Need help ASAP please!

Kooky Korky, BSN, RN · Mar 1, 2015

ABC (airway patent, is pt breathing? does he have a pulse/circulation?

Care Plans

Nursing Process

Use all of your senses (sight, smell, hearing, touch, etc.)

Consult with others (peers, doc, etc. - your Instructors for now)

Doctors' Orders

Policies of the facility and of your school

Laws in your state

Possible Scenario for you: You see that a pt falls out of bed. BEFORE YOU MOVE HIM: You assess that he is alert, he seems to know his name but can't tell you why he fell. His limbs appear to be in normal alignment. You see no bleeding or OBVIOUS injury or APPARENT broken bones. He's on his back. There are no bruises on his chest or abdomen - yet. VS are pretty normal. AS A STUDENT: what do you do next? (plan and action) Get your Instructor. Don't leave him if you can help it. Or have someone else stay with him, you go get the Instructor (or another nurse if you can't find the Instructor quickly). Then follow the lead of the Instructor or nurse.

What they will do is just what you did - inspection for injuries, assess neuro status - orientation/confusion, pupils, handgrips, and moving all limbs as before the fall - and VS, & get enough help to get him back onto the bed. They will notify the doctor, do an Incident Report, chart on him, notify the family or guardian, re-assess the pt soon (like within 15 or 20 minutes), evaluate for pain, do another set of VS, gently wake him if he appears to be asleep, chart again, and make a point of rectifying any hazardous situations and putting the call light, TV remote, water, Kleenex, urinal, etc. within easy reach. You can also ask the Pharmacist to advise about any meds that might be contributing to disorientation, weakness, slow pulse or low BP and inform the doc to see if he/she thinks new orders are needed. Are labs WNL? If not, which ones are out of whack? Why might this be? You should let the doc know about these, too.

Try to only call the doc once, so that means you need to gather all the information first. (VS, neuro check results, any apparent injuries, most recent labs, input from Pharmacist, also input from staff or others (roommate, visitors, housekeepers, etc.) who know the pt or saw/heard anything related to this incident.

Is the pt scheduled for surgery or a procedure that now needs to be postponed? Notify the surgeon/others, like Radiology if the pt's scheduled MRI is going to be postponed.

You can never do too many VS, you can never do too many neuro checks. Does the pt have a glass eye? Was he blind or deaf to begin with?

Learn by watching what other nurses do.

Suppose a pt has a seizure. What is your course of action as a student? What does your care plan book say to do? What does the Policy and Procedure Manual of your hospital or nursing home say to do?

If a woman comes into your ER and is having what she says are labor pains, what do you do as a student?

A woman c/o chest pain in the waiting room of the clinic where you are a student. What do you do?

A pedestrian is hit by a car. You are a student. Now what? Does your state require you to help? I would call 911, I would not move the person unless not moving him will cause further injury (like drowning, getting run over again, or something else very serious). I would get someone else to direct traffic, someone to try to prevent the driver from leaving the scene. Try to keep the victim warm, still, NPO, and talking/alert/conscious. Pray for 911 responders to arrive quickly. Are there any other victims?

Try to practice scenarios like this with other students. I think you'll be fine. Why do you think you won't make it through the semester?

BecomingNursey · Mar 2, 2015

Why wouldn't they teach us how to apply the knowledge? Isn't that the point of being in nursing school? If they don't teach us how to use the information then how can we take care of our patients?
I did buy the Saunders NCLEX book and I am working through that. I guess I am looking for something that says "If the patient has this wrong with them, the nurse will want to do this, that, and the other." Is there nothing out there like this?

How far along are you in nursing school? If you're still in your 1st/2nd/3rd semester normally they are still trying to get you to understand the basics. It's not until your final semesters that they start tying it all together and having you apply it.

I'm not telling you it's going to be easy, I'm telling you it's going to be worth it.

Author: Art Williams

Esme12, ASN, BSN, RN · Mar 4, 2015

Why wouldn't they teach us how to apply the knowledge? Isn't that the point of being in nursing school? If they don't teach us how to use the information then how can we take care of our patients?
I did buy the Saunders NCLEX book and I am working through that. I guess I am looking for something that says "If the patient has this wrong with them, the nurse will want to do this, that, and the other." Is there nothing out there like this?

But they do teach you....at least they should be.

You critically think using ABC (Airway, Breathing, Circulation) and what is going to either kill them or make them the sickest the fastest.

Then you think Maslows Hierarchy

1. Biological and Physiological needs - air, food, drink, shelter, warmth, sex, sleep.2. Safety needs - protection from elements, security, order, law, stability, freedom from fear.
3. Love and belongingness needs - friendship, intimacy, affection and love, - from work group, family, friends, romantic relationships.
4. Esteem needs - achievement, mastery, independence, status, dominance, prestige, self-respect, respect from others.
5. Self-Actualization needs - realizing personal potential, self-fulfillment, seeking personal growth and peak experiences.

