lillymom

That's going to be what most of your clinical experience will be. Talk to your instructor and let them know what exactly you would be interested in and maybe if they see a pt. like that they will assign them to you. When I was in clinical I kept getting stroke pt's and I talked with my instructor about it and she made up a paper with all our names on it and asked us to put the admit Dx on it so we would get more of a variety. It was also a small unit so we often asked if we could float to another unit and they allowed us each to do rotations on other units.

So this may sound crazy but talk to yourself. Seriously, I mean act like you are going to teach someone what you know or find someone to teach. Start by verbalizing what you know then think of some questions that someone may ask you and if you don't know look it up then teach some more. I have always felt the best way to learn is by teaching because it uses verbal, visual, and interactive/cognitive thinking. For example: CHF is the loss of the ability of the heart to pump blood. Why? Various reasons including MI, HTN, bottom line the heart has had to work too hard, S/S well class that depends on the side of the heart that is affected. Right - generalized edema Why? because there is a back up of blood due to the decreased ability of the heart to pump so it accumulates in the body. Left - SHOB, orthopnea, pulmonary edema, and right sided failure too. Why - because the blood is now backing up into the lungs and they are literally drowning. There is just not enough pressure (due to decreased muscle strength) to adequately empty the heart (low BP). Also relate the body to things that you know. Again, with CHF, a failing water system - someone threw a cheeseburger in a well (clogged arteries leading to MI). The cheeseburger went into the pipes and got stuck blocking some water but the pumps know that more water must go through them so they continue to pump harder (HTN) to get more water then the cheeseburger is dislodged or someone removes it (cardiac cath). Well the first pump (right side) is tired after all that and burnt out so it quits. Well eventually the pipes get full and the well is overflowing even though the other pump (left side) is working hard to get all this water circulating because now its doing the work of two pumps! It can't possibly keep up because it wasn't designed to pump that much water. So the water backs up into the well, into the pipe, into the first pump, and into the pipe between the two pumps and now you have a problem. The pump will work but will eventually get tired to from working two jobs and it too will quit. There are quite a few other components involved with CHF but you understand the concept and how it is a chain reaction. Many systems and functions of the human body can be likened to other things that we know and use daily and it makes it much easier for me to learn that way. Just an FYI I taught myself this way through school and I was one of the top students in the class and passed NCLEX on 75 questions in 45 minutes or so. Good Luck!

They have said to aim your Q-bank scores around 65%. Any specific content area that you score less than a 55% is a weaker area and needs further studying. On question trainers 1-4 they recommend a score of 65% or higher and Q trainers 5-7 a score of 60% or higher. Some of this information will be in the front of RN Content Review Guide and it also has a study plan depending on how long before you take the NCLEX.

The wait is killing me. I have registered with Pearson and my state board, completed my fingerprints, turned in my photo identification, my background check is complete. The only thing I am waiting on is for the Dean to turn my approval into the state board and I finished my classes last week. It is driving me crazy because I have a job offer and I want to start ASAP! Good luck on the exam. PS: I would call Pearson if I were you.

The answer to that is definitely HOB first. O2 will help provide more oxygen but the main problem is that when someone with pulmonary edema is not sitting 9O degrees a greater amount of the lungs surface area is obstructed by fluids so giving more O2 doesn't help because there is not enough O2 exchange sites. I was taught to think like a bottle of liquid 1/4 full. When the bottle is sitting completely upright it becomes collected in the bottom and only takes up 1/4 of the base of the bottle but when you start to turn the bottle on its side it spreads out more and covers much more of the interior of the bottle's wall, closer to 40-50%. This is what happens with pulmonary edema with L. side HF.

There is definitely a place for holistic nurses where I come from. I live in a mountain state that has a large city with many holistic residents in the outskirts. The local hospital actually has a holistic nurse team so when any of the nurses feel that a patient needs this we call them. They are absolutely wonderful and I have seen them lower BP's, HR, anxiety, and pain when nothing else would work. I also think that most nurses believe that society as a whole is over medicated as I and the majority of my classmates certainly do. I also believe in prevention over treating when sick but there are some things that actually do need medical treatment regardless.

I agree with the other posts. I am just now finishing up my program and the first year I didn't understand much and I couldn't figure out how to prioritize care. They didn't really discuss Maslow's, Bloom's Taxonomy, in-depth assessments, or ABC's. They were focused on building the base and the above concepts are a little more advanced. Now when I started my second year this stuff started getting hammered into us. When we asked them about not teaching this stuff earlier they said that we simply did not have the fundamental knowledge to apply the concepts correctly so to teach this before then could be a detriment to the learning process. So for the HOB vs O2 the answer is always HOB. Why? Not only because you need an Rx (most policies will have a standing order for this anyway so that answer is moot) but because you need to sit them up and to help relieve any pressure they have on their airway and straighten their posture to get the maximum benefit of the O2. In other words if you kink the airway tubes O2 won't make a hill of beans difference because it isn't getting to the lungs. I will also say that they teach these things separately and randomly but by the last semester you should be able to independently make connections to the body systems and concepts. For instance when I take a test now I have to look for the topic of the question but sometimes it's not what you think it is. The question may say that they have a certain disease process such as Lupus (autoimmune) and ask you what to be concerned about (A) They will give you a normal or close to normal lab value but one that you want to monitor for lupus WBC 11,000, (B & C) they will say a typically important answer like circulation or oxygenation but this isn't really something that affects lupus pts, (D) then they will say BP 90/60 and high fever. Well I know some who would count this out because fever is expected with lupus but not high fever and technically the BP is still in range but combined with the fever this is looking like septic shock may be on the horizon and because they are more than likely immunosuppressed this would be the answer. I like A but with no other S/S it is not too worrisome because inflammation can increase WBC counts. So to answer this question you would first have to know the disease process and its treatments but also the s/s of septic shock and how the inflammatory process works. The topic wasn't really about lupus it was about septic shock and if you can independently recognize the signs in a patient whose diagnosis may mask the symptoms. Not the best example but I tried. One more last thought, answer as many questions from multiple sources and read the rationale not just for the right one but for the wrong ones too and this will help you make the connections as well. Practice makes perfect and I typically do very well on tests because I have learned on my own to connect the pieces and see the whole picture by answering multiple questions and reviewing the answers. Good luck!

