msAnneRN11

Wow. I was graduating nursing school when I had my first baby induced at almost 41 weeks with moderate amt of meconium plus oligohydramnios! Thankfully he was fine :) Anne

My suggestion is for you to contact your former professors, clinical instructors, hospitals where you did your rotations. Look online for career fairs or open houses. Take any job - CNA or GNA, unit secretary - if those are the only available as of the moment. When you are in the system, it is easier to bump you up. Don't lose hope please. If you forget all the advices here or just cannot handle everything, put this in your head "NEVER GIVE UP". Say that when you wake up, before you eat, before you work out, after your day and before you sleep! Anne

Hi! everyone! I just recently graduated nursing May 2011. Had an interview and it went really well, next day took the nclex and FAILED! Well, the hospital really wanted me to work as an RN. They gave me an offer for $32.50/hour as an RN effective next week. Well, I contacted them telling I don't have license yet and will need to retake in December 17 but willing to work as a tech for the mean time. I thought she will red flag me or throw my application in the trash can but then she sent me a revised offer- this time as a psychiatric technician for $13/hour. My heart just dropped. It seems too low. I do have a BS in psychology. But I guess I should just suck it up until I get my license? Or can I negotiate the price up to 14.50? I just don't know how to do this. I have never been offered less than $14 ever.. just now its just not enough for day care and for the bills to pay. I am staring at the offer right now and wondering if I should just accept, decline or negotiate. She did say another option is to take the orientation as RN in December.

Just wondering Anne

They gave me an offer to work as a tech first but the salary is $13.00/hour only.. She said once I get the RN it will change which I should be getting in December 17. the base pay seems low but oh well.. I have a month to sacrifice. I am wondering if I can negotiate the salary? Anne

Forgot to mention that I passed the course with no failing or repeats! now just waiting to take the NCLEX!!!

I think this is actually a good thing provided it is included in your tuition

Its not just who you know that counts.. They actually look at your resume and if it is not striking enough they will not bother. Then I believe hospitals hire at a certain month each year. Sometimes if you resume is considered, they will contact you for an open job interview. There, you will meet nurse managers, SEE THEM ALL. Don't just stop at 1 or 2. There you need to be an eye candy with good wit. Once you passed that, the nursing manager will decide wether they want to hire you, if you are considered, the HR will get back to you and then you need to fill up legal forms.. sometimes a lot of applicants get stuck in this process. Either their references did not answer or what they put in the application did not match what they found out in the background report. I know it is very time consuming and nerve wracking at our part in waiting for a response. But Hospitals hire new grads more because they know they mostly cleared. Don't lose hope. Keep on praying and for the mean time, enjoy your 10 month old. You will eventually get what you deserve :) Anne

dudette10, I sent them a message this morning indicating that I have to wait for my license, retake it in December and that I am willing to take a tech position. So far no response. Also I am continually studying and will take a review class next week.. soo tiring Anne

Thanks SantaRN! :) So far no calls yet.. maybe they changed their minds.. Anne

I will take the test as early as December. Today I received the letter from the board of nursing, I am below passing in the health promotion/maintenance, planning on attending a review course next week or end of this month.. been studying since I took the exam. I hope this all work out soon.. very depressing. Anne

I plan on telling them (recruiter and manager) right away. I don't like lying especially in this field. I already told the nursing manager during the interview that I do not have a license yet and will take it soon. She for some reason still said she would hire me. She asked me "How bad do you want this job" and I was very honest in telling her that I like it a lot but if I am not qualified I can let it go - thats when she stopped me and said you are very much qualified and I would love for you to work here. She said she sees herself in me. I have a BS in psychology though and the position is for psychiatric RN or psychiatric tech, I also did my clinical rotation there so I know the place very well. I am very nervous.. Anne

