ibspider

I am at a similar point and have had the same question. I've noticed that I get more comfortable with something then pick up on another aspect of nursing that I need to improve or incorporate into my routine - be it a task or way of thinking about things. I am constantly raising the bar on myself so it almost feels like I can't reach the goal. It can feel frustrating. Recently though more tasks have become more routine, my routine is getting refined and I think I'm moving on to more critical thinking and patient focus. I think it just takes time. I know anxiety over the responsibility, wanting to do a good job and feeling overwhelmed at times with workload and frustrated with the lengthy process of learning has hindred getting the tasks and my routine down. My own high expectations and fears get in the way of the my progress. It helps me to talk to other new nurses, read posts and get real with myself about where I am (as you mention - knowing it's expected to struggle). This is a long process and the nurses w/ 2 years are looking with envy at the nurses with 4 yrs experience, etc. I know I can look back at 2 months ago and see I've come a long way. If I have made it this far I will make it the whole way. It's good that we are looking at our process and are motivated to improve. It will happen.

Does anyone have any suggestions on a good stethoscope for bad tinnitus? I have a Littman lightweight II and can't hear well with it. I tried the Classic II and it was better but the ringing is so bad. I'm afraid of missing more subtle sounds in an assessment. I have some birthday cash coming and wonder about going for the Cardiology III. Is it just too "over the top" for a nursing student? Will I just have to learn to tune out the ringing? Any input appreciated.

Ok, this morning I was ready to quit or say "I don't care" and just get through and get the degree to say I didn't quit then go to work at Walmart because I couldn't possibly learn everything that's been given to me. Now, I see that I'm normal and it's going to be ok. I am going to keep repeating that to myself as I study. This is normal; overwhelm is normal. It's going to be ok. Thanks everyone!

This is so great! I'm so glad to have this resource. Thank you two for your replies. Unfortunately I won't see her again. Even if she makes it through the weekend, we only get assigned to them for two days then move on. She does have very bad lung congestion and impaired gas exchange was the first diagnosis I had for her. I'm not sure the etiology of the abdominal edema. I thought it would be related to the CHF though I expected to see edema in her feet more than anything else. She has no pitting and they are very hard, >3-4 sec capillary refill. Something about all the labs and books I looked at made me think her kidneys are / have not been perfusing so maybe the abdominal edema is related to that? Anyway, it is definately in her lungs. I am not so smart on all these topics. We have not covered some of this stuff in detail so I am going through books and trying to put it together. What meds would indicate afterload or contractility problems.... digoxin for contractility I guess and afterload, I don't know. Thanks again!

Yes, she's at risk for fluid volume deficit. It is possible to lose fluids through the third spacing of fluids. This patient will most likely dehydrate without any fluid supplementation. This is a decision that is sometimes made by the patient or family at the end of their life in order not to prolong the dying process. Some of the signs and symptoms of fluid volume deficit are: decreased skin turgor dry skin dry mucous membranes decreased urine output concentrated urine increased body temperature (development of a fever) increase pulse rate decreased blood pressure prolonged capillary refill change in mental stateDid your patient have any of these symptoms as well? Did you happen to get any of the lab values? They will also help to support the presence of dehydration. On the opposite side of this, if there was fluid volume excess, you would see (in addition to the edema and breathing problems): intake exceeding output increases in blood pressure jugular vein distension restlessness anxiety Thanks for your reply. Yes, she has some of those...dry mucous membranes, decreased urine output, change in mental status. Mostly a really hard time breathing and irregular heart. I don't know if they will give her fluids or not but I don't think I will see her next week. It happened really fast. I think I gave her some comfort that last day, at least I hope so.

I'm in my first year, second semester, first week of med surg clinicals. I am working up nursing diagnoses related to nutrition and fluids on my pt this week. She is 80, has CHF and they believe she is passing. She has edema (abdomen) and urinating little; on lasix. She had very little oral fluids the first day I had her and the second day she was nonresponsive except sometimes to pain, had no fluids and as yet on no IV fluids or nutrition. Obviously she has FVE but can she also have a diagnosis of FVD given no oral or IV fluids going in? Or is it risk for FVD? Any feedback appreciated!