We are still taught ABC first in school for assessment because the NCLEX will probably not be updated. It all about the NCLEX during school.

I am still a student but I have over 6 years of experience in various health care fields. I often get answers wrong on tests because I use what I know from real life and not what is written in some random textbook. When I challenge the answer the instructor says but we are wanting the correct NCLEX answers not what you would do in practice!

Well that mostly depends on you. I work as a CNA while going to nursing school and there are many things that I have seen and helped the nurse with that many of my classmates have had no experience with. It does help me some because if I can visualize it I learn more. I live in a rural area and our clinical sites are limited so we don't really get to experience too much in clinical. Imagine nine students with only four patients..... I think that $600 for a CNA class is pretty expensive unless it includes the certification exam and book, then it may still be a little expensive. It's about $300 for everything in my area. There are some students who work in the summer and they change their schedule to prn when they start going back to school to earn a little extra money without a continuous obligation but they still get the experience This experience doesn't really help with getting a nursing job but many employers will hire their CNA's as nurses when they graduate if they like their job performance. I also feel that nurses who have been CNA's before are generally a lot more understanding and appreciative of their CNA's in general, but not in all circumstances. Good Luck!

Sounds about right to me as far as a nursing home is concerned. We keep two CNA's per hall and there are about 26 residents on each hall but most of the time there is only one of us on the floor at a time between breaks and showers. We usually have 5 showers per day. We don't necessarily wash everyone off everyday because there isn't time. We do wash the face, pits, and privates on everyone daily though. We also leave the patient in bed on their shower day until we can get them showered right after breakfast. We only do this if they don't object or the nurse doesn't mind though. Every minute of working there is taken by something that must be done, unfortunately I would love to spend more time with my residents and talk to them. I try to talk to them as much as possible though while providing their care. As far as routing goes we get everyone up and change them, breakfast for residents, our breaks after residents are done eating, baths, change everyone, pass ice/vitals, lunch break, document, residents lunch, lay residents down and toilet the ones who don't, last break, document, any showers not done, then last round. After working with the same residents for a while you get to know them and their schedules and it becomes a little easier as you can mostly anticipate things and build a more refined schedule. Good luck!!

I'm a CNA in LTC and this happens. There are more people than you would imagine that claim that they cannot use a bedpan but can in a bed. Sounds crazy but it's true. Our facility has 2 hoyers for appx. 90-110 residents. It can take up to 10 minutes alone just to find and get a hoyer if both of them are being used. Aside from that if it happens to be the CNA's break time there is only one CNA on the hall and one nurse. The CNA is not allowed leave the hall so the nurse has to go in search of the hoyer. A bsc is not used because these residents that I am referring to will not use a sliding board at all and cannot sit up properly without assistance. Real life a resident will have to wait at minimum 20 minutes. I have to find the lift, find a lift sling - different pt needs a different clean sling, finding an available employee, putting the sling under pt. and hooking them up. It takes a lot longer than people realize and what if a 1 assist person calls needing to go to the bathroom at the same time? There is no solution really except for better staffing and management is fully aware of this but if the company does not allow for it then that's the way it is. It's not that anyone is being a bad nurse or CNA it's more like being able to do what you can and prioritizing what you can do. I tell patients that if you can wait I will be happy to help you but if you cannot I will clean you up promptly and apologize that a better option does not exist.

I agree with the above poster. I am in my 30's and will be graduating next May along with some others who are older than me. You are never to old to learn and grow intellectually.

I have read the OP 3 times and I cannot see any ill will towards students in this post, unless some of the sentences are taken out of context. The OP did not say they would make anyone cry. In fact they said they would take the pt. load and let the student go to a private place to cry if needed. I interpret that as someone else may make you cry but don't give the offending person the satisfaction of seeing you cry, hence the do not cry. I am there to learn, not socialize, so I don't care for the chit chat. I don't think that makes the OP a mean person, but then again I am not easily offended and I understand that there are introverts in nursing, myself included. I prefer to have deep conversations and to build my knowledge rather than talk about menial topics. I have trained many people in other various jobs and I have found that you have to be assertive with people and instruct them on what needs to be done, at least in the beginning. Giving someone instruction, encouraging them to try new skills, or pushing them to be their best is not the same as being militant. I have trained in this fashion and no one has ever told me that I was ordering, bossy, or militant. And last but not least the eyes and ears. If anyone has ever worked in an environment with a lot of people, particularly women, they should be well aware of all the gossip and watching that others will do out of curiosity. Word can spread fast in this type of environment and if something happens you can bet everyone working will know by the end of the shift.

Will you be my preceptor?! This is what I like in someone who is instructing me. I don't like to be coddled/petted like a child and I need to know what I am doing wrong. There are some instructors out there who are too nice which really doesn't help me learn and some who are too harsh and shut the door in my face (literally). It takes a balance of gentle and rare praise and constructive criticism to help me learn and to show me that someone is looking out for what is best for my nursing practice. I also liked to be pushed with my critical thinking so I can see the big picture and get a better understanding of the situation.