dan1100rt, BSN, RN 1,524 Views
Joined: Aug 22, '07;
Posts: 39 (23% Liked)
; Likes: 16
EKG to see if respiratory failure is related to cardiovascular system.
I wear a Vostok automatic (self-winding), made in Russia originally for their military. They're sort of unique looking (i.e. not a Timex or Casio), bomb-proof, waterproof, and the one I have has 24-hour markings and a rubber strap. I just wash the whole thing with soap and water after a MRSA- or VRE-rich shift. There's an Ebay seller named "zenitar" who has the self-winding watches for $75 - $85 (with shipping), or manual-wind ones for $35 - $50. He changed the leather band to a rubber band on the first watch I bought from him when I asked through Ebay.
I was very glad to have paid focused attention on pathophysiology which was in the first semester of my program. If you understand how body systems are supposed to work and what happens when they don't work correctly, you'll have a basis of understanding of everything else: what to look for in your assessment, how other body systems are affected, how specific medications and other interventions will address those problems, and what adverse effects to look for. There will be some things like lab values, ABGs, vitals, EKG, anatomy that you'll just have to memorize and know.
For pharm, understanding the mechanisms of actions of medications is especially important, and having that patho understanding will help. You will be able to learn tricks to remember classes of drugs (e.g. "-pril"'s are ACE inhibitors) but if you understand why the meds work the way they do by understanding the underlying patho and anatomy, you'll have a greater grasp on the big picture. I used flash cards to help memorize/understand meds.
Overall, don't procrastinate. Programs go fast, fast, fast, and the classes mostly build on what was covered the previous session, week, etc. If you start falling behind, it will be difficult to catch up. When reviewing notes or text, read once through quick (almost a skim) to grasp the overall picture, then re-read for specifics, taking notes. I used a system where I re-took notes on my class notes; I wrote the notes during class on the right side of the notebook and my review notes on the left side in a different color.
Also, don't be hesitant to ask for help. There are some pretty complicated things, and really, in this career, there are lives at stake - you do need to know this material. Ask for help from the instructors, TAs (if there are some), and co-students for things you don't understand. My study groups, which met for about an hour a week, were very beneficial to me.
It's not stupid - ABG interpretation takes some practice.
Acidosis is either too much acid or not enough base / alkalosis is too much base or not enough acid. The acidosis or alkalosis in question will have a source which would be respiratory or metabolic (i.e. no, they don't coexist).
For example, respiratory acidosis is a result of shallow breathing (from some other medical problem) which traps too much CO2 in the lungs and decreases the overall pH. If the patient's kidneys are healthy, you'll see their bicarb level go up to fight to acidosis - this is compensation.
Metabolic acidosis is when their kidneys aren't healthy and don't make enough bicarb so their pH goes down. In that case the patient often involuntarily breathes rapidly to blow off extra CO2 and raise their pH - another form of compensation.
Respiratory alkalosis can come from tachypnea (breathing too fast), thereby blowing off too much CO2 and raising the pH.
Metabolic alkalosis is from too much bicarb (usually iatrogenic) or loss of acid (e.g. from emesis or loss from too much gastric suctioning).
Here is a guide to ABG interpretation:
I reviewed my application from 2008 for my ACP position (I save everything). I also had no medical experience going into nursing school and my ACP position, but I was candid about that in the interview. I expressed my desire to use the ACP position to learn more about healthcare and hospital work, and to increase my comfort with patient care. Make sure you stress your flexibility, comfort in working with all ethnicities of co-workers and patients, and your willingness to do anything and learn anything, and to take a position on any unit in the hospital (they're all great units with their own strengths and special experiences). The ACP position is really great experience and gets your foot in the door of the hospital.
You're not going to be "just" an ACP. We RNs rely heavily on our CNAs and ACPs and a good one can make a crazy shift that much easier (and a less of a go-getter can make it more hellish).
Please post back to let us know how it went.
You've already started gathering bedside skills as a CNA so good for you - you'll be ahead of a lot of your classmates who have never been in a hospital setting prior to starting school (as I was). The fundamentals of patho and pharm are the basis of the rest of nursing: if you understand how body systems are supposed to work and how they don't work correctly when they're broken as well as how the drugs work that are used to help with the broken bits the. With an understanding of patho and pharm you can work your way backwards during school and when you're practicing at the bedside. Pay attention, volunteer to do things in clinicals, and ask a lot of questions.
