lkoch002

The patients condition was not suggestive of hypoglycemia. He had AMS, which began improving with lactulose. Even after getting dextrose and such, his mental status did not change from baseline. .it did not improve. It makes sense to immediately check blood sugar in an emergent situation knowing nothing about a person who is non responsive, and of course, his blood sugar was taken upon admission and was satisfactory. As mentioned above, he was getting Cbc and BMP every morning. I agree that status changes should be assessed. Knowing that glucose was within normal limits, ammonia was the next target, which proved to be the culprit. That being said, after the course of treatment was already determined, I wouldn't think that blood sugars are necessary based solely on the fact that a patient is getting back tube feeding. Diabetes is diagnosed by back set of values. Correct me if I'm wrong, but triglycerides, A1C values, abdominal girth...DM2 doesn't just happen over night to warrant continuous monitoring. I'd come closer to thinking DM1 would be the one to just pop up, as it's usually acquired through genetics. ...symptoms start showing up, triggering an office visit, then tests are run for diagnosis. I guess what I'm trying to say is that it's unnecessary to check blood sugars based only on the fact that a patient is being tube fed. If hyperglycemia is the concern, i say its better to have too much than too little. In class, we were told 140-180 is what ICU patients need because of the stress they're unser. Anyways, the issue was whether or not we take blood sugars...based only on the fact that a tube feeding was going. It's an issue that many at my hospital are facing. Some nurses qmd care partners think its necessary, while others do not. They just recently sent out an email saying blood sugars will not be taken without a doctors order. ..so i guess that clears that up.

Thanks for all the input! I really appreciate the insight! :)

If a patient is on a tube feeding and has no history of diabetes, do you automatically take blood sugars based on the sole fact they are getting a tube feeding? My thought is "no. You're using the gut, so it's kind of like me eating something. ..I don't take my blood sugars because I'm not diabetic. If it were TPN, I would say you do take blood sugars, so that you can manage it, as TPN is typically higher in sugar content". That's my rationale. ..so I'd like to hear what everyone else thinks about the topic. A nursing care partner got really upset with me because I told her the patient was not on blood sugar checks and that i had not taken any. There was no doctors order. He had no history of DM...her reasoning being that he had a tube feeding. He did have altered mental status, but upon admission, his blood sugar was fine. His ammonia was high, which lactulose did it's job...mental status improved.

Thank you, all, for your responses. It's very nice to hear words of encouragement, especially coming from those with experience. I truly respect the experience of those, who have been in this longer than I have, and I'm such a fan of teamwork and support. Your advice and tips are very helpful, as well. I agree that it is human nature to be "snarky" and just negative. There are times that I can lean that way, too. It just makes for a horrible working environment, though, so I work hard to put a smile on my face and look for the positive in every situation and every person. I just hope to inspire others to take on a more positive attitude, too. If not, that's ok...I'll just keep doing what I'm doing. Life is too short to be miserable, and being a nurse should never be miserable. I feel it's a blessing to look forward to going into work. It's not a place of misery for me. I just hope to not ever get burned out.

I'm not one to give up, but I sure have had some trying times, as a new grad in the ICU. There have been days that I feel I am getting the flow of things and am able to think ahead and even suggest treatments for my patients. Other days, I feel completely lost and have a hard time keeping up (i'm slow with everything. please tell me I'll get quicker) and it's worrisome to me, especially when there seem to be so many scrutinizing eyes. Just a little background of my experience so far. I started orientation in November. I was hired for a night position, but I started off with a preceptor on day shift. I only just started nights last week. Anyhow, I have been bounced around between preceptors, either because they were sick or had other things going on, so that has made my experience a little bit more challenging. It has been nice to see the different nursing styles, though. Overall, I'm enjoying nights better. The teamwork and working environment is much more cohesive. Whereas, on days, there seemed to be so much more tension and turmoil among team members; a lot of gossip and unnecessary drama. It seemed that people were more concerned with what others were doing wrong rather than being a supportive network of coworkers. I felt the hostility and didn't much care for it, and there were remarks made and behaviors that were suggestive of talk behind my back, too. I come from a place where the new guy is crapped on, until they make senior in rate. (nuclear power). The thought 'nurses eat their young' compares to the same mentality, so I know that, if I could make it through that, I can make it through this, too. Add that to my very new experience of being a nurse and it makes for stressful times. I know that I will gain confidence through experience. I know my weak areas, and I work on those. I just don't like feeling judged. That's the one thing that I truly struggle with and try to put behind me. I really appreciate constructive criticism, but the negativity and hostility that I sense from the unit at times is for the birds.

