eaRNed

I'm just starting in a new trauma/PACU/ICU live-in unit and I am trying to learn and re-learn a few things. I was hoping someone -- or several someone's -- could explain (as in-depth as we can go) the implications of a CBC with differentials and what information I can gain from this? What does each section indicate and what changes should I look for? I realize that I can get this information from wikipedia, but there are a lot of hints and tips that come from experience that I cannot gain from reading those sources. Thanks!

I actually just moved from Rome to Atlanta. I attended school in Dalton. Do you work at a hospital there?

Hey everyone, I'm a young guy 2 years out of school. I've just moved to Atlanta to start a new job and I was just wondering what all of you other nurses do to meet new people and have fun while still working crazy hours? I've lucked out and landed a M-F 3-11p shift so no weekends, but I'm not sure what to do with myself now that I have weekends off. Any suggestions? :)

I actually just moved to Atlanta. I'm a young guy not long out of nursing school (2 years) and depending on the area, the starting pay seems to be around ~$23/hr for that amount of experience. Depending on what exactly you're bringing to the table, and shift-diff etc., you can bump that up a little bit. But overall, I feel like that is a fair rate. Like has been said, getting your foot in the door somewhere is the hardest part. Once you've landed a job, worked it for 6 months or so, and networked with the right people, a lot of doors open up that way. What part of Atlanta do you live in?

Grady Memorial in Atlanta? I have been looking at hospitals in the Atlanta area. I actually interviewed for a position in my current hospital for an ICU position and it has been 2 1/2 weeks and I JUST got an email concerning a follow-up phone call/interview. Apparently they do not get in a hurry with making a decision.

Amen. I currently work on a cancer floor and this could not be more true. Once you have worked with cancer patients and their families (and you WILL work with their families haha), you will never treat your job the same.

I would definitely not stick it out. If you plan to do anything other than LTC or nursing home, you need to start getting med-surg experience under your belt. You should stay until you are able to get your foot in the door (and internships, etc. are a great way to do so as some have suggested) at a hospital. I went in to nursing for two reasons: personal enjoyment and money. And I certainly won't sacrifice either one. You should be doing a job that makes you feel good when you leave, no matter how hard you work. And we are intelligent, hard working professionals and should be paid as such. So, in a nutshell, my advice is to look elsewhere, don't stop until you find a place where you are satisfied with both, and be proud

There are a couple of things I agree with in this person's post. First off, I work on a Med/Surge floor with an entire wing dedicated to Oncology patients. I think that this will be beneficial to you in just understanding the impact and varied treatments of different cancers. The theory behind cancers can become quite complex quite quickly and most nurses will not need to know more than a basic understanding of the more common cancers to succeed. There is plenty of additional learning available after you achieve the elusive RN title and I do feel this is best left as a specialty (there are not going to be many, if any, questions on the NCLEX over this so don't fret). Secondly, as a relatively new nurse, I can with absolute certainty tell you that you WILL teach yourself a LOT. I would know absolutely nothing about anything cardiac related if not for my own reading and studying. My teacher for this section was pathetic and spent more time speaking about her crippled leg and grandkids rather than covering possibly the most important section to my nursing career. Do not depend on your teachers to tell you everything you need to know, or even everything you need to know to pass the NCLEX. Learn to weed out what matters from what doesn't and take your education into your own hands. Call light in reach. Will monitor.

I feel it's generally a grey area at times. I usually look at patients as stable, stable at the moment (but soon to be unstable), and unstable. Someone with chest pain, diaphoretic, with an altered mental status is obviously not stable. Someone who is becoming bradycardic with only symptom being palpitations could be considered somewhat stable but my guess is, 9 times out of 10, this won't last for long. It's hard to put defining factors on such a broad area but generally any sudden change in LOC, or basically a new-onset of anything would make me think either unstable or soon to be there. I hope this helps :)

I work on a Med/Surg floor with an Oncology wing. As it stands, we generally get any and all patients who are battling cancer. That being said, there is usually patient on our floor who is either inpatient Hospice care or soon to be discharged home with Hospice. I am a young, new, male nurse and I can certainly handle death and dying but this is a sad area to work in and it does take a special person to handle the pressures that come along. You will run in to families in denial (which is a struggggggle sometimes), difficult families, vast cultural differences, and a constant struggle to remain emotionally detached. I do wish you the best and all the luck. I hope this helps!

Oxycodone/APAP would be Percocet. Lortab would indeed be Hydrocodone/APAP. That would definitely be something they need to correct on your sheet... as that would directly impact your answer haha. As for the question itself (and I may have looked over this) but what program are you in exactly that is requiring you to do these calculations?

I don't think the OP is saying that he/she is 'settling' nor that they have no desire to learn. I think the situation is more of a lack in experience that the OP is worried about. I was in basically the exact same position when I came out of school. I passed boards in 30 minutes with 75 questions and got a job within a week. Did I know what I was doing on my first day? Hell no. What do you do when you're going to check on your patient only to find them standing at their door, nothing on but their socks, pushing a chair out in to the hall because they think it is a grocery cart? What do you do when you have that first, huge pressure ulcer dressing change with packing to be performed and you never got the chance in school to even see a wound? What about the first time you notice someone having a stroke but the attending MD refuses to even allow you to order a CT of the pt's head? These things have/do/will happen. They have all happened to me. And I got through all of it with one word: Help! Learn that word, because you will need it. I had an excellent, patient mentor throughout my beginning and I can only hope that you will too. I'm finishing up my second year as an RN and I feel much more confident. I'm the youngest charge nurse within the hospital. I do a good job. But I still need help basically every shift that I work. It won't be easy, but I wish you the best. Good luck!

I know at my hospital we do a comprehensive check of the chart orders for at least the past 24 hours once per shift. I don't know if this is an actual policy but it is certainly a good practice. That being said, I am also a young, new nurse and I have certainly missed my fair share of orders. Thankfully, I have no med-errors to my name but mistakes happen. We work long hours and we get tired and distracted (although these are never acceptable excuses!). We just have to learn from them and take the time to ensure we don't make the same mistakes twice (or in your case, three times ). Also, I have been pulled to our ICU/CCU many many times already and they not only check their charts once per shift but take the time to go over all orders, no matter how mundane, with the nurse receiving the patient in addition to shift report. I hope this helps. Good luck!

Let's get right to it shall we? 1. I understand the rationale behind NPO prior to procedures but something that I have never really been able to get a clear answer on is why is a patient NPO prior to something non-invasive such as an abdominal ultrasound (assuming no anesthesia would be involved)? 2. Can anyone offer a good method/website/tutorial on reading EKGs? I am somewhat familiar with most rhythms but I am certainly not comfortable with them nor could I pick them out while they run across a telemetry screen (well maybe asystole or v-tach/fib ). 3. If you could have only ONE medical/nursing reference book, what would it be? I think it would be great to have a nice, sourced, medical reference at home that I can have to comfort me on the long, cold nights that my girlfriend can't make it over. Thanks in advance for all your help. This site has been a tremendous help on more than one occasion. Most of the time I find that many others have questions similar to mine so I don't have to post very much. -eaRNed

Stool samples. Nuff said.