lwhatley

At risk for surgical site infection; At risk for ventilator associated event; Tissue perfusion impaired; fluid and electrolyte imbalance; at risk for urinary catheter associated infection; at risk for bleeding....

Searching for labs that are associated with an infection would only be helpful 48-72hrs post operatively. After ALL surgeries there will be a bump in WBC's related to the inflammation/coag cascade brought on by the trauma that is surgery... This question probably hints toward prioritizing labs that would indicate active bleeding and poor tissue perfusion...so CBC with coags, paying close attention to H&H, PLTs, ptt/inr.

Good luck. I'm an SDSU graduate and I will just say right now that the programs are incredibly impacted, and this is the norm for pretty much all BSN programs within 150 miles of the school... Get your pre-req's done at feeder schools, and don't expect much of a chance to get it if you don't have primarily A's. Ace the TEAS and get as many points as you can for the application process. Apply early. Get to know people.

The above explanations are indeed true, I just want to add that infusion rates and certain medications run the risk of literally causing trauma to the fragile beds. This rationale is also why wedging PA's is becoming outdated...the risk of blowing out the PA/capp beds is too high to continue to justify in a lot of cases.

Asking for a rectal tube is a last resort for me...it's for when I absolutely can't keep up with the amount of loose stool the patient is passing...there's a couple of reasons why this is the case for me personally... 1. In my mind, I've usually got tubes coming out of pretty much every body part in my patient, and I've got all of these sources of both discomfort, trauma, and possible infection....if I can limit even just one of those tubes going in, I'm going to do it; especially if we're talking the back door... 2. I always kind of resent the nurses that hop on the rectal tube train as soon as they see some loose stool. Loose stool happens in the ICU, especially given the scenarios a lot of these patients are coming from...post-op, tube-feeding, bowel program...get enough tube feeding and milk of mag in anyone and they're bound to be a poop fountain for a bit...you have to prepare to do a little doodoo control after the fact...warm up the barrier cream before hand, stack some chucks, run some warm soapy water and prepare for a few hours of twistin, turnin, scrubbin' and protecting....it's our job. The time that I believe a rectal tube is necessary is in the cases where break down is actively occurring...because I definitely understand contact dermatitis happens after a significant amount of time left warm and wet down there...I also believe in the use of a rectal tube when the output is putting central lines and/or wounds at risk. I wouldn't smear fecal matter in a cut anywhere on my body, so I'm gonna try to protect wounds and lines as best as I can...and in this case, it's likely the rectal tube is better safe than sorry... With that being said, like I said, I delay as long as I possibly can, and if I do put one in, I make sure I only keep it in for as short as possible...I attempt to find literally any other alternative measure I can....to be at the very least a little less emotionally traumatic for the patient.

New Grad ICU, Texas: $20/hr for orientation period, $24.95/hr after orientation with +$3.50/hr differential for nights, and +$4.00/hr differential for weekend.

No they delayed their January Internship, so they did interviews for their ICU internship positions this past week for a program that starts March 10th.

I really don't want to ruin your day, but the enforcement process takes at least 4 months it is one of the most painfully annoying processes ever. They don't communicate with you regularly, and they actually get really annoyed if you call them for updates. I'm so sorry. The $150 doesn't make a difference, they'll blame the time period on the amount of files they have in the office and the lack of employees to meet the amount...it's pretty much ********. You just keep yourself busy. You have to. There's literally nothing you can do about it. You HAVE to wait it out, just study, do your questions every day, and keep busy.

I just interviewed at Scott & White temple.

Baylor has posted their new grad positions this week, UT southwestern should be following shortly. Ben Taub Memorial posted theirs, and new grad positions for Parkland are popping up a couple times if you browse the career postings regularly...

The priority, before ANYTHING ELSE for this patient is to correct the oxygenation issue she is ailing from...but to do this, we have to figure out the CAUSE of her respiratory issue... The pt scenario tells me that my pt is communicating her complaints, which means that her airway isn't probably compromised. She's telling me that she's short of breath and that she's anxious...these two symptoms are commonly paired, because when I can't breath, I'm anxious about suffocating, but actually, in THIS scenario, that anxiety clue is more significant.... What do we know about our pt's trauma? She broke what? She broke her femur. Only the sturdiest of human long bones. Oh no. What risks are associated with long bone fracture? Oh Boston! I see your post...you were leading, great, sorry, you're on the right track...Boston wrote a really good hint....a long bone fracture is prone to throwing fat into the blood stream. So without actually writing out the answer to where I'm leading you, let's just get you really close... If pt's long bone fracture has been possibly throwing fat into the blood stream since the night before, when she broke it, and is now coming into the hospital confused, disoriented, and having trouble breathing, terrible oxygenation sats, and a panicked circulatory system, and is anxious...how could those problems/symptoms be related? What could be going on that would trump surgical prep 100% of the time?

