shrimpchips

She is only hydrochlorothiazide, most likely because of the HTN. No edema at all, no crackles in her lungs...no s/s that would would be positive for hypervolemia. It's possible she has some CHF problems but she also has some renal problems, too (hence her elevated BUN & creatinine)

This is driving me crazy! Maybe I'm thinking too hard about this but I'm struggling with coming up with appropriate nursing diagnoses. For my med-surg class, we have to write a fluid and electrolyte paper. We have to have four diagnoses total - two addressing an electrolyte problem and two addressing a fluid problem. There is a catch: we're not allowed to use hyper/hypo-electrolyte for the electrolyte problem and we're not allowed to use hyper/hypovolemia or risk for hyper/hypovolemia. It has to be a problem that we are concerned about related to the hyper/hypovolemia. Here is some background information on my patient: N.S., 66 y.o. female admitting dx: UTI, hypoglycemia comorbidities: HTN, DM, CAD, depression, anxiety, COPD, anemia, GERD, hyperlipidemia heplocked I/O that day: 1840 in, 1800 out Labs: K+ 3.0mEq/L Cl- 90mEq/L CO2 37mEq/L BUN 45mg/dL creatinine 1.87mg/dL RBC 3.75mil/cmm Hgb 11.8g/dL Hct 34.9% even though her BUN is elevated, that can't mean dehydration because her RBCs & H/H are all low, indicating hemodilution = overload. The patient has no history of renal disease but her creatinine is elevated...so I think she has some compromised kidney function going on. She is also retaining some fluid (aeb her I/O...I know that output should be equal to the intake). For the electrolyte problem, I decided to pick hypokalemia and have the following diagnoses: impaired physical mobility r/t muscle weakness (aeb blah blah blah...) constipation r/t smooth muscle atony (aeb blah blah blah...) but for the fluid problem, I'm struggling. I was thinking "risk for pulmonary edema r/t fluid volume excess" as one. As for the other, I would love to concentrate on the impaired kidney function but of course I cannot use the diagnosis, "hypervolemia r/t impaired kidney function aeb..." it has to be the other way around, but "impaired kidney function" isn't really a NANDA diagnosis. I was also thinking of "Impaired gas exchange r/t fluid volume overload secondary to COPD aeb hypoventilation and increased CO2 level" as the other one, but to be honest I'm not really sure. I already e-mailed my instructor regarding this. She helped point me in the right direction that this patient is more at risk for (or has) hypervolemia as opposed to hypovolemia, but of course it's up to me to come up with the diagnoses. Any help would be great. Thanks!

What is the name of the book?

My school requires a 74

I don't know any mnemonics but I'm hoping someone will share some...otherwise I just find notecards help with learning these!

Here's my advice: 1) get a good NCLEX book. I recommend Saunders or NCLEX-RN: Reviews & Rationales. The Reviews & Rationales book is great but if you're a visual learner, the book might not be so great because it doesn't have very many pictures; however, the Saunders one does. I'm a visual learner but I like both of them. Use your NCLEX book to practice questions pertaining to whatever you are learning in class. It will help you learn the material and also help you study for the NCLEX at the same time :) 2) If making notecards works for you then make them! I find that making notecards for things such as lab values or for drugs helps, but other than that they don't help me. it sucks, but re-writing stuff helps me learn the information. 3) If you're allowed, tape record your lectures. 4) Look through your notes the same day of lecture after having lecture and also flip through your notes every day to help you learn the material. Hope this helps!

I would have to say learning all of the bones, muscles, and the nervous system. The endocrine is a pain in the butt, too.

My school does not allow us to do any sort of invasive procedure on other students. Instead, we have dummies and sim men/babies and "injecta-pads," etc. When we learned how to do perform a bed bath, we didn't really do them on each other...They gave us those bath cloths (similar to those pericare wipes...I'm sure all of you know what I'm talking about :)) and we could practice on the hands/arms/legs/feet on each other if we wanted to, but no one told us we HAD to strip down or wear a bathing suite or anything like that. I think the thing that I did which might have made someone uncomfortable was trying to move my partner's big boobs out of the way when I was demonstrating how to listen to heart/lung sounds

