Latest Comments by Tree525

Tree525 7,200 Views

Joined: Mar 18, '10; Posts: 71 (25% Liked) ; Likes: 369

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    Flushing a citrate lock into the circulatory system
    can cause an unsafe drop in blood calcium levels. It is unlikely that such a small amount of citrate would be detrimental, but the concern still exists and the lock should be aspirated whenever possible.

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    Why don't you try for a smaller UF goal per tx, say 3500-3800, and have the patient come in for extra treatments?

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    SuperStarRN likes this.

    SuperstarLPN, I can't agree more with your last reply to this thread. I have been an RN in dialysis for 9 months now, and I have never come across a patient population such as that found within dialysis. While some are an absolute joy to work with, I find that many are very rude and just plain disrespectful. Last week a patients BP was dropping into an unsafe range throughout his tx. He was symptomatic, so I bolused him several times throughout his treatment and lowered his goal. Needless to say, he didn't meet his dry weight. The next time he came in, he threw a fit about my care with my boss and went on to tell me and the charge nurse about how I'm a " bad nurse " and " I don't know what I'm doing. " I told him kindly that yes, it is my job to provide him with a good treatment, but it's even more important for me to keep him
    safe." I went on to explain in great depth the lack of tissue perfusion that occurs with a low BP and why it is such a danger and that he needs a new dry weight. Still, I was met with " I don't care, your a terrible nurse and you clearly have no idea what youre doing . " basically it ruined my day. I dont wake up at 3 15 am to get belittled like that. These situations happen all the time in dialysis.

    I have dealt with difficult patients in the past and realize that not all will be ideal, however it is as if they all are clustered in the dialysis population. They get furiously mad if you put them on 5 min late, question them about their large fluid gains and try to kindly educate them, etc etc. Like I said, not all patients in dialysis are like this, but I find that most are and it is certainly burning me out of this field in nursing.

    How do I transition out of this field into a hospital setting, anyone do it with success? I don't know how much of my dialysis skills are appealing to employers other than dialysis clinics.

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    How do you seasoned RN's do it? For example, lets say your 1st patient is due to come off in 6 minutes, and the next patient is due to come off in 10 min. What i've been doing is this: I will go to my 1st patient once their treatment is done, rinse them back, check their BP, and disconnect them from the machine as long as their BP is WNL. Then, I go to the machine and put it into test ( we are allowed to test the machine with the old lines ). Then, I pull out the patient's needles and get them bandaged up. Now, the next patient is due to come off in 4 min. AT THIS POINT, I AM HAVING you tear down the machine, re-string, and prime the new lines before going to take the next patient off ?

    I am new to dialysis. I have been precepting on the floor for almost 4 weeks, and I will be on my own soon. Turnover is really the only thing I have been struggling with and it gives me anxiety even thinking about it. I always have everything I need for 2nd shift ready before 1st shift ends, so I know its not so much a material-related organizational issue. I really don't know what else to do to make myself quicker. Any tips/ pointers for managing turnover will be highly appreciated. Thank you.

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    SeattleJess likes this.

    Im thrilled to hear so many of you are benefiting from my post. How is everyone doing in class? Please keep me updated!

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    Quote from dmichael4017
    Thank you for the recommendation. what about the Hurst reviews Nclex Rn book? do you think it is helpful? I'm asking because its all i can afford right now and hope that the book will be helpful to me. I feel like I know nursing front to back, my problem is how to answer the questions. I don't think I'm deficient in knowledge.

    thank you

    I hear ya... Honestly I'm not sure I never bought the book. I don't see how it could hurt though. I know you said you tried Kaplan before but give it another shot. Completely soak yourself into the program and try not to spread yourself to thin by using a ton of different books; couple that with lacharity and I think you'll be okay. Kaplan is superior for test taking strategy and since you sai you know your content im sure it will do you well. Also memorize the infection control aid on this website. I bought hurst and Kaplan was provided to me by my school. I also bought the lacharity book and used these 3 for all my studying and was successful.

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    I am so sorry that you have had to do this 7 times. I know you said you are tight on money, but if you can afford to spend 300 dollars, please invest in the hurst review. It is amazing, seriously. It is an online program with videos for all body systems and nursing areas. You said you are a visual learner and I think the idea of watching videos will benefit you in that respect. She also makes everything so simple to understand and her teaching style is the reason why her program is so succesful. Ask anyone who has taken this review and they will tell you the same. Understanding core content is the key to success on the nclex. Visit and watch her sample video on fluid/ electrolytes; I think a lightbulb will go off in your head after seeing it. Pair this up with lacharity and another solid book for questions and I believe you will pass. Keep me updated and best of luck. You can do it!!

