cloudtalk

Thank you!! That actually might explain it - I work with dialysis patients, so they do tend to be a little acidotic before treatment. I was thinking maybe fluid overload might be a contributing factor as well. It just bugs me that I seem to be the only one who notices the elevated respiratory rates :/

Hi all. I'm hoping you can help me out and tell me what you'd do in this situation. Sometimes I count a patient's respirations and arrive at a high number, like 30-40 breaths/minute at rest. But when I ask the patient they deny any shortness of breath or trouble breathing, they can talk just fine, and their spO2 is 100%. I feel odd recording the vital signs without any intervention, but I'm not sure if any intervention is needed, or why the respiratory rate is so high. Also, my documentation ends up contradicting the data recorded by my coworkers, many of whom seem to record the respiratory rate as 18 every time. Part of me starts to doubt myself, like I'm counting wrong, but what could I be doing wrong? I look at the clock and watch the rise and fall of their chest. I also sometimes get a number that is a little low, like 10, with no other concerning signs, and again, I'm not sure what to do. Should I put on oxygen, notify the MD, write "will continue to monitor", or what? Any help or advice would be appreciated :)

Hello all, I was hoping you could give me some perspective/feedback on my plans for working as an RN after I graduate in a few months. I'm currently working as a PCT in dialysis, and they have offered to hire me as a nurse when I get my RN. I'm grateful, and it's interesting and I like it most of the time, so I'd like to stay to learn the nursing aspects of it. Also I think it would be a little bit easier way of starting out as a nurse since I already am somewhat familiar with a lot of it. But I'm also thinking of the bigger picture. I'm going to need a broader knowledge base. I really think I would benefit from the extra training and support if I was able to get into a new grad residency program. I know there will be a much steeper learning curve working on a regular hospital floor, and I'd like to get past that with as much support as possible. I think I'd like to work in an ICU, and probably eventually go back to school for a graduate-level degree. So, would it make sense for me to stay for about 4-6 months to train and work as a dialysis nurse, and then apply for new grad residencies (and stay in dialysis prn)? The residencies I've looked at in my area say that they define a new grad as a nurse with less than a year of experience. But I'm wondering if it would look good or bad for me to have a few months experience when applying for these. Would I have a better chance of getting hired if I applied as a newer new grad? Should I just stick out the first year in dialysis and then apply to regular RN jobs? Or can I have the best of both worlds?? I want to make good decisions; any advice or feedback would be appreciated!

Thank you, those are helpful links. So, I take it that it's a phenomenon that's not very well understood, but likely a result of a a variety of factors? However, I'm still concerned about the post-rinseback blood pressure being significantly higher than the pre-rinseback blood pressure. For example, the SBP might be increased by 15 mmHg over a period of a few minutes. Is that normally a part of what occurs with intradialytic hypertension? Will it normally stabilize over the next few hours post-treatment? Thanks again.

So, I've noticed that many patients have a higher blood pressure after their dialysis treatment is completed than they did before it began. Do any of you know why this happens? I know that sometimes blood pressure medications can be dialyzed off, but I don't think that is always the cause. One thought I had was that if their blood pressure is pretty stable throughout the treatment, it is because fluid is being gradually pulled from their tissues into the blood vessels to compensate for the fluid we are pulling out. So when I rinse them back, the ~250 ml of fluid that is returned to their blood vessels is the cause of the increase in blood pressure, as it isn't immediately reabsorbed into the tissues. But I don't know, would that be enough to cause a significant increase in blood pressure? Another thing I'm feeling confused about along with this is whether I am actually rinsing back 250 mL of blood, or 250 mL blood plus 250 mL saline. I was taught to document and add to the UF goal that we are giving them 250 mL saline with the prime, and 250 mL saline with rinse back, because that is the volume of the tubing. But aren't we actually giving them 250 mL of saline with the prime, and 250 mL blood with the rinseback? Because most of the saline emptied from the bag during rinseback remains in the tubing? I'm pretty new to dialysis, so I would really appreciate if any of you could share your understanding of these issues. Thanks!

Thank you, that is reassuring!

I'm currently at a community college. And yeah, for some reason both schools I'm interested in specifically say they want transcripts from every school attended, regardless of whether credit was earned or will need to be transferred. It not only seems unnecessary, but also it's going to be a big hassle, lol. Anyway, I hope they will be willing to give me a chance!

Thank you both for replying. I suppose the best way to find out would be to ask them. And maybe I should look into different schools. I've been disappointed by the quality of education provided at my school and I'd like to go to a school known for being better. But those schools are harder to get into. I think that as I am now I am qualified, but how I was before has the potential to diminish my opportunities. I'm frustrated about that, and wish I could change it.