All posters are incorrect thus far [EDIT: just looked at BostonFNP's post, can't assume everyone is incorrect anymore, my bad]...but not for a lack of trying... Hypoxia and increased work of breathing can cause an elevation in body temperature, as can an active inflammation process, markedly so in the very old (your patient) and the very young...but that's not the most concerning about this scenario, so ignore this for now, lets dive in... While I don't think this case study is actually trying to just give away an "infection" answer, I do believe that the correct process of elimination approach would mean you'd have to rule that out first. So don't be so quick to assume infection, but don't rule it out until you've got the labs/cultures to prove it, but keep in mind you can't conclusively dx an infection until the culture has been sent for at least 48-72hrs... Your assignment is to, with the quick pt status information, 1. list off the possible causes of temperature elevation and heart rate increases, 2. Research and list diagnostic studies and lab you should expect pre-op...so let's do this. 1a. A few causes of temperature elevation/fever/pyrexia: immune response, failed thermoregulation, infectious process, inflammation process, thrombo-embolic process. 1b A few causes of increased heart rate: sympathetic response, anxiety, hypoxia, blood loss, fluid imbalance, electrolyte imbalance, increased metabolic demands, inflammatory response 1A&B as it r/t pt: Pt is 89 yo female disoriented, confused, short of breath, confirmed femoral (hint: long bone) fx from fall likely related to disorientation/confusion. Our pt is currently unstable r/t latest VS: BP 90/65 (concerning, but not my priority), Resp 24, sat 89% (emergency) temp 38.6 (still not my priority, but concerning), pulse of 140, definitely concerning, especially after combining that result with the others...pt is ACTIVELY COMPLAINING OF SHORTNESS OF BREATH AND ANXIETY. What's my priority? Before even going ON to list the pre-op check list basics... My patient is hyperventilating, and extremely hypoxic. Something is going terribly wrong....(posting this, continuing on another post)...

A rule of thumb for pharmacology in general as it pertains to nursing practice should be to memorize the ins and outs of the most frequently used meds (usually cardiac meds and pain meds), then focus on memorizing facts about certain meds that have the most serious risks/side effects. Safety is a nurses priority. Memorizing the meds that pose the most risk to safety is always beneficial to your future practice. But for now, in school, stick to the teaching style of your professor in order to meet their individual expectations from the course, you have your entire career to fine-tune your pharmacological knowledge/expertise.

Completely depends on the preferences of your instructor. The best advice I can give is to review the syllabus, specifically under the examination heading. Professors sometimes detail what to expect from the exams. Also, the way the content is being taught in lectures can give hints as to what type of questions will be asked. Does the lecture focus on brand name/generic name memorization? Highlight side effects? Are important interactions bolded/emphasized? How about pt education required for appropriate use of medications? Professors tend to bold/italicize/underline/emphasize the material they believe to be the most important, use those identifiers as trends, if there is a certain pattern to what is emphasized, chances are it will be the topic of at least one question on the exams.

