how do you get As in RN school?

RedhairedNurse, BSN, RN · Mar 2, 2009

I was all As in prereqs but got all Bs in nursing school, except for an A in skills lab. I only know of one person that got As and that was in clinical, not theory. I don't know of one single person getting As in theory, not that there weren't, I just didn't know of any.

I wouldn't worry about getting As if you're already in nursing school.

'C=RN'

chevyv, BSN, RN · Mar 2, 2009

I don't. I also don't strive for A's; I strive for an understanding of the material. Although my gpa is great, my final theory class was 8 weeks in length and a bear! I was very happy to have passed that class.

nerdtonurse?, BSN, RN · Mar 2, 2009

here's what i do:

first, i'm an lpn in a critical care setting. while real world knowledge helps, i'm also working fulltime and going to school fulltime, so i've got to maximize every moment i've got. i'm in nur221 -- we do nur 115, nur221, nur 222, and nur 224 as the core nursing classes, with the nutrition, assessment, etc., in addition.

what i do:

for example, our next test is going to be on endocrine disorders and diabetes. what will i do to study?

1) get my a&p book out, and read the a&p of the pancreas, the thyroid, etc. i know i get confused between the thyroid and the parathyroid, so i'm really going to focus down on those areas.

2) get my pathology book out, and read in that text the section on diabetes, thyroid d/o, etc.

3) then, and only then, do i go to my textbook. i read the chapters, and make an outline, highlighting the things mentioned in all 3 books with one color (orange). if something in the textbook conflicts with the other 2 books, i ask my teacher before class, and realize that push come to shove, i'm tested on the textbook, not always the "right answer"

4) now i'm ready for class. i highlight with a different color anything in the book the teacher seems to have really emphasized, and add that back to the notes. then i study the notes, and anything i'm still asking why on, i go and study the fool out of it. if i can know why a person with diabetes has a higher risk for blindness as compared to a non diabetic, i'll be able to puzzle my way thru the question. that's where the "why" comes in -- we often get questions from a prior edition of our textbook (and don't get me started on that), and having a good "beyond the book" understanding of the subject lets me still figure out the right answer.

for example, here's my notes for the test on "the older adult"

v the older adults

► over 65, but no magic number

► specific risks: chronic illness, injuries (falls, hip fractures), unusual reactions to meds, physical, social and fiscal stress

► developmental tasks

► maslow

► ageism – discrimination against elderly lowers self confidence, s/s of illness may be dismissed as “just getting older” (aching hip may be broken hip)

► gerontology – study of the aging process and it’s consequences

► polypharmacy – need to use one pharmacy, one pcp

► may experience elder abuse d/t caregiver strain

► s/s of infection in elderly

utis make them crazy

v illness, chronic vs. acute

► acute: less than 6 months, rapid occurrence, full recovery

► chronic: cancer, htn, cva, heart disease, diabetes

longer than 6 months, permanent with permanent disability, may require rehab, long periods of care,

can have periods of remission/exacerbation (ms,chf, copd),

can lead to polypharmacy

v developmental theories:

► erikson: integrity vs. despair – life review, did i waste my life?

v physical changes in elderly:

► skin turns papery, thin, fragile, slower healing, melanocytes form age spots, less adipose tissue, hair, nails,

► cv, sbp elevates, decrease in co, increase in perph. resistance, less elastic/more rigid vessels,

► resp: increase in ap diameter, kyphosis esp in emphysema

► gi – decrease in saliva, stronger desire for salt/sweet d/t decreased taste buds, gerd, decreased gag, slower stomach emptying/motility, intestinal atrophy, decrease in peristalsis, increased risk of gallstone/gb probs, decreased liver function and enzymes from pancreas (increased risk pancreatitis, esp in etoh abuse

► gu, decreased kidney function, bladder capacity, delayed micturation reflex (pee now, pee often), more urinary retention in men, more stress incontinence in women

► reproductive: sex organs atrophy to a more prepubescent state, erections take longer, more likely to be partial, not complete

► endocrine – pituitiary insufficiency, thyroid becomes fibrous, decrease in tsh levels, insulin not released as quickly, sensory, musc/skel (table 2-6) less cortisol (reaction to systemic stress)

► neuro: slower reaction time/reflexes, decreased sensations of hot/cold, shrinkage of brain mass, increased pain tolerance, decreased physical coordination

► immune system: slowly decreasing in antibodies, allergic response, immune response (more immature t cells), increase in cancers, utis.

v what the elderly need to do to stay healthy:

► health behaviors: eat healthy, exercise, get annual vision exams, annual physicals (esp mammograms, paps, psas, prostate exams); pets can give an elderly patient purpose to get better.

► environmental: get rid of throw rugs, use smoke detectors, non skid everything, decrease temp of water heater, good non-glare lighting, maximize fall prevention.

