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reidesert

reidesert

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  1. reidesert

    Starting nursing school with an infant

    Hi :) I just wanted to reply and offer some encouragement and advice about parenting and school. I begin my prereqs a week after my baby girl was born. I started nursing school when my son was 2 months old. Even though being a parent and a student (not to mention a wife and I am also working as an RN intern at a hospital) is difficult it is worth it. So many people told me to "wait" until my kids were older. If that works for some people I give them kudos. As a parent I have found out that it doesn't get any easier as your children become older and if you want to achieve your dream then you consistently work at it. My daughter is 4 and my son will be two in May and I have been pursuing this goal for a long time now. I am on my final semester and I am already signed on to work at the hospital in which my scholarship is at with an interim permit until I pass the NCLEX. I am almost done. I wanted to add that I worked my butt off in school and managed to maintain a 4.0. Know what your resources are. Allnurses is GREAT. I have come on here many times for help. Financially, if I had not contacted the hospital I would not be able to pay for my school, even though my husband has a fairly secure job. Be up front with your partner about the need for him to help you with the baby, dinners, cleaning. My husband although lazy at times (in the whole domestic engineering realm) steps up when I need him to. When my babies were infants I would be sitting on the couch and breastfeeding while I was studying. I read my textbooks aloud. I practiced assessments on them (still do)both my kids know what a stethoscope is for and a blood pressure cuff. When my daughter fell on the playground she howled holding her knee saying that she thinks she bruised her patella. My son who is 19mo can show you where his clavicles and mandible are lol:chuckle Now that they are older it is not "quiet" like when I got to nurse my oldest on the couch and read. When they are playing I pop my cd dosage calculations into my laptop and do dosage calculations standing up. I figure that if I can figure out the calculations with all the noise and chaos then I will be safe administering meds in a busy nurses station. I am an incredibly curious person so I do like to google things and find out how things work. Never lose your curiosity. Attain your knowledge for personal satisfaction not just because you have "memorize" something for a test. I think that I have demonstrated to my children my love for learning and working hard to attain a dream. Don't let this journey consume you though. Sometimes when I am burned out on reading I will turn up the music loud and dance crazy with my kiddos. Make sure you laugh aloud and kiss your baby many many times. They grow up very quickly. If you plan on breastfeeding (I breastfed both of mine-and actually still nursing the 19mo old) I would invest in the Medela pump in style. It is a great pump that works very fast. A good site about breast pumping and storing of breast milk is kellymom.com. Oh and don't forget about your partner. My husband is very supportive but he has times when he wishes I was DONE with school. The little things make a difference- make sure you have a time when you can talk-it doesn't have to be long but gives you a chance to reconnect. Good luck with your journey! I
  2. reidesert

    Venting about classmates with families...

