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So, I am a brand new night nurse just off orientation. I had an order to perform wound care on a pt with a healing stage 4 as wound care does not come in on the weekends, and the order was as follows: cleanse wound with sterile saline, apply vashe moistened gauze to woundbed, spray periwound with 3m barrier spray, and cover with mepilex. B/c I am new and have never dealt with a stage 4 I asked 2 other nurses with more experience for help/ input as I understood the order to mean we need to repack the wound with vashe moistened gauze. There were two other nurses in the room when wound care was done and I was not the one who did it, though I was the one who documented it (the third nurse wanted to see the wound and the process as she was also inexperienced with this kind of care). The wound bed looked healthy with no tunneling. Now that I have the benefit of a day of sleep I am 100% sure we did it wrong and I feel like am going to throw up. In hindsight, I think what the order meant was for vashe moistened gauze to be placed on top of wound packing and for the existing packing to be left in place as I think it was a special packing that only wound care uses (some kind of alginat?). Anybody have any input here?

Hey all, a little update: I made it through nursing school, passed my NCLEX, and start a GN residency in January! Thanks again for the support when I was down, I am glad I stuck it out.

Hey there Texas nurses, any of you all work for worked for, or participated in BSWH nurse residency? What is it like to work for them? Pros, cons? Anyone worked at the college station or Brenham locations? What were those specific hospitals line to work for? I know new grads in the GN residency do not sign contracts, but is it expected for them to stay in their unit after the 1 year residency? How long? Thanks!

Hey there, I have a question about the Nanda nursing diagnosis Risk for Electrolyte Imbalance. Nanada defines it as, "Susceptible to changes in serum electrolyte levels, which may compromise health. Risk factors: diarrhea, excessive fluid volume, insufficient fluid volume, insufficient knowledge of modifiable factors, vomiting. Associated conditions: compromised regulatory mechanism, endocrine regulatory dysfunction, renal dysfunction, treatment regimen," (Herdman & Kamitsuru, 2018, p.182). My question is: does this diagnosis apply to someone who has an electrolyte imbalance? On our last exam we had a question about an anorexic patient who weighed 88lbs and was 5'6 and had a serum potassium of 3.0. There were a few other specifics in the question but that was all of the relevant data given. The question was asking what her priority diagnosis is and of the four choices one was risk for fluid electrolyte imbalance and another was imbalanced nutrition: less than body requirements. The other two were basically just distractors. The answer was: risk for fluid electrolyte imbalance. ***note: it has been established in our class/ program that risk for diagnoses can be priority in certain situations. It has also been established in other unrelated scenarios that you can't have a risk for diagnosis if what you say they are at risk for is already an actual problem. The accepted value for serum potassium that we use is 3.5-5.0. So, my reasoning is that it isn't risk for fluid electrolyte imbalance because she already actually has an electrolyte imbalance (potassium of 3.0). Is she at risk for further imbalance and for experiencing the effects of hypokalemia and other imbalances... yes. Is/Are that/those a big deal for this patient... yes. But, since she has the imbalance already, it is an actual and not a risk for. Therefore, that diagnosis does not apply and the answer should be (out of the four provided) imbalanced nutrition. Our professor defended the answer with the rationale of: her potassium is low but it does not say in the question that she is experiencing symptoms of hypokalemia. Therefore it is a risk and not an actual problem. She went on to defend the rationale with some patients will perpetually have low values for potassium or Hbg (she gave those as examples) just naturally. So, what then is the definition of having an electrolyte imbalance if not, you know, electrolytes outside of the normal accepted range? Is it only an electrolyte imbalance if you are symptomatic? Do you have to have multiple electrolytes imbalanced? Basically: what am I missing here? It felt like I was the only one with an issue with this question. Works Cited Herdman, T. H., & Kamitsuru, S. (2018). Nanda International, Inc. nursing diagnoses: definitions & classification 2018-2020 (11th ed.). New York: Thieme.

Thank you to all who have replied. You all are right... I need to suck it up, graduate, and get my RN. It has been very reassuring to read the input everyone has offered... this past month has been brutal. So, again, THANK YOU for the support. I can do this.

