NancyPie

My stance has always been a joint effort. We're all busy.

I wouldalso want to be oriented. I'd hate to need somethin in a hurry and not know where to go

Never would have thought to list my license on my resume, I guess I figured it's implied that I have one. However, you can look up anyone's first and last name and get their license number online so I don't understand the danger inlisting it.

OK, not an Alzheimer's patient... well it is one of his diagnoses but I really don't notice it in him at all. He's HOH even WITH his hearing aides & he had them out. I asked him if he needed help opening his banana. He acted like he hadn't heard me so I picked it up and pointed to the top and repeated myself even louder. He replied "You're single ain't you?" I looked at him confused & said "Do you want me to open this for you?" He replied "I can tell because of the way you picked that thing up, if you was married you would have grabbed it like this" , and grabbed it with his whole hand. I had picked it up with two fingers and a thumb. I began to blush, he said "Gotchya. I can do it myself" I said "good night" and left the room (it was about 9pm, I had been in his room giving HS meds). Upon leaving the room one of the CNAs saw me and asked if I was ok, I started to tell the story and she laughed and said "Yeah he's pulled that one on me a few times" She is most definitely NOT single, she's married with teenage kids! LOL. I don't know whether or not he knows it.

I have patients who get offended when I remind them to wash their hands, then refuse to do so.

Working in a nursing home, I've had to return meds for this reason. I always write Patient discharged. At least she was clear? x'D

OMH! OUCH ... wow.... GASP...

I still get out my skills packets from nursing school & go over them. Perhaps not as much as I should. It will definately improve confidence to have them down.

As far as the CNA certificate goes... I really wish I'd done it. While our instructors said that CNAs actually were at a disadvantage as far as the schooling went, I think they've had an easier time finding jobs. Job market is really tight here right now and I'm still looking for work. A friend let me know that someone where she works is quitting soon :) I am putting in an application -fingers crossed-. I'm sure that either way, there are pros and cons. My class included single people not even in a relationship (me), newlyweds, people with young children (some being their first) some who had their first near the end of school, some with children all in school, and even some whose children were all adults now. Each one of us had different challenges. Personally, I wouldn't put off family or school for the other. I've known people who it took 5 or even 10 years to get pregnant.

I don't know about Salt Lake, but St. George where I did my clinicals was about the same :)

Haha, don't know if I count as "local" just yet. I"m actually looking to MOVE to Salt Lake soon, I've been job hunting, I have an apartment lined up (it's on my sister's property) but I finally found a job opening I meet the requirements of (I'm a new grad) but it's asking for desired salary! I have no idea what to put... I've been looking for information on typical salary for an inexperienced nurse in the area so I don't look silly. Will be following this thread as I find it interesting that the salary is so low as well.

If a patient's blood were hypernatremic due to rapid water loss (vomiting/diarrhea, except doesn't diarrhea tend to dump sodium too?) adding a hypotonic solution (NA .45%) would dilute the hypernatremia by adding more water than sodium without just dumping straight water (D5W or similar) into the blood which would be too rapid of a dilution. I decided to look for more information in one of the many books I accumulated in nursing school.... Any italicization or underlining is my emphasizing a point like i would if I were reading it aloud. The following is an exceprt from Phillips manual of IV THeraputics 4th edition page 119-120 Serum sodium excess: Hypernatremia The serum level of sodium is elevated to above 145 mEq/L in patients with hypernatremia. This elevation can be caused by a gain of sodium without water or a loss of water without loss of sodium. Pathophysiology and Etiology Increased levels of serum sodium can occur with deprivation of water, occurring when a person cannot respond to thirst; during hypertonic tube feeding wit hinadequate water supplements; with excessive parenteral administration of sodium-containing solutions; and when a person is drowning in seawater. Sodium is lost with watery diarrhea (a particular problem in infants), increased insensible loss, ingestion of sodium in unusual amounts, profuse sweating, heat stroke, and diabetes insipidus when water intake is inadequate. Cerebral cells adapt to high sodium levels by shrinking as the osmotic pressure drives fluid out of the cells, leading to decreased brain volume (Hogan & Wane, 2003). Age Related Considerations In aging adults, there is a diminished thirst response that may lead to inadequate fluid intake. Infants are unable to obtain fluid independently and may be at risk of inadequate fluid intake, especially in warmer weather. -excluded s/s & diagnostics- Treatment & Management The goal of treatment of patients with hypernatremia is to gradually lower the serum sodium level, infusing a hypotonic electrolyte solution such as 0.45 percent normal saline or 5 percent dextrose in water. Gradual reduction is necessary to reduce the risk of cerebral edema. The sodium level should not be lowered more than 15 mEq/L in an 8 hour period of time for adults. Generally, treatment guidelines for hypernatremia are: 1. Infusion of an isotonic solution (0.9 percent NaCl) or hypotonic electrolyte solution (0.45 percent NaCl or 5 percent dextrose in water) 2. Sodium levels can also be decreased by use of diuretics, which induce excretion of water and sodium Nursing Points of Care: Hypernatremia Nursing assessment includes: 1. Obtain a patient history of high-risk factors for hypernatremia (e.g., increased sodium intake, water deprivation, increased adrenocortical hormone production, use of sodium-retaining drugs). 2. Assess for signs of hypernatremia. 3. Obtain baseline values of laboratory tests, especially serum sodium. Key nursing interventions include: 1. Monitoring laboratory test results with emphasis on serum sodium and serum osmolarity 2. Keeping accurate fluid intake and output records 3. Monitoring for signs of pulmonary edema when the patient is receiving large amounts of parenteral sodium chloride.

Thanks for the replies! I actually sought advice from some of my classmates and found out I'm not the only one who feels this way! I still need to overcome it, but knowing I'm not alone (though possibly still the worst) helps me feel less ridiculous. I'll just make sure I know what I'm supposed to be doing, and not let the inexperience get to me!

Do you think Jesus would have tried to revive you? ?

That has to be the funniest thing I've read in a long time ? I laughed so hard I started coughing! ? eep, hope I'm not sick!