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mjo07 4,424 Views

Joined: Jan 22, '13; Posts: 173 (17% Liked) ; Likes: 60

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  • Jun 23 '14

    There are 6 major electrolytes. Sodium, potassium, calcium, chloride, magnesium and phosphorus. It is primarily potassium, calcium and sodium that will cause problems when they are out of whack.

    • hypokalemia
    • hyperkalemia
    • hypocalcemia
    • hypercalcemia
    • hyponatremia
    • hypernatremia

    When there is a sodium imbalance quite often there will be changes in mental status - confusion, delirium, etc. Often seen with traumatic brain injury where diabetes insipidus (pathological voiding of large amounts of dilute urine) and its opposite SIADH (syndrome of inappropriate antidiuretic hormone - minimal urine output but very concentrated) may occur. Sodium imbalances are also seen with dehydration in some patients (elderly, burn victims, many others) and the blood levels will go up. Very rarely, sodium levels in the blood will go down because of consuming large quantities of fluids.

    The other main electrolyte imbalance seen is when potassium is out of whack, and its most serious consequence is cardiac problems that can be life-threatening (you will see T wave changes: depression with hypokalemia, elevation with hyperkalemia, among other changes in the EKG like QRS interval changes).

    For these 2 main electrolyte imbalances remember: Sodium equals mentation, and Potassium equals cardiac.

    Sodium does affect fluid. In fact, they say sodium always follows water. There are a lot of people with edema related hypernatremia; and a lot of dehydration related to sodium and chloride losses. Potassium tends to affect the heart and in the clinical area you will see dramatic instances of people with hypokalemia and hyperkalemia. Calcium affects the muscles and is not as commonly seen clinically because it is detected because of lab testing.

    • Sodium - body water balance
    • Potassium - contraction of skeletal and smooth muscle and nerve impulse conduction
    • Calcium - formation and structure of bones and teeth, cell structure and function, cell membrane permeability and impulse transmission, the contraction of all muscle types and is necessary in the blood clotting process
    • Chloride - important in the digestive acids; closely linked to sodium
    • Magnesium - affects nerve and muscle action by affecting calcium usage, activates enzymes involved in carbohydrate and protein metabolism, helps in the transport of sodium and potassium across cell membranes, and influences the levels of sodium, potassium, calcium and some body hormones (parathyroid hormone)
    • Phosphorus - formation and structure of bones and teeth, this electrolyte is needed in the following activities: utilization of B vitamins, acid base homeostasis, bone formation, nerve and muscle activity, cell division, the transmission of hereditary traits, metabolism of carbohydrates, proteins and fats

    Third-spacing: Where has all the fluid gone?
    table of commonly used iv solutions.doc

  • Jun 8 '14

    Ok, I'm sure plenty of others can benefit from this as well. I've just completed my first clinical rotation, and kept hearing from other people that I could sit in for the CNA exam without having to pay for the course. So I found out it's true! (Check below for the MA nurse aide registry info). Here is the scoop:

    - A nursing student enrolled in a licensed practical nurse (LVN) or registered nurse (RN) program is eligible to challenge (sit in on) the CNA state exam as long as they've completed the basic nursing fundamentals course. Both the theoretical and practical parts of the course must be completed and official school transcripts are needed for verification. As soon as you meet this criteria you may sit for the nurse aide competency evaluation.

    - The cna exam consists of a written or oral exam and a hands-on, skills examination. The written and skills exams are administered on the same day and you need to successfully pass both parts in order to be certified and listed on the Nurse Aide Registry. The number of questions on the written exam may vary from state to state, with most states requiring an average of seventy questions. The written test questions use a multiple-choice format . The second part of a CNA examination the nurse aide student must show competency in performing five (5) hands-on skills. These five skills are selected randomly from a list of twenty-five skills. Twenty five to thirty minutes are usually allocated to completing all five required skills of the hands-on CNA examination. One of the five skills chosen at random consists of taking a measurement and recording your findings. Some of the most commonly requested measurements are the blood pressure, the pulse, or the weight of a client. When challenging the CNA examination, five of the following skills need to be correctly performed in order to pass the skills portion of the certification exam.