Before I dive into the advice, let me start off by saying that I'm sorry you're feeling lost and overwhelmed, a lot of people on these boards can relate, you're definitely not alone. With that being said, here's some advice, step back and take a look at your history of learning, ANY learning. 1. Identify a Learning Pattern. Yaknow all those random facts of knowledge you have stored in your brain? The ones that you either feel odd for consistently remembering or repeatedly being reminded of over the years? My examples: I'll never forget the names of the great lakes because the mnemonic H.O.M.E.S, or I can recall the names of every state because I learned that song way back when in elementary school, I never missed a deadline date or appointment after I write it down in my planner...etc. After hitting nursing school and feeling the same frustration you felt by being suckerpunched with a massive fist of content/material, I was desperate to figure out the best way for me to retain the information in the least amount of time for the sake of using the spared time to retain the information from OTHER nursing topics/classes (exhausting, I know, hang in there). So, given our experience in at least 12 years of schooling prior to nursing school, I decided to call upon that experience and try to I.D the times that I felt like I mastered material, didn't matter what kind of material it was, and exactly HOW I did it...was it a memorable lecture? Did I go and ask the teacher to give me another explanation? Did I study the topic with a group of peers? Did I watch an interesting movie? Draw a diagram? Etc. The pattern I found for myself was that I learned best from being exposed to the lectured content. Professionals in the biz call this being an "Audible Learner". Remember those learning styles? Kinesthetic? Audible? Etc...the learning styles I didn't exactly believe could be condensed into such few styles? Yeah, they were on to something....anyway... Use this pattern identification to then outline your future learning & study habits. Keep in mind that you might have a different learning style for different types of courses, like how I learn the content of History Courses better by actually reading the textbook (its the ONLY subject that this remains true), and I physical science concepts, for me (and probably most), are learned best by actually conducting an experiment in a lab. There are exceptions to rules and different unique methods you'll find for yourself as you go along. By the end of nursing school, I figured out that I actually could cram (never responsible) for exams better if I color coded the material, and that I could sit down and focus for longer periods of time if I listened to dubstep with no words....it's the little things, but remain consistent! You'll notice results! 2. Establish a Study Zone Self explanatory. Establish an area that you use and associate primarily for studying. You'll find yourself more focused and productive later on. I could not EVER study for classes in my house because I was the type of person who would rather talk myself into prioritizing ANY household chore over remaining focused on studying stuff. My study zone was the library, and I literally spent DAYS at a time there (not recommending that practice, just admitting my experience). 3. Resourcefulness is the Key to Success Have a painfully boring professor that you can't stand to listen to for more than 10 minutes? Are concepts of certain courses being explained in a way seemingly more complicated than astrophysics? Time to move on to a different source of knowledge...but howww? You already noted some experience in this supplementation suggestion with how you use the NCLEX review textbooks to review concepts you've encountered in class, great! Here are some more that I used while I was in nursing school, I still joke that at least half of my degree should be attributed to what I learned on behalf of Apple, I probably should owe them tuition... Podcasts, Itunes university, youtube, and specialized forums like this one (allnurses) were invaluable to me over my nursing semesters. The more ya gotta dig for podcasts/videos/recordings on topics you want clarification on or an alternative teaching method on, the more well-rounded your understanding of the topic will become. My psych nursing lecturer taught in a format that may well have been in pig latin for how well I comprehended the content, sometimes I'd eve recognize a concept I actually REALLY wanted to know more about and the prof didn't deliver the way I would have liked, so what did I do? Dave's Psych Lectures podcast on itunes was AWESOME and taught me the majority of usable/testable content from the course in a style that I felt was tailored to ME, but this resource took some time to find, there are a ton of podcasts and itunes university pages on the subject of psychology, like I said before, ya gotta dig, but once you find that lecture that you felt was written and composed FOR you, you'll be glad you did the work to find it. Non-internet based resources to consider: 1.Attending medical conferences in your area. Most of the content will be above your head, but exposure to the material will help you in the long run, and it's an excellent opportunity network, and I don't care WHO tells you otherwise: nursing is, and always will be based on WHO you know first, and WHAT you know second. Took me a while to actually swallow that news and resent not networking more before graduation, but the concept as repeatedly been reinforced during my job hunts. 2. Keeping current on Journal Articles coming out. You don't have to understand the intricacies of the results being presented, but like attending those conferences, exposure to the material and the content being actively researched will help you cement topics you're currently trying to nail down in a variety of your classes. Making associations is one of the best ways to remember ANYTHING, it's how your memory works the most effectively. 3. Concept maps, drawings, comics: I drew things out, I marked diagrams, I made inappropriate comics about certain topics so that when I came upon them later on, I could laugh about making stupid comics about it, and then be reminded about all the data I tried to jam into a stupid comic, again, associations are awesome, get creative. Bonus: not sure what you're interested in, but assuming they're similar to my interests, here are some of my favorite podcasts that I still regularly listen to: Mark Crislips podcasts (persiflagers, puscast, quackcast), EMcrit, EMbasic, Frontline, ICU Grandrounds, ERcast, Tedtalks. Summary That's all I got for now, but mostly because in the time that I spent writing this out, I neglected the actual project that I need to finish sitting right in front of me. Remember how I said I can't be productive in my own home? Basically, exposing yourself to content in as many ways as you can will help ensure you remember it, but don't waste time exposing yourself to the content in a way you know doesn't jive with your learning style. I stuck with lectures because if people kept TELLING me about the topic, I could almost start reciting the material. I also figured out that if I wrote something down a couple times, I could remember it forever, so I started writing out ALL of my notes instead of typing them out like I used to in previous classes, my grades inflated! Find your pattern and expose yourself to methods that get along with the pattern you identified! Hope this helps.