erint91DC

This week, one of my patients was in for compression fractures of the lumbar vertebrae due to osteoporosis. She had severe, "red hot searing" pain in her lower back whenever she attempted to move, even when we raised and lowered the head of bed. Despite looking through her chart and talking to the current nurses, I didn't know exactly how old these fractures were so it was somewhat difficult to gauge where she was in the healing process. Due to my limitations as a student and the nurse's patient load, and despite my advocating for the patient, her pain management was not up to par today. Near the end of the shift, the patient had slid down in her bed. The primary nurse and I decided to boost her up. When the nurse was lowering the HOB, it became stuck on a chair that the nurse had just moved. When the nurse moved the chair out of the way, it caused the HOB to fall about 6 inches. The patient SCREAMED in pain. I became adamant that the nurse administer the PRN hydromorphone that was supposed to be administered an hour prior. I was unable to administer it because it was an IV push med and I have not learned that skill yet. I assessed the patient's back after this, and it appeared normal. Should I have submitted a report, as the patient was caused harm due to the HOB falling? This issue is complicated by the fact that our unit is quite cramped, so there was not much room for the chair to be moved away from the bed. If there are any recommendations for my performance during this event, it's also greatly appreciated. Edit: In retrospect, it may have been helpful to obtain more orders for PRN pain meds. it seems silly to do that as I am a student and obtaining these orders would somewhat be for convenience. However, it still would have helped in our care for this patient. She only had PRN orders for acetaminophen PO and hydromorphone IV push, which is odd considering pain was the main foci for this patient. She also had scheduled acetaminophen and hydromorphone. I feel slightly disappointed that this did not occur to me while I was still on shift.. However, one of her concurrent health challenges contraindicated use of NSAIDs, so that would not have been an option for her treatment.

I'm nearing the deadline for my preceptorship application and I'm struggling with what to put! We have to choose 3 options for preceptorship: medicine, emergency, general surgery, maternity, prevention, orthopedics, mental health, neurosciences, or pediatrics. I've been curious about renal nursing for a while now, I like renal pathophysiology, and the concept of dialysis fascinates me. I have a passion for providing care for clients that I see for an extended period. I would also enjoy a setting in which I need more specific/specialized knowledge (e.g., dialysis). I've had suggestions to consider geriatric, dialysis, palliative, or some other long-term care. My school's nursing staff is split on the "get med-surg experience first" debate and I feel the same. I have taken a nursing elective course on high-acuity nursing. I am considering taking a nephrology nursing elective. I am thinking medicine would be the best choice for preceptorship. I would love to gain more general experience, but I would also love being exposed to a renal setting. Questions: What would be the best choices to put for my preceptorship, considering my interests in longer-term care and nephrology? Can anyone offer a description of a typical day in renal nursing? Any other advice? I feel like I am struggling with choosing a placement.

I'm aware of how to change the IV tubing (primary or secondary) with a new IV bag. Say you come onto shift and discover that the IV tubing is 2 days past the date it should've been changed. Would you wait until the bag needs to be changed? Or would you just prime a new bag, hang that one, and discard the old one? I think you would prime and hang a new bag, but isn't that a waste? I guess wasting some IV solution is better than postponing the tubing change even later. What do you think?

Hello, I'm a first semester student and I'm wondering if my NDx are correct. Sorry for the wall of text that follows! I recently had an older adult (>80 y/o) as a patient who was being discharged. They were in rehab after sustaining right hip and wrist fractures due to a fall. I've had a hard time coming up with nursing dx for them because they seemed very healthy. Right hip DHS (dynamic hip screw) Right forearm cast Concurrent health challenges: non-insulin dependent diabetes mellitus, hypertension, hypothyroidism, hepatitis C, and afib. Used a 2 w/w with gutter. Relatively mobile, ADL's without assistance Daily meds include: Acetaminophen Amlodipine 10 mg PO Calcium carbonate Hydromorphone SR 3 mg PO TID Lactulose Metformin Levothyroxine Ramipril 10 mg PO Sennosides 24 mg PO Sotalol 80 mg PO BID Ursodiol 500 mg PO BID PRNs administered while I was there: hydromorphone 1 mg Strong social support network, daughter is an RN Very positive, previously very active (walking) before their fall, pt stated they "cannot wait to cook proper food at home" (not overweight) I've come up with three NDx, but I'm unsure. 1. Risk for falls related to impaired physical mobility, history of falls, use of mobility device (2w/w), and use of medications associated with falls. Since they are >65 years old, would I include this? Do I have to put AEB for this dx? I am going to list the meds in the data/cues section. Would it be "Risk for falls as evidenced by impaired physical mobility, use of mobility device and use of medications associated with falls; related to history of falls, right hip and wrist fractures, hypertension*, and pain."? **Unsure of including hypertension as a R/T but they are receiving antihypertensives? 2. Impaired physical mobility related to pain and discomfort and restrictive therapy (cast) as evidenced by limited ROM, pain rating of 8/10, and decreased muscle strength. 3. Readiness for enhanced self-health management as evidenced by desire to improve, effective coping skills, and no acceleration of illness symptoms. Do these seem correct? I'm more concerned about the Falls dx. I used Doenges Nurse's Pocket Guide for Diagnoses, Prioritized Interventions, and Rationales + NANDA's Nursing Diagnoses: Definitions and Classification 2012-14 for this.