Thank you!!!!

I just got offered a job in the ICU, as a new grad! I honestly didn't expect to get so lucky, but I did work very hard for good grades and elevated our student nursing association to a higher level, as president....so hard work pays off! At least, I credit these factors as being part of the reason I got hired. I did 120 hours of preceptor program in another ICU, which didn't have the acuity this one does. I have to say that experience wasn't the best. There was some underlying tension and my preceptor was not invested or even interested in my learning experience. ..I feel this opportunity is completely different. The unit culture seemed much more positive band supportive, especially towards new grads, so I feel that my orientation and training will go great! That's very important to me, as this is a career change, and I have experience only from clinicals. (I was a navy nuke for I.5 years). Anyways, I am very excited and would appreciate any words of advice!

I would love to have you as a preceptor! I'm a new grad and have experienced those preceptors, who obviously hated teaching and let that trickle over into their behaviors, as a preceptor. ..not good experiences. You sound perfect!

I'm not sure what the exact circumstances are. I do know I applied at the first of September and my application was denied, saying the position had been filled. Then, I got a call the day after I passed the nclex for an interview. I thought that was odd, so I checked their website and another application had been submitted on the 29th of September. I hadn't submitted another, so I don't know how that happened. It seems that they might had selected a new grad that failed the nclex, so they immediately opened the position back up, or they had somebody quit. It was rather odd, but I'm very happy that I got the opportunity to at least have an interview!

I didn't even think to send a thank you card! Thanks for that tip, JustBeachyNurse! She did not give a decision date. I did really well on the scenario questions, psu_213. About how long should I give, before I call the recruiter or expect to hear back?

Just a preface: I'm a new grad, who just passed the nclex. This is a career change for me. I did 8.5 years in the military as a nuke electronic technician. I just had my first interview this past Mon, and it was to the ER. I feel that it went ok, but I really can't tell. I kind of clammed, when asked about my reason for wanting to work there, giving a very short and succinct response. I did all right with giving a brief history about myself, and I blew the scenario questions out of the water. I asked questions about their orientation and remarked on the things I knew about their department and facility. The manager gave me a tour and gave me her card, telling me the recruiting manager will be in touch with me. It seemed to end on a positive note. She kept apologizing for being late. I really didn't know what to say to that. I let her know I wasn't bothered by it. "Things come up, and it happens". She said she had more interviews to do and I'd hear from HR this next week. I really want this job, so the wait is a but nerve wracking. I honestly don't know what to expect. (If I'd gotten the job, I'd know in the spot???) What do you guys think?

How do you feel about the Lippincott books? Those are what I'm using.

Hi! I'm take the NCLEX in about a week and a half and have been using the Lippincott review book and have been wondering if anyone else has had success with this book. It seems to be the run of the mill review book, but I'm not sure what it really compares to. I've been hearing a lot about Saunders and feel I should've gone with that. Anyhow, I'm really nervous about this exam! I did really well on the Hesi exit exam, and I hear that it's a good indicator of how I'll do. I don't buy into that, though. I feel like I was more relaxed, which contributed to my success, knowing it didn't really count against me or gaining a license. That being said, I know my weakness is exam anxiety. Of course, the unknown is terrifying. Thank you for any words of advice and encouragement!