crystalchen

I totally agree! I am a new grad last year and during my 8 months working in long term care facilities as an NP, there is SO MUCH that they don't teach/never mentioned in NP school. I was a good student, graduated with honor, and several clinical rotation places wanted to hire me after my rotation. Then what, I really don't know much! I guess PA school will provide you more clinical knowledge and medication knowledge, and for NPs, we gotta learn from our experiences. Best luck!

relax dear, it was fullmoon last night

So I guess last night was full-moon.... no wonder why my pts were all crazy:devil: Don't feel bad if you got crazy pts, too

I think your LTC experience will help you a lot in med/surg.

I was told by experienced RNs that you should do a bedside swallow eval, just ask the pt to drink a sip of water first. If they have to troubles, give them pills, because I have seen pts that was ordered swallow eval but result is not available before I am giving meds.... If you ever question a pt's ability to swallow, contact the pharmacy to see if you can crush it, for sure...

In our hospital we have to follow unit policy. In my unit we can only push 7 meds, which is not including dilaudid or phenergan or ativan........ sad.......... Check it with your preceptor, and remember to always ask pharmacy if you have any questions about if you should dilute it before administration, how much you should dilute it with, and how fast you can push :)

I learn that antibiotic is extremely important for the first 24 hours, and it needs to be given after the labs, right? keep them hydrated.

Thank Xing! I will need to look at the curve again, this always confuse me during school and now. I dont remember his pH, I will go to work tomorrow night and find out more about his labs. I found an interesting graph to explain it: here is shows what you just corrected yourself that in acidic body, blood doesn't combine to O2 and release more O2 to the muscles where needed, am I explaining right? so there is not enough O2 in blood and then it becomes more acidic. in his ESRD kidney not working so no base can be released to blood to adjust this imbalance? Here is the graph

All of the nurses on my floor take 30 minutes uninterrupted break, it is safe for our patients. I do believe that I need those 30 minutes to get off the floor and do something else. Of course, charge always ask around who wants to take the first the break and who is the last, depending on the patient load, if the nurse is getting an admission, and just like handing over a shift I think, I always feel absolutely ok to give a minireport to the nurse who will be covering me, I know it is frustrating if something happens during the break, but taking some rests is necessary for better taking care of your patients. I would rather take the break later in my shift, though, because it will make the rest of the day pass faster :)

I learn that knowing your resources and don't be afraid to ask stupid questions. Utilize family members, keep them busy if you can, do your teaching with patients, even one sentence, they don't usually ask questions, but they appreciate your teaching because they think you care. :)

Does charge nurse has patients last night? Did they call to ask if anyone else is ?available to work? I work in emergency - observation and each nurse always just have no more than 5 patients. If someone called sick, charge nurse should either find someone else to work, or charge should take those patients, or management should come in to take patients (we have 2 nurse leaders and 1 crn on the floor). I think it is unsafe and you should talk to management about this. but my friend works on surgical oncology saying they usually have 6-8 pts at night...... maybe it is an unit thing?

I suppose she was having diarrhea? If so I would call the team and put a rectal tube in her, which is both good for her skin and for the staff on the floor.... I had a pt before, similarly, refuse to use a lift because she had a bad experience before. I could imagine this is hard to take care of her, someone who does not appreciate your help at all. I like the quote by the previous post, and in reality, it is so true.

he was admitted for SOB at home, he tried on a cpep mask and was planned to have that machine home this Friday because he always wakes up at night because of SOB and I noticed he had to move from bed to chair and many different positions to sleep during my shift. You answered my question about the lactate and Co2s.... thank you!!! yeah his K was high before yesterday's dialysis but then after that 4 lab draws could not run that K test because hemolyzed... his blood was like... very dark blue color this morning! I didn't know if the spouse has diabetes. He is in the 60s,sponse is a lpn worked in a school clinic for 20 years... Could you explain more on this please?"Lactate reflects that cells are hypoxic and in anaerobic metabolism. Acidotic blood doesn't give away O2 easily". Thanks a lot! ps i am from China, but i was educated and working here in the US :)

I am glad you experience that in nursing school.... I had my first code yesterday and did my first post mortum care... it was a little scary, and also sad... I could not sleep for 4 hours after went home and then kept dreaming about the whole thing..... I think it will be better and better along with more experiences...

I am thinking about pain management because a fracture is a lot of pain....... effective pain management will also stablize the patient for future interventions.