    • Wash hands
    • Apply one knee-high elastic stocking
    • Assist to ambulate using transfer belt
    • Assist with use of bedpan
    • Clean dentures
    • Count and record client's radial pulse
    • Count and record patient's respirations
    • Donn and remove gown and gloves
    • Dress client with affected (weak) right arm
    • Feed client who cannot feed self
    • Give modified bed bath
    • Make an occupied bed
    • Measure and record blood pressure
    • Measure and record urinary output
    • Measure and record weight of ambulatory client
    • Perform passive range of motion exercises for client knee and ankle
    • Perform passive range of motion exercises for client shoulder
    • Position client on side
    • Provide catheter care for female client
    • Provide fingernail care
    • Provide food care
    • Provide mouth care
    • Provide perineal care for female client
    • Transfer from bed to wheelchair using transfer belt
    For more info. you can call here and ask:

    Massachusetts Nurse Aide Registry
    Massachusetts Department of Public Health - Division of Health Care Quality
    99 Chauncy Street, Boston, MA 02111
    Phone: (617) 753-8143
    License Verification: (617) 753-8192

    This will definitely come in handy for nursing students who want to get cna experience while in school.

    I hope this can help someone else as well!

  • May 7 '14

    On certain weekends during college I would spend the entirety of the time that the library was open studying; I would get there at 9am and not leave until 11pm, and still I thought this wasn't enough, especially if I had an exam that week. I got good grades (not great), I was no over-achiever compared to some of my classmates. That's not to say I wasn't academically competitive, I was and I still am. I honestly think it's the only thing I have ever been competitive about.

    On my last day of clinicals in my last semester on the last week of college, I made a mistake A BIG ONE.

    I was on the Labor and Delivery unit for my preceptorship. I was just getting over a cold so I almost got sent home that day, but I insisted that I wasn't sick anymore and it was my last day so I really wanted to stay.

    I had a high risk patient with maternal Diabetes and an STD. She was already in labor but the possibility of an emergent c-section was high due to her risk factors. We had to infuse an antibiotic quickly so that the baby wouldn't get an infection on its way out of the birth canal. She was also allergic to penicillin which prompted us to use a different antibiotic than usual.

    My Preceptor (RN) gave me the bag to hang, she said "just open it wide up." The antibiotic we were supposed to use was 100mg of Unasyn, the bag that the pharmacy had sent up and put the patients name on was 100units of Humilin (a fast acting insulin). I hung the bag only checking the patients name and birthdate. Neither I or my preceptor checked the name of the medication, and there was no electronic medical record at the time. This resulted in the patients' blood sugar dropping to 40 and an emergent c-section. In the end neither the mother nor the baby were injured in any way, but that's not to say this error wasn't damaging.

    I was initially told that it would just be a ding on my record, nobody would even find out....

    On the morning of my pinning I got a text from one of my instructors saying "hey did you check your email?" Of course I hadn't since it's the week of graduation and everything is done already. So reluctantly I opened up my email and it stated that I would not in fact be graduating, and I would have to repeat my last semester due to this one mistake. I finished reading the email, and when I had finally realized what it entailed, I screamed... I cried bloody murder so loud my roommate thought my mother had died or something. To me it was the worst thing that could have happened, and to top it off my boyfriend at the time broke up with me that same day. I felt like I hit rock bottom, things could only get better from here, right?

    Despite having the worst morning ever, I did in fact walk the stage that night, and as soon as I started the next semester, things were starting to look up. During my final semester I got to precept under my idol (the president of the nursing program at my college) in a pediatric oncology unit, I participated in the California gubernatorial debates, and I presented my research at the pediatric society of nursing conference in Las Vegas. It was an exciting and challenging time in my life.

    After I graduated, I spent 5-10 hours a day for a month (yes every day) studying for the NCLEX (the RN licensure exam). When I took it, the computerized exam shut off at the minimum amount of questions: 75. And two weeks later I found out I passed the test.

    As a kid you are told that you should "work hard, go to college, and get a good job so you can be successful". And there I was; I had worked hard my whole life towards being a nurse, and now I was...sort of. So after getting my license I started applying for nursing jobs daily. In the mean time, I worked as a waitress at Outback Steakhouse.

    I probably applied to over 200 jobs over the course of a year. The amount of applications per day that I was submitting would wax and wane depending on how I was feeling. After months of applying for nursing jobs, and not hearing back from any of them, I got really depressed. No one wanted to hire me; I was living in my parents' house, working a job I could have gotten out of high school, and realizing everything I learned as a kid was a lie.

