Advice for a Rusty Student and her New Job

[maeli]

Hi everyone,

In about two weeks I will be heading back to school for my third year after a long summer off. I have also been hired for a student nurse position on a medical floor (we have an employed student nurse program up here in BC). While I'm excited to be back at school and grateful for the job, I am feeling a tad bit rusty.

In an attempt to get a head start, I would like to review some content. While I have my big Med-Surg textbook in front of me and a few ideas, I figured your input would help guide me. So here are my main questions:

• What are some of the most common/most important conditions to be knowledgeable of, specifically on a medical floor? (i.e. hypertension, diabetes, etc.)
  
• What lab values would you suggest being very familiar with? (I know they all serve an individual purpose, but which ones do you find yourself looking into most?)
  

Any other information or pearls of wisdom you would like to throw my way would also be appreciated!

[Pangea Reunited, ASN, RN]

Since you'll be working as a student nurse, I'm sure you'll have plenty of opportunity to learn on the job. What's common on each medical floor may vary, but I'd say renal failure, CHF, COPD, abdominal pain, chest pain, altered mental status, CVA, UTI and pneumonia are pretty common (along with HTN and DM). As for labs, I'd guess I deal with electrolytes, WBCs and cardiac enzymes most frequently.

[maeli]

Thanks so much Pangea, that gives me a great start!

You're right, I'm sure I'll get excellent training. I just want to avoid showing up looking like a deer in the headlights.

[dream'n, BSN, RN]

Depends if your Medical/Surgical floor has Telemetry. If Telemetry monitoring is on another floor, acute heart issues will probably be scarce where you are. Learn the early signs of sepsis; very important. I'm Oncology mostly so some of my main lab concerns are WBC, ANC, platelets, and H/H. Know what Lactic Acid is and what it signifies. Study up on COPD exacerbation, GI bleeds, and cellulitis. They are very common. Alot of your patient's will be diabetic, so know your insulins and length of action.

For your surgical patients, learn the s/s of bleeding and complications. Know the policy on the frequency of post-op vitals and assessments. Study common surgeries; lap chole, appy, urinary stent placement, I & Ds, and hemicolectomies.

Sure there is much more, but this is at least a starting point.

[dream'n, BSN, RN]

Just adding some information regarding labs, watch for trends (And this list is not exclusive/all inclusive, it's just a quick note to review):

Renal patient; BUN, Creatinine, Potassium, Phosphorus

Liver patient; ALT, AST, Alkaline Phosphatase, bilirubin, ammonia

GI bleed; H/H, platelets

If a patient has low sodium, the level will need to be increased slowly. Serial sodium counts will need to be monitored. Increasing the sodium level too fast can cause brain issues.

If giving Vancomycin IV, make sure a trough does not need done prior to giving the medication. Vancomycin is hard on veins and the kidneys. Many dialysis patient's get their ordered Vancomycin at dialysis. If you have the misfortune of an IV infiltrating during Vancomysin, call the pharmacy as there is an antidote (don't remember its name) that you give in tiny injections to the infiltrated site that helps decrease any tissue damamge.

[RescueNinjaKy]

I work in cardiac so I usually see afib, chf, chest pain, mi, copd, pneumonia, post op cabg, tavi, stents, etc.

Labs that I like to look at include wbc, hgb, troponin, creatinine, bun, potassium, magnesium, phosphorous, calcium.

No one expects you to know everything, I'm an rn and I sure don't know even close to half of everything. Just know the general basics that plague the general population. Diabetics, hypertension, hyperlipemia, renal failure, coronary artery disease, copd, pneumonia. Just about everyone that goes to the hospital has at least one of the above. Once you're a licensed nurse and on the job, you can spend more time researching the cases that YOU see more often on YOUR floor. Otherwise you're going to be overwhelmed by everything. Take it easy while you've got the time, there's plenty of time to feel stressed and stupid during your first year as an rn.

[maeli]

You guys are fabulous, thank you so much!

The specific unit I've been placed on does not have telemetry, but I've been told there may be a chance for me to float to the unit that does, so the cardiac info will definitely come in handy for that.

Labs are definitely a weak spot of mine, so thank you for the breakdown by diagnosis!