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tlc2u

tlc2u

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  1. I have been a floor nurse on a memory care unit for a few months now and was recently told that some CNA's say they do not want to work with me because I do not give them enough support. This came as a shock to me as several of the CNA's have told me what they like about me being the nurse on that unit. They say previous nurses spent much of their time in the nursing office on cell phone or computer. They said they like that I am on the floor most of the time and help monitor and assist the residents. I spend about 15 mins. in the nursing office eating a quick sandwich and ordering meds. Other than that I am on the floor giving meds and assisting with residents. I do not bring my cell phone to work. Only once in 2-1/2 yrs. has my family called me at work. I was not told which CNA's feel they need more support or what support they need. I'd love for the CNA's here (especially those from assisted living or Alzheimer's units) to tell me what they need from the LPN. Thanks for any tips you are willing to share!!!
  2. Hi and Thank You to all who are willing to share advice to my concern!!! Alz. floor nurse X few months working with 2 CNA's (not always the same 2). 3 CNA's told me different positive reasons they like me as their nurse. A couple CNA's rarely say anything to me (and only speak to the residents when necessary) and seem very disinterested with the job. One CNA who works most frequently, has difficulty staying on task and wastes time anxiously repeating there plans instead of just getting the job done. This CNA knows how to perform well when upper level staff are around and therefore they have stated this is one of the best CNA's on the unit. When I started on this unit I tried giving honest praise and saying Thank You to this CNA however the CNA's response was very adamant not to Thank for doing the job as if saying Thank You was unnecessary and therefore considered demeaning. This CNA has an occasional "good mood" day, but most days is loud and anxious, often trying to rush residents. CNA often states in a gruff, agitated tone, that this resident won't come to dinner etc. and that the nurse is going to have to go and get the resident. When other CNA's care for the same resident's they use their dementia training skills and find a pleasant way to get residents to come for dinner etc. I rarely have to direct the other CNA's on how or when to do the tasks of their job, they know what needs to be done and what timing to best complete ADL's with their assigned residents. This CNA will spend so much time grumbling when asked to do something that I just do a lot of the tasks myself which puts me behind on my nursing work. Recently upper level staff told me some CNA's say I don't give them enough support and they don't want to work with me. I was not told which CNA's said this or given input on what support the CNA's feel is lacking. I want our work atmosphere to be calm and enjoyable while still getting the job done and I certainly don't intend to not be supportive of the CNA's. Any suggestions on how to best support the CNA's on an Alzheimer's unit would be greatly appreciated. Thanks. tlc2u
  3. tlc2u

    Graduation pushed back a year due to failing a semester!

    Are you out of school until the fall? Get a Saunders NCLEX reveiw book. (To some the book is overwhelmingly thick, Don't worry your goal is to practice questions not read the entire book.) Near the front of the book read the test taking strategies. Write a concise list of the test taking strategies to keep beside you when you practice questions. Practice NCLEX questions in this book. Set a goal to practice a certain amount (of time, or number of Q's or chapters each day). Determine number of questions or chapters to practice each day so you complete all the chapter questions in the book Do not mark the correct answer to the question in your book so you can go back and quiz yourself later. As you mentally answer the question check your answer to see if you were right or wrong. With a pencil place a check by the question for right and an X for wrong. After answering all the questions at the end of one chapter analyze why you got the question right or wrong. Do this using the test taking strategies. This will help you determine; what content you know best and what you may need to reveiw and which test taking strategies you have mastered and which you need to focus on improving. "only read content for the questions you missed due to lack of knowledge." If you miss a question due to weak test taking strategies continue to practice those strategies.) When finished all Q's in book practice Q's on the CD from the book. Do this to get used to taking test on computer like the real NCLEX. Newest edition in stores approx. $60.00 Online you can search for a used book from the last few years and find one much cheaper. Make sure it will come with the CD and check the price of shipping. Hope this helps. Best of Luck.
  4. tlc2u