I'm not really sure on how many students they admit into the accelerated program, but I'm in the basic BSN program there and we originally had 160 (some dropped/failed though... ). I'm currently in a class that's for the accelerated students but since I am currently out of sequence, they allowed me to take it (basically, I'm a semester ahead...so instead of graduating in Spring 2011 I should graduate this December ) - to my understanding, accelerated students all take the same class at the same time. They also take classes in the summer. Akron is a great program - I love it there :)

usually around 6...but it just depends...

surprisingly, my school did not do a drug test; however, our student handbook says that they can do random drug testing, I guess. I've only ever had drug tests for my job - I work as a nurse tech in a hospital.

maternity/postpartum nurse...if you work in labor & delivery (L&D), that would make you a labor & delivery nurse. I'm a nursing student but I've already had by OB rotation in both maternity/PP and L&D so I can offer some insight. The hospital where I did my rotation at had a traditional well-baby maternity/PP unit along with a special care nursery which is basically like a step below the NICU...they have a children's hospital branch with a NICU so babies that need to be sent to the NICU automatically get sent there...but if the special care nursery can handle the case, they'll stay there. I went to the special care nursery. There were a lot of premature infants, a lot of them in respiratory distress. There was also a drug withdrawal baby, which was a sad case. The hospital also had it's own L&D unit. We would spend a few weeks on maternity/PP and then transition over to L&D. PP is a lot of teaching - you have a lot of new moms coming in that need to be taught how to care for her baby (how to feed, when to feed, how to change diapers, etc etc etc) as well as how to care for herself. The patient load depends on the size of the unit, but the average the nurses had on my floor is about 4 - so technically 8, because you are responsible for both mom AND baby. If you have twins or triplets or more, you're responsible for all of those babies. We assessed 3 times each shift - at 8am, 12pm and 4pm - on both mom AND baby. that includes vital signs. doing all of those assessments can be tedious after awhile lol. There is a lot of charting on PP. Medications were mostly on a PRN (as needed/as necessary) basis. Expect to do a lot of teaching with new moms but you will also get moms having their 2nd child or something, so usually those patients don't have a lot of teaching needs but you always need to make sure! We were responsible for making sure the baby got fed and also reminding mom to feed her baby. As for baby medications, Hepatitis B is pretty much routine on PP. PP was a good experience - some days it was busy, and other days it wasn't. On the less-busy days, after everything was done, I would hang out in the nursery taking care of the babies by feeding them/changing them and cradling them :)

Daytonite, THANK YOU!!! These will definitely come in handy for my upcoming nursing class this semester...we focus a lot on F&E

Our patches are sewn on the right shoulder/sleeve

Doing practice questions I think helps you study and helps you learn the material, but in the end you need to actually understand the material and learn how to apply it to nursing situations.

I recommend Saunders. I also have Prentice Hall's Reviews & Rationales: Comprehensive NCLEX-RN Review. It's very good and it also comes with a CD like the Saunders one which is nice, but I like the Saunders slightly better because it has pictures and things lol. I'm a visual learner!

Pharmacology - B (like a tenth of a point away from a B+...) OB & Mental Health - B+...and in those classes I was SO SO SO close to an A- in both...kind of salty about them, but oh well what can you do!

I try to get a decent amount of sleep the night before...then the morning/day of the exam, I always review a little before taking it...I'll also get up earlier to grab some Starbucks coffee :) I eat a good breakfast and also eat some protein right before taking the exam (such as a spoonful of peanut butter or a handful of nuts or something) - one of my instructors always recommended doing that, and I think it helps. Afterwards I usually go grab something to eat because I'm usually starving from using up so much glucose in my brain lol

check amazon.com. I usually always get my books from there for a much cheaper price, too. barnesandnoble.com is also a good place as sometimes they will give 10-20% off from ordering online (at least that has happened to me). another option would be to ask your fellow classmates if they books.