► teaching should be by a peer, not a kid, group learning should be age-cohorted., 15-30 minute chunks, bright colors, but not overwhelming, large print, assume some degree of hearing loss

► monitor for depression, anorexia

v community care

► patient also includes patient’s family

► use referrals – pastoral, pt/ot/msw/csb, discharge planner

► hook up with community resources – adult “day care”, meals on wheels, parish nursing,

► home health nurse must be provider of health care, not a maid, not an errand runner – strong boundaries, accepting of other cultures/mores, coordinates care and educates family/patient. first and foremost, you are the nurse, and you may need to “macguyver” solutions to situational problems – hang iv bag from a hanger on curtain rod if no pump…

v rehab

► impairment – disturbance in structure/function

► disability – degree of impairment (30% disability)

► handicap: adjustment to disability that is permanent with no return to 100% pre-incident function

v dementia

► a symptom, not a disease in and of itself

► not a normal part of aging, although half of all over 85 year olds have some dementia…so doesn’t that actually make it a normal function of aging…?

► diagnosed with 2 or more impairments in memory, language, reasoning, judgment, with no loss of consciousness

► risk factors:

age, family hx, smoking, drinking, drugging, dm, atherosclerosis, high cholesterol, pre-exising brain damage / disease / injury

► what could mimic it? cva: cerebral ischemia and infarction occur when there is a significant ↓ in o2, then electrical fx occurs & s/s of ischemia. area of infarction dictates symptomology: [most frequent location of occlusion: middle cerebral artery) make sure dementia/ad aren’t actually small strokes affecting the following areas.

l sided cva

aphasia

↓ of verbal skills

personality changes k

reduced retention of verbal materials

right paralysis

r sided cva

disorientation

impaired judgment

↓ in performance skills

time orientation problems

left paralysis or paresthesia

v alzheimers

► diagnosed definitively at autopsy, a disease of exclusion: rule out everything else, only ad’s left, may use folstein’s mini mental status exam. must have dementia, onset between 40-90, no other disease that could cause ams, like low fsbs, no loc)

► form of dementia, most common degenerative neurological disorder/cognitive impairment

► progressive, irreversible, death usually within 10 years of diagnosis (diagnosis, not first symptom)

► caused by neurofiber tangles and placques in the brain

► if inherited, slow / late onset, if non-inherited can be early/fast onset

► death is usually from aspiration pneumonia (may have peg tube)

► s/s

memory loss that affects adls

language problems

no longer a/o to day, place, and eventually name

decreased capacity for abstract thought

lability of emotions

loss of initiative, depression, esp. once diagnosed.

► stages:

stage 1

þ physically healthy, forgetful, restless, poor coordination (falls), family often aware and compensating until sentinel event – getting lost, starting a fire, falling

stage 2

þ loss of spontaneous behaviors, repetitive behaviors, more d/o to time and place, eventually can’t carry out adls, don’t sleep at night, sundowners

þ language deficits: paraphasia (wrong word), echolalia(echoing words), scanning speech(trying to find the word and can’t), to total aphasia

þ sensory: apraxia (can’t perform deliberate motions), asterognosis (can’t identify things by touch), agraphia (can’t write correctly, or mimic a simple drawing, like a clock face)

stage 3

þ fecal/urinary incontinence

þ loss of language

þ loss of ability to simplest self care

þ usually become bedbound

þ complications

o pneumonia (particularly aspiration), decubitus, falls, depression, delusions, seizures, paranoia

► how to help

keep pt in least restrictive environment which still maintains safety

minimal sensory stimulation

keep routines, try not to take them out of their element

v alzheimers meds

► tacrine hc (cognex) first med for ad

► mild to moderate ad

donepezil hc (aricept)

rivastigmine tartate (exelon)

alantamine hydrobromide (reminyl)

► moderate to severe

memantine (namenda)

► avoid: antihistamines, maois, tricyclic antidepressants, benzodiazepams, ambien makes them nuts.

► sedate cautiously, can cause exact opposite reaction

v therapy

► dance, music, art – great, they’ll fall and break a hip while dancing, they’ll be too deaf and sensory challenged to understand the music, and they’ll eat the crayons…. safety first

v nursing diagnosis

► impaired memory

► risk for falls

► chronic confusion

► anxiety

► hopelessness

► caregiver role strain

► risk for impaired skin integrity (stage 1-2 decube)

► risk for impaired tissue integrity (stage 3-4 decube, and/or decube with eschar

v osteoporosis

► metabolic bone d/o causing bone loss

► can be caused by age, endocrine d/o (cushings disease, hyperthyroid, hyperparathyroid, dm, malignancy like osteosarcoma, osteocarcinoma

► s/s

kyphosis, loss of height, pain in lumbar spine, fractures of the forearm, spine, or vertebral bodies

bone diameter increases, thinning out the core structure

► diagnosis

bone density scan

ast elevated

► meds

estrogen replacement therapy

evista – mimics estrogen

fosamax/actonel inhibit bone destruction

forteo synthetic parathyroid hormone to stimulate bone formation/mass

boniva – monthly treatment/prevention

calcitonin – increases formation, prevents reabsorbing of bone

patient must be able to sit up (or be propped up) for 30 minutes

v eyes

► in general:

mydriasis is dilation of the pupil: think “my eyes got big when i found out the test was thursday!

