nickos

When I reminded her to punch out for her lunch break, this isn't what I meant!

I'm sorry that you had that experience! I am a first year RN student, and we have HESI exams every term at midterm and final. Last midterm I got an 86, every other score previous to this term I got between a 72 and a 77. I am generally an A student, and this was especially upsetting because at my school, you can have a 99.99% in everything else, but if you don't get at least a 70 (or 72?) average between the midterm and final HESI you are out of the program. Our program has lost a few people this year just like that. SO. This term, after seeing more people disappear due to the HESI, I went to a review class held by a 2nd year student, and used my Saunders review book pretty intensely, but only for about 8 hrs prior to the HESI and I scored a 98.5%! I almost cried, I was so relieved. The main, important points of the HESI review class were this: 1.Is it appropriate? - often you can eliminate an answer or two based on their ridiculousness/inappropriateness. 2.Safety of the patient - safety is the first priority! 3.Airway - comes first! 4.Breathing - comes second! 5.Circulation - comes third! 6.Nursing Process - after you have worked your way through the above, the use the nursing process to whittle down your answer. Sometimes the question says "what assessment...?" Make sure you categorize the answers - which ones ARE assessments? Which are interventions? Eliminate the wrong ones. 1.Assess 2.Analyze 3.Plan 4.Implement 1.Patient centered - think about what answers are pt-centered. 2.Maslow - if you get this far, make sure that physiological needs are considered before psychosocial. 1.Physiological 2.Psychosocial 5.Evaluate I hope this helps!! Best of luck!! ~nickos

based on this information i grouped the significant symtoms and with the help of my nursing diagnosis handbook, came up with the possible diagnosises of ineffective airway clearance, imparied gas exchange, and ineffective breathing patterns. after that i am asked to give a complete diagnosis with the "related to" and "aeb". i can not decide whether to use impaired gas exchange r/t ventilation-perfusioninequality aeb abnormal breathing, cyanosis, tachycardia, hypoxemia, anddyspnea, or ineffective airway clearance r/t hyperplasia of the bronchial walls and asthma aeb adventitous breath sounds, cyanosis, and dyspnea. i realize that both might apply to the patient, but i need to pick the one that is most accurate/ more serious. which diagnosis is it most likely to be with the senerio? first, i want to say congratulations on starting your program! i am just a few weeks away from wrapping up my first year already, and i can't believe how fast it has gone. secondly, case studies are *hard*. they are time-consuming, and can seem quite tricky until you get the hang of them. i imagine that the "rules" are different from school to school, but it sounds to me like you have good handle on what they are looking for. i am thinking that either impaired gas exchange or ineffective airway clearance r/t copd as evidenced by (s/s) might be your best bet. i have found that our instructors haven't necessarily been looking for a specific answer. they just want to see that you are using the right line of thinking and covering your bases. i just kind of skimmed the info you gave, but i am curious about the "hyperplasia of the bronchial walls". it may very well be correct, but where did you get that information? (sorry if i missed it!) good job showing the work you have done. while i may not be the most helpful person to respond, i know you will find fellow nursing students/nurses much more willing to help when you show the work you have done when asking for help (and you're totally on the right track as far as i can see!) :) nickos

I think I understand where you are coming from. I am currently picking up shifts left and right at a job that I both love and feel I am ready to move on from, and am trying to scrape pennies to make minor improvements to my first house (which I bought when I was 21 and engaged; I'm now 30 and divorced) to try to sell it in a crappy market so I can move and start the nursing program in September that I *finally* got into. I have mixed feelings... I curse that darned house that feels like a potential money pit, I get frustrated at my lack of skill usage at work, I daydream about moving forward from both.. but I think I'm gonna cry my eyes out when the big change time comes. I don't know if you like country music, but if you do, check out Trace Adkins' "You're Gonna Miss This". :heartbeat

See if you can make a few laminated cards (maybe each side of one = one floor w/departments?) and hole punch them and clip them onto your nametag. I have done similar for frequently used phone numbers, door codes, etc. Good luck!

I am not a nurse yet, but work in the ED with mental health patients. It is standard practice for our RNs to do a basic domestic violence screen, alcohol/drug abuse screen, ask if pts have thoughts of self-harm, etc. Generally I hear them use the approach of "it is our policy that we initially speak with the pt alone, if you have questions or concerns I can come and speak to you afterwards" and direct family to the lobby or family room, etc. As I am not an RN and don't work on a "floor" I wonder, is this approach possible?

