are in the weeds someone will owe you a favor!
#4 refer to #1 under tips for pre-nursing students. being comfortable touching, talking to and just being around patients is one of the biggest obstacles that many nursing students have to overcome when they start their clinical experiences. if you have already done that, it will be that much easier for you.
the final act: being a graduate nurse
for those of you who are still with me, bravo! i never anticipated this article becoming this long. to think i was actually worried about getting to the minimum 500 words! but anyway, a few tips on being a graduate nurse:
#1 start applying to jobs early. this has become so much more important with the economy in the toilet like it is now, but even in the good times, if you are going to be a may graduate, start applying no later than february. that's right, i said february. facilities only have so many resources to train new graduates, and so will orient them in stages. if you are counting on having a paycheck coming in june, you want to be one of the first new graduates hired. if you heeded my pre-nursing advice and already have a job in a healthcare facility, consider it a foot in the door, but don't count on being hired by that facility. apply early, follow up, and above all, be professional. have your resume and cover letter proofread by as many people as you can. ask your instructors and nurse managers if you may use them as professional references. dress appropriately for the interview. if you have difficulty knowing what appropriate is, look at what your nurse manager wears to work. if he or she wears khakis and a button down, you should wear khakis, a button down and a jacket. always go one step above what is expected.
#2 a few more interview tips: know where you want to work, and why you want to work there, but be flexible with your expectations. if you want to work icu or another sought after specialty, have some good reasons why you want to do so, and also some good reasons why you will be the the best candidate for the job. don't say "because i need the icu experience to get into nurse anesthetist school". and if you are interviewing for a med-surg job when what you really want is labor and delivery, be honest without being too honest. a great phrase is "i want to work on this unit because i know that having a solid med-surg background will serve me well in whatever specialty i go into eventually"
#3 on the nclex. you are already doing 500+ nclex questions a week. you already have all of the review books. you have essentially been studying for this test for the past two (or four if you are a bsn graduate) years. you are ready. if you don't believe me, take a review class. if you want to pay for kaplan or something like it, by all means do so, but there are plenty of other options. many healthcare facilities offer free review classes to their new graduate nurses, so that is something to look into before you pay for one yourself. what you should definitely not do is wait. statistically the longer you wait to take the nclex the higher your odds are of not passing on the first try. it's true, look it up. take it within three months of graduation at the longest. and don't listen to everyone who tells you it's the hardest test they ever took. for me, it was the easiest test i'd taken in two years.
that is it. i have spilled my wealth of knowledge regarding nursing school, and everything that comes before and after. if you really do take my advice, i don't think there is any way you could not be successful. and for my parting words, i will quote my friend abby, who once told me that "c equals degree man, don't sweat it!"
Studying And Managing Coursework
It's your first day of class. Your excited, scared, and eager. All the hard work in your pre-requisites has finally payed off, and you are officially a nursing student. Your professor walks in, greets the classroom, and dives right into the syllabus. One look at the syllabus, and the anxiety starts to kick in. It is several pages long. " Geez, this might be the biggest syllabus I've ever had!" You turn the page and there is the reading list--- you think to yourself, " you have got to be kidding me...there is just no way one person can study this much material! "
Get used to this feeling. Not only will it start in your very first nursing fundamentals course, but it will continue all the way up until graduation. Nursing school is no joke -- it is very overwhelming. It may seem impossible, but with the right study habits and time management skills, you can and will succeed.
The following are the most valuable pearls of wisdom I can give you in terms of studying and achieving good grades in your courses.
What to Study
Only study what is covered in class--this will cut down your workload significantly and make your time spent studying that much more meaningful.
You must be thinking to yourself "you mean I don't have to read all 1 million chapters assigned by the professor for week 1?!" THAT IS EXACTLY WHAT I'M SAYING!