    Help with Nursing Diagnosis

    When I was in school one of our books to purchase was "Mosby's Sixth Edition Nursing Diagnosis Handbook". I was so consumed reading and studying for nursing tests by the time I got to looking at this book I was exhausted and found this book overwhelming and not user freindly. (WOW!!! WAS I WRONG) In hindsite I see how valuable this book is in learning how to write the parts of a nursing diagnosis. You state you identified defining characteristics in the nursing diagnosis manual that you guess would be the AEB. In nursing school I overlooked a lot in my ND manual. Take a few minutes and familiarize yourself with your ND Manual. Skim the first few sections, the appendixes in the back and the index. If you have a good ND manual you should learn alot about how to write a ND in 15 minutes or less of getting familiar with your book. The first 4 pages in my ND book explain how to write a nursing diagnosis and basically how to use the book. ( WOW!!! I wished I had read these pages while I was in nursing school.) Section II of this ND book is, 112 pgs., of alphabetical order, medical diagnosis, and problems a nurse would need nursing diagnosis for, along with appropriate nursing diagnosis and r/t. When you find yourself wanting to use the medical diagnosis as the r/t, look at the pathophysiology of the medical diagnosis and you will often find your r/t there. Ex. Arthritis-medical diagnosis ND Chronic Pain r/t progression of joint deterioration ND Activity Intolerance r/t chronic pain, fatigue, weakness Ex. COPD ND Activity Intolerance r/t imbalance between oxygen supply and demand ND Ineffective Airway Clearance r/t bronchoconstriction, increased mucus, ineffective cough, infection
  5. tlc2u

    Priority Nursing DX

    Maybe it would help if you think of this patient as someone close to you a parent or grandparent. What comes to mind why an 80yr.old with asthma might be in the ED in respiratory distress? For me I would think knowledge deficient, poor health maintenance, or memory impaired, does he know what to avoid that triggers his asthma, does he recognize early signs of an asthma attack, what medication is he on and does he know what to use when, does he know how and when to use his rescue inhaler. NANDA DIAGNOSIS: risk for Ineffective Airway clearance r/t tracheobronchial narrowing, as "Karolyte" stated above. risk for Ineffective Health Maintenance r/t deficient knowledge regarding physical triggers, medications, or treatment of early warning signs. risk for Ineffective Therapeutic Regimen Management When I was in nursing school often I felt stumped too when the instructor asked questions. In hindsight, I felt I needed to give a very intellectual sounding answer or a word for word Nanda nursing diagnosis. Now, honestly, I think if I had said risk of his airway constricting, or risk of future asthma attacks, something that would have told my instructor I understood this patient's "priority diagnosis" would involve the "A" of ABC's Airway, Breathing, and Circulation I would have been fine with those answers. I quess it all depends on how strict your instructor is. For the Schizophrenic patient disturbed, Thought Processes, is the first thing that comes to mind but for your patient who had been fighting I would prioritize Violence or Injury. risk for self- and other-directed Violence r/t lack of trust, panic, hallucinations, delusional thinking risk for injury These are some other possible nursing diagnosis for schizophrenia but not ones that I could spout off in post conference without having looked at a list of nursing diagnosis ahead of time. Social interaction impaired risk for, relocation stress syndrome disturbed personal identity ineffective community coping Best of Luck
  6. tlc2u

    Help with Nursing Diagnosis

    R/t or in other words what is going on with the heart that is causing the decreased cardiac output. As you have noted your evidence is HR 108 and BP 162/88. Decreased Cardiac Output, r/t, altered HR and altered afterload, AEB HR 108 bpm and BP 162/88. Afterload - the force against which a ventricle contracts that is contributed to by BP or vascular resistance
  7. I will try to help you understand this problem and then you can work it out. If you still have questions then post back. K = Potassium V-cillin K = an antibiotic (Potassium salts of penicillin) As you know p.o. is oral so you will be giving an oral antibiotic. You state there is no conversion needed as you have "Units" and "Units" but look again is that really what you have? On hand you have "Units per mL" and your order is for "Units". What does "per mL" tell you? This means you're not giving a pill. You are giving a liquid you will need to measure (often times measured in a small medicine dose cup). Now as your problem states you have liquid V-cillin K on hand of which 5mL of the liquid contains 200,000 U. If your order is for 300,000 U how many mL's or teaspoons would you need to give? (5 mL is equal to 1 tsp) Hope this helps. Best of Luck
  8. tlc2u

    What site to buy books???

    Fetchbook.info a search engine of online booksellers. lets you compare prices and find the lowest prices.
  9. tlc2u

    Med calculation question

    The drug you are working with is an antibiotic and can come as a small vial of powder that you add 3 or 4 mL of liquid to or a large (100 mL) 1g or 2g piggyback bottle. If a small vial of 2g cefepime is constituted with 4mL of liquid and your order is for 500mg cefepime Then: 4mL = 2g cefepime AND 1mL = 500mg cefepime This would give your answer of 1 mL. When doing pharmacology math try to look at the question in relation to the medication in the question, how it comes and how you would actually prepare it in the real situation. for me this helps make sense of the question as opposed to looking at it as just another math question. Good Luck.
  10. tlc2u

    How can I stop being stupid with NCLEX questions?

