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  1. Authorization to Test (ATT)I'll start my story by first telling you that I graduated from Nursing school this past May in Florida. A week after graduation I moved to Texas. I knew in advance that I was going to move, so that did help, but I remember it took an extra three weeks for me to get my ATT from the TXBON compared to my classmates who all took the NCLEX in FL. The TXBON website was actually very helpful, you could log on and check your "Application Status" and it would show exactly what you needed and when it was complete, a date would go next to it. After seeing that I had "completed" all the necessary requirements (fingerprints, affidavit of graduation, application, and fee to Pearson Vue, and jurisprudence exam) I started to get nervous. So, of course, I called the TXBON directly and make sure everything was okay. The woman on the phone was very helpful and you could tell the poor woman had answered this same question a million times, but she was still nice enough to explain to me that once the BON has all of your requirements as "completed" they get up to 15 BUSINESS days to get your ATT to you. It ended up taking 11 agonizing business days, which turned out to be 18 days because of the weekends and one holiday. On a side note, I do want to mention that you do NOT have to complete the jurisprudence exam to get your ATT issued to you. I just did it early because I am a true nerd. I was so excited when I finally got my ATT, all my peers from FL said they got the email at 9 am, so I was wondered if that was the only time emails went out. That is not the case, I received my ATT via email in the middle of the afternoon, so definitely feel free to check your email all day because it could come at any time. So once I finally got my ATT, I immediately went to schedule my date. I had been planning to take it three weeks after I received my letter to allow myself time to study properly. Remember I had just moved to Texas after graduation and getting into the house took longer than expected so I didn't even really get to move in until late May. Of course, when you're moving, you're not really studying. Sure I tried, and I was able to study a little bit here and a little bit there, but not like I normally would. So I was really nervous when I went to pick my date and the only dates available were for the same week, the next week, or not until August! Well I knew I couldn't wait until August, and testing the same week would have been ridiculous, so I went for the latest date I could... Thursday, June 20. That meant I would be testing in 9 days and I only had 8 days to study. Of course, I freaked out just a bit. The day I scheduled my ATT was a wasted day, I had way too much nervous energy to study, so I got on the treadmill for an hour, walked the dog, called both my parents and just tried to plan out how I would study. My plan that I created and stuck to consisted of about 200 Kaplan questions a day on top of the ones I had done here and there before I got my ATT. I also read content out of two different review books on the material I felt rusty on. I didn't read "new" material, but I brushed up on a lot of things. I think my biggest helper was Kaplan. I didn't take the review course, I only did the questions. The next few days I became a wreck. I was having a hard time controlling my anxiety, my stomach was in knots, I was eating terribly and not getting the sleep that all the "experts" say you need to get before a major exam. I had so much nervous energy I think I worked out almost every single one of those 8 days. This is probably the most important thing that I have to tell you: Don't worry what the "EXPERTS" tell youDon't worry about how to sleep, eat and study before a major exam. You know your body best, you know what works for you and you know what you need to do to get you through this. Obviously, you got through nursing school, so you know what works for you! I think the reason I had such a hard time was because I know that I like to study the whole day before and the morning of the exam. That is just how my brain functions best, I need to study a little bit in the morning just to kick start my brain and get it into gear. I don't study anything hard, I just review notes over basic simple things. 24 Hours Before the Exam:I know "experts," say don't study the day before, do something relaxing. I don't work that way, I like to study the day before. So I tried to find a balance, I only did 100 Kaplan questions, worked out and at one point even watched a movie, after all that I made sure to drive by the testing center so I could know for sure how to get there and what traffic might be like. I also made a trip to the gas station to make sure I had a full tank! I checked and rechecked probably 10 times that I had my ID and ATT ready. I also packed a snack in case I was there for 6 hours. By this point the day was coming to an end and I could feel my anxiety coming on, so I tried to do things to distract me, but I could feel my heart beat already. The Night Before NCLEX: The night before the exam I knew that I was supposed to get a decent amount of sleep, so like a fool, I tried to go to bed earlier than normal. (My exam was at 8 am and I planned to be up at 5:30) I know better than to try to change my routine but I listened to what everyone else said about how important it is to sleep the night before the exam and went to bed too early. I thought that if I just continued to lay there in the dark with my eyes closed that eventually, I would fall asleep. I was so wrong. I spent the whole night fighting my pounding heart trying to think of anything else that might relax me. Finally, I gave up fighting, turned on my light and checked my phone. It was 2:48 in the morning, and I was still wide awake with a pounding heart. I knew I wasn't sleeping and that just compounded the anxiety. So I did the only thing I could think of, I pulled out my iPad and at 3 am started to watch the most mindless television I could think of... Family Guy. Yup, I watched family guy until 4:30 in the morning, then for the last hour before my alarm was supposed to go off I browsed the internet searching for anyone else out there who might have had a similar experience to mine. I found nothing that sounded as bad as me not sleeping at all. So I listened to music till 5:30. Needless to say, I NEVER SLEPT. Morning of the Exam:Well, I didn't sleep in lol that was one worry I didn't have. I thought about the "expert" advice for about 2 seconds and threw it out the window. I know how I function best, I did some flashcards to jump start my brain, had my typical "test day breakfast" which consists of two slices of honey wheat toast with Peanut Butter, then I reviewed some notes that I had compiled over the last few days. Then I got ready, put on my favorite comfy test day clothes, kissed my boyfriend good-bye and left. Honestly, I think it might have been good that I didn't sleep the night before, I think the lack of sleep was the only thing keeping my brain from running at bullet train speeds. When I got to the testing site, I said "thank you" to my peers that wished me good luck via text and left my phone in my car. I took my purse with my ID, and ATT and went inside. There were 11 other people there to test. I won't say much about the testing center because I don't want to accidentally disclose anything I'm not supposed to, but I will tell you that security is serious, however, the ladies at the desk were very nice and very calm. I think the fact that they were so calm helped me calm down too. When I took the test all I will say is that I sat down at the computer like any other time, and just fell right into test mode. I answered the questions the same as I had practiced. This is where I think the online Kaplan questions were so beneficial, they really get you ready for the test format and getting comfortable with how it plays out. I remember looking and seeing that I was on question 71 and telling myself to pay attention so I know how many questions I have, but I kept clicking next and all of a sudden my screen went blue and I thought "oh crap, my computer froze", but it didn't. I was already done. Test time was at 8 am with everyone getting there at 7:30, and I was back in my car by 9:03. After The Exam:I walked out with mixed feelings. On one hand, I thought the test was WAAAY EASIER than everyone had made it out to be. I was actually worried because some of my questions towards the end seemed "too" easy so then I also worried that I failed. Granted I graduated from a difficult school, so I think that prepped me a lot, but I really felt like it was not that bad and I freaked out just a little too much. I know that I spent too much time agonizing over what the "experts" recommend you do to prep vice what I actually did. I, of course, went home and did the Peasron Vue Tes (PVT) first thing, I remember it kept letting me enter my information and with each step, I could feel the tears forming... but then finally, I got to the CC information and I got the "good pop-up". I knew it was definitely not official, but it was a good sign. For the rest of the day, I was still coming down from the anxiety. I think I did the PVT at least 10 times that day just to be sure it didn't change. I checked the BON's website the next day (Friday) and of course, nothing was up yet, but all my peers from FL that took boards literally had their license number up in 48 hours, before the PVT quick results were even available!!! I was hoping for the same, but I kept reading that TX only does updates on Tues and Thurs. So then Saturday morning rolled around, and nothing. Anxiety was driving me nuts, so I invested $7.95 to get quick results and ease my anxiety. Results: PASS!!!!!! I was so excited, but being the true worry wort that I can be, I knew that technically it wasn't official. So, Sunday morning I checked the TXBON, nothing, and the same on Monday. Then on Tuesday around 8:40 am I checked... and STILL NOTHING. So I started to worry, most people had their results by Tuesday, so I figured I'd wait until 9 and then call the TXBON just to inquire. I distracted myself with breakfast and then when back to double check at 9:23 am. I felt like a little kid on Christmas morning getting up, and hoping to find what I have been wishing, waiting and working so hard for. I felt like I was 10 and Christmas came early. There, on the TXBON website, was my name, and under it... a license number!!! I was officially an RN!!!!!! So that is my story... I know it is long, but I remember one of the worst parts was agonizing over what all the textbooks and "experts" say about how to prep for this exam. I can't emphasize enough that you already know how to get there. At some point along the way, you had to have figured it out because you did graduate from nursing school, which is a well-known feat in itself! Trust in yourself, do what you know works for you, and do NOT let other people get in your ear and get your anxiety levels any higher than they need to be. This test is totally doable. One of my peers even told me, the passing rate for NClex is somewhere in the high 80s! So most people are passing. If you are reading this and taking the NClex soon, I wish you the best of luck and hope you can keep the anxiety at bay! Hope this story helps!!!
  2. ICUfaq - Excellent all the way around ... Cardiovascular Physiology Concepts EKGusa - ABG tutorial RealNurseED - ABG tutorial self-learning 12LeadECG - Introduction to 12-lead ecg, the art of interpretation CCMTutorials - Intubation, ventilators, respiratory distress, critical care Simulation of Respiratory Mechanics Auscultation Assistant Stethographics Rale Reference Collection Blaufuss Multimedia - Heart sounds/cardiac arrhythmias ECGLibrary - Cardiac tracings/advanced TheMDSite - Website by Dr. Dale Dubin, author "Rapid Interpretation of EKG's" AdvancedCardiacLifeSupport.info - Mock Codes ECGLearningCenter RNCeus - ECG Strip identification/evaluation ECGSim - Interactive simulation program ECGLibrary Skillstat - ECG recognition w/time limit ICUMedicus - ICU case of the week MedlinePlus - Arrhythmias LearningRadiology - Radiology interpretation Practical Clinical Skills EKG Practice/Drill Atlas of Human Cardiac Anatomy (University of Minnesota)
  3. I know that many of you are freaking out about this important exam that determines your future, I know because I was constantly thinking about it and I was constantly on this website reading success stories. I was inspired by many people who posted about their NCLEX experience and I like to share my experience with you, and also share some of my notes that helped me. I did about 5000 questions, I went over the content a couple of times. Honestly, the most important thing is doing questions and reading EVERY single rationale. Virtual ATI was my primary source. I am totally a visual and tactile person so I used a book with lots of pictures. Example: CHF, CF, pulmonary edema, left and right sided heart failure, copd, etc). While in school, I HATED ATI, it was really hard and some questions were completely wrong and the rationales were not that clear and specific. I also hated the virtual ATI, but I had to take it. 2 weeks before the NCLEX, I started to like ATI and I was getting pretty high scores. I felt confident, now that I passed the NCLEX, I can honestly say ATI was 1000000 times harder than the actual NCLEX. NCLEX test style questions were so so so similar to ATI. I did not tell anyone when I was going to take my NCLEX, so no one could pray for me. I posted here and asked everyone to pray for me and reading the comments had therapy effects on me lol, I felt so good and confident. A special thank you goes to those who prayed for me, I really really really appreciate it. I did not do anything the day before the exam (I mean studying). However, I got a massage, which I loved every second of it, I got mani and pedi, I went shopping, watched a movie and I went to bed at 9:30. Anyway, I feel like I'm writing a book and I know that many of you don't have the time or patience to read posts so let's just get straight to the NCLEX tips and tricks! Tips & Tricks Priority questions: this is the most important information make sure you read it 1 or 2 days before the test and I guarantee that you will answer all the priority questions correctly!!! Remember: NCLEX does not want you to kill any patients or damage any of their organs or parts of their body. This is what determines competency. Ex: if you have to administer medication and you have no freaking idea if the med is given with food or without food, and you get that question wrong....you will NOT kill the patient *and NCLEX doesn't take those questions seriously. But if you miss a blood clot, stroke, heart attack s/s, blood and medication reactions and anything that can lead to death or loss of body function......that question will weigh a lot on your score, it will drop you from the top of the graph to the bottom. *Memorize: Lab values ABGs Cranial nerves Normal changes of aging Child development Math formulas In disaster: help the ones who are most likely to live Most likely to be sequential order: ( anything that has a lot of steps is likely to be a sequential order)*Examples:*Urine culture Starting a new iv *Administering meds via g tube Drawing insulins ( clear or cloudy)Inserting foley catheters ( males and females)Sterile field Personal protective equipment( what would you wear and how you would take the off) Abdominal assessment: always start with RLQ*Performing exams such as breast and testicular exam Administering ear and eye drops Delegation: Remember that the RN can only delegate stable pts to NA and LPNs. In NCLEX, you are one nurse (no other nurse is available to help you). You have only one patient. All the orders you need are written (no need to call a doctor). The only time the nurse needs to call the doctor is after she has intervened and there's nothing else the nurse can do! When you call MD about concerns: never call about something that is expected with the disease process. Such as: the pt has voided 20 cc/hr instead of 30 cc/ hr but the pt has chronic renal failure. The doctor is going to say, "Are you stupid?" Duhh! Only call MD for something that is not expected with the disease process, in order to know what is expected and not expected you need to know signs and symptoms of the disease. The nurse assistant CANNOT do these: Position hip replacement Total knee replacement ICP Acute CVA Above or below knee amputations Priority Patients: These are the conditions/patients you would see first: Compartment syndrome Central line with s/s SOBEpiglottitis (pt is dying, MD). Autonomic dysreflexia Epigastric pain (in pregnant woman) = preeclampsia**, Pain in LLQ= diverticulosis, Pain in RLQ= appendix ... Must see the above patients firsts, severe conditions can lead to death or loss of body function. Remember: acute problems comes first, chronic later In case of a disaster and need to make room in ED for new pts. These are the patients you would send home: Copd and CF laporoscopy w chest pain or shoulder pain (it is expected) Chronic conditions Meniers disease Bloody urine Kidney and gallbladder stones. These people can survive they are not dying, they can always wait a couple of days. Not priority: Teaching Sending/ drawing *lab values Pain Bleeding (unless it is coming from a major artery) *Increased/ decreased BS Documentation I personally summarized this information from my ATI books and class online. Unfortunately, we cannot share questions from NCLEX because it is against the law and you will read all about it before you get to sit. I studied all the common conditions and procedures that are common and we hear about it everyday, everything I wrote helped me a ton!!! The priority tips alone helped me answer 30 questions or more.*I have more notes to post I just do not have time to type them all at this time.*I hope you find these notes helpful and good luck, and believe in your inner strength. *If you have any questions about anything, feel free to send me a message or comment in the page. Peace and love! DO NOT KILL PATIENTS or their organs or their body parts and you will PASS! Notes: to be continued Watch From Failure to Success: My Tips for Passing NCLEX video... i-am-an-rn-nclex-tips-and-tricks-just-for-you.pdf
  4. AccelCNL

