BirdFeederLady

I work as a veterinary assistant, a CNA, and a cat-sitter. I may try to get a a PCA position in a hospital per-diem this summer. Two more final exams to go before senior year! WooHoo!

As Beautiful B stated, "Thank you to all of you. . .extremely wonderful and kind-hearted. It makes me happy that there are people out there . . ." like the crow's caretaker Triage RN and her father-in-law. I'm sorry that the crow did not make it, but at least you spared him some suffering, Triage RN, suffering that your heart now seems to be assuming. We are all connected. What you did mattered, and your sharing made my heart a gladder place. Thanks again for the care, all you kindhearted folk!

What does RNCS PC mean? (They belong to an instructor of psychiatric nursing.)

[Originally posted by wooh: "Wasn't there, but looking back there were times that instructors would hit me up with stuff like that, and if I could just verbalize why I did or didn't do something, that's what they wanted to hear. I consider it training for sticking up for yourself against holier than though MDs."] I like your take on things, wooh (devil's advocate). Before reading the four pages of responses to my original post, I could not have been nearly as eloquent in explaining my reasons for not "going there." In the very detailed care plan we are required to submit, we must comment on eleven functional areas, the ninth being sexuality/reproductive. For this patient I wrote, "This area was not assessed," going on to discuss the norms of pubertal development for males of my patient's age. The instructor makes notations in red pen and we are then required to address all of her comments. She wrote "Why?" above my "This area was not assessed." I submitted my revisions last Thursday, and my answer was informed by this forum: "I took underwear to be a declination. Due to psychosocial developmental issues, I did not feel this was appropriate for the kind of focused assessment I was doing. Doctors would have been able to assess this at the time of surgery." Regardless of my instructor's response, I have really learned a lot by her challenge and your responses. I look forward to continued learning about the nursing process!

Thanks all for your interpretation of what is appropriate in the "real world." In the meantime, I'm struggling to survive this crazy world called "nursing school". . . Time to go back to writing my care plan!

Well, your assumption is close, because when I expressed my incredulity that I was expected to examine the genitals, my instructor said that while I was assessing his abdominal region, I should have lifted up the elastic waist band of his underwear and taken a quick look. Thank you for your feedback. This is exactly the kind of information I was looking for: what exactly is and isn't done in real-world nursing.

Wow, Clee1, that's a strong response, but it does a lot to validate my own instincts regarding the issue.

I hope I will get some gentle tips/assistance with an issue that came up during my first pediatric clinical rotation. I am a junior in a BSN program, and naturally we are expected to do a head-to-toe assessment of each patient. My first pedi patient was a 13-year-old male recovering from a laparoscopic appendectomy. This young man had his underwear on, and I did not even consider asking him to remove it, feeling this to be an unnecessary intrusion. I was quite surprised to find out in post-conference that I was expected to evaluate his sexual maturity according to the Tanner Scale! When I expressed my surprise, my instructor explained that by failing to assess his genitals, I was not doing my job. Feedback is requested: Is this is a real-world expectation? If so, then I request help in how to approach this with my patients. . .Thanks in advance for any assistance! Finally, I want to hasten to add that I assessed for abdominal pain, rebound and guarding, and I auscultated bowel sounds X 4 quadrants, evaluated the laparoscopic appendectomy dressings for drainage, and the like . . .but I really can't come up with a justification for checking under the poor kid's underwear! I want to learn to be a good nurse, and I treasure this forum for helping me learn the ropes!

Sharann: "Where did your instructor get this from?" Answer: I really don't know, but for the longest time, I thought CAT must be the acronym for "Can't Answer This!"

Answer: Codeine-Associated Triad: Nausea, Vomiting, Constipation

Thank you, VickyRN, for being a such a great resource. I have visited briefly the excellent websites you provided, and will study them at greater length in between (or after) Thanksgiving preparations. Thanks, also, to my fellow student Amanda for reaching out to another student. Good luck with those final exams! For my affective domain goal, I shall use our combined effort: "Client demonstrates a progressive state of self-confidence AEB client rating himself as 7 or higher in ability to manage catheters on a scale of 1-10." Thanks to both of you once again!

Having the client rate his own confidence level sounds like a great idea! Thanks!

My dim understanding of the 3 domains is that cognitive is "thinking", affective is "feeling" and psychomotor is "doing". This is my work in progress: Cognitive: Client identifies 5 infection control techniques in caring for his urinary catheter and drainage bags. Affective: Client will express confidence in his ability to manage his indwelling urinary catheter and drainage bags. (I just don't know how I will make this measurable, for evaluation purposes . . .) Psychomotor: Client demonstrates proper technique for connecting his catheter to a drainage bag and for emptying his drainage bag.

Okay, I'm struggling with a teaching plan assignment. I'm teaching a gentleman about catheter care and management, so my working cognitive goal is "Client identifies 5 infection control techniques in caring for his urinary catheter and drainage bags." I'm struggling with the affective domain. How can I write a measurable goal about attitude? Arrgh! Any help will be gratefully accepted!

"if there is something you question and have not done it before -- don't do it." Thanks for your guidance, onconurseRT, I shall take it to heart.

"why do you give Pepcid IV instead of PO?" My patient was NPO at the time . . .

Thanks for your kind replies, all. I'm learning about IV Pepcid and more!

In response to P_RN's query, "However, what was the written order? Students need to follow the rules while students": I've had one day of exposure to the ICU, and another day in the ED. I will be now be spending 5 days with an instructor on a med/surg floor. So I will have no opportunity to see the order again. I was doing my best not to slow the nurse down, who wasn't thrilled with my presence. (She had no idea she'd be working with me until I arrived, and exclaimed "Great!" (sarcastically) upon finding out I was assigned to her.) That said, I do hear your warning about "following the rules." Having read many of the posts about being "guests," what is a tactful way to follow the order (which I believe was to use a slow infusion pump) while maximizing the opportunity to get "hands on" that this nurse was graciously giving me?

Q from Bipley: "Any chance it was Protonix vs. Pepcid?" No, in fact it said "famotidine" on the syringe label.

Hi, this is my first semester in med/surg, so bear with me. I shadowed an ICU nurse last week. She had me give Pepcid via IV Push instead of with a slow infusing device. She said, "If you want to run around, find an extension set, set up the infusor, you can, but it's an H2 blocker, what's the point?" Since I didn't have the keys and the knowledge to independently get the proper equipment, I followed her lead, which seemed to indicate that only an anal idiot would bother with such things. Can anyone tell me why an order would be written for a slow infusion of Pepcid? Is it irritating to the veins? Thanks in advance for any help you can give!

Hi, I am a junior in a BSN program. My Med/Surg prof. posed this challenging question for "bonus points" and even after hours of searching on the web, in textbooks, etc., I have failed to find the answer. I thought of "cat" as being shorthand for catecholamines, and asked her if the cat reaction would be medical slang for an overactive and excitable response to a narcotic, rather than the expected drowsiness, that is, CNS stimulation as opposed to the more common CNS depression. Her response: "Nope!!! Keep trying." She did say in response to another email attempting to provide the answer, "The CAT reaction has to do with humans, specifically women. Hope that helps." Does anyone have any leads or ideas for finding the answer to this question?