Tree525

Flushing a citrate lock into the circulatory system can cause an unsafe drop in blood calcium levels. It is unlikely that such a small amount of citrate would be detrimental, but the concern still exists and the lock should be aspirated whenever possible.

Why don't you try for a smaller UF goal per tx, say 3500-3800, and have the patient come in for extra treatments?

SuperstarLPN, I can't agree more with your last reply to this thread. I have been an RN in dialysis for 9 months now, and I have never come across a patient population such as that found within dialysis. While some are an absolute joy to work with, I find that many are very rude and just plain disrespectful. Last week a patients BP was dropping into an unsafe range throughout his tx. He was symptomatic, so I bolused him several times throughout his treatment and lowered his goal. Needless to say, he didn't meet his dry weight. The next time he came in, he threw a fit about my care with my boss and went on to tell me and the charge nurse about how I'm a " bad nurse " and " I don't know what I'm doing. " I told him kindly that yes, it is my job to provide him with a good treatment, but it's even more important for me to keep him safe." I went on to explain in great depth the lack of tissue perfusion that occurs with a low BP and why it is such a danger and that he needs a new dry weight. Still, I was met with " I don't care, your a terrible nurse and you clearly have no idea what youre doing . " basically it ruined my day. I dont wake up at 3 15 am to get belittled like that. These situations happen all the time in dialysis. I have dealt with difficult patients in the past and realize that not all will be ideal, however it is as if they all are clustered in the dialysis population. They get furiously mad if you put them on 5 min late, question them about their large fluid gains and try to kindly educate them, etc etc. Like I said, not all patients in dialysis are like this, but I find that most are and it is certainly burning me out of this field in nursing. How do I transition out of this field into a hospital setting, anyone do it with success? I don't know how much of my dialysis skills are appealing to employers other than dialysis clinics.

How do you seasoned RN's do it? For example, lets say your 1st patient is due to come off in 6 minutes, and the next patient is due to come off in 10 min. What i've been doing is this: I will go to my 1st patient once their treatment is done, rinse them back, check their BP, and disconnect them from the machine as long as their BP is WNL. Then, I go to the machine and put it into test ( we are allowed to test the machine with the old lines ). Then, I pull out the patient's needles and get them bandaged up. Now, the next patient is due to come off in 4 min. AT THIS POINT, I AM HAVING TROUBLE....do you tear down the machine, re-string, and prime the new lines before going to take the next patient off ? I am new to dialysis. I have been precepting on the floor for almost 4 weeks, and I will be on my own soon. Turnover is really the only thing I have been struggling with and it gives me anxiety even thinking about it. I always have everything I need for 2nd shift ready before 1st shift ends, so I know its not so much a material-related organizational issue. I really don't know what else to do to make myself quicker. Any tips/ pointers for managing turnover will be highly appreciated. Thank you.

Im thrilled to hear so many of you are benefiting from my post. How is everyone doing in class? Please keep me updated!

I hear ya... Honestly I'm not sure I never bought the book. I don't see how it could hurt though. I know you said you tried Kaplan before but give it another shot. Completely soak yourself into the program and try not to spread yourself to thin by using a ton of different books; couple that with lacharity and I think you'll be okay. Kaplan is superior for test taking strategy and since you sai you know your content im sure it will do you well. Also memorize the infection control aid on this website. I bought hurst and Kaplan was provided to me by my school. I also bought the lacharity book and used these 3 for all my studying and was successful.

I am so sorry that you have had to do this 7 times. I know you said you are tight on money, but if you can afford to spend 300 dollars, please invest in the hurst review. It is amazing, seriously. It is an online program with videos for all body systems and nursing areas. You said you are a visual learner and I think the idea of watching videos will benefit you in that respect. She also makes everything so simple to understand and her teaching style is the reason why her program is so succesful. Ask anyone who has taken this review and they will tell you the same. Understanding core content is the key to success on the nclex. Visit hurstreview.com and watch her sample video on fluid/ electrolytes; I think a lightbulb will go off in your head after seeing it. Pair this up with lacharity and another solid book for questions and I believe you will pass. Keep me updated and best of luck. You can do it!!