    When doing practice questions in an NCLEX book do not circle, underline, or mark the correct answer on the page as you will want to go back and take these questions again in the future. A short chapter in the front of Saunders NCLEX books provides test taking strategies. As you do practice questions and read the answers and rationales, also determine from these test taking strategies why you answered the question right or wrong. Beside the question write in the test taking strategy most helpful in answering the question? Take notice of the test taking strategies that you use well consistently and the test taking strategies you need to improve your use of. For me answering NCLEX style questions correctly requires a knowledge base as well as consistent use of these test taking strategies.
  11. How much time per question does your nursing school allow on tests? I was always under the impression that nursing's final test "the NCLEX" allowed one minute per question. However if you do the math there is more than one minute per question allowed on the NCLEX. Now I am curious where the idea of one minute per question came from? Do most nursing schools time student's tests? And is one minute per question the standard for the timing of the tests?
  12. Know that you are not alone there must be other nurses in the building on other units that you can call for questions. Find out where the extension numbers are for the other units. Before you ask another nurse though see if you can find the answer to your question yourself. Example: Where do they keep a list of all the doctor's phone numbers? Different client's may have different doctor's the number should be on the face sheet in the front of that client's chart. How do I fill out a telephone order or neuro check form or fall evaluation? Again look in the client's chart and you should see one that has been previously filled out. Get familiar with where the blank forms are kept and then rely on a previous example in the charts to fill it out. That should help with some of the paperwork. Best of Luck
  13. Wow! Thanks for the response. I really appreciate you taking the time to answer. Sounds like you are a hard working CNA who cares and works as a team with the nurse. Just curious what are some of the things you do to help the nurse? I can't imagine leaving a clients room to find the CNA for tasks that would take only a few minutes, I work 3-11 and from 6-8 or 8:30 while the CNA is giving showers depending on the night I run 70-95% of the call bells. Some nights between this time I have only administered meds to 3 clients due to call bells or redirecting a client who cannot find their room or safely redirecting a client who is pacing in the hallway without the walker and scared to go back in their room. However I am getting feedback from (7-3 supervisor) that I never help the CNA. This is why I asked the question as I wondered if I am not giving the help a CNA expects. My other thoughts are maybe the CNA does not realize how many call bells I am answering since she is in a room with the door closed and the shower running. After 9 or 9:30 the CNA has some time to sit and relax between the few last client needs of the CNA. While I am still running like a chicken with my head cut off and multi-tasking of nursing duties until past 11:30. Facility is asking why I cannot get done on time. Not to sound better than anybody else but I grew up working hard and am very work focused and have always been willing to do what it takes to get the job done. I wonder if this is my downfall. Maybe I never learned how to say no, or to the client whose TV isn't working and requires 10 minutes of pushing buttons on their remote to get it back on track to say I don't have the time or I don't know how. Anyone reading this I would appreciate any suggestions of things you do on your shift that helps get the job done on time and any suggestions of what as a CNA you feel is helpful to you from the nurse. Sincere Thanks, tlc2u
  14. tlc2u

    New job and nervous as all you know what...

    You say you are afraid you may be late getting folks to dinner I am guessing you are working rehab or Assisted Living. Just remember you won't be all alone. Hopefully you will have a nurse who knows the residents well. Before tuesday write down specifics of anything you can remember from your 3 days of training. Any client you can remember and what they needed or didn't need. writing things down helps remember them. Ask the nurse for verbal guidance or ask if they have written guides for the CNA. Ask the nurse for any tips that will help make the shift flow smoothly. At our facility someone has written out a list of some helps for the CNA. Things like: Who gets pushed to dinner in a wheelchair. Who gets showers on 2nd shift and what day their shower is. Who needs their bed covers turned back. Who needs ted hose taken off and washed. Who needs help getting ready for bed. etc. If you are working assisted living some of the clients can tell you how to help them or what help they need. If you find yourself asking some of the same questions over and over or constantly forgetting where something is or that a particular client wants ted hose off at 730 or to be put to bed at 9 then make notes and organize them later in a helpful order. Let your nurse know what you need help with or what questions you have and ask your nurse what you can do that would be helpful to the nurse. You are there to work as a team. Do remember that the nurse does have her own work to do and at times may appear too busy but you won't get help or an answer to a question if you don't ask. Best of Luck P.S. I started a post wanting to know what the ALF nurse can do to help the CNA, I hope you will add to your post here and let us know how your first days, weeks, go and what the nurse could do or have done to help you. I'd love to hear your feedback.
  15. I am an LPN in an Assisted Living and thought I was doing things to be helpful to the CNA's. However recent feedback has me wondering if I am helping enough or too much:rolleyes: I would love to hear from any ALF CNA's (3-11 shift or any shift) about what they feel the LPN can do to be most helpful to the CNA? Thank You for any tips or advice you are willing to share.
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