Like BusyBSN said, a lot to study with not enough time! You become a pro at time management and organization.

I've always found that I retain more by handwriting notes! Instead of writing outline-style lecture notes, I tend to write all over the page with arrows, different sized fonts, colours etc. I'm already able to connect the information in lecture, and re-writing my notes after improves my retention even more. Sadly, there is just so much information in NS that no matter what, I take ages to do handwritten notes. I cannot seem to cut down the time with it! Usually, I underline/circle/highlight/abbreviate while reading my textbooks (gassspp! defacing textbooks), and then I type up shorthand notes from that. I do this one small section at a time, but it still takes a long time . I also make flash cards with the prototype meds in pharm. I include the med class on the front, and on the back, indications, actions, pharmacokinetics (route, duration, onset, peak, half-life), adverse effects (group them by the system they affect), drug-drug interactions, contraindications, cautions. I fit all of this on the 4x6 cards. I do not copy the textbook; I paraphrase as much as possible without taking away from the info. Got a bit carried away with this! Haha I like to share/compare study methods :)

Thanks! This is pretty much what I've been doing, keeping a calendar with due dates and working on things ahead of time. I feel fairly organized but it never seems like enough in this program :/ I have found that moving helps :) If I'm reciting meds or reviewing skills, I like to walk around my room. Wow 23 credits? I think most of my complaints come from the fact that my workload has stunned me. Previous to this, I was taking 3-6 credits for a couple of semesters (prereq's weren't offered in the same semester)! So although I am working very hard, I can always manage time better. There's really no time to stress.

Yes, I understand that it will only get worse. I'm sitting for so long on my days off because there is a humongous amount of work to do.

The general school scale? I'm not sure about that one. However, anything below 65% for our nursing classes is a fail.

I know credit hours aren't the most realistic thing to judge the difficulty of a program, but isn't 16.5 credit hours per semester really unreasonable? This is my first semester and I haven't really done anything other than school. I read on my bus rides to/from school and clinical. Classes are from 8:30am to 4:30pm on Tuesday/Wednesday, clinical from 6:30am to 2:30pm on Thursday/Friday. I'm pretty much studying every single moment that I'm not at school, but I still can't finish all of the pre-readings! I'm able to finish assignments on time, but it's still pretty stressful. I'm overwhelmed, but not too much. Most of my concern is regarding my health (sitting so much) and wondering how I'll do 5 more semesters of this while giving myself a bit of balance. I have started some exercise. Mainly yoga and moves to get my heart pumping (i.e., burpees!). However, I still sit on my butt minimum 12 hours a day when I have days off from school. This includes mini-breaks, where I get up and walk around the house, talk with mom, play with the dog, etc. Is this typical NS? 16.5 credit hours? I know this is probably quite common, having a first-semester student complain, but does anyone have advice?

Sorry that you may have to retake it! I have a friend that finished the admission requirements for the BSN program a few years ago, but they had to postpone it to have a child. By the time she was ready to start the program, they had completely remodelled the program and she ended up having to take another year of prerequisites! Sometimes it just doesn't make sense. Hope it turns out alright for you :)

I wouldn't rent a textbook. You may need them in the future and if not, you can always resell them for some money back. I recently resold a few books that have been laying around and I made almost $400!

Thanks! That's basically what I expected.

As in, how do schools generally place you into your clinicals? Do you get any say in the matter? Do you need to have an interview or anything like that?

So I just received my acceptance letter for the BSN program at Douglas College! The letter included the supply/book list, instructions, etc.. but a blood pressure cuff wasn't on the supply list? They only list a stethoscope, gloves, scrubs, shoes, books, and penlight. No BP cuff. Isn't that kind of odd? Maybe they would either have them for us at school, or they'll tell us to buy one during the orientation.