    Never Give Up on Your Dreams

    When I signed up on this site in 2006 I was at my second college and trying to get into the nursing school there. I was not a successful student at my first college (due to college shock and illness). When I transferred I thought things were finally going to change. However, things got worse. In the space of one semester, I went from feeling faint sometimes to passing out almost every day (and being a well known visitor at the local ER at least 3x a week). My grades were not that great but I was pulling through and applied to nursing schools and I was repeatedly denied. Eventually, I left that school due to chronic syncope and took a semester off and moved back home. In Fall 2009, I transferred to a school that allowed me to be a commuter student. Despite being the sickest I was in life (at that point), I was determined to do well and decided to redo all my science prereqs while completing my BA in History. I got a 4.0 my first semester and continued on that trend. I was set to graduate in Spring 2011. However, the day of my APII final I passed out on campus and had to go to the hospital. That weekend (on Mother's Day) I had a stroke. Thankfully I did not have any lasting effects due to a quick medical response. I basically had to pull out that semester and take Incompletes for all my classes. That summer I eventually began to show sign of epilepsy and by the end of the summer, I was having grand mal seizures at least twice a week. However, I refused to stop my life. That summer I attended an intense language immersion program I received a scholarship for. I got sick up there several times, but I refused to let my illness define me. I went back to school in Fall 2011 and graduated in Spring 2012. I graduated magna cum laude with a GPA of 3.79. However, despite having the GPA, at this point, I could not pass the physical for nursing school due to uncontrolled epilepsy (despite being 3 different meds). I decided to go another route and considered MPH programs. However, after graduation, I got so sick that I was literally housebound. I was having a seizure ( all types) practically every day, several times a day. I was extremely unhappy and I decided to take my medical issue into my own hands and found a second opinion. Eventually, it was found out that my issues were caused by a hormone imbalance that I was diagnosed with as a teenager that became severe as an adult. However, sometimes people cannot see the forest through the trees, and my doctors became very tunnel visioned. It took a new doctor to find the issue. Today, I am completely healthy. I have a full-time job. I finally got my driver's license. But most of all, I will be starting nursing school in the Fall. I will be moving to attend a direct entry MSN/CNL program that is 21 months long. I hope to become an adult acute NP one day and maybe become a CRNA. Sometimes, when life happens it seems like our dreams will never come to fruition. However, keep on going and NEVER give up. It took me 8 years to get to this point but I don't regret the journey. It made me a better and stronger woman. Just never give up.
  5. Over 56,000 qualified nursing school applicants were turned away in 2017. You read that right - 56,000. This is happening while hospitals and clinics continue to report a nursing shortage. According to Becker's Hospital Review, some of these qualified applicants are graduating high school with a 3.5 GPA or higher. These are candidates that will likely be successful nursing students. You may be wondering why this is happening in the middle of a nursing shortage. Let's discuss the statistics, reasons for the problem, and a few solutions. The Statistics Here are a few concerning statistics about the number of aspiring nurses being turned away each year by nursing programs: The National League of Nurses reported that up to 45% of ADN applicants and 36% of BSN applicants were turned away in 2014 Cabrillo College in Aptos, California reported having hundreds on their wait list for a 60-seat nursing program Many schools are saying that applicants will be on wait-lists for up to six years and some schools are discontinuing wait lists altogether The Reasons To fix the problem, you need to understand why thousands of students are turned down each year by nursing schools across the country. Not Enough Instructors Nursing faculty positions go unfilled year and year. In fact, the American Association of Colleges of Nursing reported in their Special Survey on Vacant Faculty positions that the United States has an annual national nursing faculty vacancy rate of slightly over 7%. This equates to about two teachers for every nursing program out there. And, over 90% of these vacancies require or prefer the nurse filling the position to have a doctoral degree. The survey went on to break down the vacancies by region. The most substantial number of vacancies can be found in the Midwest, with nearly 10% of all faculty positions remaining unfilled. Just behind that region was the South (9.7%), North Atlantic (9.5%), and finally the West (9%). If you look at the issue by type of institution - 9.6% of all vacancies are found at public colleges. And, one more break down tells us that the largest number of vacancies are in Baccalaureate programs (14.6%). Do Nurses Want to Be Instructors? Being a nursing instructor may be of interest to many nurses until they begin doing their homework about the position and salaries. Up to 18% of all faculty positions do not have a tenure system at the institution, and another 32.6% of the jobs just don't qualify. The amount of education required for these vacant positions appears to be another barrier. Over 22% of all vacant positions required a doctoral degree. The special report by the AACN also reports that many schools have insufficient funds to hire new faculty. And, in some schools, the administration doesn't support the additional faculty positions, even though they are turning away potential students. Clinical Space Shortage All programs require a significant amount of hands-on experience in a clinical setting. Finding nursing units available for clinicals can be a challenge for nursing programs. If we had enough faculty, would they receive the training they needed? The answer is probably, no. Many schools are reporting that there are a limited number of clinical spaces for students to get this experience. And, finding preceptors in specialty areas can be another barrier. This has further compounded the need to turn away qualified nursing school applicants. Higher Clinical Nurse Salaries As clinical nursing salaries continue to grow, nursing faculty salaries have not been able to compete. Up to 33.9% of schools with faculty vacancies reported that noncompetitive wages were to blame for the inability to fill the position. In fact, the AACN reported in March 2016 that a masters-prepared faculty member made an average of $77,022 per year. Compare this to a masters-prepared nurse practitioner salary of $87,000, and you can easily see why these positions are difficult to fill. The Answers Identifying the problem is only half the bottle. Let's explore a few solutions to this nursing dilemma. Bridge Programs Many nurses choose nursing as a second career. Or, they start out as an LPN or ADN and move up to a master's or doctoral prepared nurse later on in their career. Professionals can make these transitions with the use of bridge programs. These programs allow qualified candidates to continue their education when it's convenient for them. These programs have adopted an online format over the past several years, making it even easier for nurses to continue to work and advance their education. With the help of bridge programs, some of these faculty positions could be filled. Think Outside the Box for Clinical Sites As our healthcare environment moves away from extended hospital stays, nursing programs need to consider new locations for clinicals. Instructors are now turning to rehab centers and nursing facilities to gain exposure to patients who were once kept after surgeries and other procedures. Nursing jobs are changing too. Looking for preceptors in-home care, hospice, and other community-based settings is crucial for the future of nursing education. And, it gives students exposure to non-hospital nursing career options. Create a Competitive Salary Structure Teaching is such an essential career, yet, teachers across all industries seem to have lower paying salaries. There is undoubtedly a demand for more nursing instructors, so this needs to be rectified. If you are interested in pursuing a career as a nurse faculty member - you can increase your earning potential based on the location and type of school. You may also look at roles, such as nurse education director, to improve your salary. What are your thoughts about nursing schools turning away qualified applicants? Have you experienced a long wait-list or other issue related to starting your nursing education? We would love to hear your thoughts and experiences.
  6. jay dickson