I'm wondering the same thing. At this point ive put in 30+ applications, and have been offered a full time position in dialysis. Am I making a mistake by accepting the position?? How will future employers look at dialysis experience when I'm potentially applying to hospital positions in the future?

Salutatorian of my class, received awards from my state league of nursing, president of my college's honor society, passed nclex 75 questions in 45 min, youth mentor, 25 job apps, worked as a student nurse in a surgical ICU= no job. I'm at a loss. Honestly, I don't know what else there is to do. Good luck with everything.

First off, YOU WILL MAKE IT! Dont ever let anyone tell you that you wont. How can they even make that assumption? The fact that you are on this website several weeks before your class starts and reading up on how to make the most of your nursing education alone speaks volumes about your dedication, drive, and desire to become a nurse. It's not about how "hard" something is, its about how bad you want it, and Crystal you WANT IT! your going to make it, dont worry As far as the notes go, I think there are a couple ways of finding a solution to this: 1) do you know your future professor's email address? typically this type of information is provided on your school's website. Email him/her and ask him/her for the syllabus. If this doesnt work ( sometimes they will be hesitant to provide a syllabus so early on because they want to edit/update them), then ask for the first week's powerpoint slides. Then, take the powerpoint slides, find the topics covered on the powerpoint in your textbook, and take notes on those sections only. 2) If you can't obtain the professor's email address, try to find students who have taken the class already. Befriend these people-- they can be a huge resource for you as you progress through nursing school. You can simply ask them what was covered, or even better, ask them if you can borrow their old syllabus and/or powerpoints and use the strategy I provided above to get a good idea of what you should be taking notes on. I think that taking notes on all those chapters without some sort of direction is not a wise idea. You will probably end up taking notes on too many things you dont need to worry about and you will create more work and anxiety for yourself. I hope this helps you.

I agree with the posters above me. Everytime I see vitamin c ordered for a patient, it's always been for wound healing.

Just want to say I appreciate each and every one of you. THANK YOU!

My school enrolled us in the classroom version of Kaplan. Honestly, the classroom portion was a waste of time. All they do is go over questions outloud on a powerpoint, and you talk with the instructor about why this is right/wrong etc. Nothing you cant do at your own home. Also, the instructor teaches you how to use their "decision tree." Again, not THAT useful, although it does help with some questions. My advice would be if you were going to do anything kaplan related, get their Q bank and question trainers. The questions are extremely challenging but very similar in wording/presentation to actual nclex questions. Best of luck.

I think you can still use the flashcard approach with nursing courses as long as you are practicing applying the information with nclex questions-- this is the most important part. Nursing exams will never ask you to regurgitate facts-- your instructors are most concerned with how you can use the information you have learned, and thats where the nclex books come into play. All of your exams in nursing school will be set up in nclex format. The reason behind this is that your school wants you to get used to that format as early as your very first exam so that by the time you graduate and take your boards, you will feel comfortable answering the style of questions that will appear on your actual NCLEX. The best piece of advice I can give is to purchase an nclex book early on in your academic career. When I took my first exam in nursing school, I walked out of the classroom thinking " what the heck was that?! " The style/format of the questions are unlike anything you have ever seen, which is why it is so important to get used to them early on.

How long have you been using Hurst? Have you given yourself enough time to learn the core content? Another possibility is nerves with your test date being so soon; I noticed that my practice test scores were a bit lower than usual a few days before the exam, and it wasn't because I didn't know the info, it was because I was a nervous wreck about my upcoming NCLEX.

I honestly felt like I read a short story after finishing some of the syllabi in nursing school haha

I could be wrong , but my understanding is that warmth causes vasodilation and cold causes vasoconstriction. Vasodilation causes your BP to go down. So if a client is on catopril, an ACE inhibitor which already lowers your bp, than they would need to avoid extreme warmth to prevent any unnecessary vasodilation which would further lower their blood pressure. Not sure if this is the rationale that they are speaking of but it is the only one that makes sense in my mind for those specific circumstances. Hope this helps!

