Tips from experienced RNs for putting it all together

[SwabbieNurse, BSN, MSN, RN]

I'm a third-quarter BSN nursing student with a strong science background, lots of previous experience in healthcare, and a nurse tech job. I do well in classes, but I am finding it extremely difficult to pull all of the knowledge together to understand real-life patient cases.

For example, at my job, we had a DKA admit from the ED with VERY high SBG....when I looked at the labs, I knew the tests measured, but I just couldn't understand the way the body was reacting in terms of this diagnosis (WBC, electrolyte, bicarb, pH values all over the place), even though we've studied DKA, electrolyte and acid-base balance, and the inflammatory response. Same goes for every case I've seen in clinicals and at my job.

Every experienced RN keeps telling me it will come together, but I'm terrified it won't, without my making an effort while these things are still fresh in my head. I want to be a great RN, and I know it takes effort.

Does anyone have any tips or books they've found helpful for putting it all together?

[DookieMeisterRN]

Truthfully, speaking as an experienced RN it doesn't always come together. EACH case can be different and not 'text book', the cause and effect will not always jump out at you. In time after seeing routine dx's you will get it. But there will always be that odd case that makes completely no sense. There is always something to learn.

Keep asking yourself "why".

[nurseprnRN, BSN, RN]

keep asking "why?" for each case that you see. it's patterns that stick in our memories, not just data points. give yourself time to recognize them.

when you've seen a bunch of dkas, it will suddenly occur to you what acidosis makes them all do (hyperventilate) and what we do to them (bicarb, fix cause of acidosis), and why they pee like crazy (high blood glu) and why you have to anticipate a lot of iv fluids for the resulting hypovolemia, why their k+s go nuts (because the insulin drives it into their cells), why they have pvcs (because their k+s are low now), and why they have high wbcs (it's a sign of the infection which is what got them into trouble with their dm in the first place).

[KelRN215, BSN, RN]

I'm a third-quarter BSN nursing student with a strong science background, lots of previous experience in healthcare, and a nurse tech job. I do well in classes, but I am finding it extremely difficult to pull all of the knowledge together to understand real-life patient cases.

For example, at my job, we had a DKA admit from the ED with VERY high SBG....when I looked at the labs, I knew the tests measured, but I just couldn't understand the way the body was reacting in terms of this diagnosis (WBC, electrolyte, bicarb, pH values all over the place), even though we've studied DKA, electrolyte and acid-base balance, and the inflammatory response. Same goes for every case I've seen in clinicals and at my job.

Every experienced RN keeps telling me it will come together, but I'm terrified it won't, without my making an effort while these things are still fresh in my head. I want to be a great RN, and I know it takes effort.

Does anyone have any tips or books they've found helpful for putting it all together?

I agree with the previous posters... you just have to think it all through and always ask WHY?

In the case of DKA... think about what's going on here. The patient's blood sugar is through the roof because they don't have enough insulin on board to metabolize glucose. If the body can't metabolize glucose for energy, what happens? It starts breaking down fat stores producing ketones and causing ketoACIDOSIS. How does the body compensate for metabolic acidosis? The person begins to hyperventilate blowing off CO2 (an acid), using the respiratory system to compensate. Have you studied ABGs? Once you learn these and understand which direction the numbers move in which situation and how the body compensates, it makes a lot more sense. At least I found that it did.