Hi to all! First of all, I would not have written this if I am so sure of myself! I just graduated RN this May 2011 with an ADN program in a nice well known school in our area. I did not take the nclex right away because of personal issues, mainly because I want to hang out with my infant and prepare his 1 year birthday in August. I felt like I owe him a lot of time for not being there with him while in nursing school. Anyway, 2 weeks ago, I got a job interview, went to the interview, the manager said she would love to hire me, told her I am awaiting to take the nclex RN. Well I took it last week and failed I know I failed because my mind was not clear at that time. My husband and I just argued the whole night before the test and the D word came up. Of course it was 3 am and I couldn't re schedule the exam. I failed. And was so depressed. Still am, but the hubby was so sorry too and said he will pay for the next test. Anyway, today the recruiter sent me the new employee packet and 8+ forms to fill up. In the letter she said I was "Selected for a hire". I did the background check online and I am sure I don't have any criminal history maybe just a parking ticket but just that. I am worried about my license though. In the letter she said once I am cleared in the background check, she will call me and give me an offer then give me a written offer if I accepted. Next week is the orientation. I am really nervous. I do not know what to do. I am planning on discussing with them my NCLEX failure, but one of my friends told me to just say I need to retake it in December. My question is, will the hospital consider this? Maybe they can hire me as a tech for now which I do not mind. I am just really anxious right now. I really wish I get that call. When I saw the nursing manager whom I will work with, I really felt the connection was there.. but if this is not what God wants for me, then I need to let it go. Also, I am planning on taking a review class. Maybe Kaplan or Hurst or Martin? Thankfully my husband will pay for it! very depressed right now.. but still with a tiny bit of hope. Anne

Well, I took the NCLEX RN yesterday. Gave me 200+ questions! I was very tired, hungry, my eyes were falling apart! I finished the questions. Tried the trick after 4 hours and led me to the CC page :-( I am sure I failed. I had I think 30 SATA, A LOT of delegation and Medications! No audio questions! Maybe about 7 calculation! I did not expect this to be as hard! No I am waiting for the official result! My ATT is still valid until January, if I retake, should I pay again ATT or just pay pearson $200?? this is really annoying but I have to pass! I have to pass! I have a job offer I have to pass!! :-( Anne

Is this a correct order of priority 1. Decreased cardiac output R/T cardiovascular dysfunction (altered preload, afterload, heart rate and rhythm) AEB prolonged capillary refill, diminished peripheral pulses, changes in BP, weakness 2. Impaired physical mobility R/T aging ( endurance,  muscle control;  muscle mass;  muscle strength); musculoskeletal impairment (rheumatoid arthritis, osteoporosis) intolerance to activity, AEB complains of weakness, tiredness fatigue of lower extremities, difficulty turning, unsteady gait; limited range of motion; postural instability; slowed movement 3. Activity intolerance R/T imbalanced between oxygen supply and demand, cardiac depressant effects (beta blockers) AEB alterations in heart rate, BP, states weakness

she also has Rheumatoid Arthritis. And her med diagnosis is weakness, altered mental STATUS, pneumonia. she has no problem with her airway/breathing.

