pixiebuddymick

Oh YES we are! That is all my first clinical is. Literally. The PCAs are sitting there twiddling their thumbs because we are doing a lot of what is considered "their" work. I will be honest. At first I thought umm, I am not sure I want to do THAT. But you do it and move on. Even though I was emptying a bedside commode 10 minutes ago, working side by side with the wound care nurse to assist with a wound vac change afterwards was totally worth it. Makes me nuts to see nurses who like to pin the responsibility on somebody else and wander off. Not that everyone does that but still if it is something you can do in your scope of practice to better someone's care, just glove up and do it.

I TOTALLY GET IT! I am right there with you. Second year as well. Hang in there. Interestingly enough, my grades are actually way up from the previous semesters. Some of my friends in the program ask how I did on an exam and I say I got an A (total shock to me I got an A on my foundations nursing exam... first one) and they say "you are SO smart!" and I sit there feeling like I know absolutely nothing. I am not one of those students you see who gets an A on everything and goes "omg I am going to fail". I have gone from a C to an A in part two of this course somehow. Yet I go into clinical and you would think I just started yesterday. Scares me. Intimidates me. My clinical instructor can be as sweet as pie, then at the flip of a switch a complete troll. I leave clinical ready to cry. Then I realize I am doing this for my patients, not a persnickety clinical instructor. And if I have made it this far, I must know something. I right now am just going back through to brush up on basics. For example, my head to toe (that I passed and did really well on for return demonstration final last semester) is GONE. Just poof. Left. So I made a reference sheet for myself. I've always been told by a friend who went through nursing school that "you know more than you think you do". I believe that and have found it to be true. Sometimes I just do not TRUST that I know something. Then again, this is my second year. This is my first clinical. I have only been to clinical 3 times. I shouldn't know everything. Hang in there.

I like the idea of incorporating her a little! Thank you. She already asks questions about what she sees on powerpoints. Might as well practice some teaching!

ATI is the devil! Ok only sometimes. I actually have found some of the practice for pharmacology helpful. It isn't always specifically what I need but provides some review. I remember the tutorials from last year being painful to watch and when answering some of the questions at the end I felt like they had nothing to do with the material covered. I haven't experienced that this year though so we will see. There has not been a huge emphasis on it yet. The communication interactions can be a little entertaining to watch.

I know I am not alone here... I am by myself tonight with my recently turned 3 year old daughter. I should also mention that tonight I am trying to study because I am not concerned with the super bowl! Her father was so here I am. I feel guilty leaving her to entertain herself but I also am in nursing school after all and somehow have to get through this... We have already switched activities several times. She now wants to play a game on the Wii her dad plays with her but as he is not home, she wants ME to play. Besides the fact I do not know how to play Metroid or whatever is on there, I really can't be playing video games instead of studying. I keep having to turn down her offers to play with her and it makes me a little bit sadder each time. If only I could REALLY get her to understand the importance of what I am trying to accomplish at her young age. So I try my best not to get frustrated when she interrupts the lecture I am listening every 5-10 minutes. At this point I feel like I either am a bad parent, or a bad student. But nursing school is all about finding a balance right? Now in my second semester as a sophomore, I am finding that I have to up the studying. I am also finding that with a three year old in her developmental stage I have to up the involvement factor significantly and answer "why?" after every statement I make. Any ideas fellow parents? It is not always like this, but at these times I feel guilty. And of course I have an exam and a quiz tomorrow. Can the super bowl NOT be the day before an exam next year????!

Well I have made some MORE corrections. Realized neck and spine are not bilateral, they are medial, so they would not have full ROM bilaterally.... and a couple other things. What I am now doing is posting each section on a forum on our school page in hopes of having it reviewed and critiqued by the person grading it because at SopranoKris pointed out, this grading is very subjective.

I know! Talk about some ANXIETY! I am afraid I will forget something. And don't forget I still have to do the actual assessment..... ahhhh! What I really, really, REALLY wish had been provided for us was an example. Just one! I've been scouring the internet, putting the sections from my textbook together to double check, re-watching the videos.... just still seems like so much information.

GOOD point. I suppose dental X-rays would be necessary. I think we are mainly looking for the presence of visible fillings. And for turgor the way they have showed us documentation is to say the skin is elastic and also discuss the turgor. Yeah it is a lot... Overwhelming at times. Any other major duplications jumping out at you? Thanks.

Whoops! See that's why I was wondering if anybody else saw anything that jumped out. After reading it so much it becomes a sea of words. Thank you.

For dorsalis pedis, I was putting too much pressure and could not find it. I start with the second toe from the big toe, and move down with LIGHT pressure until I find it.

If you have access to this, what I have recently started doing is bringing a laptop to each class. I would always take written notes in a notebook but found I couldn't get the information down quickly enough. I am the type of person who likes to have novels instead of outlines though. I type all of my notes and review them later. I find I don't miss as much information, and it is easy to reference and edit later. Also... writing so fast, sometimes I can't tell what I wrote later!