I would recommend Saunders comprehensive review, it is an amazing book and it is broken down by category. I used it all throughout nursing school and it is one of the best books out there in my opinion. If anyone else has any other questions please let me know. I am thrilled so many of you liked my post, if there's anything else I can do to help please don't hesitate to ask!!

You're welcome everyone. I hope you all excell in your studies. I'm thinking about possibly typing a guide for surviving clinicals as well. Thoughts?

Studying And Managing CourseworkIt's your first day of class. Your excited, scared, and eager. All the hard work in your pre-requisites has finally paid off, and you are officially a nursing student. Your professor walks in, greets the classroom, and dives right into the syllabus. One look at the syllabus and the anxiety starts to kick in. It is several pages long. "Geez, this might be the biggest syllabus I've ever had!" You turn the page and there is the reading list--- you think to yourself, "you have got to be kidding me...there is just no way one person can study this much material!" Get used to this feeling. Not only will it start in your very first nursing fundamentals course, but it will continue all the way up until graduation. Nursing school is no joke -- it is very overwhelming. It may seem impossible, but with the right study habits and time management skills, you can and will succeed. The following are the most valuable pearls of wisdom I can give you in terms of studying and achieving good grades in your courses. What to StudyOnly study what is covered in class--this will cut down your workload significantly and make your time spent studying that much more meaningful.You must be thinking to yourself "you mean I don't have to read all 1 million chapters assigned by the professor for week 1?!" THAT IS EXACTLY WHAT I'M SAYING! Although you "should" read everything, it's just not feasible. There are not enough hours in the week to do all that reading and simultaneously prep for clinical, eat, sleep, and maintain your health and sanity. Take it from me. During my first fundamentals course, I read and studied every single page, box, etc assigned in the syllabus. I was too scared to skip anything. I was so anxious that I even started studying 3 weeks before the class actually started, which accumulated into over 5 weeks of studying by the time the first exam was even given. It took a serious toll on my health, yet I continued to read and study every page, box etc for the remainder of the course. By the time the first semester ended, I was mentally and physically exhausted and I told myself I didn't want to do this anymore. I vented to a friend of mine who was a senior nursing student getting ready to graduate, and she told me to only study what was covered in class. I thought to myself, " there's no way," but I had to try something or else I was going to end up withdrawing myself from the nursing program. So I took her advice with me into my next course. The assigned readings/ chapters list was comparable, if not larger, than the list for my fundamentals course. Even though deep down I wanted to read all of it to be on the safe side, I only read what was covered in class. I got a 96 on the first exam. For example, let's say on the syllabus your teacher assigned chapter 21, " postpartum assessment and complications " to be read and studied. However, during class, he or she only teaches certain sections of chapter 21. ONLY STUDY THOSE SECTIONS! There is a reason for this-- the professor is covering what he or she deems the most important information, which translates into the information that will be covered on the test. I used this technique all the way until my very last exam in nursing school, and not only did it prove to be correct each time, but it was probably what saved me from burning out and subsequently withdrawing from school. How to StudyStudy what you need to know as a nurse.What I mean is this: your professor won't care that you can describe why the pain felt during a heart attack is due to the buildup of lactic acid as a result of oxygen deprivation and every biological step involved in anaerobic metabolism ( and these processes are covered quite extensively in nursing textbooks). Sure, it's nice to know, but your not getting a degree in chemistry. Instead, they want to know what YOU would do if a patient presented to the ER with chest pain, important nursing actions to take during this situation, and why you take those actions. Study what you need to know as a nurse. In addition, applying what you study is most important and this is where the bulk of where your testing will come from. From day one your teachers will speak of critical thinking and the nursing process, and your licensing exam will focus heavily on these concepts. These principles are exactly what makes nursing so difficult and also why so many people will not make it through nursing school. At this point, you're probably asking yourself, " Well how do I know if I can critically think and apply what I have learned? " Practice applying what you know with NCLEX style questions. One of the best pieces of advice I can give you is to purchase an NCLEX practice question book early on in your academic career. Purchase a book that divides the questions up into sections, ie cardiac, oncology, etc. so that you can use them to study when you are covering different topics in school. Time management is also essential to success in nursing school yet very difficult to get a grasp of early on. To effectively manage your time, there are several steps to take. First off, get a calendar. On the very first day of class, mark each and every quiz and exam on the calendar. Next, and probably most important, study every day. By no means do I mean 4-5 hours a day. Not only is that foolish but you will burn out fast. Study 2 hours a day, and as far in advance as you can. Not only will you be adequately prepared, but the information will stay in your long-term memory-- there's no such thing as cramming in nursing school the night before, you've gotta know this stuff forever. For example, let's say your test is in two weeks. Start studying the very first day the teacher presents the information. Take notes in class, and clarify any missing portions with your textbook. Learn this information, then start practicing the information with corresponding NCLEX questions. At first, you will probably get a decent amount of the questions wrong. BUT THAT'S OK! This is how you learn, and when you go back to do more questions you will start to notice that there is only so many ways they can ask you about a given topic or scenario. Also, do every question you can get your hands on. I used to go to Barnes and noble, pay for a coffee, and take all of the NCLEX books out of their nursing section and do them until I got sick of them. If you practice questions and study your notes like I said for 2 hours a day up until the exam, you will be an expert by the time you have to test and I guarantee you will pass, probably with flying colors. Purchase Med/surg nursing reviews and rationales by Mary Ann Hogan. Essentially this book is a cliff notes version of your bulky med/surg textbook. It has notes on the most important diseases, procedures, surgeries etc divided by body system and is worth its weight in gold. There were several times where I replaced my med/surg text with this book and used it along with NCLEX questions for practice to learn the info. For example, let's say you are covering cardiac tamponade in class, but don't have time to take notes on it from your med/surg text. Open up reviews and rationales by Mary Ann Hogan, turn to the cardiac section, and you will find an excellent breakdown of the disease in bullet-point format which includes a definition, signs and symptoms, and associated nursing interventions. Study this breakdown, and then practice NCLEX questions on it. Repeat this process over and over for all disorders/diseases/procedures you are learning about it and you will shine when it comes to testing time. Well, that about covers it. I really hope this will help nursing students to excel in the classroom and do well on exams. If you're wondering how I did, I graduated with a 3.9 cumulative GPA and passed the NCLEX in 75 questions. Best of luck everyone. Test Taking Strategies for Nursing Students (added by staff to further help our readers)my-guide-to-making-the-grade-and-maintaining-your-sanity.pdf