    NCLEX / HESI Study Guide

    All three of us passed the first time with 75 questions. If you know everything on this guide you will do well. Kind of long but worth studying. Best of luck to you Please give me feedback Jay BSN HESI Hints & NCLEX Gems Answering NCLEX Questions Maslow's Hierarchy of Needs Physiologic Safety Love and Belonging Esteem Self-actualization Nursing Process Assessment Diagnosis (Analysis) Planning Implementation (treatment) Evaluation ABCs Airway Breathing Circulation Before we continue Watch About A Nursing Student: The Life Of A Student video... Normal Values Hgb Males 14-18 Females 12-16 Hct Males 42-52 Females 37-47 RBCs Males 4.7-6.1 million Females 4.2-5.4 million WBCs 4.5-11k Platelets 150-400k PT (Coumadin/Warfarin) 11-12.5 sec (INR and PT TR = 1.5-2 times normal) APTT (Heparin) 0-70 sec (APTT and PTT TR = 1.5-2.5 times normal) BUN 10-20 Creatinine 0.5-1.2 Glucose 70-110 Cholesterol Bilirubin Newborn 1-12 Phenylalanine Newborn Na+ 136-145 K+ 3.5-5 HypoK+ . . . Prominent U waves, Depressed ST segment, Flat T waves HyperK+ . . . Tall T-Waves, Prolonged PR interval, wide QRS Ca++ 9-10.5 Hypocalcemia ... muscle spasms, convulsions, cramps/tetany, + Trousseau's, + Chvostek's, prolonged ST interval, prolonged QT segment Mg+ 1.5-2.5 Cl- 96-106 Phos 3-4.5 Albumin 3.5-5 Spec Gravity 1.005-1.030 Glycosylated Hemoglobin (Hgb A1c): 4-6% ideal, Dilantin TR = 10-20 Lithium TR = 0.5-1.5 Arterial Blood Gases ... Used for Acidosis vs. Alkalosis PH 7.35-7.45 CO2 35-45 (Respiratory driver) ... High = Acidosis HCO3 21-28 (Metabolic driver) ... High = Alkalosis O2 80-100 O2 Sat 95-100% Antidotes Digoxin ... Digiband Coumadin ... Vitamin K (Keep PT and INR @ 1-1.5 X normal) Benzodiazapines ... Flumzaemil (Tomazicon) Magnesium Sulfate ... Calcium Gluconate? Heparin ... Protamine Sulfate (Keep APTT and PTT @ 1.5-2.5 X normal) Tylenol ... Mucomist (17 doses + loading dose) Opiates (narcotic analgesics, heroin, morphine) ... Narcan (Naloxone) Cholinergic Meds (Myesthenic Bradycardia) ... Atropine Methotrexate ... Leucovorin Delegation RN Only Blood Products (2 RNs must check) Clotting Factors Sterile dressing changes and procedures Assessments that require clinical judgment Ultimately responsible for all delegated duties Unlicensed Assistive Personnel Non-sterile procedures Precautions & Room Assignments Universal (Standard) Precautions ... HIV initiated Wash hands Wear Gloves Gowns for splashes Masks and Eye Protection for splashes and droplets Don't recap needles Mouthpiece or Ambu-bag for resuscitation Refrain from giving care if you have skin lesion Droplet (Respiratory) Precautions (Wear Mask) Sepsis, Scarlet Fever, Strep, Fifth Disease (Parvo B19), Pertussis, Pneumonia, Influenza, Diptheria, Epiglottitis, Rubella, Rubeola, Meningitis, Mycoplasma, Adenovirus, Rhinovirus RSV (needs contact precautions too) TB ... Respiratory Isolation Contact Precautions = Universal + Goggles, Mask and Gown No infection patients with immunosuppressed patients Weird Miscellaneous Stuff Rifampin (for TB) ... Rust/orange/red urine and body fluids Pyridium (for bladder infection) ... Orange/red/pink urine Glasgow Coma Scale ... Myesthenia Gravis Myesthenic Crisis = Weakness with change in vitals (give more meds) Cholinergic Crisis = Weakness with no change in vitals (reduce meds) Diabetic Coma vs. Insulin Shock ... Give glucose first - If no help, give insulin Fruity Breath = Diabetic Ketoacidosis Acid-Base Balance If it comes out of your ***, it's Acidosis. Vomiting = Alkalosis Skin Tastes Salty = Cystic Fibrosis Lipitor (statins) in PMs only - No grapefruit juice Stroke ... Tongue points toward side of lesion (paralysis), Uvula deviates away from the side of lesion (paralysis) Hold Digoxin if HR < 60 Stay in bed for 3 hours after first ACE Inhibitor dose Avoid Grapefruit juice with Ca++ Channel Blockers Anthrax = Multi-vector biohazard Pulmonary air embolism prevention = Trendelenburg (HOB down) + on left side (to trap air in right side of heart) Head Trauma and Seizures ... Maintain airway = primary concern Peptic Ulcers ... Feed a Duodenal Ulcer (pain relieved by food) ... Starve a gastric ulcer Acute Pancreatitis ... Fetal position, Bluish discoloration of flanks (Turner's Sign), Bluish discoloration of pericumbelical region (Cullen's Sign), Board like abdomen with guarding ... Self digestion of pancreas by trypsin. Hold tube feeding if residual > 100mL In case of Fire ... RACE and PASS Check Restraints every 30 minutes ... 2 fingers room underneath Gullain-Barre Syndrome ... Weakness progresses from legs upward - Resp arrest Trough draw = ~30 min before scheduled administration ... Peak Draw = 30-60 min after drug administration. Mental Health & Psychiatry Most suicides occur after beginning of improvement with increase in energy levels MAOIs ... Hypertensive Crisis with Tyramine foods Nardil, Marplan, Parnate Need 2 wk gap from SSRIs and TCAs to admin MAOIs Lithium Therapeutic Range = 0.5-1.5 Phenothiazines (typical antipsychotics) - EPS, Photosensitivity Atypical Antipsychotics - work on positive and negative symptoms, less EPS Benzos (Ativan, Lorazepam, etc) good for Alcohol withdrawal and Status Epilepticus Antabuse for Alcohol deterrence - Makes you sick with OH intake Alcohol Withdrawal = Delerium Tremens - Tachycardia, tachypnea, anxiety, nausea, shakes, hallucinations, paranoia ... (DTs start 12-36 hrs after last drink) Opiate (Heroin, Morphine, etc.) Withdrawal = Watery eyes, runny nose, dilated pupils, NVD, cramps Stimulants Withdrawal = Depression, fatigue, anxiety, disturbed sleep Medical-Surgical Hypoventilation = Acidosis (too much CO2) Hyperventilation = Alkalosis (low CO2) No BP or IV on side of Mastectomy Opiate OD = Pinpoint Pupils Lesions of Midbrain = Decerebrate Posturing (Extended elbows, head arched back) Lesions of Cortex = Decorticate Posturing (Flexion of elbows, wrists, fingers, straight legs, mummy position) Urine Output of 30 mL/hr = minimal competency of heart and kidney function Kidney Stone = Cholelithiasis Flank pain = stone in kidney or upper ureter Abdominal/scrotal pain = stone in mid/lower ureter or bladder o Renal Failure ... Restrict protein intake Fluid and electrolyte problems ... Watch for HyperK+ (dizzy, wk, nausea, cramps, arhythmias) Pre-renal Problem = Interference with renal perfusion Intra-renal Problem= Damage to renal parenchyma Post-renal Problem = Obstruction in UT anywhere from tubules to urethral meatus. Usually 3 phases (Oligouric, Diuretic, Recovery) Monitor Body Wt and I&Os Steroid Effects = Moon face, hyperglycemia, acne, hirsutism, buffalo hump, mood swings, weight gain - Spindle shape, osteoporosis, adrenal suppression (delayed growth in kids) . . . (Cushing's Syndrome symptoms) Addison's' Crisis = medical emergency (vascular collapse, hypoglycemia, tachycardia ... Admin IV glucose + corticosteroids) ... No PO corticosteroids on empty stomach Potassium sparing diuretic = Aldactone (Spironolactone) ... Watch for hyperK+ with this and ACE Inhibitors. Cardiac Enzymes ... Troponin (1 hr), CKMB (2-4 hr), Myoglobin (1-4 hr), LDH1 (12-24 hr) MI Tx ... Nitro - Yes ... NO Digoxin, Betablockers, Atropine Fibrinolytics = Streptokinase, Tenecteplase (TNKase) CABG = Coronary Artery Bypass Graft PTCA = Percutaneous Transluminal Coronary Angioplasty Sex after MI okay when able to climb 2 slights of stairs without exertion (Take nitro prophylactically before sex) BPH Tx = TURP (Transurethral Resection of Prostate) ... some blood for 4 days, and burning for 7 days post-TURP. Only isotonic sterile saline for Bladder Irrigation Post Thyroidectomy - Keep tracheostomy set by the bed with O2, suction and Calcium gluconate Pericarditis ... Pericardial Friction Rub, Pain relieved by leaning forward Post Strep URI Diseases and Conditions: Acute Glomerulonephritis Rheumatic Fever ... Valve Disease Scarlet Fever If a chest-tube becomes disconnected, do not clamp ... Put end in sterile water Chest Tube drainage system should show bubbling and water level fluctuations (tidaling with breathing) TB ... Treatment with multidrug regimen for 9 months ... Rifampin reduces effectiveness of OCs and turns pee orange ... Isoniazide (INH) increases Dilantin blood levels Use bronchodilators before steroids for asthma ... Exhale completely, Inhale deeply, Hold breath for 10 seconds Ventilators ... Make sure alarms are on ... Check every 4 hours minimum Suctioning ... Pre and Post oxygenate with 100% O2 ... No more than 3 passes ... No longer than 15 seconds ... Suction on withdrawal with rotation COPD: Emphysema = Pink Puffer Chronic Bronchitis = Blue Bloater (Cyanosis, Rt sided heart failure = bloating/edema) o O2 Administration Never more than 6L/min by cannula Must humidify with more than 4L/hr No more than 2L/min with COPD ... (CO2 Narcosis) In ascending order of delivery potency: Nasal Cannula, Simple Face Mask, Nonrebreather Mask, Partial Rebreather Mask, Venturi Mask Restlessness and Irritability = Early signs of cerebral hypoxia IVs and Blood Product Administration 18-19 gauge needle for blood with filter in tubing Run blood with NS only and within 30 minutes of hanging Vitals and Breath Sounds ... before, during and after infusion (15 min after start, then 30 min later, then hourly up to 1 hr after) Check Blood: Exp Date, clots, color, air bubbles, leaks 2 RNs must check order, pt, blood product ... Ask Pt about previous transfusion Hx Stay with Pt for first 15 minutes ... If transfusion rxn ... Stop and KVO with NS Pre-medicate with Benadryl prn for previous urticaria rxns Isotonic Solutions D5W NS (0.9% NaCl) Ringers Lactate NS only with blood products and Dilantin Diabetes and Insulin When in doubt - Treat for Hypoglycemia first First IV for DKA = NS, then infuse regular insulin IV as Rx'd Hypoglycemia ... confusion, HA, irritable, nausea, sweating, tremors, hunger, slurring Hyperglycemia ... weakness, syncope, polydipsia, polyuria, blurred vision, fruity breath Insulin may be kept at room T for 28 days Draw Regular (Clear) insulin into syringe first when mixing insulins Rotate Injection Sites (Rotate in 1 region, then move to new region) Rapid Acting Insulins ... Lispro (Humalog) and Aspart (Novolog) ... O: 5-15 min, P: .75-1.5 hrs Short Acting Insulin ... Regular (human) ... O: 30-60 min, P: 2-3 hrs (IV Okay) Intermediate Acting Insulin ... Isophane Insulin (NPH) ... O: 1-2 hrs, P: 6-12 hrs Long Acting Insulin ... Insulin Glargine (Lantus) ... O: 1.1 hr, P: 14-20 hrs (Don't Mix) Oral Hypoglycemics decrease glucose levels by stimulating insulin production by beta cells of pancreas, increasing insulin sensitivity and decreasing hepatic glucose production Glyburide, Metformin (Glucophage), Avandia, Actos Acarbose blunts sugar levels after meals Oncology Leukemia ... Anemia (reduced RBC production), Immunosuppression (neutropenia and immature WBCs), Hemorrhage and bleeding tendencies (thrombocytopenia) Acute Lymphocytic = most common type, kids, best prognosis Testicular Cancer ... Painless lump or swelling testicle ... STE in shower > 14 yrs ... 15-35 = Age Prostate Cancer ... > 40 = Age PSA elevation DRE Mets to spine, hips, legs Elevated PAP (prostate acid phosphatase) TRUS = Transurethral US Post Op ... Monitor of hemorrhage and cardiovascular complication Cervical and Uterine Cancer Laser, cryotherapy, radiation, conization, hysterectomy, exenteration ... Chemotherapy = No help PAP smears should start within 3 years of intercourse or by age 21 Ovarian Cancer = leading cause of death from gynecological cancer Breast Cancer = Leading cause of cancer in women Upper outer quadrant, left > right Monthly SBE Mammography ... Baseline @ 35, Annually after age 50 Mets to lymph nodes, then lungs, liver, brain, spine Mastectomy ... Radical Mastectomy = Lymph nodes too (but no mm resected) Avoid BP measurements, injections and venipuncture on surgical side Anti-emetics given with Chemotherapy Agents (Cytoxan, Methotrexate, Interferon, etc.) Phenergan (Promethazine HCl) Compazine (Prochlorperazine) Reglan (Metocolpramide) Benadryl (Diphenhydramine) Zofran (Ondansetron HCl) Kytril (Granisetron) Sexually Transmitted Diseases Syphilis (Treponema pallidum) ... Chancre + red painless lesion (Primary Stage, 90 days) ... Secondary Stage (up to 6 mo) = Rash on palms and soles + Flu-like symptoms ... Tertiary Stage = Neurologic and Cardiac destruction (10-30 yrs) ... Treated with Penicillin G IM. Gonorrhea (Neisseria Gonorrhea) ... Yellow green urethral discharge (The Clap) Chlamydia (Chlamydia Trachomatis) ... Mild vaginal discharge or urethritis ... Doxycyclin, Tetracycline Trichomoniasis (Trichomonas Vaginalis) ... Frothy foul-smelling vaginal discharge ... Flagyl Candidiasis (Candida Albicans) ... Yellow, cheesy discharge with itching ... Miconazole, Nystatin, Clomitrazole (Gyne-Lotrimin) Herpes Simplex 2 ... Acyclovir HPV (Human Pappilovirus) ... Acid, Laser, Cryotherapy HIV ... Cocktails Perioperative Care Breathing Es taught in advance (before or early in pre-op) Remove nail polish (need to see cap refill) Pre Op ... Meds as ordered, NPO X 8 hrs, Incentive Spirometry & Breathing Es taught in advance, Void, No NSAIDS X 48 hrs Increased corticosteroids for surgery (stress) ... May need to increase insulin too Post Op restlessness may = hemorrhage, hypoxia Wound dehiscence or extravisation ... Wet sterile NS dressing + Call Dr. Call Dr. post op if ... 100 or Post Op Monitoring VS and BS ... Every 15 minutes the first hour, Every 30 min next 2 hours, Every hour the next 4 hours, then Every 4 hours prn 1-4 hrs Post Op = Immediate Stage ... 2-24 hrs Post Op = Intermediate Stage ... 1-4 days Post Op = Extended Stage Post Op Positioning THR ... No Adduction past midline, No hip flexion past 90 degrees Supratentorial Sx ... HOB 30-45 degrees (Semi-Fowler) Infrantentorial Sx ... Flat Phlebitis ... Supine, elevate involved leg Harris Tube ... Rt/back/Lt - to advance tube in GI Miller Abbott Tube ... Right side for GI advancement into small intestine Thoracocentesis ... Unaffected side, HOB 30-45 degrees Enema ... Left Sims (flow into sigmoid) Liver Biopsy ... Right side with pillow/towel against puncture site Cataract Sx ... Opp side - Semi-Fowler Cardiac Catheterization ... Flat (HOB no more than 30 degrees), Leg straight 4-6 hrs, bed rest 6-12 hrs Burn Autograph ... Elevated and Immob 3-7 days Amputation ... Supine, elevate stump for 48 hrs Large Brain Tumor Resection ... On non-operative side Incentive Spirometry ... Inhale slowly and completely to keep flow at 600-900, Hold breath 5 seconds, 10 times per hr Post Op Breathing Exercises ... Every 2 hours Sit up straight Breath in deeply thru nose and out slowly thru pursed lips Hold last breath 3 seconds Then cough 3 times (unless abd wound - reinforce/splint if cough) Watch for Stridor after any neck/throat Sx ... Keep Trach kit at bed side Staples and sutures removed in 7-14 days - Keep dry until then No lifting over 10 lbs for 6 weeks (in general) If chest tube comes disconnected, put free end in container of sterile water Removing Chest Tube ... Valsalvas, or Deep breath and hold If chest tube drain stops fluctuating, the lung has re-inflated (or there is a problem) Keep scissors by bed if pt has S. Blakemore Tube (for esoph varices)... Sudden respiratory distress - Cut inflation tubes and remove Tracheostomy patients ... Keep Kelly clamp and Obturator (used to insert into trachea then removed leaving cannula) at bed side Turn off NG suction for 30 min after PO meds NG Tube Removal ... Take a deep breath and hold it Stomach contents pH = NG Tube Insertion ... If cough and gag, back off a little, let calm, advance again with pt sipping water from straw NG Tube Length ... End of nose, to era lobe, to xyphoid (~22-26 inches) Decubitus (pressure) Ulcer Staging Stage 1 = Erythema only Stage 2 = Partial thickness Stage 3 = Full thickness to SQ Stage 4 = Full thickness + involving mm /bone Acute Care VA ... Hemorrhagic or Embolic A-fib and A-flutter = thrombus formation Dysarthria (verbal enunciation/articulation), Apraxia (perform purposeful movements), Dysphasia (speech and verbal comprehension), Aphasia (speaking), Agraphia (writing), Alexia (reading), Dysphagia (swallowing) Left Hemisphere Lesion ... aphasia, agraphia, slow, cautious, anxious, memory okay Right Hemisphere Lesion ... can't recognize faces, loss of depth perception, impulsive behavior, confabulates, poor judgment, constantly smiles, denies illness, loss of tonal hearing Head Injuries ... Even subtle changes in mood, behavior, restlessness, irritability, confusion may indicate increased ICP Change in level of responsiveness = Most important indicator of increased ICP Watch for CSF leaks from nose or ears - Leakage can lead to meningitis and mask intracranial injury since usual increased ICP symps may be absent. Spinal Cord Injuries Respiratory status paramount ... C3-C5 innervates diaphragm 1 wk to know ultimate prognosis Spinal Shock = Complete loss of all reflex, motor, sensory and autonomic activity below the lesion = Medical emergency Permanent paralysis if spinal cord in compressed for 12-24 hrs Hypotension and Bradycardia with any injury above T6 Bladder Infection = Common cause of death (try to keep urine acidic) Burns Infection = Primary concern HyperK+ due to cell damage and release of intracellular K+ Give meds before dressing changes - Painful Massive volumes of IV fluid given, due to fluid shift to interstitial spaces and resultant shock First Degree = Epidermis (superficial partial thickness) Second Degree = Epidermis and Dermis (deep partial thickness) Third Degree = Epidermis, Dermis, and SQ (full thickness) Rule of 9s ... Head and neck = 9%, UE = 9% each, LE = 18% each, Front trunk = 18%, Back Trunk = 18% Singed nasal hair and circumoral soot/burns = Smoke inhalation burns o Fractures Report abnormal assessment findings promptly ... Compartment Syndrome may occur = Permanent damage to nerves and vessels 5 P's of neurovascular status (important with fractures) Pain, Pallor, Pulse, Paresthesia, Paralysis Provide age-appropriate toys for kids in traction Special Tests and Pathognomonic Signs Tensilon Test ... Myesthenia Gravis (+ in Myesthenic crisis, - in Cholinergic crisis) ELISA and Western Blot ... HIV Sweat Test ... Cystic Fibrosis Cheilosis = Sores on sides of mouth ... Riboflavin deficiency (B2) Trousseau's Sign (Carpal spasm induced by BP cuff) ... Hypocalcemia (hypoparathyroidism) Chvostek's Sign (Facial spasm after facial nerve tap) ... Hypocalcemia (hypoparathyroidism) Bloody Diarrhea = Ulcerative Colitis Olive-Shaped Mass (epigastric) and Projectile Vomiting = Pyloric Stenosis Current Jelly Stool (blood and mucus) and Sausage-Shaped Mass in RUQ = Intussiception Mantoux Test for TB is + if 10 mm induration 48 hrs post admin (previous BCG vaccine recipients will test +) Butterfly Rash = SLE ... Avoid direct sunlight 5 Ps of NV functioning ... Pain, paresthesia, pulse, pallor, paralysis Cullen's Sign (periumbelical discoloration) and Turner's Sign (blue flank) = Acute Pancreatitis Murphy's Sign (Rt. costal margin pain on palp with inspiration) = GB or Liver disease HA more severe on wakening = Brain Tumor (remove benign and malignant) Vomiting not associated with nausea = Brain Tumor Elevated ICP = Increased BP, widened pulse pressure, increased Temp Pill-Rolling Tremor = Parkinson's (Tx with Levodopa, Cardidopa) - Fall precautions, rigid, stooped, shuffling IG Bands on Electrophoresis = MS ... Weakness starts in upper extremities - bowel/bladder affected in 90% ... Demyelination - Tx with ACTH, corticosteroids, Cytoxan and other immunosuppressants Reed-Sternberg Cells = Hodgkin's Koplik Spots = Rubeola (Measles) Erythema Marginatum = Rash of Rheumatic Fever Gower's Sign = Muscular Dystrophy ... Like Minor's sign (walks up legs with hands) Pediatrics Bench Marks Birth wt doubles at 6 months and