Hello! New to the forum because I browse it frequently while studying looking for bits of info and decided it was time I join. On Tuesday, yes, coming up WAY too soon... I have a final return demonstration of a Head to Toe assessment. I have been practicing in advance and writing up my documentation to make sure I have the correct information. I already went to my lab instructor to review the documentation but I still have questions. I will post my documentation below. Basically, we are told what we have to assess, have to recall it and perform it without any notes, and document it without any notes. So we were told to memorize our documentation. We are given a paper that has the systems we are assessing listed, and we document according to system. Here are my questions.... 1. We have to name each cranial nerve we are assessing. We are only assessing II, III, IV, VI, VII, VII, VIII, IX, X, XI, XII. Originally, I had under Neuro that Cranial Nerves blah blah blah were intact. Now, I am told we ALSO have to include the cranial nerve in the other systems. How do I do this? I feel like it gets very wordy and sounds awkward. 2. Under Ears, Mouth, and Nose, my instructor wrote "type" next to "client is able to hear whispered two-syllable word bilaterally while putting pressure on opposite tragus". What do you mean "type"? Type of pressure? I'm lost. 3. Under Head, Neck, and Face... instructor says it should NOT say rotation in "neck rotation and shoulder shrug resistance against strength 5+". She said it should be ROM. But this isn't necessarily range of motion, it is the muscle strength grading? Or is this testing of the spinal nerve in which it is a totally different concept? If we do not pass this we do not pass the class. I want my documentation to be absolutely perfect. Everything has to be detailed. I have looked up documentation online and what I have found would NOT fly in my class because basically we have to explain every single step like they have no idea what we are talking about. Has to be VERY clear. Any advice is GREATLY appreciated! Thank you and Happy Thanksgiving. Integumentary System Skin is warm, moist, and dry to the touch throughout. Smooth and even tone to skin throughout; anterior and posterior, no nevi. Skin color is beige with pink undertones. Hair is of natural color and is free of pest inhabitants. Scalp is even throughout, no lesions or dandruff. Turgor return is prompt, skin is elastic, no lesions. Patient shaves legs. Health Promotion: Used sunscreen on exposed areas of skin in the winter when going outside. Head, Neck, Face Skull is symmetrical and normocephalic. No lumps, lesions, or tenderness. Hair on scalp is distributed evenly throughout and soft. Trachea is midline without deviation. Face is symmetrical with no drooping bilaterally. Thyroid not palpable. Frontal and maxillary sinuses not tender to palpation. Preauricular, postauricular, occipital, superficial cervical, jugulodigastric, submandibular, submental, deep cervical chain, posterior cervical, and supraclavicular lymph nodes not palpable. No warmth, tenderness, or edema in neck. Neck rotation and shoulder shrug resistance strength 5+. Health Promotion: Wear a helmet when you ride horses. Ears, Mouth, Nose Nose is midline with no lesions. Patency in nares bilaterally. Ears are symmetrical, with no thickening of the skin bilaterally. Pinpoint lesion on earlobe bilaterally. Client is able to hear whispered two-syllable word bilaterally while putting pressure on opposite tragus, verifying Cranial Nerve VIII (Acoustic) is in tact. Buccal mucosa is moist, pink, and free of lesions. Teeth are white and straight. No caries present. Uvula rises midline with phonation. Tonsils 1+. Health Promotion: Brush teeth twice daily and after meals. Eyes Cranial Nerve (Optic) I in tact, verified by Snellen chart with results of 20/20 OS, 20/20 OD, 20/20 both. Cranial Nerves III, IV, V (Oculomotor, Trochlear, Abducens) in tact verified by Cardinal Position Test. Peripheral vision intact. Pupils measure 5mm bilaterally. Pupils are equal, round, and respond to light and accommodation. Sclera is white, conjunctiva is translucent. Iris is flat and round with even coloration. Cornea is smooth and clear. Health Promotion: Wear sunglasses daily when going outside. Thorax/Lungs Anterior and posterior chest symmetrical bilaterally. Elliptical shape with downward sloping ribs. Patient is sitting in a relaxed posture. No lumps, tenderness, or warmth on posterior or anterior chest bilaterally. No lumps, masses, or tenderness upon palpation of spinous process. Bronchovesicular breath sounds heard bilaterally posteriorly and anteriorly. No abnormal or adventitious breath sounds bilaterally posteriorly and anteriorly. Respiration is regular, unlabored, thoracic, regular depth, at a rate of 12 respirations per minute. Anterior/posterior transverse diameter is 1:2. No lumps, tenderness, or warmth in anterior or posterior chest bilaterally. Health Promotion: Avoid second-hand smoke Abdomen Abdomen is flat and symmetrical, absence of pulsations. Active bowel sounds in all quadrants. No bruits heard over aorta. Tympany heard upon percussing. Patient denies tenderness and does not guard during palpation. Abdomen is soft and palpable with no organomegaly or masses. Spleen not palpable. No CVA tenderness bilaterally. Cardiovascular/PVS Right and left corotid artery 2+. No bruits hear bilaterally. Radial and brachial pulse 2+ bilaterally. Posterior tibial and dorsalis pedis 2+ anteriorly. No edema or pitting edema bilaterally. No jugular distension detected at 30 degrees bilaterally. No heaves, pulsations, or lifts. Patient denies tenderness in chest. No pulsations or thrills palpated over heart. Apical impulse not palpable. Apical rate was 76 bpm. No extra or abnormal heart sounds. Nail beds on all 20 digits pink. No clubbing with a profile sign of less than 160 degrees. Capillary refill of less than 3 seconds in one digit on each hand and foot. No edema found bilaterally. MS Patient has full range of motion in all joints assessed; neck, shoulders, elbows, wrists, digits, spine, hips, knees, and ankles bilaterally upper and lower extremities. No lordosis, kyphosis, or scoliosis observed. Normal spine curvature. Joints and muscles symmetric bilaterally; no swelling, warmth, crepitus, masses, or tenderness. Muscle strength 5+ in neck, shoulders, and upper extremities bilaterally. Neurological Negative Babinski sign. Negative Romberg sign. Speech, appearance, and behavior appropriate to the setting. Patient identifies sharp and dull touch bilaterally. Patellar reflex 2+ bilaterally. Firm grasp bilaterally. Cranial Nerves II, III, IV, VI, VII, VIII, IX, X, XI, XII intact. Patient is alert and oriented to person, place, and time.