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cnmbfa 5,705 Views

Joined: Jan 14, '06; Posts: 159 (58% Liked) ; Likes: 392

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  • Jan 7 '17

    You won't find anyone here who will advise you to "skip this" or "don't worry about learning that."

    You are in nursing school. Learn everything that you can. Stop looking for the quick notes. Everything that you learn now is FUNDAMENTAL. Future lessons build upon this basic course. Learn it or face future failure.

  • Jan 7 '17

    I wouldn't worry about memorizing every tiny detail. If you have a good foundation in A&P, then when the prof talks about the pathophysiology, it'll make sense and reinforce what you already know.

  • Jan 7 '17

    You'll be fine, but you'll want to review that A&P on your own so that you are prepared to learn as you go through the semester. So, like someone else said, before the renal lecture you should spend some time refreshing your brain on the basics. I bet you that if you worked hard last semester, that stuff is still in there, you just need to bring it back to the front of your brain. Thats good to do anyway, because it will help make it stick better. Use your A&P textbook as a resource. I also think that khan academy is a great resource - check out their "health and medicine" section and watch the videos before you have that section in your patho class. Good luck!

  • Jan 7 '17

    No because faculty expect you to be able to apply knowledge and content from earlier courses.

  • Jan 7 '17

    What do you think the definition of the word "prerequisite" is?

    It means you need to take this course before that one, because you will need a good working knowledge of the material in this one and we will assume you have it.

    I hope you didn't sell your book and toss your notes, because you have a LOT of catching up to do.

    Hint: This applies to all your nursing courses, too. When you take second semester, they're going to assume you remember first; at fourth, you'd better have all of 1, 2, and 3 solidly between your ears. And they're going to assume you remember A&P, patho, chemistry, and all those other PREREQUISITES.

  • Jan 7 '17

    No. My nursing instructors did not have time to review A&P. We were advised to review it on our own as needed. I strongly suggest you review frequently in order to retain that info. It will never go away--the rest of your career, you will need to understand A&P. The more often you see it, the more it becomes part of your knowledge-base.

  • Jan 7 '17

    You will not find vital sign parameters in drug guides. Why? The drug guide is about the drug, not about the patient. A heart rate of 40 may be life-threatening in an 80 year old woman taking beta-blockers. Or it may be perfectly normal in a 25 year old athlete. The drug guide, nor any other source, can give numeric parameters for giving or withholding a drug. Only a physician with knowledge of the patient can do that.

    You'll be much better served studying the mechanisms of action and the contraindications for medications rather than looking for specific numbers. Numbers you have to memorize. By learning how the drug works, you'll be able to identify situations where it may not be appropriate to give it. It will give you a much more comprehensive understanding and make you a better nurse. Let me illustrate the difference.

    A. "Don't give metoprolol if the patient has a heart rate less than 50."
    -Great. Now you know one specific fact about this drug. Do you have any understanding about WHY you shouldn't give it for a heart rate less than 50 or how it works? No. So you decide to dig a little deeper....

    B. You learn that that metoprolol is a beta-blocker. Beta-blockers are also called beta-adrenergic blockers. What's that? You find out that beta-adrenergic agents are part of the sympathetic nervous system. You remember from pathophysiology that the sympathetic nervous system is the "fight-or-flight" response that prepares out body for emergencies. You learn that adrenaline is a beta-adrenergic agent. When the kidneys release adrenalin, it causes that fight or flight response. The heart rate increases and the blood vessels constrict. Metoprolol blocks that response. It keeps the heart rate from increasing and the blood vessels more relaxed. You also remember from pathophysiology that blood pressure is a measure of the force that the heart has to use to push blood through the veins, and so when veins are more relaxed, blood pressure is lower.
    Now you know how metoprolol (actually all beta-blockers) work, and what effect they have. So if your patient has a history of hypertension, you now know why they have metoprolol ordered, and if your assessment reveals a low heart rate or a low blood pressure, you understand why it might not be a good idea to give this drug.

    See the difference? By focusing on how the drug works, you'll learn both why it's needed and when it might be unsafe to give it. You'll learn much more than you will by just memorizing certain parameters.