miosis– microscopic pinpoint pupils….

never ever use a mydriatic med in narrow angle glaucoma, because the pupil dilation will crimp off the ability of the aqueous humor to drain, and your patient just went into acute narrow angle glaucoma

► cataracts

bilateral clouding of lenses (unless trauma etiology)

age, genetics, sunlight, trauma, smoking, etoh abuse, uncontrolled dm, radiation possible causes – remember the blind tigers in new zealand (under the ozone hole), and the thousands of blind caused by hiroshima/nagasaki a-bombs. so, a teenager who uses a sunbed, a nerd using a computer, a farmer could all have a high risk.

types: immature – partial obstruction, mature, entire lens opaque.

problems with glare, blue/purple discrimination (shorter wavelength injury)

only treatment is surgery to remove cataract, and either implanted lens, contacts or glasses then required.

post surgery care:

þ no heavy lifting

þ nothing to increase iop like bending over

þ don’t sleep on surgical side

þ keep followup appointments

þ monitor cushings disease pts

þ call md immediately if pain, vision loss, headache, n/v occur

► glaucoma

optic nerve neuropathy

only symptom is narrowing of vision field, and vision loss is usually significant by the time it brings the pt to the doc – preventative scans a must

types

þ open/wide angle

o most common in adults, hereditary

o angle between iris and cornea okay, but outflow of aqueus humor obstructed, so pressure just climbs and climbs.

o painless

þ acute/narrow angle glaucoma

o medical emergency

o can be total closure, no fluid gets out at all

o severe pain, n/v, colored halos, abrupt changes in vision, bloody conjunctiva, corneal edema, pupil fixed at midpoint.

treatments

þ to give eye meds:

o tilt head toward affected eye

o apply pressure for 30 sec – 1 min over iner canthus to prevent systemic absorption

o beta-blockers

o for wide angle, decrease aqueous humor production,

o drops iop

o push on tear duct to prevent systemic absorption of the med (it’s a bp med, after all)

þ drugs that decrease aqueous humor diuretics, miotic drops like acetylcholine

þ surgical

o gonioplasty – scar iris edge to pull open chamber

o iridotomy – lots of iris scars to pull open chamber

o iridectomy – small section of iris removed

► age related macular degeneration

leading cause of blindess/impairment over 65 years old

could be genetic / smoking/ links, unknown

may be reduced with use of antioxidants, beta-carotene, zinc

types:

þ wet – blood vessels occlude inner eye, causing central vision loss, treated with surgery or light therapy

þ dry – slight vision loss, treated with high dose antioxidants and zinc

s/s

þ blurring of central vision, (amsler grid) gridlines would appear to have gravity wells

► retinal detachment

permanent vision loss can occur

risks: aging, myopia (big pupils like mine), aphakia (no lens, like after cataract surgery)

s/s

þ curtain across the vison

þ floaters, lines, flashes of light, no pain, no observable defects

treatments

þ scleral buckling

þ cryotherapy, laser to make retina reattach to choroid

þ air into vitreous cavity (pneumatic retinopexy) to force retina and choroid together

med/oncRN · Mar 2, 2009

I was one of those anal students who got all A's in nursing school. I worked my ass off, got little sleep and was stressed all the time. In hindsight, WHY?! You don't need all A's to pass. I am a good nurse, however I work with many of my classmates who weren't excellent students, but ARE excellent nurses. The main thing is critical thinking. I was book smart when I graduated. I honestly don't remember a lot of the trivial things I had to memorize. I graduated book smart, but a little weak clinically. I was eager to learn though and always volunteered to do things once I was a Grad nurse. I'm several years out now and can apply what I learned and critically think through a situation. Take it from someone who has been there, concentrate on passing, not being the one with the best grades. Don't beat yourself up like I did. Nursing school has enough stress without the pressure to get the perfect grade. Good luck and relax a little.

med/oncRN · Mar 2, 2009

One tip I will give you is for cumulitive tests. After your regular exams, go through your notes, lecture outlines and books and highlight what you remember being asked on your tests in a different color. That is what you study for cumulitive tests since the questions are pulled from your previous tests. I also never studied in a group, I found too much gossiping and getting off track. I would get paranoid because everyone seemed to focus on something else. I just focused on the outlines they gave, and what the instructor put emphasis on. I also did all the assigned reading. But really, try and relax. What did all my stress get me? An award to hang on my wall! I wouldn't stress myself out if I had it to do over again. I would just concentrate on passing. I should mention, I was in my 40's when I graduated, married, with 3 kids, a dog, a part-time job, and a mortgage. I wish I would have spent a little more time relaxing with my family and just got passing grades, instead of stressing and getting all A's.