Then you look at Ericsson's development

[TABLE]
[TR]
[TD]Stage[/TD]
[TD]Basic Conflict[/TD]
[TD]Important Events[/TD]
[TD]Outcome[/TD]
[/TR]
[TR]
[TD]Infancy (birth to 18 months)[/TD]
[TD]Trust vs. Mistrust[/TD]
[TD]Feeding[/TD]
[TD]Children develop a sense of trust when caregivers provide reliabilty, care, and affection. A lack of this will lead to mistrust.[/TD]
[/TR]
[TR]
[TD]Early Childhood (2 to 3 years)[/TD]
[TD]Autonomy vs. Shame and Doubt[/TD]
[TD]Toilet Training[/TD]
[TD]Children need to develop a sense of personal control over physical skills and a sense of independence. Success leads to feelings of autonomy, failure results in feelings of shame and doubt.[/TD]
[/TR]
[TR]
[TD]Preschool (3 to 5 years)[/TD]
[TD]Initiative vs. Guilt[/TD]
[TD]Exploration[/TD]
[TD]Children need to begin asserting control and power over the environment. Success in this stage leads to a sense of purpose. Children who try to exert too much power experience disapproval, resulting in a sense of guilt.[/TD]
[/TR]
[TR]
[TD]School Age (6 to 11 years)[/TD]
[TD]Industry vs. Inferiority[/TD]
[TD]School[/TD]
[TD]Children need to cope with new social and academic demands. Success leads to a sense of competence, while failure results in feelings of inferiority.[/TD]
[/TR]
[TR]
[TD]Adolescence (12 to 18 years)[/TD]
[TD]Identity vs. Role Confusion[/TD]
[TD]Social Relationships[/TD]
[TD]Teens need to develop a sense of self and personal identity. Success leads to an ability to stay true to yourself, while failure leads to role confusion and a weak sense of self.[/TD]
[/TR]
[TR]
[TD]Young Adulthood (19 to 40 years)[/TD]
[TD]Intimacy vs. Isolation[/TD]
[TD]Relationships[/TD]
[TD]Young adults need to form intimate, loving relationships with other people. Success leads to strong relationships, while failure results in loneliness and isolation.[/TD]
[/TR]
[TR]
[TD]Middle Adulthood (40 to 65 years)[/TD]
[TD]Generativity vs. Stagnation[/TD]
[TD]Work and Parenthood[/TD]
[TD]Adults need to create or nurture things that will outlast them, often by having children or creating a positive change that benefits other people. Success leads to feelings of usefulness and accomplishment, while failure results in shallow involvement in the world.[/TD]
[/TR]
[TR]
[TD]Maturity(65 to death)[/TD]
[TD]Ego Integrity vs. Despair[/TD]
[TD]Reflection on Life[/TD]
[TD]Older adults need to look back on life and feel a sense of fulfillment. Success at this stage leads to feelings of wisdom, while failure results in regret, bitterness, and despair.[/TD]
[/TR]
[/TABLE]

Essentially what care plans are trying to teach you.

YOu need to buy a NCLEX review book with rationales and practice practice practice...it will begin to make sense.

amdelay · Mar 8, 2015

i found during my first semester of nursing school that the bates Pocket Guide to Physical examintation and History taking ISBN-13: 978-1-4511-7322-2 and the Nursing the ultimate study guide ISBN: 9780826193360. realy helped me start putting things into perspective as far as the knowledge learned and application of said knowladge. Also when starting your clinicals and working on care plans they help as well. Ie..... pt has pneumonia and is on the telemetry ward what to look for: labs, chest x-ray, and BMP values for CHP. Then teach pt to deep breath and cough, trying to get the flem that is in there out.

nurseprnRN, BSN, RN · Mar 11, 2015

Please use the search function and find threads where Esme and I teach the nursing process and nursing diagnosis. You do this by searching "esme nursing diagnosis" and "grntea nursing diagnosis" in the search box you access by hitting the little magnifying glass icon in the yellow bar above.

The essential book for you moving forward will be the NANDA-I 2015-2017, the most current edition. It has a wonderful new FAQ section in it aimed at nursing students that will get you a leg up in understanding and applying nursing diagnosis and planning nursing care.

TLizS · Mar 14, 2015

practicing NCLEX style questions is what I have found that helps me learn to apply what I am learning.....The saunders Nclex review and the questions that go along with it help me a ton....we also use PREPU and ATI....I can learn the information all day long but learning to apply it was a whole different beast for me....and practice is the thing that helped the most... (even answering questions that were way above my knowledge base helped....because reading the rationales gave me the info I needed to connect it to what I already know)