JVerne07

So I was able to make this connection the other day, actually. In the absence of insulin, cells can't use glucose and the body starts to break down fat and protein for energy. I knew this, but for one reason or another - I think it's because the focus in DKA is so heavily on the byproducts of fat metabolism - it didn't click that protein catabolism = low serum albumin. Understanding that critically ill patients in general are hypermetabolic and will likely be losing a lot of their protein is useful too, so thank you.

Oh wow! Thanks for the help, I can't believe I didn't piece that together.

Hey there! This is a bit of a crosspost, but I'm a student having trouble understanding a couple lab values going back over some clinical paperwork. Why would a patient in DKA have low total protein and albumin levels? My texts keep saying that hypoalbuminemia and DKA can occur together, but not exactly why. Can anyone steer me in the right direction on the pathophysiology here? Thanks!

Hi all! I'm a student losing my dang mind trying to figure out why a patient of mine (who was in DKA) would have low total protein and serum albumin levels. Can anyone steer me in the right direction with the pathophysiology here? Thanks!

Re: your program - where is the deficit in points coming from? My program is points based as well, and they were allotted for having taken prerequisites and specific bio courses, GPA, entrance exam score, and prior medical experience. If you really think you'd like it, I know surgical techs who love their jobs. It's a good option. Having experience is always useful, I didn't have any going in and the curve was steep for that reason. Truthfully, my classmates who were CNA or EMT trained prior to school seem to transition the best.

Oh my god, both. Actually... before it's usually a good bath so I can preserve my hair. Afterward, it's a sincere shower. On full steam, with some serious loofah. I'm a weirdo though and at the very least I'll take off my scrub top and hospital shoes before I get in my car.

Hey everyone, thanks for taking the time to read this! I'm a student nurse in my final semester of school, and have been attending clinical in ER and ICU. I love these areas. Pacing is exactly what I have been looking for, and they click with my way of thinking -- "What deeper picture is there to see? Given the pathophysiology, what problems could emerge here, and how am I going to stay on top of them?" I think I could, with some experience and practice, be pretty happy over in critical care. The psychological side of nursing has been my biggest challenge. I'm proud of my growth. I've learned that when I'm able to manage my stress well, stay positive, and stay confident, people are generally easier to work with. Others perceive me better, I am happier, my actual clinical performance is better. Now the problem part! ER nursing! I'm faltering down in the ED. Some of my favorite instructors and nurses to work with are ones who hold a high bar, I learn so much from them. I am so grateful for a steel-faced instructor who pushes me. Where I'm running into issues, it feels like, is the sink-or-swim environment in ED. I think we've all encountered the kind of nurse that seems to be testing our mettle, and is less than constructive in the process. I realize that respect is earned in this area by stepping up and taking all that nice nursing school stuff in my head and *using it* to *do things*. Further, I can identify this type of personality as just sort of an unfortunate reality that I'll have to figure out how to cope with. Problem is, when I'm under these people lately, I absolutely WAFFLE. I hate it! I shut down. The way it's manifesting (for instance) is that when there are ten people milling about a code, I'll lose my nerve and not have the confidence to jump in and help. This is unlike me, clearly a plan of action is needed. SO, what helped you step up early in your career? How were you able to maintain your confidence? What kind of mental exercises did you do, where did you find support systems? How did you continue build your skills later on in school? Advice and feedback are very much desired here!

I'm a student set to complete my ADN in less than six months, and have personally agonized over the ADN vs. BSN issue. There is immense pressure to go out and get your BSN (I plan on starting mine the second I complete my current program) because the job market is leaning more and more toward BSN nurses, at least as far as new grads go. I'm aware that some job opportunities will be available to me as an ADN nurse, but not really within the pay grade, hospitals, or specialities that I would prefer -- or consider equitable. Having compared my curriculum with those of various BSN programs in the area, I see no difference between us in terms of actual clinical skills and time spent in the hospital setting. The RN to BSN bridge that I'll be taking consists of theory and research classes, a dedicated pathophysiology course, and one course focusing specifically on physical assessment. This requirement that I continue to go to school is one that I accept, and I am actually pretty fond of school/plan on continuing my studies beyond the BSN level. I do consider the entry point somewhat unfair to nontraditional or less advantaged students (like myself) who have eked out their degrees utilizing quite a lot of grit, against financial and personal odds. I don't really see this changing at all, but if you're listening, maybe consider that ADN nurses should be recognized as capable and hard workers and at the very least given a shot.

Oh god! I recently watched this show and I relate to Zoey so much in that as a student/new nurse you feel like a total goober who is just trying to stay positive, make friends, and make the best out of the situation you're thrown into. Like, I know I we come across as corny, terrified, green little things, but MAN don't you remember meeting some of those battleaxe veteran nurses and being like PLEEEEASE LIKE ME, I JUST WANT TO BE GOOD AT MY JOB!

I have to break it to you, gently I hope, that coming across as a person who doesn't prepare is the #1 thing that will make life impossible in nursing school. Your instructors will not be motivated to help you, and may (as I think might be happening in your case) be more inclined to grade you harshly because they feel you haven't done your end of the work. I speak as someone who has been on the receiving end of this kind of smackdown. This is why communication is so vital. Email an instructor to clarify assignment instructions, make sure you review what you expect to be doing the night before clinical, have backup supplies in your car, memorize that syllabus, admit when you are fuzzy on how to do something, show humility. Your recourse is to do whatever you need to in order to show instructors that you are prepared and motivated to do well. Sometimes you have a rough clinical, a rough semester, or a poor instructor fit... get up and do better :)

Ug, this is exactly what I needed to read today! I go into preceptorship and then graduate next semester. Clinical this semester is hammering me. I've recently taken on the policy of asking whatever potentially stupid question I need to because I *sincerely* want to graduate with as few gaps in knowledge as possible... I don't want to hurt anyone! I don't want to be the one reason a patient winds up with some completely avoidable complication because there was some finicky detail I just didn't know. I'm not gonna lie though, some of the feedback/pushback I get as a result of this feels harsh as hell and it does seem like there are folks out there who want to straight up haze us. Questioning your goals/abilities/existence appears to be kind of a hallmark experience of nursing school, and you do have to learn to toughen the **** up or just not survive. Some days I just have to remember that I'm here to gain skills and try to cull as much as I possibly can, then go home and privately nurse my butthurt so I can pull it together and do my job when I'm called on to do it.

In the email that was sent out, is the math exam they referenced the same as the ATI? Or totally different?

I did my CPR certification with Prism, and they were pretty good. Very close to CSN too. My main concern with getting a titer is that for some reason I won't be immune to whatever they test for, and I'll have lost the time I'd need to get vaccinated by Jan 15/16. Am I being a little paranoid?

Somehow in my frazzled haze today I managed to forget where it is that we're supposed to go and buy our uniforms. Anyone know which room I need to go to, or if they're available through the bookstore? Also, I bit the bullet and bought the entire book package today. I'm curious about the ebooks because they do look very useful, but I don't think I'm ready to switch over yet.

Also, sorry if I'm giving you guys information you all already know, but if you buy refurbished from the Apple site you can save a decent amount on an iPad: Refurbished iPad - Apple Certified, 1-Year Warranty - Apple Store (U.S.) I buy just about all of my devices this way and I have *never* had an issue.