I am in my third semester of nursing school and, if I make it through this semester, I will only have one more to go until graduation. But, I HATE nursing school. I keep reading that being a nurse is not like nursing school and I leave my clinicals feeling intrigued, interested, challenged, and excited for being a nurse. Mainly, my issues are with how it is structured and how I simultaneously feel pressure to ask a million questions and shamed by/ hostility from professors for asking ¨stupid questions.¨ My school requires a 75 or higher to be considered passing in a class. If you do not get that, you fail the whole semester and have to repeat the class you failed with a 75 or higher before you can move on to the next semester. It also has a zero tolerance policy for late work (very understandable), drilled into us in the first and second semester about all of the things that would get us kicked out of the program (also important to know... but there are better ways to go about it), and expects us to always be prepared (also very understandable), and how they have the right to change our schedules (due dates etc) at any time for any reason. However, the professors are often unprepared, do not understand the instructions for their own assignments, give vague/ unclear directions with information that is half correct, often seem like they don´t really know what is going on, and/ or get defensive/ hostile/annoyed/ look at you like you are an idiot when you ask specific questions to clarify (because whether they told you or made it clear or not you are accountable for it... that is why I ask a lot of questions). Also, and I am not trying to imply that class should be entertainment, but where is the sense of humor? Where is the attempt to make learning fun/inspiring/ even remotely engaging? I know we are going into a profession that requires a very high degree of professional communication, but we are all human and the medical field deals with life and death and uncomfortable situations on a daily basis... you have to laugh, or you´ll pull your hair out from stress, cry your eyes out, and/or get burned out. Further, all that therapeutic communication stuff that we have been learning about since first semester? Definitely not practiced in the academic setting. Basically, it just feels like there is perpetual disorganization, lack of respect for our time, dual standards of expectations, and zero sense of humor. And I am finding myself angry, already burnt out, frustrated, and perpetually exasperated. Additionally (I swear I am almost done), I am in OB this semester. I am a female in my early 30´s, married, no kids, don´t want kids, think birth and pregnancy are gross, and find that people are continually trying to explain things in terms of what you do with your own kids/ with your own pregnancy. Also, for the ones who don´t have kids yet that are either younger or male, there is a definite assumption that they will and, I am quoting my professor here, ¨you should learn it now, so you know when you go through it.¨ What about those who have tried and are unable? What about those who are like me? Screw you for implying that I am less capable/less something because I don´t have kids and don´t want them (this has also happened a couple of times in clinicals and a few times in other classes... it is never overt, but the implications are clear). So, what now? I am seriously considering quitting, but, as I and my husband have sunk a considerable amount into this already, I need to be 100% sure and have a plan of action before I bring it up with him. I decided to go into nursing school to make a career change from working in various roles in retail and food service and to join a career path that can actually make a difference for the better in the lives of others while still being able to pay the bills. I have a bachelor´s degree, but the degree is basically useless (it was a build your own major with an emphasis on English and creative writing, but I did a lot of work in Sociology and Biology... I took the long way around to graduate). I am very afraid that I have made a horrible, expensive life mistake.

I have just been accepted to nursing school and was hoping to get a bit of clarity on the following: The only possible thing that might show up on my criminal background check would be the underaged drinking ticket I got when I was 20 in college in the state of PA. I am now over 30 and the details from then are hazy. I vaguely remember pleading guilty or no contest and paying the fine. The TX BON asks for disclosure about non traffic related misdemeanors and if you have ever pleadno contest/ guilty. So far as I can tell in PA an underaged drinking ticket is a summary offense and not a misdemeanor, but I did plead guilty/ no contest (I don't remember which) on the ticket that I mailed to the court with my fine. I was never arressted and never went to court. Furthermore, I don't remember if I actually paid the fine or not. It was a long time ago and I was pretty broke back then. Here is the exact wording from the TX BON: Licensure Eligibility To check your eligibility for renewing your license, please review the following: Been convicted of a misdemeanor? Been convicted of a felony? Pled nolo contendere, no contest, or guilty? Received deferred adjudication? Been placed on community supervision or court-ordered probation, whether or not adjudicated guilty? Been sentenced to serve jail or prison time or court-ordered confinement? Been granted pre-trial diversion? Been arrested or have any pending criminal charges? Been cited or charged with any violation of the law? Been subject of a court-martial; Article 15 violation; or received any form of military judgment, punishment, or action? NOTE: You may only exclude Class C misdemeanor traffic violations