triples at 12 months Birth length increases by 50% at 12 months Post fontanel closes by 8 wks Ant fontanel closes by 12-18 months Moro reflex disappears at 4 months Steady head control achieved at 4 months Turns over at 5-6 months Hand to hand transfers at 7 months Sits unsupported at 8 months Crawls at 10 months Walks at 10-12 months Cooing at 2 months Monosyllabic Babbling at 3-6 months, Links syllables 6-9 mo Mama, Dada + a few words at 9-12 months Throws a ball overhand at 18 months Daytime toilet training at 18 mo - 2 years 2-3 word sentences at 2 years 50% of adult Ht at 2 years Birth Length doubles at 4 years Uses scissors at 4 years Ties shoes at 5 years Girls' growth spurt as early at 10 years ... Boys catch up ~ Age 14 Girls finish growing at ~15 ... Boys ~ 17 Autosomal Recessive Diseases CF, PKU, Sickle Cell Anemia, Tay-Sachs, Albinism, 25% chance if: AS (trait only) X AS (trait only) 50% chance if: AS (trait only) X SS (disease) Autosomal Dominant Diseases Huntington's, Marfans, Polydactyl, Achondroplasia, Polycystic Kidney Disease 50% if one parent has the disease/trait (trait = disease in autosomal dominant) X-Linked Recessive Diseases Muscular Dystrophy, Hemophilia A Females are carriers (never have the disease) Males have the disease (but can't pass it on) 50% chance daughters will be carriers (can't have disease) 50% chance sons will have the disease (not a carrier = can't pass it on) This translates to an overall 25% chance that each pregnancy will result in a child that has the disease Scoliosis ... Milwaukee Brace - 23 hrs/day, Log rolling after Sx Down Syndrome = Trisomy 21 ... Simian creases on palms, hypotonia, protruding tongue, upward outward slant of eyes Cerebral Palsy ... Scissoring = legs extended, crossed, feet plantar-flexed PKU ... leads to MR ... Guthrie Test ...Aspartame (NutraSweet) has phenylalanine in it and should not be given to PKU patient Hypothyroidism ... Leads to MR Prevent Neural tube disorders with Folic Acid during PG Myelomeningocele ... Cover with moist sterile water dressing and keep pressure off Hydrocephalus ... Signs of increased ICP are opposite of shock ... Shock = Increased pulse and decreased BP IICP = Decreased pulse and increased BP ... (+ Altered LOC = Most sensitive sign) Infants ... IICP = Bulging fontanels, high pitched cry, increased hd circum, sunset eyes, wide suture lines, lethargy ... Treat with peritoneal shunt - don't pump shunt. Older kids IIPC = Widened pulse pressure IICP caused by suctioning, coughing, straining, and turning - Try to avoid Muscular Dystrophy ... X-linked Recessive, waddling gait, hyper lordosis, Gower's Sign = difficulty rising walks up legs (like Minor's sign), fat pseudohypertrophy of calves. Seizures ... Nothing in mouth, turn hd to side, maintain airway, don't restrain, keep safe ... Treat with Phenobarbitol (Luminol), Phenytoin (Dilantin: TR = 10-20 ... Gingival Hyperplasia), Fosphenytoin (Cerebyx), Valproic Acid (Depakene), Carbamazepine (Tegritol) Meningitis (Bacterial) ... Lumbar puncture shows Increased WBC, protein, IICP and decreased glucose May lead to SIADH (Too much ADH) ... Water retention, fluid overload, dilutional hyponatremia CF Kids taste salty and need enzymes sprinkled on their food Children with Rubella = threat to unborn siblings (may require temporary isolation from Mom during PG) Pain in young children measured with Faces pain scale No MMR Immunization for kids with Hx of allergic rxn to eggs or neomycin Immunization Side Effects ... T Call Physician if seizures, high fever, or high-pitched cry after immunization All cases of poisoning ... Call Poison Control Center ... No Ipecac! Epiglottitis = H. influenza B ... Child sits upright with chin out and tongue protruding (maybe Tripod position) ... Prepare for intubation or trach ... DO NOT put anything into kid's mouth Isolate RSV patient with Contact Precautions ... Private room is best ... Use Mist Tent to provide O2 and Ribavirin - Flood tent with O2 first and wipe down inside of tent periodically so you can see patient Acute Glomerulonephritis ... After B strep - Antigen-Antibody complexes clog up glomeruli and reduce GFR = Dark urine, proteinuria Wilm's Tumor = Large kidney tumor ... Don't palpate TEF = Tracheoesophageal Atresia ... 3 C's of TEF = Coughing, Choking, Cyanosis Cleft Lip and Palate ... Post-Op - Place on side, maintain Logan Bow, elbow restraints Congenital Megacolon = Hirschsprung's Disease ... Lack of peristalsis due to absence of ganglionic cells in colon ... Suspect if no meconium w/in 24 hrs or ribbon-like foul smelling stools Iron Deficiency Anemia ... Give Iron on empty stomach with citrus juice (vitamin C enhances absorption), Use straw or dropper to avoid staining teeth, Tarry stools, limit milk intake Sickle Cell Disease ...Hydration most important ...SC Crisis = fever, abd pain, painful edematous hands and feet (hand-foot syndrome), arthralgia ...Tx + rest, hydration ... Avoid high altitude and strenuous activities Tonsillitis ... usually Strep ... Get PT and PTT Pre-Op (ask about Hx of bleeding) ... Suspect Bleeding Post-Op if frequent swallowing, vomiting blood, or clearing throat ... No red liquids, no straws, ice collar, soft foods ... Highest risk of hemorrhage = first 24 hrs and 5-10 days post-op (with sloughing of scabs) Primary meds for ER for respiratory distress = Sus-phrine (Epinephrine HCl) and Theophylline (Theo-dur) ... Bronchodilators Must know normal respiratory rates for kids ... Respiratory disorders = Primary reason for most medical/ER visits for kids ... Newborn ... 30-60 1-11 mo ... 25-35 1-3 years ... 20-30 3-5 years ... 20-25 6-10 years ... 18-22 11-16 years ...16-20 Cardiovascular Disorders Acyanotic = VSD, ASD, PDA, Coarc of Aorta, Aortic Stenosis Antiprostaglandins cause closure of PDA (aorta - pulmonary artery) Cyanotic = Tetralogy of Fallot, Truncus Arteriosis (one main vessel gets mixed blood), TVG (Transposition of Great Vessels) ... Polycythemia common in Cyanotic disorders 3 T's of Cyanotic Heart Disease (Tetralogy, Truncus, Transposition) Tetralogy of Fallot ... Unoxygenated blood pumped into aorta ulmonary Stenosis VSD Overiding Aorta Right Ventricular Hypertrophy TET Spells ...Hypoxic episodes that are relieved by squatting or knee chest position CHF can result ... Use Digoxin ... TR = 0.8-2.0 for kids Ductus Venosus = Umbelical Vein to Inferior Vena Cava Ductus Arteriosus = Aorta to Pulmonary Artery Rheumatic Fever ... Acquired Heart Disease ... Affects aortic and mitral valves Preceded by beta hemolytic strep infection Erythema Marginatum = Rash Elevated ASO titer and ESR Chest pain, shortness of breath (Carditis), migratory large joint pain, tachycardia (even during sleep) Treat with Penicillin G = Prophylaxis for recurrence of RF Maternity Day 1 of cycle = First day of menses (bleeding) ... Ovulation on Day 14 ... 28 days total ... Sperm 3-5 days, Eggs 24 hrs ... Fertilization in Fallopian Tube Chadwick's Sign = Bluing of Vagina (early as 4 weeks) Hegar's Sign = Softening of isthmus of cervix (8 weeks) Goodell's Sign = Softening of Cervix (8 weeks) Pregnancy Total wt gain = 25-30 lbs (11-14 kg) Increase calorie intake by 300 calories/day during PG ... Increase protein 30 g/day ... Increase iron, Ca++, Folic Acid, A & C Dangerous Infections with PG ... TORCH = Toxoplasmosis, other, Rubella, Cytomegalovirus, HPV Braxton Hicks common throughout PG Amniotic fluid = 800-1200 mL ( Polyhydramnios and Macrosomia (large fetus) with Diabetes Umbelical cord: 2 arteries, 1 vein ... Vein carries oxygenated blood to fetus (opposite of normal) FHR = 120-160 Folic Acid Deficiency = Neural tube defects Pre-term = 20-37 weeks Term = 38-42 weeks Post-term = 42 weeks+ TPAL = Term births, Pre-term births, Abortions, Living children Gravida = # of Pregnancies regardless of outcome Para = # of Deliveries (not kids) after 20 wks gestation Nagale's Rule ... Add 7 days to first day of last period, subtract 3 months, add 12 months = EDC Hgb and Hct a bit lower during PG due to hyperhydration Side-lying is best position for uteroplacental perfusion (either side tho left is traditional ) 2:1 Lecithin:Sphingomyelin Ratio = Fetal lungs mature AFP in amniotic fluid = possible neural tube defect Need a full bladder for Amniocentesis early in PG (but not in later PG) Lightening = Fetus drops into true pelvis Nesting Instinct = Burst of Energy just before labor True Labor = Regular contractions that intensify with ambulation, LBP that radiates to abdomen, progressive dilation and effacement Station = Negative above ischial spines, Positive below Leopold Maneuver tries to reposition fetus for delivery Laboring Maternal Vitals ... Pulse NON-Stress Test ... Reactive = Healthy (FHR goes up with movements) Contraction Stress Test (Ocytocin Challenge Test)... Unhealthy = Late decels noted (positive result) indicative of UPI ... "Negative" result = No late decels noted (good result) Watch for hyporeflexia with Mag Sulfate admin . . . Diaphragmatic Inhibition Keep Calcium gluconate by the bed (antidote) Firsts etal HB ... 8-12 weeks by Doppler, 15-20 weeks by fetoscope Fetal movement = Quickening, 14-20 weeks Showing = 14 weeks Braxton Hicks - 4 months and onward Early Decels = Head compression = OK Variable Decels = Cord compression = Not Good Late Decels = Utero-placental insufficiency = BAD! If Variable or Late Decels ... Change maternal position, Stop Pitocin, Administer O2, Notify Physician DIC ... Tx is with Heparin (safe in PG) ... Fetal Demise, Abruptio Placenta, Infection Fundal Heights 12-14 wks ... At level of symphysis 20 weeks ... 20 cm = Level of umbilicus Rises ~ 1 cm per week Stages of Labor Stage 1 = Beginning of Regular contraction to full dilation and effacement Stage 2 = 10 cm dilation to delivery Stage 3 = Delivery of Placenta Stage 4 = 1-4 Hrs following delivery Placenta Separation ... Lengthening of cord outside vagina, gush of blood, full feeling in vagina ... Give oxytocin after placenta is out - Not before. Schultz Presentation = Shiny side out (fetal side of placenta) Postpartum VS Schedule Every 15 min X 1 hr Every 30 min X next 2 hours Every Hour X next 2-6 hours Then every 4 hours Normal BM for mom within 3 days = Normal Lochia ... no more than 4-8 pads/day and no clots > 1 cm ... Fleshy smell is normal, Foul smell = infection Massage boggy uterus to encourage involution ... empty bladder ASAP - may need to catheterize ... Full bladder can lead to uterine atony and hemorrhage Tears ...1st Degree = Dermis, 2nd Degree = mm/fascia, 3rd Degree = anal sphincter, 4th Degree = rectum APGAR = HR, R, mm tone, Reflex irritability, Color ... 1 and 5 minutes ...7-10 = Good, 4-6 = moderate resuscitative efforts, 1-3 = mostly dead Eye care = E-mycin + Silver Nitrate ... for gonorrhea Pudendal Block = decreases pain in perineum and vagina - No help with contraction pain Epidural Block = T10-S5 ... Blocks all pain ... First sign = warmth or tingling in ball of foot or big toe Regional Blocks often result in forceps or vacuum assisted births because they affect the mother's ability to push effectively WBC counts are elevated up to 25,000 for ~10 days post partum Rho(D) immune globulin (RhoGAM) is given to Rh- mothers who deliver Rh+ kids... Not given if mom has a +Coombs Test ... She already has developed antibodies (too late) Caput Succedaneum = edema under scalp, crosses suture lines Cephalhematoma = blood under periosteum, does not cross suture lines Suction Mouth first - then nostrils Moro Reflex = Startle reflex (abduction of all extremities) - up to 4 months Rooting Reflex ... up to 4 months Babinski Reflex ... up to18 months Palmar Grasp Reflex ...Lessens by 4 months Ballard Scale used to estimate gestational age Heel Stick = lateral surface of heel Physiologic Jaundice is normal at 2-3 days ... Abnormal if before 24 hours or lasting longer than 7 days ... Unconjugated bilirubin is the culprit. Vitamin K given to help with formation of clotting factors due to fact that the newborn gut lacks the bacteria necessary for vitamin K synthesis initially ... Vastus lateralis mm IM Abrutio Placenta = Dark red bleeding with rigid board like abdomen Placenta Previa = Painless bright red bleeding DIC = Disseminated Intravascular Coagulation ... clotting factors used up by intravascular clotting - Hemorrhage and increased bleeding times result ... Associated with fetal demise, infection and abruptio placenta. Magnesium Sulfate used to reduce preterm labor contractions and prevent seizures in Pre-Eclampsia ... Mg replaces Ca++ in the smooth mm cells resulting relaxation ... Can lead to hyporeflexia and respiratory depression - Must keep Calcium Gluconate by bed when administering during labor = Antidote ... Monitor for: Absent DTR's Respirations Urinary Output Fetal Bradycardia Pitocin (Oxytocin) use for Dystocia... If uterine tetany develops, turn off Pitocin, admin O2 by face mask, turn pt on side. Pitocin can cause water intoxication owing to ADH effects. Suspect uterine rupture if woman complains of a sharp pain followed by cessation of contractions Pre-Eclampsia = Htn + Edema + Proteinuria Eclampsia = Htn + Edema + Proteinuria + Seizures and Coma ... Suspect if Severe HA + visual disturbances No Coumadin during PG (Heparin is OK) Hyperemesis Gravidarum = uncontrollable nausea and vomiting ... May be related to H. pyolori ... Reglan (metaclopromide) Insulin demands drop precipitously after delivery No oral hypoglycemics during PG - Teratogenic ... Insulin only for control of DM Babies born without vaginal squeeze more likely to have respiratory difficulty initially C-Section can lead to Paralytic Ileus ... Early ambulation helps Postpartum Infection common in problem pregnancies (anemia, diabetes, traumatic birth) Postpartum Hemorrhage = Leading cause of maternal death ... Risk factors include: Dystocia, prolonged labor, overdistended uterus, abrutio placenta, infection Tx includes ... Fundal massage, count pads, VS, IV fluids, Oxytocin, notify physician Jitteriness is a symptom of hypoglycemia and hypocalcemia in the newborn Hypoglycemia ... tremors, high pitched cry, seizures High pitched cry + bulging fontanels = IICP Hypothermia can lead to Hypoxia and acidoisis ... Keep warm and use bicarbonate prn to treat acidosis in newborn. Lay on right side after feeding ... Move stomach contents into small intestine Jaundice and High bilirubin can cause encephalopathy ... Nutrition K+ ... Bananas, dried fruits, citrus, potatoes, legumes, tea, peanut butter Vitamin C ... Citrus, potatoes, cantaloupe Ca++ ... Milk, cheese, green leafy veggies, legumes Na+ ... Salt, processed foods, seafood Folic Acid ... Green leafy veggies, liver, citrus Fe++ ... Green leafy veggies, red meat, organ meat, eggs, whole wheat, carrots Use Z-track for injections to avoid skin staining Mg+ ... Whole grains, green leafy veggies, nuts Thiamine (B1) ... Pork, beef, liver, whole grains B12 ... Organ meats, green leafy veggies, yeast, milk, cheese, shellfish Deficiency = Big red beefy tongue, Anemia Vitamin K ... Green leafy veggies, milk, meat, soy Vitamin A ... Liver, orange and dark green fruits and veggies Vitamin D ... Dairy, fish oil, sunlight Vitamin E ... Veggie oils, avocados, nuts, seeds BMI ... 18.5-24.9 = Normal (Higher = Obese) Gerontology Essentially everyone goes to Hell in a progressively degenerative hand-basket Thin skin, bad sleep, mm wasting, memory loss, bladder shrinks, incontinence, delayed gastric emptying, COPD, Hypothyroidism, Diabetes Common Ailments: Delerium and Dementia Cardiac Dysrhythmias Cataracts and Glaucoma CVA (usually thrombotic, TIAs common) Decubitus Ulcers Hypothyroidism Thyrotoxicosis (Grave's Disease) COPD (usually combination of emphysema and CB) UTIs and Pneumonia ... Can cause confusion and delerium Memory loss starts with recent - progresses to full Dementia = Irreversible (Alzheimer's) ... Depression, Sundowning, Loss of family recognition Delerium = Secondary to another problem = Reversible (infections common cause) Medication Alert! ... Due to decreased renal function, drugs metabolized by the kidneys may persist to toxic levels When in doubt on NCLEX ... Answer should contain something about exercise and nutrition. Advanced Clinical Concepts Erickson ... Psycho-Social Development 0-1 yr (Newborn) ... Trust vs. Mistrust 1-3 yrs (Toddler)... Autonomy vs. Doubt and Shame ... Fear intrusive procedures - Security objects good (Blankies, stuffed animals) 3-6 yrs (Pre-school) ... Initiative vs. Guilt ... Fear mutilation - Band-Aids good 6-12 yrs (School Age) ... Industry vs. Inferiority... Games good, Peers important ... Fear loss of control of their bodies 12-19 yrs (Adolescent) ... Identity vs. Role Confusion ... Fear Body Image Distortion 20-35 yrs (Early Adulthood) ... Intimacy vs. Isolation 35-65 yrs (Middle Adulthood) ... Generativity vs. Stagnation Over 65 (Older Adulthood) ... Integrity vs. Despair Piaget ... Cognitive Development Sensorimotor Stage (0-2) ... Learns about reality and object permanence Preoperational Stage (2-7) ... Concrete thinking Concrete Operational Stage (7-11) ... Abstract thinking Formal Operational Stage (11-adult) ... Abstract and logical thinking Freud ... Psycho-Sexual Development Oral Stage (Birth -1 year) ... Self gratification, Id is in control and running wild Anal Stage (1-3) ... Control and pleasure wrt retention and pooping - Toilet training in this stage Phallic Stage (3-6) ... Pleasure with genitals, Oedipus complex, SuperEgo develops Latency Stage (6-12) ... Sex urges channeled to culturally acceptable level, Growth of Ego Genital Stage (12 up) ... Gratification and satisfying sexual relations, Ego rules Kohlberg ... Moral Development Moral development is sequential but people do not aromatically go from one stage to the next as they mature Level 1 = Pre-conventional ... Reward vs. Punishment Orientation Level 2 = Conventional Morality ... Conforms to rules to please others Level 3 = Post- Conventional ... Rights, Principles and Conscience (Best for All is a concern) Calculations Rules & Formulas Round final answer to tenths place Round drops to nearest drop When calculating mL/hr, round to nearest full mL Must include 0 in front of values Pediatric doses rounded to nearest 100th. Round down for peds Calculating IV Flow Rates Total mL X Drop Factor / 60 X #Hrs = Flow Rate in gtts/min Calculating Infusion Times Total mL X Drop Factor / Flow Rate in gtts/min X 60 = Hrs to Infuse Watch HESI Study Tips... Conversions 1 t = 5mL 1 T = 3 t = 15 mL 1 oz = 30 cc = 30 mL = 2 T 1 gr = 60 mg 1 mg = 1000 ug (or mcg) 1 kg = 2.2 lbs 1 cup = 8 oz = 240 mL 1 pint = 16 oz 1 quart = 32 oz Degrees F = (1.8 X C) + 32 Degrees C = (F - 32) / 1.8 37 C = 98.6 F 38 C = 100.4 F 39 C = 102.2 F 40 C = 104 F Fall Precautions Room close to nurses station Assessment and orientation to room Get help to stand (dangle feet if light headed) Bed low with side rails up Good lighting and reduce clutter in room Keep consistent toileting schedule Wear proper non-slip footwear At home ... Paint edges of stairs bright color Bell on cats and dogs Neutropenic (Immunosuppressed) Precautions No plants or flowers in room No fresh veggies ... Cooked foods only Avoid crowds and infectious persons Meticulous hand washing and hygiene to prevent infection Report fever > 100.5 (immunosuppressed pts may not manifest fever with infection) Bleeding Precautions (Anticoagulants, etc.) Soft bristled tooth brush Electric razor only (no safety razors) Handle gently, Limit contact sports Rotate injection sites with small bore needles for blood thinners Limit needle sticks, Use small bore needles, Maintain pressure for 5 minutes on venipuncture sites No straining at stool - Check stools for occult blood (Stool softeners prn) No salicylates, NSAIDs, or suppositories Avoid blowing or picking nose Do not change Vitamin K intake if on Coumadin
  7. jb2u