Hey punky, I'm not sure how you should handle the situation, but definitely TAKE THAT SLOT in the program! It is clear that you respect what has been invested to hire and orient you for your current job, so make that clear when you discuss your desire to go PRN or quit or whatever. The guilt you feel for changing your committment to this job will pass, and be easier if you handle it with honesty and integrity. Congratulations on getting in! You will be ok :)

Great post! When I first started working as a ward clerk on my hospital's busy med/surg floor a few years ago, I had the pleasure of being trained by a very competent coworker who taught me a couple of very simple, yet effective things: 1.) "If you don't know the answer, FIND IT." All of our hospitals calls went straight to one of two ward clerk desks on our unit (and most of the time, we only had one working). All KINDS of questions were asked. She told me my job was to give people answers and make things happen. My question to her was "If you don't know the answer, what do you do?" She said, "If you don't know the answer, find it." This one baffled me for a long time, until I realized I would rather call lab (or x-ray, or CT, or dietary, or the nurse, or the doc etc) a million times to politely and patiently make sure I was entering orders correctly rather than guess without confidence; at the least delaying treatment and at the worst, injuring or even killing them. 2.) "There are almost no mistakes you make that cannot be fixed." Just knowing that most of what I did, although very different from nursing, was reversible (even if it wasn't easy) let some pressure off. Hand in hand with this information, she also taught me the same things your post discusses. If you make a mistake: recognize it, acknowledge it, and immediately find a way to rectify the situation. I have tried to do this in all of my work (as a med/surg floor CNA, a med/surg floor ward clerk, an ER mental health tech, an ER tech, and an ER ward clerk) ever since. I am very grateful for her (and your!!) advice, and I hope to always keep these main ideas in mind as I will hopefully soon be starting a nursing program and most likely making lots of new mistakes! :)

Hello OP :) I am currently employed as a mental health tech in a smallish ER in Oregon. While we don't have nurses that specialize in psych, our staff nurses sort of take turns working the "psych side" of the ER. Certainly an ER setting isn't ideal for long-term treatment of psych pts, but we do what we can to stabilize and care for pts while we determine what our goal is (whether it be placement in our inpatient psych unit, placement elsewhere in the state, outpt treatment/referrals, medication administration for control in a crisis situation, etc. I can't speak for other ERs, but our "psych" nurses do not hold special certifications (beyond whatever is required of them to work in our ER in general). However, we do have an inpatient psychiatric unit where I work that employs both nurses and CNAs. From my understanding, the CNAs do not necessarily need special certification (there is definitely training involved, but not a special degree or certificate based outside of the place of employment), but I do not know about the nurses. As far as sexual trauma victims in our ER, I am not aware of a program (volunteer-based or otherwise) where I work that provides individuals for the victim to speak to/be consoled by. We do have a number of ER nurses that have also voluntarily gone through SANE (sexual assault nursing education, I believe) certification to be certified to participate in SA exams and evidence collection and documentation. I hope this helps!

Hi, OP! I couldn't help but respond, as I lived in Wisconsin for my first 20 years and have been here in Oregon for my last 10. Although I am not a nurse (I have been a caregiver/CNA pretty much since I moved here), I do currently work in a hospital and would like to help you if I can. Where in Oregon do you think you might land? Portland? Eugene/Springfield area? Feel free to PM me :)

Marie, I am 8 years older than you and am not even in a nursing program yet. If I were your CNA, all I would be concerned about is you knowing your job and being respectful; just like I would about anyone else. I say go for it..don't wait to continue school because of what other people might think! I admire you for knowing what you want to do at a young age and for already being an LPN, and if anything, I'm a little envious Keep it up!

I work as a tech in an ED, primarily with mental health patients, and try to acknowledge their feelings of panic, fright, sadness, fear of the unknown, etc. I try to say things (and mean them!) like "I realize that this room can be intimidating" and asking if they have ever been to our hospital for anything similar. I ask if they would like me to explain the general routine of how their visit will be handled, etc. I also try to use light humor (depending on the patient's response) and, when leaving the room, tell them to let me know if they need anything.

Is there a possibility of an online LPN>RN bridge program that you could do in your little spare time while continuing to work cable?

Elvish, I do not know the right thing to say to help you through this, but that I am very sorry for your loss. You sound like a strong person and I am glad that you are able to come here and let us support you. Jolie: thank you for sharing such a personal and tragic story. I have not experienced a miscarriage and have no children, but your story moved me to tears.

Okay, this might be diverting a bit from the original topic, but I see a few people who say "regardless of contact precautions, I glove up any time I make contact with the patient". Really? So if you go in to give them a glass of water or take vital signs, you put gloves on? even if the pt has intact, clean skin and isn't coughing or spitting or on any precautions? I always wash my hands before and after pt care but I don't glove every time...only if precautions are in place or there are fluids/ickiness involved..