The best tip I can give you is to relax the day of your test. Instead of letting the thought of possibly failing plague my mind, I thought about how great my life would be as a new RN and all the things that I want to do now that I am "taking my life back." I played my favorite CD on the way there, and was telling myself the whole time " I'm going to pass, and today my life will change. " When I got to the center, I was surprised at how calm I was before and during the exam. I actually started laughing once I saw the first question --- I couldn't believe I was actually taking the nclex. Remember 1) breathe, 2) stay positive, and 3) you have the knowledge. I passed 1st time in 45 min, 75 q. You can do it!! good luck!

Kazza, I couldn't have said it better myself. I used Hurst as well and I can't say enough good things about this review. It brings you to a whole new level of understanding and it has certainly made me more confident with my knowledge as a fresh RN.

The trick works. Took the exam yesterday, good pop up as soon as I got to my car and checked it on my phone, today my license appeared on the state BON website. =)

UPDATE: tested yesterday,75q, good pop up and..... MY LICENSE IS ACTIVE ON THE BOARD OF NURSING WEBSITE AS OF THIS AFTERNOON!!!! AHHHHH I CANT BELIEVE THIS!! YOU CAN DO IT GUYS BELIEVE IN YOUR CAPABILITIES!!!!!

On average I studied about 2 to 4 hours a day. There were days that I studied longer than that, but it was on my weaker areas. Took the nclex RN yesterday- shut off at 75 and got the good pop up. Good luck!