I am having a hard time thinking about the appropriate PRIORITY nursing dx for my patient. The thing that ticks me off is her medical diagnosis which is: Weakness, altered mental health, pneumonia. I mean is it even possible to have 3 disorders as a med diagnosis? maybe it is.. but I am really having a hard time because I also need to research about the pathophysiology of the medical diagnosis. Pneumonia is easy but that was resolved already before my interaction. For weakness and altered mental health, i just dont know where to get the patho for both!! arrghh.. anyway here is my assessment: An 84 yr old woman was admitted on ER 03/25/2010 for altered mental status, lower extremity weakness and pneumonia. She was concerned about her LE stating that all of a sudden she couldn't move it. Radiology tests showed that she mild degenerative pelvic/hip changes, chondrocalcinosis and vascular calcifications. CT scan suggested mild cerebral atrophy & small vessel ischemic changes. Thorax CT showed coronary calcification. CT scan showed a leakage of silicone in her system, which was scheduled to be removed on 04/05/2010. There was no lung infection noted. History Medical: CHF, HTN, breast cancer, hypothyroidism, osteoporosis, dementia Surgical: Appendectomy, R wrist fx, breast implants on both breast Family: Husband died, daughter -dead - had bipolar disorder, and son is alive. Allergies: Penicillin - shock Health assessment data Vitals are: temp 97.3, pulse 65, resp 18, bp 96/49, pulse ox 96% on RA Peripheral pulses are palpable, weak. Apical pulse is weak Alert and oriented x3 Short term memory impairment noted - patient does not know how long has she been sitting, does not remember what the doctor told her 15-20 minutes ago, forgets about her wrist brace. Pupils are slowly reactive - patient stated "I should be wearing glasses" Mucous membranes are pink and moist Lungs are clear to auscultate, no crackles, wheezing or adventitious breath sounds When asked to cough, she was able to w/o pain or No dentition problem Skin is warm, dry and intact Bruises noted on her lower abdomen, left brachial arm and left leg - from a previous fall Muscle mass is diminished - possibly due to old age Limited ROM Needs assistance on walking - unsteady gait, fatigue easily She is using a walker On a bed rest - bed to chair - chair to bed only On a cardiac diet Bowel sounds are present on all quadrants Patient stated elimination problem - last BM was on 03/30/2010 - compacted - not her usual Urinary incontinent - on depends Psychosocial Patient is interactive confabulate On a depressed mood - her best friend died yesterday Nursing dx My thoughts are 1. Impaired mobility r/t neuromuscular and cognitive impairment as evidenced by leg weakness, unsteady gait, memory impairment, diminished muscle mass, history of fall. 2. Activity intolerance r/t old age, degenerative disease, neuromuscular impairment as evidenced by early signs of dementia, leg weakness, fatigue 3. Constipation r/t impaired mobility, old age as evidenced by hyperactive bowel sounds, last BM was 03302010 Risks for Risk for injury Risk for impaired skin/tissue integrity Should I also include Impaired memory? I know she is not confused on the moment I was there so I will not put that one in. The thing is, I just need 3 Nursing dx and to prioritize it! risk for is not included at all! PLEASE HELP!!!!

What do you think about this book? Nursing Care Plans: Guidelines for Individualizing Client Care Across the Life Span (Paperback) 8th Ed. here is the amazon link: http://www.amazon.com/Nursing-Care-P...9754685&sr=1-4 I am actually using spark's and taylor nursing diagnosis reference manual since last year and now that I am half way through nursing school, I would like to consider a care plan book that will help me with my med-surg clinical and learning. I know most of you guys have tried the Gulanick or the All in one nursing, but when I looked at this book, it has more information eg. it has considerations for laboratory support, and diagnostic procedures per disease/disorder. If you guys have any other suggestions please enlighten me and if you still lean towards Gulanick or All in one nursing care plans, please give a constructive comparison and the reason why you prefer such. Thank You and More power to nurses!

What do you think about this book? Nursing Care Plans: Guidelines for Individualizing Client Care Across the Life Span (Paperback) 8th Ed. here is the amazon link: http://www.amazon.com/Nursing-Care-Plans-Guidelines-Individualizing/dp/0803622104/ref=sr_1_4?ie=UTF8&s=books&qid=1269754685&sr=1-4 I am actually using spark's and taylor nursing diagnosis reference manual since last year and now that I am half way through nursing school, I would like to consider a care plan book that will help me with my med-surg clinical and learning. I know most of you guys have tried the Gulanick or the All in one nursing, but when I looked at this book, it has more information eg. it has considerations for laboratory support, and diagnostic procedures per disease/disorder. If you guys have any other suggestions please enlighten me and if you still lean towards Gulanick or All in one nursing care plans, please give a constructive comparison and the reason why you prefer such. Thank You and More power to nurses! :)