    The Case Against Med-Surg!

    "I believe that everyone should spend their first year in Med-Surg." These are the words as spoken by the Director of my nursing school. As one that has always liked a challenge, I made my case as to why one shouldn't go to Med-Surg. I am not against Med-Surg nursing as a profession. My belief is that you should only go there if that is where your heart leads you. Going into Med-Surg, if that is not where you want to go, leads to lost time, wasted money, and lost sanity. If you follow the crowd to Med-Surg post-graduation, you will find yourself with a lost year. The year will not be wasted. Med-Surg offers the new graduate plenty of learning experience. Besides solidifying your nursing skills, you will also learn invaluable organizational skills that will serve you no matter where you end up spending your career. So, why not just go to Med-Surg then? Well, it depends on where you want to work. You can learn invaluable nursing and organizational skills in telemetry, renal, ICU, or just about any floor that you go to. This proves that going to Med-Surg for your first year is not needed in order to learn nursing or organizational skills. So, why would the year be lost? Let's say you really wanted to go into ICU nursing. If you go straight into ICU, you now have one year of ICU experience. In your second year, you will be an experienced ICU nurse. If you had listened to those that say, "spend a year in Med-Surg," you would be an experienced nurse without any ICU experience. Also, you do not even know if someone has an ICU position for you after your first year. You may be spending another miserable year in a position that you did not want in the first place. In addition to losing time, you will also be wasting money. I am not talking about your money. I am talking about the hospital's money. It cost the hospital good money to recruit and train a new graduate. What do they get for their money? They get to train a nurse for a whole year. It will take you a good full year to really get comfortable in nursing. After your first year, you should be able to take on any assignment. You should be able to organize and plan your nursing care without having questions for the experienced nurses. At the time when you are really ready to function, you are now telling your manager, "I'm sorry; I did my year in Med-Surg. I am off to the ICU." Now, the manager has to spend more money to recruit and train another nurse. Time and money may be lost, but you can always find misery. This one does not apply to everybody! I do know some Med-Surg nurses that love it; however, I have seen many new graduates, as well as experienced nurses, in Med-Surg in misery. I have witnessed several new graduates on Med-Surg crying. Nursing school prepares you for the NCLEX. Nothing prepares you to have 6-10 patients with 20 medications a piece, complex wound care, total cares, angry doctors, and short staffing. I would not want to put myself through all this just to get some nursing skills and learn how to organize my day! To truly enjoy your first year, I say go into the field that interests you most. You will spend that first year learning the medications that you need to know. You will learn how to care for the types of patients that you are interested in caring for. You will learn how to organize your day for the type of unit that you are on. I went straight into ICU. While my peers from school were running up and down the halls of Med-Surg, I was studying my two ICU patients. The first year I learned about vasopressors and advance life support. I learned the skills that helped me succeed and better contribute to my unit as I went into my second year. Learning is easier when you are interested in the subject. I really wanted to learn ICU; so, I got more from my first year. But most of all, I spent my first year happy!!
  8. jennifermejia_1

    HESI A2 entrance exam!!