Everyone with whom I went to nursing school came out of the NCLEX testing room with the same stunned expression. I ran into questions about things I had never heard of, but did pass with 75 questions. Rely on the test taking strategies covered in Hurst or Kaplan when in doubt.
Timex Expedition: 24 hour time option, analog/digital, Indiglo, basically indestructible. A quick search on eBay revealed at least thirty options for less than $30
I graduated about a year ago and have been working for nine months. I had some students on our floor yesterday and it made me remember how much I liked this forum when I was a student.
What you're probably seeing in the nurses on the TCU that seem to do everything with ease is the result of experience and comfort that develops over time. I didn't experience a sudden "click" but I did find that with around three months on the job I was able to remember more basics (for example critical lab values or good/bad vital signs) which freed my brain up to develop those instincts regarding patient care. It's never a breeze, but it most certainly gets easier. I am astounded at what I am able to do with less than a year of experience and even more astounded about two weeks ago when other nurses started to ask me for advice.
Those shifts when nothing works do come up. Yesterday I had an unsteady encephalopathic patient on a bed alarm who got out of bed 37 times during the shift (an average of every 20 minutes). I got through the day, all four of my patients were assessed, were safe, got their meds, got to their therapy sessions, and I even discharged one and admitted another ... and I got everything charted and reported to the next shift. I would not have been able to handle this day six months ago.
Also remember, your charge nurses and more experienced nurses are always there to support you (maybe not all of them - you'll also develop an instinct about whom to ask and when). No one came out of school knowing everything and EVERYONE will encounter something they don't know.
Nursing Process: ADPIE
Assess (Pt's needs)
Diagnose (nursing diagnosis - how the pt is responding to stressor)
Plan (Pt's care)
Evaluate (did the implemented care work)
If I had known how much future courses were going to be based on our Pathophysiology course, I would have paid even more attention. That's the course in which my program was taught fluid and electrolytes and arterial blood gases (see wildchipmunk's post above)
For some reason, had trouble remembering the order for pushing IV meds; preceptor told me...
I had a great L&D clinical. Eight rotations: 3 x Labor, 2 x transition, 2 x postpartum, 1 x NICU.
Labor: had outstanding preceptors two of the times and a short-tempered impatient one the third, so I had two great days and one bad one. Also contributing was the two good days were extremely busy and the bad one was very slow (one delivery all day). Helped moms before and during delivery, and did lots of fundus and lochia checks afterwards (we called it "fun with fundus"). Watched a C-section. Also had a mom with a burst uterine artery who had to go for general surgery for a repair.
Transition (taking care of new baby immediately after birth): outstanding, and my favorite. Did APGARs, initial assessments, eyes-n-thighs, weight/measures, first baths ... the most interaction I had with the patients. Also contributing was the best preceptor that I've had in any clinical.
Postpartum: OK, but not as exciting for me as labor or transition. Some assessments and VS, Rhogam shots, meds, more fundus checks. Pretty routine stuff aside from some bili treatments.
NICU: eh - a little boring: tube feedings, VS, weights, change diapers, wash...rinse...repeat.
There are several hospitals in the Denver area that have positions that are sort of nursing interns ("clinical assistant," "advanced care partner," "nurse work-study"). The responsibilities are CNA-like (VS, I's/O's, ADLs) but since these positions are filled by nursing students, they are also authorized to do things like IV and catheter starts/stops and central line dressing changes. The requirements for the positions are completing the fundamentals and M/S I courses in a BSN program. I have learned a great deal about time management and keeping track of patient data, but I would agree that the work can be very stressful. I am in the rooms as often (sometimes even more often) than the RNs and I have borne the brunt of upset family members from time to time.
Here is a map of Denver, broken up into neighborhoods.
(DSON is in the Union Station neighborhood)
Neighborhoods that I like that are pretty convenient to DSON:
- Congress Park
- Park Hill
- City Park West
- Wash(ington) Park
- Highland (not Highlands Ranch, the more southern suburb)
When I moved here I spent a weekend driving the neighborhoods that had been recommended to me by friends. I answered ads in the Denver Post and Westword for housing, but ended up finding a very nice apartment in Congress Park that was not advertised except for a sign on the front lawn. The places I saw from the ads in the paper(s) were fine also, but most wanted a 1-year lease whereas the place that I took had a 6-month lease.
You should be able to find rental houses that accept dogs - there are a lot of dogs in Denver.
If there is one course in which you should pay attention during the first semester, it's pathophysiology. The information that you'll learn is directly applicable to future classes. Dr. Sampson is outstanding and will present you with a solid foundation for the rest of the curriculum.
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