So, I'm going to finish my ADN pretty soon and I want to get into an RN-BSN program ASAP. I'm doing well in my program, but I'm worried that my past is going to hold me back. The programs I want to apply to are competitive and require transcripts from every school I've attended, which is unfortunately a lot. Before I started nursing school, I struggled for many years with an undiagnosed illness. During that time, I continued to try to further my education, but not very successfully. I went to several different schools. I dropped out of a university after a year of failing of withdrawing from all my classes. Then I went to a few different community colleges due to moving around. At the community colleges my grades were all over the place, with As, Bs, Cs, Fs, and Ws. I'd always think at the beginning of the semester that I was ready to pull myself together and succeed, but often as not I'd end up feeling poorly again and stop going to classes or turning in assignments. Finally, after many years, I got a diagnosis and medication and it truly turned my life around. Since I've been going to the school I'm at now, with nursing and most of the prerequisite classes, I have about a 3.8 GPA. But the RN-BSN programs I'm applying to require that I submit all of my transcripts whether I got any credits or not. My GPA from the schools I went to before my diagnosis is somewhere around a 2.0. But its so many credits and failures that even adding in my current GPA brings the total to around 2.5. Also, beyond the RN-BSN, I think that someday I may want to pursue a more advanced degree such as DNP or CRNA. But would I even have a chance of getting into these competitive programs with my checkered past? So I guess my overall question is, is there anything I can do so that my past doesn't determine my future? Should I explain these circumstances somehow in my applications? Would it look bad to disclose an illness? How are admissions committees going to view all this? Have any of you dealt with, or known someone who has, something similar? I would really appreciate any advice/guidance! Thank you!!!

What would happen if you accepted but then changed your mind if you got into another school? If they'd just charge a fee it might be worth it, because that fee is likely to be far less than the difference in tuition.

Hi all. I'm a nursing student, and I got a job as a pct in a local hospital over the summer, where I was trained and worked full time for three months. Now that school is back in session, I'm done with training, and I work a couple days a week. I really try to do all my tasks well and "by the book". But I've been finding that I still make mistakes here and there like forgetting to document something correctly, forgetting a step in a procedure, or not noticing a vital sign in a patient that should have caught my eye until I see it twice. I'm wondering if this is normal because I haven't been doing this very long, or if there is something wrong with me if I'm still making these kinds of mistakes. Feedback would be appreciated, thanks!

Thank you all so much for the advice, it made me feel better, like I can deal with this and come out stronger. Hopefully I'll develop a thicker skin. I'll just focus on learning everything I can, asking lots of questions, and staying positive; her bad attitude be damned!

Hi all, So I've been doing an internship for several weeks, and I'm feeling a bit discouraged and lost. I was expecting a lot more guidance and support than I'm getting. I was assigned a preceptor, but I feel like she has no interest in teaching me, and she ignores me unless I ask her a question. I've been shadowing her, but I feel like she is constantly irritated with me. She doesn't say anything, but it seems to me that she is shooting me dirty looks, grumbling under her breath, and is shaking her head. She certainly never has a kind word to say. And she seems to be a totally different, friendly person with anyone else. I try to be nice and helpful, and I want to learn, but I feel like she hates me. I feel like I am being left to train myself, and I could learn so much better if someone could give me some guidance! Am I wrong to want more from my preceptor? Is this normally how an internship goes? And what can I do to make this a better experience? Thank you for any advice you can offer!

Look at schools you might be interested in attending, find out what kind of nursing programs they have. I know some schools have special programs specifically for students who already have a bachelor's in another area. Think about whether you want to get an ADN or BSN. ADN might be faster, but it might be easier to find a job with a BSN. Either kind of program will likely consist of 2 years of nursing classes (unless it is accelerated) after you finish/transfer in your prerequisites. Find out what the prerequisites for the programs are, and if you are missing any I would recommend taking them at a community college. Most schools have all this information on their websites. You might want to make appointments to speak with admissions counselors or attend open houses at schools you are interested in. You'll also need to think about how far you are willing to travel for school, how you are going to pay for it, and whether you will be working and attending school at the same time. Basically, just do a lot of internet research and soul-searching, then start filling out applications! Good luck!

Thanks! That is good advice. I'm just being very indecisive because like you said, I don't want to end up regretting my decision. And some people have said it might be hard to move to something else if I end up not wanting to do dialysis.