Although you "should" read everything, it's just not feasible. There are not enough hours in the week to do all that reading and simultaneously prep for clinical, eat, sleep, and maintain your health and sanity. Take it from me. During my first fundamentals course, I read and studied every single page, box, etc assigned in the syllabus. I was too scared to skip anything. I was so anxious that I even started studying 3 weeks before the class actually started, which accumulated into over 5 weeks of studying by the time the first exam was even given.
It took a serious toll on my heath, yet I continued to read and study every page, box etc for the remainder of the course. By the time the first semester ended, I was mentally and physically exhausted and I told myself I didn't want to do this anymore. I vented to a friend of mine who was a senior nursing student getting ready to graduate, and she told me to only study what was covered in class. I thought to myself, " there's no way ," but I had to try something or else I was going to end up withdrawing myself from the nursing program. So I took her advice with me into my next course. The assigned readings/ chapters list was comparable, if not larger, than the list for my fundamentals course. Even though deep down I wanted to read all of it to be on the safe side, I only read what was covered in class. I got a 96 on the first exam.
For example, lets say on the syllabus your teacher assigned chapter 21, " postpartum assessment and complications " to be read and studied. However, during class, he or she only teaches certain sections of chapter 21. ONLY STUDY THOSE SECTIONS! There is a reason for this-- the professor is covering what he or she deems the most important information, which translates into the information that will be covered on the test. I used this technique all the way until my very last exam in nursing school, and not only did it prove to be correct each time, but it was probably what saved me from burning out and subsequently withdrawing from school.
How to Study
Study what you need to know as a nurse.
What I mean is this: your professor won't care that you can describe why the pain felt during a heart attack is due to the buildup of lactic acid as a result of oxygen deprivation and every biological step involved in anaerobic metabolism ( and these processes are covered quite extensively in nursing textbooks). Sure, it's nice to know, but your not getting a degree in chemistry. Instead, they want to know what YOU would do if a patient presented to the ER with chest pain, important nursing actions to take during this situation, and why you take those actions. Study what you need to know as a nurse.
In addition, applying what you study is most important and this is where the bulk of where your testing will come from. From day one your teachers will speak of critical thinking and the nursing process, and your licensing exam will focus heavily on these concepts. These principles are exactly what makes nursing so difficult and also why so many people will not make it through nursing school. At this point your probably asking yourself, " Well how do I know if I can critically think and apply what I have learned? " Practice applying what you know with NCLEX style questions. One of the best pieces of advice I can give you is to purchase an NCLEX practice question book early on in your academic career. Purchase a book that divides the questions up by sections, ie cardiac, oncology, etc. so that you can use them to study when you are covering different topics in school.
Time management is also essential to success in nursing school yet very difficult to get a grasp of early on. To effectively manage your time, there are several steps to take. First off, get a calendar. On the very first day of class, mark each and every quiz and exam on the calendar. Next, and probably most important, study every day. By no means do I mean 4-5 hours a day. Not only is that foolish but you will burn out fast. Study 2 hours a day, and as far in advance as you can. Not only will you be adequately prepared, but the information will stay in your long term memory-- there's no such thing as cramming in nursing school the night before, you've gotta know this stuff forever.For example, lets say your test is in two weeks. Start studying the very first day the teacher presents the information.
Take notes in class, and clarify any missing portions with your textbook. Learn this information, then start practicing the information with corresponding NCLEX questions. At first, you will probably get a decent amount of the questions wrong. BUT THATS OK! This is how you learn, and when you go back to do more questions you will start to notice that there is only so many ways they can ask you about a given topic or scenario. Also, do every question you can get your hands on. I used to go to Barnes and noble, pay for a coffee , and take all of the NCLEX books out of their nursing section and do them until I got sick of them. If you practice questions and study your notes like I said for 2 hours a day up until the exam, you will be an expert by the time you have to test and I guarentee you will pass, probably with flying colors.
"What do I do when i'm crunched for time and can't take notes from my textbook?"
Purchase Med/surg nursing reviews and rationales by Mary Ann Hogan. Essentially this book is a cliff notes version of your bulky med/surg textbook. It has notes on the most important diseases, procedures, surgeries etc divided by body system and is worth its weight in gold. There were several times where I replaced my med/surg text with this book and used it along with NCLEX questions for practice to learn the info.