Hey just want to let you know that I got an A on the third exam! this made me super happy! on my last two exams, I got a 29/40, and a 26 or 27/40 now I have 36/40. However, I am still worried. I need a C in able to pass the course, we have our last exam on Nov. 30 and then a Comprehensive exam of 100 items on Dec. I just got an email from my instructor. She wants to talk to me about the status of my NU110 and my options. I am so worried. I thought if I really did well on the 3rd exam, I wouldnt have any problems, especially now that I know how to study and how to prioritize. My spirit is just super down as of the moment.. I hope what we will talk about will lift my mood. I really want to be successful in this course.

WOW great information I will print this!! THANK YOU Okay so it is Acute pain r/t hip surgery aeb patient states pain 5 out of 10 on movement Constipation r/t depressant affects of narcotic analgesic, decreased activity, decreased intake of food and fluids aeb patient is on vicodin, lost his appetite and on a bed rest. (Should I also include vomiting here? when I read the adverse effects of vicodin, it states there constipation, vomiting?) Imbalanced nutrition: less than body requirements r/t nausea, loss of nutrients associated with vomiting and feeling of fullness aeb hyperactive bowel sounds, inadequate food intake (he intake only 20%) , poor muscle tone Muskuloskeletal impairment r/t total hip surgery, acute pain aeb patient states pain 5 out of 10 on muscle movement. Sensory problem? I wasnt able to check his balance, but his right pupil didnt constrict when checked with a pen light. Also, he doesn't have any hearing problems. He wears glasses but he doesnt know his prescriptions. He also said that he has been having problems with his eyes especially the right one so I encourage him to see an ophthalmologist. He was able to use the walker from bed to toilet with minimal assistance. What do you think?? I used sparks and taylor nursing diagnosis reference manual and my assessment, hey you want to know my interventation that I did for this patient? My interventions for him includes: 1. To assess his respiratory and encourage the use of incentive spirometer and deep breathing a. Reason: after surgery, patients have a high risk of respiratory ailment due to the tube inserted during surgery/anesthesia, lung collapse 2. To check his vital signs, temp, BP, Pulse ox a. Reason: essential for every post op patients, to make sure he is recovering well 3. To check his wound/skin a. Reason: To make sure that it is healing well, intact, and has no signs of complications 4. To check for pain a. Reason: it is important to the patient so he can function well 5. To make sure he eats/eliminate, encourage him to eat crackers and drink sprite to determine whether he will vomit again or not a. Reason: patient lost his appetite because of vomiting 10/27/09, fluid imbalance might happen or dehydration 6. To ambulate him or at least move him a. Will promote better healing for him and inhibit muscle wasting, prevent pressure ulcers i. Patient can use the crutch, walker properly. ii. Patient was seen by a PT. 7. To check his neurological status a. To make sure patient is not confused or in any mental condition because of anesthesia/medications, or pain. 8. To provide therapeutic communication a. To talk to patient and encourage the patient to open up if he has any concern, also talk to the patient’s wife so they will feel secure that someone is caring for them 9. To always provide safety a. Patient had a hip surgery, he is susceptible to fall therefore bed should be in the lowest position every time I leave, side rails should be up, call light should be with in reach, make sure I wash my hands or pump in then wash out. 10. To check his lab values/medication a. To better understand his complication and be able to see any apparent value change that might worsen his condition 11. To educate the patient about the use of deep breathing, incentive spirometer, proper body mechanics (how to sleep on his side: make sure he puts pillows in between legs and doesn’t cross his legs), teach about hospital materials (eg. The use of the table) a. This promotes well being for the patient and his wife. THANKYOU DAYTONITE

if it makes you feel better, this afternoon i went to the learning center because i am also failing my lectures. turns out, i tend to read the questions fast and i do not stop and think... here we go... critically. i know the concept, i know what to do, it's only the part where you have to dissect the question in order for it to make sense. i agree some questions are too wordy, so it is up to you to word it in a sense that you will understand it. she told me to remember this word: mims meaning: make it make sense (to you) then answer it accordingly. oh by the way, i too was embarrassed to have an appointment with her but for the effort of meeting up with her, i believe she gave me extra two points :)