  • Jan 7 '17

    Quote from srercg6
    no, that's just additionally. for instance a family that has a family member who needs a LOT of care - can't do a lot themselves - but some, but the family claims they are homeless (when they clearly are not) or don't have room for the person etc because they don't want to have to take care of them, and the person can't be sent to a facility because they are undocumented so they are left to use the more expensive services of the hospital as their long term care - years.
    Family not wanting to take care of a patient has nothing to do with their immigration status. There may be valid reasons why a family member would not wish to take care of a patient. Maybe Daddy raped his daughter every night for years -- I cannot imagine why you would expect the daughter to then take an aged Daddy into her home (where she may have her own young children) and care for the man for possibly years. Perhaps Mother cut off all contact with a daughter who married a man of a different faith, had a child out of wedlock, or simply chose to live her own life rather than the life Mother chose for her. After forty years of no contact, Mother is ill and needs care. Are you going to force that daughter to take her in and care for her?

    No one should be forced to care for someone they don't want to, family member or not. Many of those poor, lonely elderly patients are lonely for very good reasons.

  • Jan 7 '17

    ^^ exactly what CCU said. Or sometimes it's even worse. We recently had a patient who was a post cardiac arrest with an anoxic brain injury, but not brain death. The family wanted everything done. Trach/PEG, etc. The patient is minimally functional- essentially the only thing he does is breathe over the vent and occasionally opens his eyes. He is an undocumented immigrant. So now we have basically an LTACH patient, stable, who will live out the rest of his life in one of our hospital's trach to vent PCU beds, simply because his family continues to insist that everything be done, but they are unable to pay for any of his care/private placement, and he's not eligible for medicaid.

    Edited to say that I'm not saying that he isn't deserving of care in any way shape or form. Just saying that our system/way of managing this scenario is clearly broken.

  • Jan 7 '17

    In ICU, I don't have to know their immigration status.

    the issue was working in hospital, in a floor with the lowest level of care provided by that hospital. Case Management will start working on their discharge so they can go to Rehab, because they're not safe to live at home. They have no insurance, so CM tries to enroll them in medicare/medicaid/whatever. During this process it is discovered that they are not eligible due to their immigration status.

    So we're in this pickle, because we can't discharge them to an unsafe environment at home (e.g. no family, no home, etc.) and we can't discharge them to rehab without payment. So someone who medically does not require a hospital setting will stay in the hospital setting for MONTHS sometimes. Occasionally having a shift where one of your patients is healthy enough for discharge is nice. Having those shifts for months, is not.

    Doesn't matter if the person is a super nice person or a rude and nasty one. It stinks that our tax dollars will pay for this, but not for the level of care they need. It would be SO MUCH CHEAPER to send them to rehab or home with PT/VNA, but that's not the system we live in. It sucks for the patient to be in hospital for months when they don't require it, it sucks for the healthcare provider who misses out on Med/Surg experience with a healthy person padding their numbers.

    My issue with this is that it highlights a huge failure in our healthcare system, not ANYTHING to do with the patient. I happily care for whatever patient gets tossed my way, with minimal complaining. I just don't see why, if we pay for hospital, we won't pay for anything else. Hell, if this guy hadn't been too scared to go to a clinic in the first place instead of waiting for an issue to be so bad he needed hospital, I personally would've gladly had my tax dollars pay for his Amoxicillin instead of his 28 day Sepsis hospitalization, for sure.

  • Jan 7 '17

    My patients are children with terrible diseases. I couldn't possibly care less about their immigration status. I am grateful that they have made it to a place where they can receive treatment for their illnesses.

    My most recent one was a teenager from Central America. He came, on his own, to the US with a note from his parents that he was seeking refugee status. He, a minor, was detained by INS for a month before being sent to live with a family friend. A few months later, he was diagnosed with leukemia. In the US, ALL has a very high survival rate. In the rural village where his family lives, he most likely would have died. How he was able to get on Medicaid is not my concern. I am happy that he made it here before he was diagnosed and will likely survive his cancer.

  • Jan 7 '17

    How do you know they're undocumented?

  • Jan 7 '17

    Quote from Davey Do
    I don't understand "undocumented patients".
    Quote from heron
    "illegal aliens"
    Oh. Okay. Thanks.

    We did have a patient on the geriatric psych unit, Thurston Howell, who was there for months and months. But he wasn't an undocumented patient.

    Whenever a patient is now there for an extended amount of time, we often ask, "Will this patient be Thurston Howell II ?"

  • Jan 7 '17

    Quote from srercg6

    What do you think about undocumented patients who abuse the hospital system?

    Firstly, they cannot abuse the system G6 because of set protocols, secondly, they generally have little power because of their status and are probably scared and thirdly their rudeness is maybe as a reaction to you because your responses appears to imply a condescending attitude with maybe some xenophobic overtones! Maybe you need to review yourself because a person's status is not part of our purview! Maybe you have a preference of what wounds you treat or medications you administer? How about which Drs orders you follow?

  • Jan 7 '17

    ( good luck.