RonCA84

I'm relatively new to hospice, but after training with several other nurses; I've come to an understanding of morphine, haldol and ativan usage. I would continue to administer morphine as ordered, even if the patient isn't groaning. I felt the same way about holding morphine since patient was unresponsive and resting but not complaining of pain (grimaces or moans) while on morphine but although metabolism slows down, and your pt's hepatitis or hepatitis-like dx is present, we administer to prevent breakthrough pain (many cancer patients) or rebound pain. In regards to feeling youre speeding up the process, do your research on roxanol and haldol and become familiar with dosages so you can use your nursing judgment to advice hospice to increase or decrease dosages. Pt respirations may slow down but it does not happen to every patient. Signs of active phase of death/decline include all the sx you've described. Also if hospice pt have hx/sx of alzheimers/dementia; take a closer look after administering ativan. Active ingredients in ativan sometimes cause lil relief in agitation with these pt, that's when I'd call hospice and ask to switch to haldol for "ineffective relief of terminal agitation." We're here for the patient, if family can't arrive in time, well they just won't arrive in time. I've had to tell myself over and over that I'm there to comfort my patient and be an emotional support for family; trying to lessen their dosage so family can arrive in time isn't in the patients best interest (pain wise). It's such a fine line, but rest assured you should feel no guilt. I commend you for entering an excellent speciality and wish you the very best with all your hospice patients and families. :)

I took the exit hesi, passed both times (school makes us take it twice)...interesting the first one I scored 857...but I knew I psyched myself out and then after the hesi live review class I scored 1110. I knew reducing my nerves was key... I totally get you...I'm prepping for NCLEX and just will do my best to keep focused, but still balanced. Not saying you're not, lol... Exciting? Definitely!!!! Look forward to you passing in five days!!!!!

You really need to relax - change your attitude, it will make a big difference. Read material on "the process of elimination..." i had a fantastic instructor from TN visit our campus for a hesi live review and her advice really helped... prepare yourself on identifying HOT KEY WORDS for every question, answer your question first before even looking at the options, if two answers are almost identical then it's probably not the one, and above all.... prioritize! Whether or not the HESI and NCLEX passing rates are accurate to one another, you are doing everything you should be doing, get at least 3000 questions done overall, take breaks, sleep well, eat well, and reduce your stress. Judging from your post, you're panicking and you need to get a hold of that. I might sound harsh, but I'd prefer this to be a wake up call for you to think "I don't have control over what's on the NCLEX, but I'm going to pass because I'm doing my best..." PERIOD. A blessing for you - I'm sure you will do well. Keep us in the loop =)

Everybody is right, you've made this far down the road, keep going and don't stop!!!!!!! Treat yourself to a little vacay as your reward, remember what brought to the program and what you will create once you have your license! Good luck and keep on going!!!!

I can relate to what seems like a very sloppy, disorganized LPN/LVN program (according to what you have shared with us). I could go on about my LVN program, feels similar in that many students have not done a foley, barely know how to handle a needle, chem strips, wound dressings, g-tubes, ng-tubes, ostomy care, etc. But I would like to answer your question and offer a piece of advice. No, that is not normal for your entire class to be located at one site and remain at one site. (from my experience and most friends' lvn programs as well). Many are split up (8-10 students per clinical site) similar to what was shared earlier, and in our program we are assigned the same number of patients according to the # of rotation we are in (e.g. 1st rotation - 1 pt, 2nd rotation - 2 patients and so on) and required to turn in q2 charting with a full care plan. Considering you only have three months left for you to graduate and take your exit boards and nclex, too much time has passed; my advice is to focus on studying for your exit hesi, OB hesi (4th term here and what we are preparing for) and make time to look up procedures (youtube, etc). You can get an idea of what it looks like and prepare yourself. You can be more proactive and approach the staff to shadow during procedures (not assuming you haven't done so, but just throwing it out there.) But like i said, at this point in the game, focus on moving forward and forget this school. At least now, you know how prepared you need to be the next time you are researching a program (hopefully RN). Hope this information helps. Kick butt on your exit hesi, be well. =)

thank you for posting this, begininging my OB/Peds rotation myself and definitely gives me plenty to research on, learn, and observe. And yes, the attitude will always carry one on either side of the spectrum (postive or negative). Thanks!

I was a former volunteer and completely agree with many of these posts. Starting out, you obviously will not remember where everything is located or how every process works, that is what time and experience provides. I received praise from many nurses and staff for learning these steps and "anticipating" items, procedures, or processes (within our scope as volunteers) could do right away. If I didn't know a step, I would ask "if you have a moment to show so that I can help you in the future more effeciently, I'd appreciate it..." BOOM that will win them over (of course if they are busy, do not expect it). Good luck and since you are a student, keep those eyes and ears open, learn!!!

I break it down into smaller segments; first of all to drop the nerves (especially in front of a clinical instructor) and secondly to focus on the vital sign. So I start with temperature, Assess: what does my reading show from my thermometer? how the patient feel? (subjectively) how does the patient feel? (objectively) I look at this like writing an english paper. Make an outline and write down your own flow. Half the battle is performing the assessment, the other is practicing your presentation in front of your clinical instructor. Good luck, study your VS, and let us know how you do. =)