Yup! I have some in mind; Acute pain rt surgical incision aeb.. Patient states 5 when ever he moves Imbalanced nutrition rt bowel obstruction, adverse effect of pain meds aeb vomiting, inability to eliminate Impaired physical mobility r/t surgery, pain aeb patient prefers not to move bec of pain Hmm.. Risk for infection Risk for ineffective breathing pattern/clearance Anymore?

My patient tonight was a post op total hip replacement too and this is what I assessed: Male, 72 years old, NKDA retired physicist, surgery procedure: THR on 10/26/2009 - assessed during 10/27/09 and 10/28/2009 1. Pain - 5(severe) - hip - stabbing - everytime the patient moves - relieved by pain meds 2. Wound - left hip -clean, skin is intact, no redness or swelling 3. Respiratory - lungs are clear to ascultate - no adventitious breath sounds - resp rate 15 - pulse ox 96 - able to use the incentive spirometer properly 4. Cardiovascular - s1,s2 - no wheezing or murmurs - BP 108/60 - capillary refill time less than 3 sec - radial/pedal pulse palbale, strong. 5. Musculoskeletal - A-ROM upper extremeties strong, lower extremeties weak (due to surgery), able to walk with walker/crutches, on physical therapy 6. Nutrition/Electrolytes: On a regular diet, lab values are normal except for an elevated glucose 115 (10/27), on 10/27 patient started vomiting, gave meds, tolerated 4 crackers without vomiting. on 10/28 patient was constipated, was not able to eliminate bowel, bowel sounds are hyperactive, he is now on stool softener and vomited 7pm 10/28. 7. Neurological - alert x3, cranial nerves intact, left pupil contricted but right eye pupil did not - patient states having a problem with his right eye, patient uses eye glasses, had a history of brain injury 8. Knowledge: patient knows about hospital procedures, about therapy, about deep breathing, patient is aware and mind is intact. 9. Psychosocial: Patient is very cooperative, wife is caring for her, he is glad to have a student nurse to take care of him. Initial diagnosis: Acute Pain r/t surgical incision AEB patient states pain of 5 everytime he moves Imbalanced nutrition r/t ??? AEB patient ?? (no bowel movement? vomiting?) (I NEED 4 ACTUAL DIAGNOSIS AND SOME RISKS!!)

Hello there! I keep on browsing allnurses.com and I decided to finally register Anyway I have a problem. I am a first year Nursing student and I LOVE IT! the clinical rotations, the research about pathology/diagnosis and every other subject involved, even my professors are telling me that I am doing a great job during clinicals and documentation. However, I am having a hard time with the chapter exams on the subject "Foundational concepts of nursing" or NU 110. It's not that I don't understand the subject or study.. I think It is NCLEX style 40 questions per chapter that confuses me. Right now I took 2 tests and one I got a C and one a D and there are 2 exams left plus a 100 comprehensive exam on the finals. I have a 3.5 GPA and I dont want to mess up on this one.. I don't want to drop either. I am getting hopeless with this one So pleasee can someone help me on how to practice these types of questions? a Book suggestion would help :) Also, another curiosity, I am using sparks and taylor dx book but I find it lacking information. I recently looked at Ackley Nursing dx evidence based and find that very easy read and informative. Can you give me more info on what nursing dx or care plan to get? I like having a lot of info and I like the text to be an easy read too. I don't care about the size. I looked at nursing care plan by gulanick and the information there is limited.. FYI.. I love reading. Thank you guys for reading.. I appreciate any comments :)