    I didn't understand why nobody wanted to hire me; I graduated cum laude, did extra projects, and even had a job working as a student aid in the nursing sim-lab. How was I not a prime candidate? What's so awful about me that you can't even give me the time of day to respond to my email?

    I often glorified the past in my mind; I missed college, when everything was exciting and challenging, and now that was all gone. I was at a stand-still. I realized I was never going to get a nursing job in California; not as a new grad anyways. This was my defining "now what?" moment.

    My friend, Colleen, who I went to nursing school with, was living in Hawaii, and she had just gotten a job in a new-grad nursing program at Hilo Medical Center. I saw this as my opportunity to get out, even if I couldn't get a job at the hospital right away, at least I knew they were hiring nurses in Hawaii. And on top of that I was tired of waiting around in California for "my life to start." So I dropped everything, and bought a one-way ticket.

    When I first got to Hawaii, I got a job as a waitress at a local restaurant called Cronies. Even though I didn't have a nursing job yet, the change of scenery made me happy; I had minimal responsibilities, no one to call home to, and plenty of time to spend on the beach.

    After about a month I got hired at a clinic, it wasn't the ideal nursing job, but beggars can't be choosers right? The job was only going to be part time, so I kept my job at Cronies. And thank the flying spaghetti monster* I did, because I actually only ended up working at the clinic for about a week. I got hired on Monday and fired on Friday. They gave me a lot of silly reasons why they fired me that mostly added up to "people don't like you." It hurt my feelings that people didn't like me, but it hurt even more to think that if I couldn't even keep a stupid clinic job, how was I gonna keep an acute care job? It was worse than if they had not hired me at all.

    Once again I felt like a failure, I felt incompetent, stupid, not-worthy and I was a stranger in a strange land. I felt so bad I was paralyzed; I couldn't get myself to open a computer and look at a job application for months. When I finally did, I got hired at a long term care facility. Four months later I got hired at Hilo Medical Center in their new-grad nurse program.

    I have now been living in Hawaii for over 2 years, and I just completed my first year of acute care nursing. The most important thing I learned during this time was that failure is an option, in fact it's likely, but I also learned that I have the strength to get back on the horse and try again, bruised and battered as I may be.

  • May 4 '14

    Learn the broad classes of meds.. Like psychotropics, heart meds, anti seizure, pain meds/ analgesics, etcetera.

    Then learn the major sub classes--like under psychotropics are anti anxiolytics (anti anxiety), anti depressants, anti psychotics/meds for bipolar, etcetera

    Under heart meds are beta blockers, calcium channel blockers, ace inhibitors, etc

    Under pain meds are narcotics and non narcotics,

    Each of the sub categories usually had a particular suffix associated with it, like "-pams" are anti anxiety like lorazepam, beta blockers are "-lol"s, ace inhibitors are "prils", numbing pain meds are "caines".

    Learn only 1 medication from each sub category and learn the common suffix associated with it. You can use that to be able to figure out what category any other med fits into.

    Like the op said, learn the actions of the meds, too. This way the use will make sense.

    I also use mneumonics and try to associate the med and it's use with someone I know.

    For example, my ex took atenolol to lower his blood pressure and I laugh out loud at him, hence -Lols are to lower BP. Or this mean / strict lady I knew has a name that rhymed with verapamil so I remembered that verapamil blocks all the fun...verapamil blocks calcium channels. Calcium is needed for the heart to pump.

    I hope this makes sense. This is what I did to get thru school and I still use this method as a new grad working nurse.

  • Mar 11 '14

    You might actually be the only one.

    I find it interesting that you find the need to put quotes around "compassionate" -- as if atheists weren't able or likely to be compassionate. That, to me, suggests bashing atheists. Guides have a right to have and post their opinions, too, and the quotation remarks around the word "guides" suggests that you have a problem with that as well.

    I suspect that you're a Christian -- maybe I'm wrong. But whether or not you are, you should know that there's more than one brand of spirituality, and Christianity is not the be all and end all.

    I try to stay away from the "Nursing and Spirituality" forum because a lot of what is posted in the forum -- even by fellow Christians -- is offensive to me. But the quotation marks around the word compassionate when paired with the word atheist caught my attention. Sadly, I wasn't mistaken about the tone of the actual post.