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    I'm wondering the same thing. At this point ive put in 30+ applications, and have been offered a full time position in dialysis. Am I making a mistake by accepting the position?? How will future employers look at dialysis experience when I'm potentially applying to hospital positions in the future?

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    Salutatorian of my class, received awards from my state league of nursing, president of my college's honor society, passed nclex 75 questions in 45 min, youth mentor, 25 job apps, worked as a student nurse in a surgical ICU= no job. I'm at a loss. Honestly, I don't know what else there is to do. Good luck with everything.

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    Mary Ann Hogan's Review's and Rationale's series contains an excellent study book for med/surg nursing.

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    Serhilda and applejackcrunch like this.

    Quote from Crystal74
    Hi there, thank you so much for this post, I am scared to death and have been told by several people I wont make it at all:-( I dont know if this has been asked, but I have been out of school for some time and when I went to orientation on the 3rd we weren't given a syllabus yet, but we were told we had to read 9 chapters before school starts on the 23rd. So right now I have no idea what they want us to know. Can you go into a little more detail on how to take notes from the book if your not quite sure what they want you to know yet?

    Thank you


    First off, YOU WILL MAKE IT! Dont ever let anyone tell you that you wont. How can they even make that assumption? The fact that you are on this website several weeks before your class starts and reading up on how to make the most of your nursing education alone speaks volumes about your dedication, drive, and desire to become a nurse. It's not about how "hard" something is, its about how bad you want it, and Crystal you WANT IT! your going to make it, dont worry

    As far as the notes go, I think there are a couple ways of finding a solution to this:

    1) do you know your future professor's email address? typically this type of information is provided on your school's website. Email him/her and ask him/her for the syllabus. If this doesnt work ( sometimes they will be hesitant to provide a syllabus so early on because they want to edit/update them), then ask for the first week's powerpoint slides. Then, take the powerpoint slides, find the topics covered on the powerpoint in your textbook, and take notes on those sections only.

    2) If you can't obtain the professor's email address, try to find students who have taken the class already. Befriend these people-- they can be a huge resource for you as you progress through nursing school. You can simply ask them what was covered, or even better, ask them if you can borrow their old syllabus and/or powerpoints and use the strategy I provided above to get a good idea of what you should be taking notes on.

    I think that taking notes on all those chapters without some sort of direction is not a wise idea. You will probably end up taking notes on too many things you dont need to worry about and you will create more work and anxiety for yourself. I hope this helps you.

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    healthstar likes this.

    I agree with the posters above me. Everytime I see vitamin c ordered for a patient, it's always been for wound healing.

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    mamaxmaria likes this.

    Just want to say I appreciate each and every one of you. THANK YOU!

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    My school enrolled us in the classroom version of Kaplan. Honestly, the classroom portion was a waste of time. All they do is go over questions outloud on a powerpoint, and you talk with the instructor about why this is right/wrong etc. Nothing you cant do at your own home. Also, the instructor teaches you how to use their "decision tree." Again, not THAT useful, although it does help with some questions. My advice would be if you were going to do anything kaplan related, get their Q bank and question trainers. The questions are extremely challenging but very similar in wording/presentation to actual nclex questions. Best of luck.

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    Quote from mamayogibear
    So basically don't listen to the people that say you have to read everything to pass? I aced A&P, Miro and Biochem and only studied lecture notes which I would then re-write as illustrations. Basically all I did was draw flashcards over and over for other people that wanted flash cards but didn't want to make them. I learn best by drawing things or in a lab. How can I I apply visual and hands on learning to nursing school without studying more than a couple of hours a day?
    Also you are saying if a student studies NCLEX style questions on the subject covered in lecture they should be able to do well on the schools tests? Do all nursing schools have tests written like NCLEX questions where the correct answer is the most applicable answer for the situation even though all answers would be apt?
    I really need to get a time management plan in order before I start school since I am a single mom and will have to work while in school.

    I think you can still use the flashcard approach with nursing courses as long as you are practicing applying the information with nclex questions-- this is the most important part. Nursing exams will never ask you to regurgitate facts-- your instructors are most concerned with how you can use the information you have learned, and thats where the nclex books come into play.

    All of your exams in nursing school will be set up in nclex format. The reason behind this is that your school wants you to get used to that format as early as your very first exam so that by the time you graduate and take your boards, you will feel comfortable answering the style of questions that will appear on your actual NCLEX. The best piece of advice I can give is to purchase an nclex book early on in your academic career. When I took my first exam in nursing school, I walked out of the classroom thinking " what the heck was that?! " The style/format of the questions are unlike anything you have ever seen, which is why it is so important to get used to them early on.