Blu rose

I am starting my pre-grad in two days and I feel exactly like you do even before starting it. I feel incompetent. I am afraid of making mistakes...I have not made one in my previous clinical experiences. However, considering that in pre-grad I will have to work for six days a week, chances of making mistakes is higher. I dread the very thought of it. I agree with the comment above. I believe that I need to be more confident, so that I can overcome the fear of making mistakes. This will help me be more independent rather than looking for someone to confirm that whatever I'm doing is correct. I am glad I read your post at the right time. I needed to know that I was not alone and also, needed a dose of optimism which the comments gave me. I hope all of us turn out to be fantastic nurses because I know that we're working hard to be so! :)

It makes sense. I was thinking that eventhough cardiovascular assessment is a priority in this case, your first intervention will be to administer oxygen and then, get an order to start an IV, right? Thank you, xtxrn :)

It's not like I did not go through my books. The thing is that either the list of nursing problems is not complete in the books (I have two medical-surgical books) or weakness is simply not an acceptable NANDA nursing diagnosis. I don't think that it was a bad idea to look for help online. Thanks, anyways :)

I am sorry for my late reply. I did try to look in NANDA online but, they need you to pay for the registration, so, I didn't see it :$ I have a list of nursing diagnoses but, I don't think it's complete. Thanks.

Thanks for the suggestion :) We don't have NCLEX in Canada, though

Well, the potassium level is low- 2.9 mEq/L and I don't have the reading for oxygen saturation on the scenario (I would get it first if it was a real patient). Whatever you said makes perfect sense. I appreciate your help.

I agree that the data given is insufficient. If this was a 'real' patient, I would get more lab work but, with a scenario written on a piece of paper, you can just make assumptions. Oh, how come I didn't tell that the potassium level was 2.9 mEq/L :/ I didn't get this scenario on the test but, of course, the comments helped me think better. I passed the test! Thanks a lot :redbeathe

I agree! Thanks for your input :)

Hi, I am having trouble figuring out which one would be the priority assessment for a patient with eating disorders and having shortness of breath + hypokalemia. Would it be respiratory? I thought I would get the oxygen saturation and see if the person needs oxygen adminstration. But, then, he has hypokalemia as well. It can lead to dysrhythmia. (I don't have the blood pressure readings because it was not provided on the case scenario). Getting more confused..could it be neurological since hypokalemia can hinder with the Na-K pumps in the brain and something may go wrong with the patient's LOC? Forgot to mention that the patient had a fainting episode too. I have a huge physical assessment test tomorrow and I'm freaking out! Any timely help will be appreciated! =)

The blood pressure is 189/68. What body system do you think is affected? Which nursing diagnosis from NANDA can fit it? You could actually get more information through a physical assessment. Is the data provided by you from a real patient or is it just an assignment scenario you got?

In this case, weakness is definitley a problem for the patient as it results in difficulty walking. Just to clarify myself, I was wondering if weakness is listed under NANDA as a nursing problem or diagnosis. Anyway, thank you for your comment =)

I listen to music (well, even while studying) and sleep (I miss sleeping peacefully like before starting nursing school)

Hi allnurses, Could anyone please tell me if 'weakness' is a nursing problem? I have a patient with weakness in lower extremities. So, I guess it goes under both 'activity and rest' and neurological assessment (since the patient had anoxic brain injury). I've put ataxia and dysarthria under activity and rest with 'impaired physical mobility' as the nursing problem. I was wondering if I can put the same data under neurolgical function and put 'weakness' as the problem. Sorry for typos, if any. I'm typing in a hurry. Thanks.

Last semster, my clinical instructor got sick so, we didn't go to the clinical. She gave us some make up assignments instead. She gave us many scenarios with loads of information about the patient and asked us to write many mini care plans for the patients. Well, I don't know how will your students learn and practice new things though. Maybe find a classroom and do assessments on each other? :/

I think you did the right think because patient safety is a nurse's top priority.

Well, charting as you do things may be a good idea but, real life nursing can be really busy and you might not get the chance to chart after providing care to each client (that's what my clinical instructor said). So, I always keep a small notebook with me (that can fit the pocket of my scrub) and keep writing the important information, vital signs, the assessmentsand and the time in it.Then, later on I transfer it to the client's chart which actually decreases the risk of making a mistake because it's like a double check.

Hi, This is what I do when am at clinical. 1. As soon as I go into the patient's room, I look at their skin (see if it looks normal, blue or pale). 2. Check if they respond to opening of the door, my voice, turning on the lights or touch. (Best eye opening response- Glasgow coma scale). Then, I introduce myself to them. 3. Take vital signs and especially note the BP, so that any antihypertensives can be put on hold, if BP is low. [i don't know why but, I am always concerned about the BP eventhough the nurse might say this reading is normal for the pt.- well, the nurses know their patients well]. 4. Administer medications and check for any side effects 5 minutes later. 5. Start preparing for the bed bath. 6. Do a quick assessment while giving the bed bath---note any abnormal findings on the skin, any bleeding on the dressings etc. 7. If there's time, go back and complete the neuro assessment (or other assessment related to the patient's diagnosis). Usually there's not enough time to do a complete assessment so, I just check the orientation and alertness, listen to chest, lung and bowel sounds. I try to stick to this routine, but sometimes it gets disturbed when I have to help my groupmates with turning, holding, repositioning or bathing heavy clients. Do you have health assessment pathways? If you practice doing a priority assessment with the help of the pathways, it may help you be better at doing an assessment on your own, later on. well, this is an advice from a third semster practical nursing student..hope it helps :)

I do my charting at the end of the shift to make sure I chart everything I did. Presently, we are required to write a progress note listing the care provided, any important information found (edema, bleeding etc.) or any procedures done (catheterization, wound dressing/packing, trach care etc.). Then, there are flowsheets where we put a check mark for the assistance given with the ADLs.(bed baths, shower, toileting, skin care etc.) While flowsheets and progress notes are charted on paper, vital signs are charted on computer. It depends on the clinical facility (last semster, I did computer charting only).

EricJRN, from what you said, I think I should stick to the original diagnosis typed on the patient's chart. Also, in either case, the priority assessment would be neurological, right? Thank you for your comment :)

I see! Thank you, Ashley.

Hi, I've been assigned a patient whose chart has 'posterior fossa extra and intradural globus jugular resection' as the medical diagnosis. Even the speech therapist had typed the same thing in her progress note. However, when I did my research I found out that it should actually be 'glomus jugulare' not 'globus jugular'. So, I asked a nurse if it was a typo and she said that it should be correct if it is on the chart. Though I think it is probably a spelling mistake, I want to make sure what's correct. Any help regarding this will be appreciated. Thank you.

Well, you don't need to be scared of her. You are there to learn and if you don't get your questions answered, how are you going to do that? You have some rights as a student. If at any time you feel like your teacher's picking on you because you ask questions, you should report her behaviour to your program co-ordinator and they will have an investigation. You can also write that on your feedback about her.(I am saying this because that's how it works at my school).

Did you like or hate what you did at your placement? I think this question is important to reflect on because you will be doing those things as a nurse after all.

I know a couple of patients who are scared of nurses with artificial nails on

That's sad! I'm in my early twenties and even I don't like many people in my age group (those I know). The good thing is that not everybody is rude :)