Starting first Clinical course this summer - 111 - want to prepare- ADVICE???

NCRNMDM, ASN, RN · Jan 25, 2012

Take a break, and don't stress too much. By the time we started our first clinical we had been checked off on IV insertion, IV push medications, subcutaneous and intramuscular injections, NG tube and catheter insertion, bladder irrigation, dressing changes, JP drains, hemovac drains, and a few other skills. Before clinical, we were given a list of 20 commonly administered drugs to make drugs cards of. We were expected to know these drugs forwards and backwards by the time clinical started. Some of the drugs on the list included: Morphine, Narcan, Phenergan, Zofran, Vicodin, Percocet, Heparin, Lovenox, and Coumadin.

When clinical started, we were placed on a floor specializing in post-surgical patients, but also accepting ICU-stepdown and medical overflow. Most of our patients were either direct from surgery, or had been stepped down from MSICU. I saw a few rare medical overflow patients when the medical floor was full. We worked with a lot of big, open abdominal surgeries, a lot of orthopedic surgeries, some trauma surgeries, a fair number of OB/GYN surgeries, and a few urological and minimal cardiac procedures. Most of my patients had undergone open exploratory laparotomy (some had minimally invasive laparoscopic procedures) with some sort of intervention (like appendectomy, resection of damaged liver, resection of cancerous tissue, splenectomy, cholecystectomy, etc).

In addition to giving medications to control preexisting conditions (like hypertension, diabetes, COPD, asthma, anxiety, depression, arrhythmias, etc) I emptied surgical drains, managed post-surgical pain, nausea, and vomiting, emptied Foley catheters and NG tubes, infused IV fluids, IV drips, and other medications, totaled intake and output for the shift, did head to toe assessments, monitored lab data in the computer, and charted all my work. If lines, Foleys, or NGs came out of my patient, I restarted them. If they needed extra lines, I started them. I was very busy each day, and the 12 hour clinicals usually flew by.

As far as committing things to memory, I can't really tell you. There are so many medications, procedures, laboratory tests, and diagnostic studies that can be done. There is no way to remember them all, and trying to remember much of anything at the fundamentals level can be intimidating. In second semester and beyond, you will get into the physiology of things, and you will begin to understand why lab values are the way they are. For instance, when a patient is dehydrated, their serum sodium and hematocrit values increase. This is because the concentration of sodium ions, and red blood cells, is increased when compared to the amount of fluid they are floating in. During fundamentals, you won't learn this information (or I didn't), so when you see elevated hematocrit and sodium levels at clinical they won't mean as much to you. You won't learn arterial blood gas interpretation until at least second semester, so ABG values won't mean much to you during clinical either. You may briefly discuss the CBC and WBC values and their meanings in fundamentals, but you won't delve very deeply into that either. Fundamentals is sort of a broad spectrum introduction to everything.

As you progress through nursing school, and as you get more clinical experience under your belt, you will begin to learn what everything means. You will see a patient with elevated hematocrit and serum sodium, increased pulse, slightly decreased BP, poor skin turgor, sticky mucous membranes, and everything will make sense to you. You will say, "Oh, this patient is dehydrated or loosing fluid somehow. I need to get to the bottom of this." During your fundamentals level clinicals, you will be so nervous that you may not put all the pieces together initially. It will get better as clinical progresses, so don't feel bad. Just take things as they come, enjoy yourself, and learn all you can. I love clinicals, and they should be something you look forward to. Good luck!

JasmineD · Dec 5, 2013

I will be taking nur 111 in January. How can I prepare and what should I expect??