    I can't help to respond and I apologize in advance if I come off rude or inconsiderate. I haven't had adequate sleep and I am stressed out about an upcoming test. That being said, I just want to say that I have experienced school without children (taking a full 20 unit load at UCLA) and double majoring ( BA and BS) in biological sciences and psychology (finished in 3 1/2 yrs) while working full time in a psych related field. I just wanted to say that it was no walk in the park but a whole lot less stressful than having a family while attending nursing school. My children are young (under 4) and I have a hardworking but stressed out husband who doesn't always understand my need to study. When you have you own schedule (however hectic it is) and only have to meet your own needs it is easier to get things done. When you are single its easier to manage your finances because it is only you you have to think of. I have single and married friends in the program and it is from personal experience that the ones that are married and have kids are better at prioritizing their time (such as starting to study ahead of time than cramming for a test at the last minute) and coming to class. I try to maximize my learning experience in the classroom and at clinical because it is time spent away from my babies. I think that moms feel guilty about spending time away from their children to study and work and then feel guilty when they are spending time away from studying or work when they are playing with their kids. It is a tough balance. Nursing school is demanding no matter what your situation and I try to focus on my challenges and to not compare my situation to others because in the end it is really just a waste of time b/c what good does it really do? In realization the 5 minutes that it took me to type this out I could have been studying or playing with my kids....
  3. Thanks so much for your suggestions! I really appreciate that you took the time to read and comment. I forgot about the BNP and calling the RT is important too. Thank you!! Rachel
  4. Critical Thinking Case Study and Study Questions Alterations in Function: Cardiovascular (1st page of our packet) You are caring for a 72 year old female client with congestive heart failure. The client is alert and oriented, BP is 170/80, HR 110, RR 32, Temp 98.6, O2 sat 89% # RA, crackles heard bilaterally at bases, jugular neck vein distention noted with HOB elevated 30%, 3+pedal edema, urine output 90ml over past 4 hours, saline lock to right arm, no redness or swelling. Identify all abnormal assessment findings and discuss possible causes for those findings. BP 170/80 (normal range for systolic 90-140 and diastolic 60-90): the systolic blood pressure is elevated. Hypertension or abnormally high blood pressure increases the amount of work the left ventricle has to do to pump blood out into the circulatory system. Over time, this greater workload causes left ventricular hypertrophy and can damage and weaken the heart. This can lead to heart failure. HR 110 (normal range for HR is 60-100 bmp: the HR is slightly elevated. The heart muscle is too weak to contract fully. Reduced volume of blood leaves ventricles during systolic ejection. A heart rhythm that is too fast (or slow) and is sustained over time can cause the heart to weaken, which can cause heart failure. RR 32 (normal range 12-20): tachypnea r/t respiratory distress d/t increased effort of breathing d/t circulatory overload. Compensatory Mechanisms: Heart failure results when heart is unable to increase workload to handle excess blood volume: Left-sided heart failure- pulmonary edema Temperature 98.6 (normal 98.6 F or 37.0 C): temperature is normal Oxygen saturation 89%@ RA (normal range 95-100%): This indicates moderate hypoxemia. Crackles heard bilaterally at bases are an adventitious lung sounds that may be r/t congestion in the pulmonary circulation; d/t the inability of the left heart accommodate the blood entering it from pulmonary circulation. Left-sided heart failure- pulmonary edema Distended Jugular Neck Veins r/t water and salt retention d/t the blood not being adequately pumped from the systemic circulation into the pulmonary circulation. The heart is unable to handle systemic venous return and blood gets "backed up" which results in systemic venous congestion w/ signs and symptoms of fluid volume excess that leads to circulatory overload. Right-sided heart failure-peripheral edema. 3+ Pedal Edema is r/t fluid overload d/t the heart's inability to handle systemic venous return and results in systemic venous congestion. This results in systemic edema. Urine output @ 90 cc over 4 h (normal urine output = 30 ml/ h which over 4 hours 30 ml X 4 h = 120 ml): her urine output indicates inadequate output. This may be d/t fluid retention d/t fluid volume excess and fluid building up into the interstitial space 2. What assessment findings are consistent with Right Ventricular Failure- (Congestion occurs when blood is not pumped adequately from the systemic circulation into the pulmonary circulation resulting in systemic edema, blood gets backed into the systemic circulation). A. Peripheral Edema 3+ pedal edema. B. Jugular Vein distention 3. Which assessment findings are consistent with Left Ventricular Failure- (reduced compliance that alters diastolic pressures that leads to an inadequately filled heart d/t left ventricular hypertrophy. This means decreased cardiac output to the systemic circulation and pulmonary congestion d/t the inability of the left ventricular to accommodate the blood entering it from the pulmonary circulation.) A. Pulmonary Congestion: Bilateral lobar crackles C. Tachycardia: HR 110 D. Tachypnea: RR 32 E. 90 ml urine output in 4 h- oliguria-(decreased urine production) during the day. 4. What is the client's primary nursing diagnosis? * ABC's is always a priority in any client* Ineffective Breathing Pattern r/t pulmonary congestion AEB bilateral lobar crackles, Tachypnea, and oxygen saturation of 89% 5. Identify possible independent nursing interventions: (1st thing I would do is put patient on oxygen, recheck oxygen saturation and call doctor for order) although this is a dependent intervention) 1. Elevate HOB to High Fowler's position. 2. Monitor VS, lung sounds, heart sounds, peripheral pulses, edema, jugular vein distention, intake & output, urine output, creatinine and BUN, potassium level (in anticipation of administering diuretics), get a weight baseline if it has not been done (to have something to compare to when doing daily weights). 3. Evaluate for and reduce anxiety by encouraging patient to deep breath and reducing stimuli in room (turning off lights, noise etc...) 4. Frequent turning/positioning and hygiene care because of edematous skin/tissue. Do not elevate feet because it increases blood flow to the heart too quickly and increases workload of the heart.
  5. reidesert