    I do not have my HESI grade report with me because I accidentally closed down the tab after I was done taking the exam (I have to wait 24-48 hours for results to be posted online now SO DON'T CLOSE YOUR TAB ONCE YOU'RE DONE) but I do remember my overall grade, 86.7. I took READING, MATH, VOCABULARY, GRAMMAR, ANATOMY AND PHYSIOLOGY, AND CRITICAL THINKING. On each section, my score was above an 80%, Anatomy was a 92%, and Critical Thinking was around 860 (can't really remember)!!! I am so happy though, especially because it was my first time taking the exam and the school I am applying to requires a 75-80% on each section and a 750 on critical thinking. I used the HESI ASSESSMENT EXAM REVIEW, 4TH EDITION (HAER) as a study guide for each section. READING For reading, I honestly just read HESI ASSESSMENT EXAM REVIEW, 4TH EDITION. I did not do anything else but read the book since I wasn't really nervous about this section. This section on the exam was pretty smooth. However, I took almost an hour on this section because I wanted to make sure I understood everything. I can't really much say of this section since it was just pretty basic. MATH On this section, I took my time reading the HAER book. This section is BASIC MATH. Work on each sample questions even if you think you got it, that way it sticks in your head while you're learning other materials. This section on the exam was mainly proportions and ratios (honestly), work on those two mainly!! I felt like out of the 50 questions, there were 30 of these. There was also many %'s, e.g. (NOT COMING FROM THE TEST, JUST GIVING AN EXAMPLE FROM MY HEAD --> KATIE HAS 16 FRIENDS, 2 OF THEM ARE FEMALES, WHAT IS THE % OF FEMALE FRIENDS KATIE HAS?) Not many metric questions, I think it was a total of 4, BASIC, but learn them. I did not get ONE question of degrees conversion but if I were you, I'd still learn them. Got one question of converting military time to U.S. time. Honestly, DON'T stress on this section because you have a calculator on screen. VOCABULARY OK! Lets get serious! Who isn't nervous about this section? Even if you are so good in vocabulary, this is just random words picked out. BUT guess what?! The HAER book was helpful (LEARN THOSE, LITERALLY LEARN THEM AND KNOW THEM, TAKE YOUR TIME ON THOSE). I cannot say more than know those words. However, I felt like those words weren't enough, I knew the test was going to bring out words that weren't covered on the book and it did. I think it was like 20-30 question words that weren't on the book, on the test BUT *TA DA!* I found a great quizlet account! This girl went out of her way and put more words down and honestly like 15 of those words were on my test! She put down the book vocabulary down on this quizlet and added more words. If I were you, I'd go over the book first to just focus on those words and then go over her quizlet to review not only the same words that are on the book but new words that CAN be on your exam. HESI A2 words Flashcards | Quizlet GRAMMAR Some people tend to be so nervous on this section (I was) but honestly it was not so bad! I took my time on reading the HAER book and used a helpful website.. Grammar Bytes! Grammar Instruction with Attitude This section was mainly on (pick the noun or phrase that is NOT used correctly), but A LOT of subject-verb agreement. Get the hang on S-VA. OK, I am feeling a little too happy so I am going to break down the subject-verb agreement for you guys!! If your subject is singular then your verb will have an "s" on the end. E.g. -> SHE (singular) plays. If your subject is plural then your verb will not have a "s" on then end. E.g. -> THEY (plural) play . MULTIPLE SUBJECTS: OR/EITHER/NOR/NEITHER/AND This AND that ---> plural verb This AND those --> plural verb This OR those ---> plural verb Those OR this ----> Singular verb How to choose if its singular or plural? GO BY CLOSEST TO THE VERB. ANYONE, EVERYONE, SOMEONE, SOMEBODY, NO ONE, NOBODY, EACH, AND EVERYBODY WILL ALWAYS BE SINGULAR. ANATOMY AND PHYSIOLOGY HAER book!! Go over it and KNOW IT ALL, in depth. I also used these two helpful websites.. 1. HESI Flashcards | Quizlet --> This Quizlet account basically broke down the book so go over this!!!! It will make you understand the book more. 2. Anatomy & Physiology --> Go over each chapter!!!! Go over the power points, SO HELPFUL. Literally. This is why I got an A on this section because questions that didn't come from the book, somewhat came from these power points! I can't really tell you what was really on this section but questions derived from the book and power points. CRITICAL THINKING OK! Obviously this one is not in the book but this section was more like scenarios. All answers are correct, they just want to know (as a nurse) what would you do given the scenario. The better choice you pick, the more points you get. EX: ONE PATIENT, 45 YEAR OLD MALE, E-MAILS YOU TO HANG OUT, WHAT WILL YOU DO?? OBVIOUSLY, PICK THE "KEEP THINGS PROFESSIONAL." HONESTLY, DO NOT GET NERVOUS! I THINK THE BEST ADVICE I CAN GIVE YOU IS TO NOT BE NERVOUS, IS EITHER YOU KNOW IT OR YOU DONT!!! P.S. I ALSO USED "HESI A2 EXAM PREP 2016 EDITION- POCKET PREP, INC." APP, IT LOOKS PURPLE. I THINK IT WAS $12.00 BUT SO HELPFUL!!!! BUY IT!!! That's all. Hope this helps!!!!!
  9. I found 20 Examples of Cardiac and Pulmonary Auscultation. This should help with assessment and clinical. 01 - Normal Heart Sound-Apex.mp3 02 - Third Heart Sound,S3(physiological0-Apex.mp3 03 - Fourth Heart Sound,S4-Apex.mp3 04 - Aortic Stenosis-Right Base.mp3 05 - Mitral Regurgitation-Apex.mp3 06 - Midsystolic Click-Apex.mp3 07 - Ventricural Septal Defect-Left Base.mp3 08 - Atrial Septal Defect-Lowewr Left Sternal Border.mp3 09 - Mitral Stenosis-Apex.mp3 10 - Aortic Regurgitation-Mid Left Sternal Border(3rd Intercostal Space).mp3 11 - Normal Tracheal Sound-Trachea Interscapular.mp3 12 - Normal Vesicular Sound-Right Lower Lobe,Left Lower Lobe.mp3 13 - Fine Crackles with Deciduous Bronchial Sound-Right Middle Lobe.mp3 14 - Coarse Crackles-Right Lower Lobe.mp3 15 - Bronchial Sound-Left Lower Lobe.mp3 16 - Inspiratory Stridor-Trachea.mp3 17 - Rhonchus-Right Lower Lobe.mp3 18 - Wheezing-Left Lower Lobe.mp3 19 - Fine Crackles-Lung Basis.mp3 20 - Pleural Friction-Right Middle Lobe.mp3 Watch the following video for a better understanding of what heart sounds tell us...
  10. In my 49 years of life I have had many life-changing events as we all do. I was born the eldest of two children. My younger brother was born in 1963 and diagnosed as "severely mentally retarded," a vegetable that would never walk or talk. Danny proved them all wrong. My parents brought him home rather than institutionalizing him. Did my parents know the force of nature contained within their tiny frail son with the oversized head? I don't think anyone knew what was in store for any of us - only Danny knew. He learned to walk then he ran everywhere. When he was 19, Danny had a stroke. He was in a wheelchair which did not slow him down. The wheeled instrument just got him to his destination faster, running over anything in his way. I grew up with my brother as a constant companion and shadow. To his chagrin, I went off to college leaving him behind. He became a resident at Allegheny Valley School where he was happy in his own world at the Brown House. I got married and had four children. He was happy for the marriage (he brought twenty of his closest friends to the reception) and loved my children. They adored their Uncle Danny. During this time my mother had several heart attacks and my dad was having health issues. I felt like a true part of the sandwich generation, but mine was a triple- decker with brother and his issues. My parents were not able to be with him in the hospital each time he was there. The hospital was close to my home so I took over. Danny could not communicate verbally. One had to be in tune with him to understand him. A staff member from his school would try to come and help out but it just didn't always happen. Some of the nurses figured out how to communicate with him immediately. These would be the "good" visits. He would co-operate with them in his care and recuperate enough to go home to AVS. If the nurse made no effort or poor effort to communicate with Danny, it just did not go well at all. He was frightened and would not do as instructed. He refused to eat and drink. I was called in to get him to comply. The next year found Danny in the hospital more than he was out. By this time he was totally paralyzed except for some movement in his neck. The level of care and his response to care came down to one thing: the nurse and her willingness to decipher him. I stayed with him many nights. I saw things with his care that enraged me and other that touched my heart. I did not set out to be his advocate. Danny had his parents and AVS staff to be his voice. Since I was put into this role unexpectedly, I did what any mom has trained herself to do. I stepped up the challenge and become a loud voice that everyone heard. I took this job seriously and addressed every issue with his care in a professional manner with the staff at the hospitals. Danny passed away in March of 2010 at 46 years of age. He was in the hospital on a ventilator and with a temporary pacemaker. I was with him for his last conscious moments, singing the Sponge Bob song to him with the staff of the care unit singing along. Danny slipped into a coma from which he never awoke. I am so thankful that his last stay in the care unit was with some of the most skilled and caring staff we had ever met. Life support was disconnected the next day with family, friends and AVS staff there with Danny. During the last two years of Danny's life I had been thinking a lot about my own life. What was I going to do when my last child was old enough to not need me all the time? My identity was as their mom, no longer an engineer or a professional woman. I thought maybe nursing was for me. I called the local community college to find out about how I could enroll. I was told I had to retake my Biology class because it was too old. Umm, no thank you. Maybe I was too old and a career in retail was in the future for me. I just knew I wanted to be in the medical field and with people. Nursing was what I wanted but having to retake that stupid biology class was annoying. I just kept thinking about nursing. My oldest daughter insisted that I reconsider the biology requirement. She insisted on driving me to campus that day where I met with an advisor. I found that I only needed a few classes to apply to the nursing program. My first semester took care of all of my prerequisites and I scored well on the required entrance exam. I applied to the CCAC nursing program the next semester. I continued with my co-requisites not knowing if I would make the cut into their competitive program. Studying was difficult being a full time mom, especially with four teens in the house! My acceptance letter came just weeks later. I was 48 years old and I was a nursing student! My family was overjoyed and extremely supportive. I started nursing school in August of 2011 with ananticipated graduation date of May 2013. This story is not over yet. There is more to come but so much has happened during my first year of nursing school. I was accepted into the honors program which requires special projects or designated honors courses to maintain the honors distinction for graduation. My first semester project was on platinum drug therapy. My second semester was supposed to be a continuation of that project. On a pediatric rotation everything changed and my topic became advocacy for the developmentally disabled adult. At the end of the semester, I presented my project to my entire class. They learned a lot about me that day but more than anything else, many were introduced to the challenges of working with a developmentally disabled adult patient. My facebook updates are often about the demands of my nursing school schedule. Many friends or acquaintances will pull me aside and ask how hard going back to school really is. I tell everyone it is hard, no doubt, but worth every effort. I encourage anyone that will listen to make the first step - the rest will fall into place. I warn that going into nursing school is like jumping into a raging rapid. If you hang on, it is an exciting ride! My kids joke that they can see if the part on my head moves because my nose is always in a book these days. They know I am in the stands at their games but I am more than likely toting a book or pda to study during down time. They are proud of me and more supportive that I could have ever imagined. I was elected President of my nursing class and completed my first year of the nursing program. I am not only learning to be an advocate for all of my patients as I did for my brother, but also for those that are thinking about a life-changing direction in life. I am 49 years old and halfway through nursing school. This is not where I would have imagined to be at this stage in life. I can offer advice to anyone that is thinking of going back to school. Do it! You have nothing to lose and if you put forth the effort your life experience can serve you well in your journey. If you are contemplating a career change to nursing, call local schools to see what you need to do to get into the program. Then you have to make that one big leap - DO IT! If it is in yourheart, go for it. You will never know if you don't try. Be ready to work and drive hard. It can be done. I will finishmy program when I am 50 years old. I will then be embarking on a new career after being a stay at home mom for over21 years! I could never have imagined this is where I would be now, but it is. It could be for you, too!
  11. There is no doubt that nursing school is tough. For me, it was one of the hardest things I have ever done in my life. I attended an accelerated program and it seemed that every waking moment was comprised of something that related to school. Keeping up the pace required a fail-proof study plan. I'm happy to share my top tips with the next generation of nurses! 1. Teach someone else what you just learned. As an adult student, I had a husband and 3 teenagers to help me study. I found that the very best way to remember what I had just read or learned in a lecture was to teach someone else the material. It started from by sheer excitement about what I was learning. I would be amazed by how some part of the body worked, what nurses do, or something that happened in the lab, and I would just have to tell someone about it - usually my husband. Before long, I realized that this really helped me commit the details to memory. Soon, I intentionally began telling him or one of the kids everything that I was learning. When it came time for a test, I was able to recall the information. Teaching someone else forces you to know the material. You must think it over, put it in your own words, and regurgitate it. This process helps your brain analyze, process and store the information. If you stop reading right now, this 1 tip alone will help you greatly. 2. Make flash cards and use them to study in small bites. Use your own style to make flashcards. Some people choose the question and answer method, but for me, I just wrote down things that I knew I must memorize. I kept my flash cards with me at all times and read them over and over whenever I had time. I took the bus to school, so I used that time to read my flashcards. I also read them while standing in line at the grocery store, while waiting to get my oil changed, and any other time when I had 5 minutes to spare. This really helped me to memorize drug classes, signs and symptoms, steps for performing procedures and many other things. Keeping your flashcards handy really lets you take advantage of small bites of time which would otherwise be wasted, and those short slots of time really add up. Soon recalling the information on your cards will come very easy to you. 3. Draw pictures of bones and other body parts. This was my secret weapon against anatomy. Staring at photos in the textbook and trying to memorize the names of bones, muscles and other body parts just didn't cut it for me. However, when I decided to make flashcards to study, I realized that sitting down and drawing the details of the bones, and the names of each point and bump on the bones really helped to cement the names in my mind. Then I also had the flashcards to continue my memorization. Yes, I did have one of those handy flip books issued to all anatomy students, but I found it really didn't help until I incorporated the tactile sensation and concentration that it took to make detailed drawings. Just like when you teach someone else, using a different part of your brain (as in drawing) really helps to implant the information and recall becomes much easier. 4. Watch videos about the subject matter. Reading your textbook is an absolute must, don't get me wrong, but after you read the information, try to find some good videos to watch. YouTube is a great place to find videos on just about any topic. It is very important that you find reliable sources, but they are out there. Many of the top universities have YouTube videos that further explain nursing topics. By watching a video, you incorporate your visual sense which can truly help you remember the details. You know what they say - seeing is believing! 5. Find a way to relate what you learned to real life. Nursing school is full of topics that almost anyone can relate to real life. Who in your family has heart disease? When studying cardiology, relate what you learned to that person. Did they struggle with edema or shortness of breath? What tests and procedures did they have? How do they manage their disease process? Relating what you learned in Nursing school to something tangible in your life lets you put a face to it. When it comes to test time, you can see this person in your life, what they go through and you will remember the things you need to know. (Hint) You can also go teach them about their disease and how to take better care of themselves for bonus learning. I'm sure that by now you have noticed a pattern in my 5 Tips for Surviving Nursing School. If I had condensed this to just 1 suggestion it would be this: find a way to incorporate multiple senses into your study habits. Try to find ways to visualize that what have learned. Use your creative side to draw or make a model, or write a song relating to your topic. Incorporate your emotions by connecting your lessons to your life outside of school (if you still have a sliver of life outside of Nursing school). Let my 5 top study tips be your inspiration for finding the exact methods that work for you. And one last thing - You got this!
  12. So what is this exam? The CPNE is a rigorous 2.5-day exam consisting of four timed lab stations on the first night (Friday), then a minimum of three Patient Care Scenarios (PCSs) on Saturday and Sunday, during which masters- or doctorate-prepared nurses evaluate our ability to formulate care plans, carry out assigned areas of care, and evaluate and document everything in a total of 2.5 hours using actual hospitalized patients who have agreed to have student nurses. The Clinical Associate (CA) oversees the testing and is in charge of the Clinical Examiners (CEs) who oversee the students. We are assigned a minimum of two adult patients and one pediatric patient for the PCSs, though some hospitals with a low pediatric census may substitute an adult patient for the pediatric patient (but don't count on this!). During the CPNE weekend you can fail and repeat each lab station once, as well as fail and repeat one adult and one pediatric PCS. Where do you go to take the CPNE? Excelsior's CPNE test sites are located in hospitals in Georgia, New York, Pennsylvania, Ohio, Wisconsin, and Texas. Generally speaking, students who apply to test at the NY sites seem to get a date the fastest, and this is likely because there are more sites in NY than anywhere else. The sites are split up between regions, into what they call RPACs-regional performance assessment centers. The Midwestern Performance Assessment Center (MPAC) includes Wisconsin and Texas (three sites total). The Northern Performance Assessment Center (NPAC) is the NY and Pennsylvania sites (six sites total). Finally the Southern Performance Assessment Center (SPAC) oversees the Georgia sites (four sites total, one of which doesn't hold the CPNE every weekend). You can only apply to test in one RPAC at a time, but you can apply to test at multiple sites within each RPAC. If there's one particular site you want, you can choose only that location, but with the realization that it might slow you down in terms of getting a date. I applied to the one Ohio site-Mansfield-because it was within driving distance for me. I didn't take a cancellation date, so it took me about seven months from application to actually being at my CPNE. I needed that time, though-I used it to finish Micro and two CLEPs, then to study for the CPNE. Mansfield closed as a site a few years ago. Enrolled students with a login can access information on all the CPNE sites: Excelsior College Just a personal take on "which site is the best"-first, whether a person passes or fails at a site is seriously going to color his/her perception of the site. How could it not? This is an intense exam that usually requires life-consuming focus for preparation, and when someone pours that much into an endeavor that isn't successful, there is bound to be some negativity. My advice: pick a site and focus on YOUR preparation. Don't listen to the reasons Fred chose Utica, or the reasons Mary won't go to Wisconsin. I can tell that during my time around Excelsior students on various message boards, I've seen some sites go from being evil pits of despair to being the golden ticket, then back again. For every site, you will hear both good and bad, usually depending on how a student fared there. When I arrived at my CPNE site, I merrily logged on to the old EC electronic peer network (EPN) to let people know I'd arrived safely and was ready to go get that GN. One of the first posts I saw was from someone bashing Mansfield because they'd failed there the previous weekend; the post said the CA and CEs were horrible, the site was unfair, no one would ever pass there, and on and on. I thought I might vomit. But I knew that I was going to be successful because I would allow no other option, no other thinking. So yes, maybe people should stay off of websites around the time of the CPNE, but the EPN and Allnurses were big support systems for me, and I needed that more than I needed to NOT read angry spewing about my site (where I was, indeed, successful on my first CPNE attempt). The flow of the exam That first evening are the four lab timed stations: calculating and administering an IM or SQ injection (you'll get one or the other, you don't know which), calculating and performing an IV push, IV piggyback (calculating and setting a gravity drip), and packing a wound with perfect aseptic technique. If you fail any of these lab stations, you can repeat them one time (before being sent home with a failure) the next day, after you take care of your patients for your first PCSs. The length of each day depends on how you do. For the labs, we met in the hospital lobby at 1615 on Friday and were done by about 2000, and there were five of us testing. There is some administrative blah-blah-blah before the labs, including positively identifying the students (bring your ID!) and reading the students the mandatory EC script. For days 2 and 3, you'll have a max of two PCSs on Saturday and a max of three on Sunday (but at least one). On Saturday, you'll also have the opportunity to repeat any labs you may have failed, which is done after the Saturday PCSs. Depending on the number of labs, you might be there late into the afternoon. Sunday you can get out pretty early if you don't have to repeat a PCS. If you end up having to do more than one PCS on Sunday, you can bet you'll be there until late afternoon. Wait, what? I know that the PCS failure thing can get kind of confusing, as can the mix of people who make it to Sunday and those who don't, or those who have to do five PCSs to pass, that kind of thing. Let me give you a couple of scenarios. Frankie is assigned an adult PCS and a pediatric PCS on Saturday. He fails both. Can he come back Sunday and still pass? Yes! But he will have to pass two adult PCSs and one pediatric PCS on Sunday, for a total of five PCS attempts. He just used up his adult and pediatric fails on Saturday, that's all. I have seen people do this and still emerge victorious! Charlie is assigned two adult PCSs on Saturday. He fails both. Can he come back Sunday and still pass? No! He used up both adult chances on Saturday, leaving him with no more opportunities to pass an adult PCS. He goes home Saturday. Natalia is assigned two adult PCSs on Saturday. She passes both. She then fails her IVP lab repeat because she throws her syringe in the trash instead of the sharps container. Can she come back Sunday and still pass? No, because she failed her repeat lab. She goes home Saturday. So what's the big deal? The CPNE isn't really a test of skills; it is basic nursing assessment and basic management. Nothing too fancy! They want to see that you can provide safe care to patients. The entire nature of the program is predicated on the students being healthcare providers already, or having gone through more than 50% of a traditional nursing program's clinicals. Beyond writing careplans, there really wasn't much foreign material for me at the CPNE, and I came into the program as a paramedic. For the PCSs, as stated, you must pass two adult and one pediatric PCS. For each PCS, you have 2.5 hours to formulate a careplan with two nursing diagnoses, carry out your selected interventions related to your careplan goals while also performing selected and required areas of care, and then documenting the whole thing without missing a critical element. You are not asked to do anything terribly invasive. It's a test of basic concepts like time management and prioritization. Your patient isn't in a bubble during those 2.5 hours-docs will come in, family members, PT/OT, x-ray, etc., so time management really is a factor. Overriding and required areas of care include demonstrating caring, ensuring physical safety at all times, not placing the patient in emotional jeopardy, evaluating mobility, checking a set of vitals to include manual BPs that must be within a few points of what the clinical examiner gets (you're using a double-headed teaching stethoscope for BPs, apical pulses, lung sounds, etc.), and fluid management (checking IV sites, infusing fluids, etc.). Assigned areas of care (most students get 3 or 4 of these assigned) include things like peripheral vascular assessments, neuro assessments, abdominal assessments, respiratory assessments, respiratory management, O2 management, comfort management, pain management, skin assessment, musculoskeletal management, specimen collection, irrigation, enteral feeding, wound management, medication management, and patient teaching. After all that, everything has to be documented perfectly, and students evaluate the effectiveness of their careplans in writing and choose a priority nursing diagnosis, supported by a rationale. As I said, you can fail one adult PCS and one pediatric PCS, and repeat those once each before you're sent home without that coveted "pass." In your documentation, if you exclude anything from that area of care that Excelsior designates as a critical element, it's a point of failure. If at any time you place the patient in emotional or physical jeopardy, you fail. Failure while in the room is usually signaled by the CE stating, "I need you to step into the hallway with me." (When I heard those words it didn't occur to me that I had failed that PCS, I thought, "Hmmm, I wonder what she wants!" Hahaha. DUH!) Why do people fail? It's usually the little things that get most people. For example, I didn't ID my patient properly in what should have been my last PCS-oops! I asked the patient's name, but failed to compare her armband with the Kardex and ID her by two identifiers, because I lost focus when the patient started in to a litany of complaints. Other reasons people fail: leaving required parts of the documentation form blank, forgetting to aspirate during the IVP station, breaking sterile technique on the wound, throwing syringes in the trash in the labs, drawing up the wrong amount of meds, forgetting to roll insulin, running out of time on the labs, and on and on. The little things. The CPNE is all basic stuff, but in a nerve-wracking framework. Students have a total of three (rather expensive) chances to be successful at the CPNE, after which they are dismissed from the program. It's a lot of pressure to have hanging over one's head, especially if you tell everyone you know that you're going (like I did), and you have an RN job waiting for you based on the outcome (like I did). Is it fair? Are there things about the CPNE that are not fair? Surely there are; the nature of the exam is very subjective. The CA is human. The CEs are human. The patients are human. We are SUBLIMELY human. The CPNE is not human, it is a framework in which we have to be so very human while functioning exceptionally/perfectly while under extreme stress. Even more than five years later, I don't quite know how I feel about the CPNE-it hurts my heart to see others fail, but I know that the CPNE is a necessary part of this program. I came out of my CPNE not liking it, but surely respecting it. I know how awful it can feel to nearly fail the CPNE-been there, done that, burned the t-shirt. After failing what should have been my final PCS in the first 20 minutes on Sunday, I paced a hallway for two hours, waiting for a CE to be available for my final, do-or-die PCS, and I paced so much I wore holes in my heels and bled through my socks and onto my white shoes (stupid Keds). I was terrified they wouldn't let me attempt the final PCS because I was bleeding, I completely skipped over "blistered" and went straight for "open wound." With all that being said, I felt my exam was very fair. Did I fail an adult PCS? You betcha! All by myself, I did, with the bonehead omission of properly identifying my patient in the first few minutes I was in the room. I could blame the CE because she was obviously new and nervous and weirdly timid, or I could blame the patient because she was cranky and gruff and obviously wanting to stir the pot and cause trouble for the poor little nursing student the minute I walked in. I could say that the planning process started poorly, with the primary nurse not being able to give me vital sign parameters for which I'd hold the patient's dose of Digoxin (yes, really), once we were able to even LOCATE said primary nurse, all of which ate into my planning time greatly. All these things that I didn't even bother to put into my journal; they rattled me, surely, but the failure was MINE, and I owned it, I claimed it, I knew it. All of us at Mansfield made it to the third day, with the exception of the student who failed all 4 labs on Friday night and just didn't show up Saturday morning; I'm not really counting her in this, because she gave up before she even really failed. The only other person who failed that weekend failed on Sunday, after this person made what they themselves called a "stupid error," and then failed a second PCS for physical jeopardy involving a tube feeding and lowering the head of the bed. This person was VERY angry and told me in the hallway (as I paced and bled) that if I failed my final attempt, I should retest elsewhere because Mansfield wasn't fair. I disagreed, told this person that I FAILED all by myself, said I planned to be successful that afternoon, and I turned and walked away because I couldn't be sucked into the negativity at that point (and I needed to do more pacing, more bleeding, ha ha). And in that moment, I realized I'd get this person's CE for my final PCS ... and she was the CE I feared the most, because she was utterly straight-face, robot-like, and thus intimidating (but strangely enough, exactly my height! LOL). But this CE showed me her human face for an instant during my PCS as she smiled and stroked the cheek of my demented 90-year-old patient, and I knew in that moment that I could pass this final PCS. And so I did. Let me explain ... no, there is too much. Let me sum up Hope that helps give you some idea of what the CPNE entails. For those of you preparing, good luck! You can do this. It's not impossible. For those of you considering Excelsior, just be aware that this can be a difficult end to what is often a long journey. I recently saw some Facebook comments to the effect of "If I'd really known what the CPNE was like, I would have gone to a traditional program." I think they were only half kidding!
  13. To say that the first semester of nursing school is overwhelming would be an incredible understatement. Between being assigned to read 20 textbook chapters a week, skills checkoffs, and your first clinical shifts (not to mention, care plans!), studying can be a pretty daunting task. Throughout my first semester of nursing school, I developed a study method that helped me to not only maximize my time, but to minimize stress and achieve grades I was proud of. Determine your learning style. We are all unique and, that being said, your professor's 250-slide PowerPoint presentation might not necessarily solidify complex disease processes for you. The VARK assessment is a great tool to help pinpoint what kind of learner you are. With this information, you can formulate a more effective study method to ensure you're not wasting your time. The VARK Questionnaire | VARK Create your own notes. Nursing lectures are notorious for being complex...and oftentimes, too much so. Trying to retain too much information is only going to overwhelm you. Whittle down your lecture notes to the "meat and bones"--the core concepts. In example, when looking at a disease process, oftentimes if you understand WHAT is taking place physiologically, you can deduce the S/S and treatment modalities. Aim to UNDERSTAND, not memorize! Adequately plan to maximize preparedness. Allowing yourself a few days to prepare for a major test isn't going to cut it. Start studying immediately following your lectures to ensure new concepts stay fresh in your mind. Keep it cumulative! Just because you feel like you understand a certain topic doesn't mean you can simply set that information aside. Continue to review this information while you're learning new concepts to make sure you don't lose it! Do as many practice NCLEX-style questions as possible! Check out books from your school's library, rent them online, or purchase. Not only will this help you apply the new concepts that you're learning, but it will also give you a good indicator of where you are in your NCLEX preparedness. Davis and Saunders make great comprehensive NCLEX review/Q&A books and the Success series makes subject-specific Q&A books. You can further reinforce concepts by reading the rationales for both correct as well as incorrect answers. If I could provide you with one last tip, it would be to remember to enjoy the ride. Cherish the friendships that you make and remember to take time for yourself. Always remember your WHY and allow that to fuel your passion and propel you into this incredible, rewarding career!
  14. savexpigoo