I think that having more exposure to needles and blood will really help overcome your fears. Fear is what tends to hold us back and the only way to overcome it is to just walk right into that fear and face it. :heartbeat I was afraid that my fear of needles would be a problem, but really I have no problem handling needles and giving injections and things like that...but if I'm on the receiving end, it's totally different. My sympathetic nervous system kicks in and I tend to get really dizzy and lightheaded if I'm receiving injections or even some simple like a blood draw or mantoux. For work purposes (and also for school...since employee health at hospitals generally vaccinate and do titres for free) I had to get a tetorifice, hep B booster & TB quantiferon done in the same day...I thought I was going to pass out! When I was getting my wisdom teeth removed, they first gave me some laughing gas to relax me. They also hooked me up to a little heart monitor. My HR was a nice, steady beat, within normal limits. After awhile they said to me, "okay M, we're going to start the anesthesia now" and then BOOM - instant tachycardia but I survived!!! If injecting needles into another person bothers you, try to look at the injection area as just the area and not as part of the person. Now obviously you don't want to hurt your patient, but I think that thinking in that sort of mindset helps people overcome those fears. For example, when I'm giving an IM injection in say, the deltoid, I talk with the patient, use identifiers, verify the med orders, and all of those other steps along with cleaning the site with alcohol. I find my landmarks, and then it's the injection spot that I am completely focused on - and I just think of it as a spot, not some arm that belongs to a person. But again, don't hurt your patient!! I hope this is making sense. Think of in surgery how they place sterile drapes over areas and expose just a small area that they are going to be operating on - I guess it's kind of like of that!

It depends on your school because all of them have different policies regarding math tests. To give you an idea at my school, it also varies within the class. We have to take a math test for every clinical nursing class that we have. For my very first Foundations of Nursing 1 class, it was very simple math - such as how many tablets/mg/mL you will give, etc. We were allowed to use calculators. For every test I have taken after that, we were not allowed to. The hardest test I took was an IV math calculation test, which in my opinion was very hard to not screw up because of all of the long division involved. I'll be honest, I failed that one twice and passed it on my third try. For my next nursing class, which is my adults med-surg class, we're allowed to use calculators. So again, it depends. As for the number of tries you have to pass the math test, that also varies. For my Foundations classes, I believe we had an unlimited number of tries to take it as long as we had it completed and got the minimum required score by the due date. Same with other classes. Some classes say you only have two or three tries to pass them. As for the percentage, all of my classes have required an 80 or 90%. I am TERRIBLE at math. I basically have to use a calculator for everything. I have some asian blood in me and trust me, the stereotype of asians being reeeeeeally good at math isn't necessarily true Your best bet is to practice, practice, practice! There is a book called Calculate with Confidence which is EXCELLENT. I highly recommend it.

You should know both generic & brand names. The only way to do that is to really study and practice, practice, practice! Making flashcards helps. In the hospital they generally include both the brand name & generic name on the MAR but some places may not. I also don't know what they tell you on the NCLEX (if they just tell you the generic name or the brand name or both) but knowing both will help. My pharmacology instructor told the class that some places would rather use generic names to avoid confusion but of course some generic names sound very similar, such as amantadine, ranitidine & rimantidine. Here is a list of some drugs that sound alike: http://www.chcanys.org/clientuploads/downloads/membership_articles/JCAHO/JCAHOproject_LookAlikeSoundAlikeMedicationsForHospitalsAmbulatoryCare.pdf

^ This. Also know that you treat them differently. In myasthenia gravis, there isn't enough Ach and may also be because of being undermedicated. in cholinergic crisis, there is overstimultion from too much Ach. Clinically, they both look the same - such as muscle weakness. Neostigmine is given differentiate between the two...if they improve, it's myasthenia gravis (also provide respiratory support). If they worsen, they are in a cholinergic crisis - provide respiratory support and be prepared to give some atropine. ...that's what I learned in pharm, anyway. :)

^ This. Also know that you treat them differently. In myasthenia gravis, there isn't enough Ach and may also be because of being undermedicated. in cholinergic crisis, there is overstimultion from too much Ach. Clinically, they both look the same - such as muscle weakness. Neostigmine is given differentiate between the two...if they improve, it's myasthenia gravis (also provide respiratory support). If they worsen, they are in a cholinergic crisis - provide respiratory support and be prepared to give some atropine. ...that's what I learned in pharm, anyway. :)

other meds: Tylenol ibuprofen percocet vicodin morphine corticosteroids (prednisone, etc... ) erythromycin opthalmic ointment narcan vitamin K injec (AquaMephyton)