    dimensional anaylsis & IV dosing

    I am totally confused. That is all the information she gave. She actually first came up with 500 units of insulin before break and then after she said that it was too much and she made an error. When I go back to class, I'll ask her how she did the problem. Thanks daytonite for trying to make sense of it.
  6. reidesert

    Case Study help

    Thanks Daytonite! I feel so overwhelmed with all the information and everything we have to learn. Being a great RN seems so far away. Thanks for all your help!
  7. I do all my math using the dimensional analysis. It got me through 1st semester just great. I am really not understanding the IV dosing questions and how to set this problems up since the text book and my teacher use ratios. Is there a way to set up these problems using dimensional analysis? For example, in lecture our teacher asked us to work out this problem: 0.1 unit/kg/hr in PB 50 kg/500mL NS 25 mL/hr How many units of insulin would you give? all I can say is huh? scratching my head while looking just confused please Help! The answer she came up with was 50 units of insulin at 5 ml/hr
  8. reidesert

    Case Study help

    We were assigned a case study. Here a few of the questions and my answers. Could someone read it over and let me know if I am on the right track? okie-dokie- here it is You are caring for a 66 year old Type 2 Hispanic diabetic woman, who has had diabetes for 24 years. She as been admitted to the hospital for uncontrolled blood sugar, and an abscess of her foot. She is 5 feet 1 inch tall and weighs 262 pounds. Blood sugar is 653 on admission. She is started on IV antibiotics, wound care, accuchecks AC and HS, and continues on her Glucovance and Glyset along with a 1600 calorie ADA diet. Question 13 If the patient told you she had morning (fasting) hyperglycemia, how would you interpret that, and what would you advise her to do about it. *I would have her check the blood glucose in the morning. I would think that she may need an insulin dose since the oral hypoglycemics are not controlling the blood glucose levels sufficiently. I would inquire her about her eating habits. Does she have a late night snack? To ensure that it is indeed fasting hyperglycemia. I would get all the information and then from that information may suggest limiting her eating time to a certain time at night or her needing an insulin dose to cover her night to control her hyperglycemia. Question 14 Identify a NANDA dx, including 'related to' and 'as evidenced by', a short term outcome, and two independent nursing interventions that would be a high priority for this patient. Please do not use 'infection' or 'pain' NANDA dx: Ineffective Health maintenance r/t deficient knowledge regarding care of diabetic condition. As evidenced by: 1. Blood sugar @ 653 on admission 2. Patient's weight @ 262 lbs (obese) 3. abscess on the patient's foot. Short term outcome Patient will have the knowledge needed to manage her diabetes to keep her blood glucose under control and care for her feet. Nursing Interventions: 1. Pt education about diet. Since she has been a diabetic for 24 years she may not know that she is allowed sweets but the must be counted into the meal plan. Explain the importance of following her diet. The importance of weight loss and the impact it has on blood sugar. Encourage her to exercise when her foot is better. Advise her to start walking around the block or water aerobics., (after assessing her cardiovascular status) Ask her what she finds most challenging about following a diet and exercise plan. Find if she needs clarification about what she should do to manage her diabetes. 2. Instruct her on the importance of checking her feet. Ask her to show you how should would check her feet to see if she can or if she needs a mirror or a person to come by and help her. See what kind of support she has at home. If she needs home health to come by and help her. If this were a 7 year old newly diag nosed Type I diabetic, withthe identical blood sugar. Identifiy 5 things that are different in his tx plan from that of the woman in the 1st part of this case study. 1. He has Type I diabetes. 2. He is not on restricted calories to try and lose weight. 3. He is a child. His insulin doses and meals will vary on his growth development and activity level. 4. She is on oral hypoglycemics to control her Type II diabetes. Type I diabetics are not on oral hypoglycemics. 5. Lifestyle changes such as diet and exercise and weight loss are effective for decreasing the complications of Type II diabetes but not on Type I diabetics. Explain 3 ways in which the teaching for self care of this child differs from that of the older adult. 1. Importance on family teaching especially to the adult who is caring for the child the importance of meals and insulin doses. How to test blood sugar, draw insulin and give insulin injections. 2. Make the family aware of hyperglycemic and hypoglycemic signs and symptoms and what to do in each case. 3. Explanation of what Type I diabetes is, that it is a life long disease and must be managed long term. What the complications are if it is not managed. If you got this far a big thank you! Again, am I on the right track? Should I add something or am I way off base.
  9. reidesert

