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!

Ever since my first clinicals, I've been getting told that I act as though I'm afraid of the patients, that I'm too hesitant, and that I don't have any confidence in myself. I'm close to graduating, and still getting these kids of performance reviews. I keep thinking I've gotten over it, and then I transition into a new rotation and I feel totally lost and completely incompetent all over again. By the time I get over my fears, I'm moving on to a new rotation. Does anyone have any advice to help me overcome this?

Does anyone know a good online resource for nursing theorists? I have to write a paper on something and incorporate at least one theorist into it, but I don't even know where to start for theory. There's a tiny table of very non-informational summaries of a few theorists in our textbook, none of which match what I was looking for. It also refers us to a website for more information which no longer exists. So, I'm really confused as where to begin looking for theories. I turned in what I had done on my paper (completely theory free) and I was told to look for theories regarding adult education or educating the adult.. something like that, it was the end of a long & tiring day and I really don't remember much of the conversation. I was originally thinking something along the lines of safe environment of care. My paper is on horizontal violence and how it creates an environment where nurses may be providing inadequate care & how to stop horizontal violence by educating staff. Through all of this, I need to work at least one theory, I'm quite lost, I've spent all day looking but I don't even know where to begin so I haven't found a thing I can use. Please Help. Thanks, Nancy

Yes :) It will pass! The only thing keeping most of my class sane right now is the week-by-week countdown we've got going on! Thanks for the encouragement! By no means was I intending to discourage anyone from starting nursing school. It has been, and continues to be, a very rewarding experience. Like my teachers have told me, you can worry about that 15 pounds later, repair your friendships later, for two years dedicate yourself to your schoolwork and focus on the end goal!

Haha. First semester I laughed it off, I was like hey this isn't so bad, yes It's a ton of homework and studying, but it's no big deal! Second semester was about twice as much work. Third was about even with second, now I'm in fourth semester and I have no life, I'm not studying nearly as much as I need to, I'm working less than I was before, I spend less time with people (other than study groups) than I used to, and I'm falling behind. Today I've been checking my e-mail because I'm too fried with school to do any schoolwork today even though I have a paper that's only barely started that I have to have done by Saturday at 5:30 am.

I put some of my tuition and all of my books on a credit card, thinking I could pay it off completely throughout the next two months. Then I lost a significant portion of my hours at work! Plus I had to put new tires on my car, the tread was almost gone and I had a blow-out of one tire. I borrowed money from my mom to pay the rest of my tuition, and this semester (my final semester!) I took out a student loan. I'm going to use the money to pay off my mom and my credit card, and then I'll pay the student loan over time, the student loan has a MUCH lower interest rate than my credit card (especially after they bumped it up to 32% because of two consecutively late payments). So, the student loan is going to be WELL WORTH it in the end. I'm currently looking for a new job because one day a week at minimum wage really isn't cutting it. Without my mom & the student loan money I'd be in serious trouble. I wouldn't even be able to finish school.

Congratulations! I wish you well. Now that you've done this test without failing, next time you have to take a test (and there will be lots of tests in nursing school) you can tell yourself "I Know that I know the information, I just have to tell them that I know it" Go into your tests KNOWING you are going to pass because you KNOW The information! Remember, they probably aren't trying to trick you, they just have to find out what you know. I wish you well !

Haha, that sounds so much like me! I often feel guilty receiving test scores over 90 when I literally didn't study at all for the test. In school things were so easy for me that I could easily let things slide until the last minute and still get them done on time. In college I've found that I try to use the same system and it just doesn't work as well. Current semester I'm running right on the border of not passing which is just horrible. Only regret I really have of nursing school so far is not being committed enough. Make a study schedule and don't blow off your study time, also schedule time for family. You can make everything fit in right if you try, I just didn't follow my schedule and did things when & where they fit and spent too much time on non-important things. I am constantly trying to be more aggressive in my clinicals, seeking out experience, but I'm quite timid and it is always on my evaluation sheets that I hold back too much. Right now while there's always someone looking over your shoulder is the time to get corrected on your mistakes, they understand that you don't know and they're here to help you learn. Learn as much as you can in school because once we're out, we're going to be a lot more "on our own". GULP this has been partially a self-realization post! Good luck and congratulations on your decision! :)

I'm stuck on the very same question! I had "Ineffective coping" but I'm trying to think of the other two parts of the nursing diagnosis. I'm thinking that the "as evidenced by" bit is "suicidal ideation and anxiety" but the related to I'm really having a hard time thinking of.

If I heard someone say how they cheated or that they cheated, I would go to one of my professors during office hours and tell him/her word-for-word as closely as I could what I heard and that I was concerned about the integrity of the exam. If people were only talking about how they COULD have cheated or how they could cheat in the future, that could be just speculation or their way of expressing concerns about the exam themselves and I would not feel to report this. Cheating has not been much of a problem in our school because our tests are all computerized and the questions are displayed in random order with the answers randomized as well. While we could easily see eachother's screens, we'd probably be caught before we had watched long enough to gain enough information to help our own test. As far as people "not cracking a book" and still getting in the 90s. Well, I'm one of those people. Our instructors told us we should be studying a minimum of 12 hours a week. I probably study about 12 hours per TEST (every 3-4 weeks). I confess that my fact recall is not as sharp as it could be, but I usually get high 80s or better on my tests. I am a very visual & audio learner and I don't gain much from reading unless I have someone to discuss it with immediately. Studying very little and still doing well on a test does not necessarily indicate cheating.

Haha I agree completely. I saw a girl wearing pink scrubs & a black tee, it looked cute at the neck & sleeves but it was too tight & made her butt look huge