    How to Get NCLEX Results

    1. The Famous Pearson Vue Trick I tried this trick and it worked for me (So far, I have not heard that this trick was inaccurate) The link below will provide you step by step on how to do the Pearson Vue trick. Basically, if you get this pop-up message, "Our records indicate that you have recently scheduled this exam. Please contact your Member Board for further assistance. Another registration cannot be made at this time," then you PASSED the NCLEX. If you did not pass, then it will take you to the credit card page which lets you register for the exam again. I tried this trick about 4 hours after completing my NCLEX and it worked. *Make sure your Pearson account page state "Delivery Successful" before you try the trick* 2. Calling the Automated License # I called this # about 24 hours after the completion of my NCLEX and my results were already up. If you PASS, it will say, "First Name, Last Name, For the occupation registered nurse, your license status is: current active ..." It will also tell you when your license was issued and when it will expired. (For some people, their results are not up until a few days later, especially if you used your driver's license # to register for BON instead of your SSN). Remember, your results may take longer to be available so don't freak out! 3. Board of Nursing (VIRGINIA) My results was up on the website the next day, but it usually takes between 2-4 days. However, it has taken up to 1-2 weeks for some people. (The website is usually slower than the Automated License #). This is the VA BON license verification link: https://www.license.dhp.virginia.gov/license/ The page should show your name, license number, profession (nursing), license type, issue date, expire date, and license status (current active) OR Virginia DHP Health Professional Data Services! (For me, my name and license number did not show up until about 5 days later)
  15. Not Your Nurse

    Online, But Not Out of Touch

    The faculty said the Associates degree nursing program was "extremely vigorous" but if you ask me that was putting it lightly. While my friends went to sandy beaches for spring break I stood home surrounded by mountains of flash cards, textbooks, and enough anxiety to make a Buddhist monk pull his hair out (if he had any). I was determined to succeed as a nursing student but there were still times when I wasn't sure how I was going to pass the semester. Nevertheless, thanks to a great support system and internal drive I happily graduated in 2 years earning my Associates degree in Nursing. Finally life was about to begin! On the same day I learned of having passed the NCLEX I also found out I was pregnant with my first son! Amidst the joy and excitement also came the realization that finding a job and pursuing a Bachelors degree would prove to be quite impractical now, especially since my belly was beginning to show. How could I take classes in a traditional classroom setting when my expected due date was mid-semester, and how could I return to class once my husband's paternity leave ends? Countless questions whizzed about in my head like flying monkeys. Soon I learned of a RN to BS online program that offered the chance for me to achieve my goals without sacrificing too much of my personal life. I did have some reservations about taking online courses (something I'd never done before). I wondered how involved the professors really were, and whether I was self motivated enough to thrive in such a program. Despite my concerns I enrolled online and with time learned that I had made the right decision. My GPA rose significantly and my professors proved to be quite helpful, especially when I went into labor early right in the midst of midterms. Not only did I receive time extensions but my professors seemed really in touch and excited for the arrival of our baby boy. It wasn't always sunshine and roses but we made it work. I read chapter assignments whilst breast feeding in the day and my husband stood up with our little night owl while I took exams at night. After a few semesters, I was holding my Bachelors degree in one hand and shaking the hands of my Penn State professors at graduation with the other. With my husband and son by my side I felt gratefully accomplished. Though I have yet to practice in the work world, I feel motherhood and my Bachelors degree have helped to enhance my skills as a RN in the real world. I hope my story sheds light on some of the benefits of online Nursing programs and inspires expecting/new parents to work hard in achieving their goals. These temporary sacrifices lead to long term success and nursing is well worth the effort!
  16. Everyone learns in different ways. Some people are visual learners, some are kinetic. Some people work best in study groups, some are solitary students. No matter how you learn, the key is to study like my Grandpa. My Grandpa was a farmer and a university professor. Kind of a funny combination. When we would visit, he would take us out to the farm. One of my most vivid memories as a child is climbing in the pen with the pigs when Grandpa wasn't looking. After he retired, my Grandpa slowing started losing his memory. Eventually, he was diagnosed with a missed stroke and dementia. The diagnosis didn't really matter to our family-the result was the same either way. Grandpa slowly slipped away from us. First, he had a hard time remembering that I was in college. Then he couldn't remember my husband. Next there came the visit when he didn't know my name, but could still call me "Granddaughter." Finally, the time arrived when Grandpa didn't know me at all. As hard as it was watching my Grandpa decline, there were funny moments too. Like the time my Grandma found Grandpa (who was also diabetic by this time) surrounded by dozens of candy wrappers. As she scolded him for eating so much sugar, he shrugged and said with a mouthful of chocolate, "What? This is my first one!" After Grandpa had retired, he had taken up the habit of reading the newspaper from cover to cover every morning. It helped keep him up to date and, for a while, kept his mind sharp. But even as dementia took over, he kept up the habit. Every day he would start into the newspaper. Some days he would get to page B6 before he would get distracted and move on to something else. When he came back to the paper, he wouldn't remember that he was on page B6, so he would go back to the front page. The next day he might only make it to A10 before getting up for a drink. Again, when he would come back to the paper he would start at page one. For a while, this drove my Grandma crazy. She would try and get him to start reading back where he left off. But he would insist on starting on the front page. He would spend all day reading the newspaper sometimes, and always, after every break, he would start back at the beginning. My background is in law. My first undergrad degree was in political science and then, given that degree is not very employable, I went on to law school. I had my first baby during my last semester of law school and decided to be a stay at home mom. Now, four babies later, I have decided to make a big change and go into nursing. At first I was very nervous about the prerequisite courses. Even though I have a bachelor degree and a juris doctorate degree, science courses are very different from anything else I have studied. Despite the difference in the subject matter, my old study skills have proven to be effective and so far my courses are going well. As I thought about my study habits and what makes them effective, I realized that I study like my Grandpa. A good example is how I study for Anatomy and Physiology 1. I am taking a class that meets for five hours once a week. The day after class, I study everything we covered in class the day before and prepare for our weekly quiz. Then the rest of the week leading up to our next class I follow the same routine. Just like my Grandpa, I start back at the beginning every day. Every day I have a block of about two hours of solid study time. Each time I sit down to study, I review chapter 1, then chapter 2, then chapter 3, and so on. Later in the day, if I find a few minutes to pull out my flashcards, I follow Grandpa's pattern again. I go through my cards for chapter 1, then chapter 2, then chapter 3, etc. In the evening, once my kids are in bed and I have a few more minutes to spare, I go online and use our class tools (practice quizzes, labeling exercises, videos, and more) to review. And again, I use the Grandpa method. I take a quiz to review chapter 1, then I do a labeling exercise for chapter 2, and I end with a video from chapter 3. Using this method, I never have to cram for a test. I have been reviewing and memorizing the materiel over and over every day. The early chapters in many courses, including this one, are a foundation of knowledge for later chapters so it is very useful to review them regularly. Even if you are short on time, dedicating a few minutes to each topic helps to keep material fresh and solidify your knowledge base. So need a new way to study? Try the Grandpa Method and ace your classes!
  17. 1. Help from a tutor If you have the opportunity to have help from a tutor, take it! 2. Quizlet It's amazing. I learn best by testing myself and Quizlet lets me do that. I highly suggest making your own flashcards, because then you'll learn the material better. But there are plenty of great sets on the website. 3. Khan Academy This site is great for a multitude of things. They have practice on several topics and a ton of videos on so many topics. 4. Crash Course This is a Youtube channel hosted by Hank Green. This channel helped me study for Anatomy and Physiology 101 and the TEAS VI. He goes a little fast but if you take notes of what he just said after pausing the video it's really helpful. Because he explains things in a simple manner and is funny about it too. 5. Time Management This should probably be number one. You need to be able to study enough but not so much that you tire yourself out and stop retaining information. Studying for an hour then taking a 10-minute break is great when you need to study for a long period of time. You can't always be staring at the computer screen, or constantly writing either. Your mind and body need a break. However, This doesn't mean go and binge watch Stranger Things (or whatever show you're into right now. Who can't wait for season 2? ). Just keep your time well managed. 6. DO NOT PROCRASTINATE This goes along with #5, but I'm bad about this, so it helps if I break things into smaller chunks that I can complete each day. Then by the time the due date comes I'm done! Get those little chunks done in one sitting or throughout your day. Just get it done before you go to bed. 7. Get enough sleep I know this is difficult with work, school, and possibly kids. But sleep is essential for your well-being. Obviously, don't sleep in till noon, but don't go to sleep at 1 or later in the morning every night. Try to make it before midnight. (Unless your job prohibits you from doing that.) Really just try to have a set bedtime. Mine happens to be around 11/11:30 and I tend to wake up around 7/7:30 depending on the day. 8. Keep your things organized and stay up-to-date on your due dates Google calendar is great if you are annoyed by writing everything out. 9. When studying for multiple classes rotate which ones you're studying for Don't neglect the one you don't like and don't neglect the one like because you're focused on something else. If you like none of them, just do your best to learn the material and get everything done in a timely fashion so you can think about it as little as possible. 10. Write keywords on your hand If you have to memorize a bunch of stuff try writing keywords on your hand and practice them while going about your day. Doing this a memorized the last chapter and a half of the Matthew (from the bible) for a speech in about two weeks while memorizing things for anatomy and physiology 101. 11. Remember what you're doing this for Remember that you're awesome and can do anything you set your mind to. (Although also remember that you may not be cut out for things. Like I could probably write a story if I set my mind to it. But it probably wouldn't be great, I'd hate the whole process, and would probably want to burn it afterward. But I still did it.) Best of luck to y'all!
  18. First, assess your own learning style and know your limits. Everyone processes information differently. Are you a visual learner? Do you learn best alone or in groups? Plan your assignments and know your due dates well in advance. A day timer or calendar is very effective. Review all your course outlines before class in order to gage the material. Do not wait until the night before to read or begin assignments! Sleep and exercise regularly. Some people think they can stay up all night. Maybe you can, but all nighters are not effective. Your brain requires adequate sleep, food and exercise in order to function properly. Students who stay up all night usually perform worse on tests and assignments. Take regular study breaks after 45 minutes of study. Go and do something else, and then return to your studies. After a certain point, you are not retaining information. Mental breaks are essential. Learn the art of note taking and reading texts. Skim the objectives of the chapter and skim the headings prior to reading the text. You will not need to know everything in your text, only the key concepts. As you read, the use of a high lighter to underline key words is useful since retention improves with active manipulation. Repeating key phrases out loud as you read can also prove effective. Attend class regularly. The instructor will highlight key ideas and concepts which saves time later on because you will know what is important for testing. Read before class. Even if all you have time for is a quick read of the material, you will have a greater understanding of the concepts that will be presented later. The power of positive thought does wonders for success also. Tell yourself you can succeed and you will eventually, even if you think you won't. As in: "I'm going to achieve an A in this course!" Using these principles, I've managed to achieve an A average. You can too! I hope that helps.
  19. I was set to do a saline lock flush with my instructor. Mind you, it wasn't my first, because I had done them in the second semester without any problem. But it was the first one with THIS instructor, and she was very very strict. A total stickler! Ok, let's see. MAR...check! 3 ml flush intact, expiration date checked.....looking good! Alcohol swab...got it! My instructor and I walk in, I introduce her, 2 ID check with patient and MAR, explain the procedure, put on gloves....awesome! I am so good, and I even did it with a smile! So I put the flush at eye level to expel the air bubble from the syringe.....and nothing happens! I push the plunger a little more, watching my instructor across from me, her arms folded, a little smirk on the corner of her mouth. My heart is beating faster. Please God, help me! Why won't this stupid air bubble budge?! Then, before I know it, the saline shoots straight up into the ceiling, and spills down like rainwater onto the MAR on the patient's bedside table! Oh no! What did I just do? I left the stupid cap on, that's why I was having so much trouble! I look over at my instructor, who's mouth is opening and closing like a little fish. I'm so scared! Is she going to fail me? "I'm sorry", I spurted, as I picked the wet MAR, "I will get another flush and I will be right back". She follows me outside in the hall. I was so mortified, all I can say is the truth, "I'm so sorry Ann. I should have made sure to loosen the cap. It won't happen again". I gathered my supplies and do the saline flush successfully this time. As she left, she shakes her head at me and makes a gun with her hand, points it to her head and shoots. Gee, thanks, lady! That sure works wonders for my self-confidence! Fast forward to this semester....it's the last semester, yay! Finally, we are going to have a little more independence! My new instructor is superb, she tells us that this semester the cord will begin to loosen. Boy oh boy, finally we are being treated with a little respect, and like real nurses! "Emily, I have an IV to hang". "Good, get your stuff ready since you have done a lot of these, I won't tell you to step by step, I will just watch you", she says. All right! I've done tons of these before, this will be cake! I gather my equipment, tubing, labels, checked the chart, MAR, 5 checks, introduced myself to the patient, provide for privacy, explained the procedure, 2 ID'S checked, my instructor is chatting with the patient, everything's fine!! My new IV bag is primed and hanging, new tubing in place, labeled, set rate entered, volume to be infused entered. I did everything so beautifully! Geez, I was born to be a nurse, the board should just give me my license already! I'm WAY too good! Everything is set, and with a big smile I press the START button and wait for the IV to drip into the chamber... BUT I HEAR THE MACHINE BEEP! I recheck everything carefully. "I don't get it, Ana", I said, "the tubing is not kinked, the clamp is off, the machine is working, what could it be"? I look at my patient, as he gives me a shy, tiny smile. His eyes move quickly to his left. I follow his gaze only to see that I FORGOT TO HOOK HIM UP TO THE TUBING!! I gasp, as I hold it up. My instructor bursts out laughing. "I wanted to tell you so bad", she said, "but I wanted to see how long it would take for you to figure it out!" As a student, I've had my share of ditzy days and more than enough humble pie. I have learned so much about myself in this time and as a soon to be RN, I am so grateful for all the lessons I've learned! Humble pie, anyone?
  20. Although now I realize it was a big - big mistake, I never really went back to my nursing books after I left nursing school , and when I was faced with a situation (got married, moved to the USA) where I have to claim my competence in my field to stay in my field I was really worried . I wondered how I am going to go over everything that I learned for 4 years once again. The whole point of my article is to give all those people who are in the situation that I was a couple of months ago, the much-needed support, encouragement, and confidence to be successful in this exam. 3 components to my success in NCLEX What are the paths to success? Positive Support, Prayers, and Hard work, and here I would say the first two factors supersede the last one at least in my case. 1. Positive Support My parents are a constant source of encouragement when I was drained of it ... But when I became overloaded with it .. To the point that stress started getting the best of me ... My husband would just balance it with calming me down saying this test is not going to change anything, anything in the way people (he and everyone else) think about me and it's okay for me to go easy on it. 2. Prayers This was the most important thing that kept me going throughout, I cannot stress how important it was for me. I prayed to all the Gods I knew Ganesh ji, Hanuman ji, Shiv ji, Durga ma, Jesus Christ, mother Mary, Shri Ram. And I believe to this day that it was my Gods who made me pick the right answers. 3. Hard work Paired with consistency is the last but not the least of the factors. My opinion about NCLEX difficulty level There is a lot of hype about NCLEX, that somehow drags down one's confidence. Although it is not an easy exam to crack, from what I have experienced, it can be done with a little extra effort. So exactly like you are doing now, I did a lot of reading on this site about, how people passed the exam, what books they used, and watched videos of successful candidates on YouTube. I do recommend doing that because it gives you choices to pick from. Resources and method used Step 1 - Saunders I purchased a Saunders NCLEX RN review book from Amazon.com but did not finish it. I completed the maternity section, gastro, endocrine, and cardiovascular from that book. At that time I wasn't sure when I was going to take the exam and I was processing my application, so I didn't do it really seriously. Step 2 - Lippincott I had a Lippincott NCLEX q and a book that my sister passed on to me, and I want to say that it was very very helpful for me (Remember I graduated 5 years back, so my knowledge of content was very poor and , doing questions [with a scenario] and reading the rationale and writing down the key points of the answer helped me remember the content better). I used this book because I had it with me, you might want to use some other book that you find had good questions and rationales, that's perfectly fine. Step 3 - Kaplan I invested in Kaplan NCLEX RN review course. I really recommend this course a lot guys. If you can afford it, get it, and once you have it take it seriously. I will say buy it when you have your exam in 1.5 months time. No need to buy the live online one like I did because they do not have the lectures on content in the live session, what they do is teach you to use the decision tree by way of example questions. And there are prerecorded videos of the same, so no need to pay extra. Additional Tips When you use Kaplan, take 2 weeks to read through the content book, cover to cover, with concentration and if possible twice. That I believe is the only amount of content you need for this exam, trust them, there is a reason why they are so popular. Next, for doing the questions make a time table. Make a schedule for the 1 month time left for the exam date, divide days for questions and days to listen to content video and days to revise all of the notes you will take after reading the rationale of all questions you do ( both right and wrong). And divide it proportionately (eg. Monday to Thursday 150 questions daily, Friday content lecture 2 units + 1 unit from course book revision, Saturday Sunday - revise notes taken from question rationales till date). At this point you might think, "man, this sounds like a lot of hard work" , but, because I have done it I am telling you, it isn't, initially it might feel like, but as you advance you will start recalling that you have already come across the same content formatted in a different question. And it is a much more reliable and easy method compared to running between 10 different types of books and ending up feeling not remembering anything learnt thus far. Finally Pay special attention to the delegation, prioritization, assessment questions, there are a lot of them on the exam. And it is very true when people say Kaplan questions are similar to NCLEX and are way harder than it actually. Believe me, if you do it right, you will pass it for sure in the first time, with 75 questions, like I did. Having said that, I will also add that, assess yourself to find out what method suits you, and follow this only if this works for you. You will know when you do it for a few days. DON'T FORGET TO PRAY All the best guy's
  21. As a nursing student, my primary focus was to excel at my pre-requisites and to gain admittance to nursing school. As many of you know, nursing school admission is competitive, and I was focused on only one thing: getting in. And yet, with increasing tuition prices, the average college education costs significantly more than most things you will buy over your lifetime, with the exception of a home. You would think that with the rising cost of education, that I would have been a better-research consumer. I can tell you that I was not. I did not even know the right questions to ask. As a nurse educator, I now counsel all prospective students to ask the right questions. This is a sampling. What are the most recent trends in your program's NCLEX pass rate, retention rates, and in your college/university four-year graduation rates? NCLEX, the nursing licensure examination, shows whether the program's graduates are prepared to practice entry-level nursing. This information is often readily available on your state Board of Nursing website. Ideally, the pass rate should be well above national and state averages over a period of years. Do not look only at isolated pass rates of one year, look for trends. However, the NCLEX pass rate does not tell everything that you need to know. You should also look at retention rates. In other words, how many of the students who start the nursing program will graduate with a nursing degree? How many graduate on time? For example, if you are attending a nursing program that generally takes two years to complete, what percentage of graduates receive their degree within that time frame? Does the school flunk out anyone who is unlikely to succeed at NCLEX? Is the school accredited, and through what organization? Note that state Boards of Nursing review programs to ensure that basic standards of education are met. This is not the same as regional or national accreditation. Ideally, look for a program with ACEN (Accreditation Commission for Education in Nursing) or CCNE (Commission on Collegiate Nursing Education). This type of accreditation is rigorous and shows that your program meets or exceeds high standards for education. This type of accreditation can pave the way to continue your education at the masters or doctoral level. As a student, I just wanted to be a bedside nurse. I never imagined that I would one day decide to be a nurse educator. If I had not graduated from a program with this type of accreditation, it would have made continuing my education much more difficult and expensive. Also, look to see if your program passed their most recent accreditation or if they had any issues or follow-up reports. If they needed a follow-up report or visit, check to see what was the cause. How many clinical hours will my program have and in what settings? What is the faculty: student ratio in the classroom and the clinical setting? This information can tell you several things. Most states set minimum faculty to student ratios and a minimum number of clinical hours. Ideally, look for a program in which each faculty member is responsible for a small number of students in the clinical setting, especially in your first clinical rotations. I have worked for programs that have used ratios ranging from one faculty member to six students to one faculty member to ten students. I can assure you that for first-semester students, the 1:6 ratio is far preferable so that I can give each student the individual attention that they deserve. The number of clinical hours can give you one estimate of whether you will be prepared to practice as a new graduate. Nursing education should be a good blend of skills, evidence-based practice, and didactic (lecture). At my school, students have more clinical hours than any other program in the state, and our graduates are highly sought after and ready to practice as entry-level nurses. Additionally, in what settings will you be able to practice in clinicals? Ideally, your exposure will be broad, not just in terms of clinical specialty such as pediatrics or ICU, but also in both rural and urban settings, hospital and community settings, and with diverse patient populations. You may find your specialty in an unexpected area!
  22. This goes to my good friend Jamie Lane who will be taking the Nursing Licensure Examinations on July 2-3, 2011. Good luck to you and to the rest of the 126, 826 future registered nurses. Exactly one year ago, I was one of those agitated nursing graduates who wanted to make their names longer by adding an R and an N. I was neither the best student in my college class nor during the review, but I made it to the list of successful examinees in one take. I did not do much to prepare, but I'm sure I did enough. I know there is nothing much to share, but who knows, the following list might lead you to the oathtaking ceremony at SMX: 1. Accept reality With three days before the big brain-drain day, accept that you can never learn everything. The normal values in your bedroom wall will remain where it is because you have just ignored what's written the whole review period. However, never doubt the answers that you are very sure of. The choices might be tricky, but never let your confidence falter. 2. Master the art of test-taking strategies Techniques like choosing the longest answer, the one with the most information must be the right answer, a process of elimination, 'All of the Above' is always the right choice, and never choose 'None of the Above' are just some of the strategies that helped me pull off the NLE. You are not to use it on all 500-items, but when the time comes that you really do not know the answer, at least you have some strategies to use. 3. Listen, but do not depend solely, on your review center They are centers for RE-viewing, a second take of what we have learned for the past four years. If you don't have anything to look back on or remember; you don't need a review center. You need another four years. 4. Listen to your review center, but believe only half of what they say Do not waste your energy recording/writing down/memorizing the 'test answers' they give during Final Coaching; even if they claim that those are the actual test questions, believe me, they ultimately do not come out. 5. Practice shading Learn that no amount of genius can calculate the weight of your hand against the Scantron paper: your license depends on gravity alone, and except for defying gravity, the next best thing to do is practice. 6. Do not alter you circadian rhythm This applies specifically at the eve of the board exam; if you are used to studying until 11PM and hitting the sack at 12 midnight, follow this routine so you wont feel uneasy at the exam day itself. 7. Bring the right kind of food during the exam This is no field trip, so better keep your oily junk foods; besides you would not want to put oil on you test paper, would you? Bring enough sweets, aside from not wanting to stain the Scantron paper with chocolate, too much carbohydrates will doze you off, and when that happens, your dreams of becoming an RN dozes off with you. Bring something sour or bitter like tamarind or coffee-flavored candy, this will wake you up when you feel like sleeping over Test II. 8. Always keep calm At this time when you have nothing to count on but yourself, keep it cool and do not let anything or anyone make you nervous. Remember that you are not the only one who's having butterflies on your stomach, there are at least 126, 826 others feeling the same way. 9. Do not cheat Keep your dignity as you answer each test item. Do not let a mere 500-item examination destroy everything you have worked for. A cheater do not in any way deserve to be included in the pool of registered nurses. 10. Pray Pray before, during, and after the examinations; if God has really called you for the profession, there is no way you would not make it. Congratulations in advance to all the hopefuls. Remember that as nurses, we have our own destiny to chart, literally and figuratively. If unfortunately, you did not make it this year, keep your spirit, there are still a lot of examinations ahead. Above and beyond, the board rating is nothing but a number.
  23. Having good social skills is crucial when working in a field like nursing where a large part of your day is caring for and communicating with people. It is important to develop positive social skills so that it will be easier to succeed with your goal of becoming a good nurse. It is my goal in this article to assist you, the nursing student, to be perceptive to the patient's needs and feelings and to treat them with dignity and respect. We will discuss ways of developing a good rapport with your patient at the beginning of your clinical day. You will be surprised at how much easier your day may be when this is done. Have you ever been to a drive through window or at a restaurant and had an employee with poor social skills "help" you? They didn't make eye contact or may have been rude. It was obvious they didn't care. In the back of your mind, you wonder if they might have spit in your food. How did this make you feel? Was this a pleasant experience? Did it make you feel welcome or want to return to the establishment to be treated poorly again? Of course not, no one wants to be treated poorly. Now put this into the perspective of a sick patient. They don't feel well and now they are being "cared for" by someone who doesn't really seem to care. In my opinion, this is not a therapeutic atmosphere for a patient. Working with people can be very interesting because we are all different. We respond differently in how we are treated and how we learn and retain information. This is where your social skill building will come into play. As you work with patients you will learn how to interact with different types of patients (this also applies to a patient's family). Some patients may fit into neat little categories: the nice patient, the grumpy, stubborn patient, the scared/fearing the unknown patient, the patient who wants to be listened to, the needy patient. Some patients are all the above. I could go on and on. I have noticed that if a patient feels that you really care and you are there to advocate for them they will be more receptive to you. When you first meet the patient, it is important to make good eye contact with them, use positive body language (they are more perceptive then you think). Make it obvious that you care and that you are there for them. If the patient is on pain medications (using a post-op patient as an example) make sure and discuss a plan for the day and discuss how you will try to control the patient's pain. Doing these things will show the patient that you care. As you work with patients you will get better at interacting with them. Remember that they are people just like you, going back to my bad service at a restaurant example. Put yourself in the patient's shoes. Do you want bad service, or good service? The answer is obvious, we want to be provided with good service. Showing a patient dignity and respect is the key. Making the most of Clinicals Part 1: Turn negative experiences into positive learning Making the most of Clinicals Part 2: You're on stage-Make a good first impression
  24. mochamonster

