IDalove2 1,842 Views
Joined: May 6, '12;
Posts: 16 (25% Liked)
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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 knowledgeable 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.
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 its 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)
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 paid 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 health, 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, let's 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, you're 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 into 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, let's 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 THAT'S 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 guarantee 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?"
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:
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