For example, lets say you are covering cardiac tamponade in class, but don't have time to take notes on it from your med/surg text. Open up reviews and rationales by Mary Ann Hogan, turn to the cardiac section, and you will find an excellent breakdown of the disease in bullet-point format which includes a definition, signs and symptoms, and associated nursing interventions. Study this breakdown, and then practice nclex questions on it. Repeat this process over and over for all disorders/diseases/procedures you are learning about it and you will shine when it comes to testing time.
Well that about covers it. I really hope this will help nursing students to excell in the classroom and do well on exams. If you're wondering how I did, I graduated with a 3.9 cumulative GPA and passed the nclex in 75 questions. Best of luck everyone.
Since the economy went downhill and facilities started hiring seasoned nurses returning from retirement, and housewife nurses that had a husband layed off, etc. the fight for your desired position has intensified. You have to be at the top of your game in this very competitive job market.
I have spoken with many other hiring entities about what they look for in a resume, cover letter, and application. What are assets? What are deal breakers? What catches your eyes? What can a new nurse with no experience do to be considered if anything? What about the cliche: If I never get a job, I can't get considered for lack of experience? What are the bare minimums you want in a resume? What makes a resume, cover letter, or application pop out? The following are some tips and suggestions for those who are struggling with the hiring process.
The Resume (Should be one page front only for new grads)
There are so many opinions as to using the "Objective" or not. I personally always have, and have never applied for a position I didn't get yet (blessing/luck possibly). Use every line, every bit of your resume to scream, "Hire me!" I usually word it this way: "To obtain a position at "whatever facility" serving the patients of "region served," with competent, efficient, holistic, and indicated care within the scope of (RN, LPN, CNA, SNA, PCT) and with in the policies and procedures of (institution) to provide the best possible outcome for the patients in my care.
This shows your desire to "serve." It shows you took the time to research the area served by the institution, and their possible needs. It shows interest in the facility you are applying for. It is the first statement that you will do everything in your "scope of practice" and with-in "policy and procedure" and a heart of "SERVICE," not a "job" or "position," and denotes "drive." It also shows you wish to put SAFE PRACTICE FIRST. That you will not compromise your efforts out of your scope, and you will do everything in your power to advocate for your patients protection, well-being, and successful OUTCOME. It also takes OWNERSHIP of their VISION. Know your applicant facility's "Vision" so you can include it in your writings, or "mirror it."
The Education and Work Experience lines are the least customizable. Just be sure to get the correct dates and locations on this part. They will do a background check on these, and it could possibly be checked in HR before sent to your hiring Nurse Manager or Superior. THIS IS RARE. But it does happen. They could possibly also use this information as contact or referral. So you'd be slicker to leave off a negative experience facility than to put an incorrect date or falsify it. I have always just been honest here- they can smell a difference
There shouldn't be large inactive times in your Employment which should cover at least the last 5 years(sometimes up to 7). It really doesn't matter what age you started work, but you should be able to account for your time in-between positions. (Time off work for schooling is totally ok. I worked through school full time, but if you didn't, in denoting times, if school causes a >than 2 month absence of work history, just put a parenthesis in the work history to explain. (Attended Associate Degree Nursing Program 2001-2003 while unemployed).
If you must place large amounts of time between work experience, and you do make it to the interview - DO NOT LEAVE WITHOUT EXPLAINING THIS. Greater than 2 months is usually a red flag. They will not continue consideration without a good excuse (sick child, homemaking, displacement, family tragedy, etc), just address it.
Add Specific Examples. If there is any "Magic" in this, here it is! This is your chance to THRIVE. Many HR Reps I have spoke to ONLY read this line first in pooling candidates. They know as many threads have pointed out that you meet "minimum job requirements," but this is your chance to STAND OUT!
This is SO IMPORTANT. What sets you apart from the herd? Examples of stand-out statements:
Advertise With Us