    I Am Meant To Be A Nurse.

    I had been in the dental field for years and had slowly moved my way up by learning each job until I was proficient and then seeking more of a challenge. I did this for 9 years until I found myself with a Bachelor's in Healthcare Management and the Office Manager for a multi-dentist practice that I had rescued from the verge of bankruptcy. Everything I touch turned to gold, so to speak. For me the next logical step was to start my own business as a practice management consultant. Then, as I see it, fate took over. The plan had always been that once the practice was humming along, I would drop down to part time to have time to pursue my ambitions of being a practice management consultant. I had a management meeting with the owner of the practice and his employee/wife. I felt the time was coming to make the move to part time, but they disagreed. They wanted me to stay on full time for at least six months after I had completed a particular project. I expected that project to take a month or so to complete. My husband and I were planning on trying to conceive our second child once I got my practice management business up and running, but with the revelation that I would be in my position full time for the better part of a year, we decided to have the baby first. We got pregnant the second month we were trying and were ecstatic. Then the rug was pulled out from under me. I was let go from my position as Office Manager. The economy had taken a turn for the worse and I had basically worked myself out of a job. My employer, who had created my position to hire me, now felt that my wages would be put to better use in his pocket, now that he saw that the general public viewed dental care as a luxury in a tough economy. I was 7 weeks pregnant and furious. If I had known I was going to lose my job 3 months after my employers basically guaranteed me full time employment for the foreseeable future I would not have gotten pregnant when I did. I was scared too. I had a 17 month old son and a mortgage and everything else that goes along with the American dream. I took the week to feel sorry for myself and then decided to try to find a job as soon as possible. I was fortunate enough to find an Assistant Office Manager position at a chiropractor's office. While it was a step down for me, it was still an administrative position, and had only taken 2 months to find. They also hired me knowing I was pregnant, so I counted my blessings. In the meantime I decided that I would take prerequisites on a part time basis for nursing school. When I told my husband I wanted to go back to school for nursing he said that he had always been surprised that I hadn't done that in the first place. I was taken aback by his response. What had taken me years to realize, he had always seen, but never said anything. I have always been the kind of person who had to figure things out for myself and I couldn't see the forest for the trees so to speak. I did a lot of research into the local schools and came across 3 accelerated BSN programs, but knew I would not be able to attend them since I had to work. I had accepted the fact that I would keep my head down and slowly but surely take classes to reach my goal of getting a BSN. It might take 5 years, which I dreaded thinking about, but at least I would be able to do it. I did long to go back to school full time, but knew it was not possible with my responsibilities. Things were going along fine at the chiropractor's office. I was 7 months pregnant and had enrolled in 2 classes at the community college for prerequisites. It was 2 days before classes were to start for the summer and my boss called me in to his office at the end of the workday. He had a meeting with his accountant at lunch and told me that the office had to pay $20,000 to the IRS for taxes the office owed over the next 6 months, and you guessed it, my salary would have to be what would cover the debt. I was floored. I was just struggling to get back on my feet only to get knocked back down. I was heavily pregnant and knew there would be no way I could find a job, let alone an administrative job. This time, I took no time in deciding what to do. The next day I went to the community college and signed up for as many prerequisites as were open. I ended up taking 27 credits that semester. I had to get special permission to do so. I had my baby over the 2 week break and came back in the fall for the rest of my prerequisites, only 15 credits that time. My baby was 1 week old. I got all A's. I was determined not to fail at this. I did get accepted for an accelerated program and started in January and am currently attending. Right now my baby girl is 6 months old and my son is 2. My experience has taught me that I am meant to be a nurse. It was fate, or God, or whatever you want to call it. The timing fit too perfectly to not be. I could not have done what I did nor could I continue to do what I am doing if it weren't for my family. My husband and parents have all rallied around me to accomplish this great goal. I know I won't fail, because if I do, I won't be just letting myself down, I would be letting everyone down. Besides, I am meant to be a nurse, of that I have no doubt.
  25. OKNurse2be

    Pre-Nursing School Jitters

    Orientation is in 17 days. August 10th I get to meet all my fellow nursing school classmates and the instructors. I have waited for this so long. I have spent over a year doing all the pre-requisite classes and testing. I have waited what seems like a lifetime already just to get that all-important letter telling me that "Yes, you are accepted." I am not a very patient person. If it were up to me, I would have everything yesterday. I am so excited about nursing school that I just want to jump into it NOW. On the other hand, I am also nervous, anxious and just a teensy bit frightened. I feel the pressure of the need to succeed, and all the "what-ifs" haunting me. You hear and read all the time about how nursing school is so different from all the other classes and there are plenty of examples about anything from bad instructors to difficult tests and everything in between. It doesn't help matters that for my family, my career change is seen as a ticket out of scraping by from paycheck to paycheck. I have never been one to shy away from a challenge, and to some extent I thrive on them. It's like when people say "You can't do this," I have to prove them wrong. I have everything I need to start classes. I have already purchased the required uniform, stethoscope, sphygmomanometer, and most of the books. I have very few things left to do. I plan on getting my hair cut and colored, because I don't know when I will have time to do that again, and I must make sure my kids have everything they need for their own school starts. I am glad that I still have things to keep me busy and my mind occupied to make the wait go by a little faster. My kids are important, so I do want to make sure that we do fun stuff together as a family, because chances might come fewer and further between for family activities. I have started to read the textbooks a little bit. Not in depth, but rather a skim through to get myself familiarized with the style of the author and to prepare myself mentally for the type of critical thinking that I know will be required. I am worried that I won't have the time to read the textbook once classes start, therefore I am trying to give myself a little head start. All in all I am looking forward to this challenge. Nursing has been my dream for as long as I can remember, and I am determined that I am going to succeed and become the best nurse that I possibly can be. That starts with becoming the best student I can be, and I can only hope that all this time spent preparing for nursing school; thinking about it, dreaming about it and preparing for it will help me be successful both as a student and a nurse.

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