    I Love Nursing School

    Usually after clinical I feel drained and tired, but today so many things for me just "clicked". My patient told me that this was the best care she received ever at a hospital and she said that it was because of how I cared for her. I was so happy that I could do that for her. I was able to put in a NG tube, a Foley Catheter today and give some IM and Sub Q injections. All in all it was such a productive day that I was just groovin in the car on the way home from clinical-so energetic and all. When I got home my two babies were happy to see me and that just put me over the top happy. We have to put together a portfolio and I was just looking over the papers. It is amazing how far we have come. To think that I was terrified of taking vital signs just makes me laugh now. In retrospect, freaking out about the medication competency test was a good thing because it got my butt in gear and made me learn it. I passed that test with no errors b/c I took the approach as one error=harm or death to my patient. I know that there is so much more to learn (this is only the first semester) but I am so excited to learn and to be able to do more. A big thanks to daytonight and vicki and everyone else who makes allnurses such a wonderful place to be!!
  10. reidesert

    You know you are in nursing school when ctxt

    When you zone into a drug commercial while watching television and you wonder what the prescribed dose would be, how you would reconstitute and how many mL you would give. ITS SICK SICK SICK
  11. reidesert

    help

    Sorry if this has been asked before...but does anyone have a link to a good site that overviews all of the diagnostic tests, there normal ranges and clinical implications. I am searching in my textbook but I can't seem to find the clinical implications of the results being over or under for most of the electrolytes (sodium, calcium, chloride etc). Does anyone know where I can find this information?
  12. Hey I found it! Its about 160-ouch! Does anyone know if it is really helpful? http://www.delmarlearning.com/browse_product_detail.aspx?catid=12644&isbn=1401871747
  13. Where can you buy access? Is it expensive?
  14. My school offers a great CD ROM that is a collection of videos of different nursing skills. I was wondering if anyone's school offers this and if you have an online access code for it. We only can use it in the computer lab and it is difficult for me to go to the school when there is no scheduled class because I have two young children. I am constantly doing my studying around their wake and sleep cycles. It would be great if I could access the videos from home so that at 2AM when my babies are asleep I can go ahead and watch a few. So can anyone help me out?
  15. reidesert

    Handwashing ?

    We had a take home assignment for Infection Control. I was wondering if anyone could tell me the correct answer for this question about hand washing. For routine client care, the Centers for Disease Control and Prevention recommend vigorous hand washing under a stream of water for at least a. 10 seconds b. 30 seconds c. 1 minute d. 2 minutes I am a little confused b/c in the text book it doesn't have CDC recommendations (it only says that the CDC recommends use of alcohol-based antiseptic hand rubs for use before and after direct client contact because soap and water are inadequate to sufficiently remove pathogens. It only states the World Health Organization which recommends hand washing under a stream of water for at least 20 seconds using soap.
  16. reidesert

    What's your study schedule?

    I usually study when my kids are asleep. I have been studying b/t 8 PM to 2 AM. My son has been having some sleep issues (waking from 1-3AM) and my daughter is an early morning riser (she is usually up b/t 4:30 AM and 6AM). Needless to say that I don't sleep lol. I did start trying to grab some reading time when my son is taking a nap and setting up an activity for my daughter during the day. The house is starting to look really bad though-I can't stand messiness so I am getting a little frustrated.