What you need to know before clinicals

gigglymo · Apr 1, 2011

Most of the lab values will come back with normal ranges in parenthesis, and they'll be flagged if they're high or low. If you must memorize, I would focus on K, Na, Hgb/Hct, BUN, Creat, and glucose.

Speaking from experience, you should know that on your first day, you shouldn't put your hand flat against the bottom of the alcohol foam dispenser, because it will result in what I like to call the "finger on a hose effect," resulting in the alcohol foam shooting out and hitting your preceptor in the eye. (Even if this happens, everything will still be OK, you should just expect that particular preceptor to avoid you from then on.)

Relax. Sleep well the night before. Eat breakfast. Ask lots of questions. If you don't know something, don't pretend you do. Ask how you can help. Perfecting those things will put you in a much better place than memorizing a bunch of lab values, IMHO.

Heidi the nurse, BSN, RN · Apr 1, 2011

Yep - not only how to work the dispensers, but where to park, when to be there, and what floor you are on.

Seriously, if they do it the same way they did 20 years ago when I was a student, they will give you a list of your patients and you can go the evening before to read through their chart. Know what their diagnosis is, what meds they are on, and something about their diagnosis.

seaghost · Apr 1, 2011

Thank you this is exactly the kind of stuff I want to be informed about! I start clinicals in the Fall and I want to start memorizing essential stuff. I hope people add to this thread! Very useful!

silentRN · Apr 1, 2011

Memorization only comes with the job and experience. I wouldn't be too stressed out trying to memorize numbers that the computer does for you :) You'll learn by doing. It would be more beneficial to know what to do or what it means when a lab value is abnormal.

silentRN · Apr 1, 2011

Here's kinda a cool site to go too to look at labs...I used to go here when I was a student. http://www.labtestsonline.org/

The labs I generally look at in the morning is K, Phos, iCal, and Mg, because I have to replace those electrolytes. Other labs I eye ball is the hct/hgb and INR in case in need to give more PRBC or FFP. If you give a lot of blood products look at a fibrinogen to see if the patient need cryoprecipitate. And if the patient is on plavix and they are bleeding look at platelets count as well. Our blood bank won't give any additional platelets unless it's below a certain number. Look at Creatinine if you need to give contrast. And just remember, with head bleeds, troponins will usually always be elevated due to the release of catecholamines....

That's the basics. Soon when you get there you'll learn about blood gasses.

ChristinaG123 · Apr 1, 2011

Luckily, I've worked at a pediatric hospital for three years before I began my accelerated BSN program so I am comfortable with getting there, finding my way, and using hand sanitizer =P I've done really well in all my classes and feel comfortable with most of the systems but the values make me nervous. I wanted to make a quick "cheat sheet" for my fellow students and I to be able to reference from time to time. I just want to have some quick reference that I can review before clinicals start every morning. I was to expand this from just lab values to other norms, like BMI (but I don't think that will ever come up... but you get the gist!).

Sarah010101 · Apr 1, 2011

We were always given a medication list including pt name, diagnosis etc the night before clinical so we could look up our patient and become familiar. I think it would be beneficial to know what the meds are (even if you are not at the level to be giving meds yet) because they all are related to the patient and the assessment findings. Plus, if you knew the patient was taking ramipril that morning and their BP was below normal.. that would be something you could alert the staff to.

Lab values are important as well.. I wouldnt worry so much about the numbers because the lab sheets usually have the norms right beside the actual value, but rather knowing what each lab value means, signs/symptoms you might see with a low or high value, what you can do about it.. and possibly why it is happening (critical thinking :) I always found it helpful to relate the lab value to patient diagnosis. So this person has pancreatitis.. what do i expect to see when i go in there... and what is this person's labs going to be liek.. what meds do they have.

hope this helps, from one student to another :)

Heidi the nurse, BSN, RN · Apr 1, 2011

It's been awhile since I saw a nursing book, but isn't there a list of values inside the back and front covers, or somewhere? Like what you find inside a med book with conversions etc.

Part of it depends on which clinical you are talking about also. For psych it would be far more important to know normal levels for lithium and tegretol than it would be to know what a "good" ABG is.

86toronado, BSN, RN · Apr 1, 2011

If you want to add to your list common medications, I know there is a thread floating around here somewhere that discusses a "top ten" for various areas of practice. I work in ER, so medications that I give everyday would be:

-Morphine

-Dilaudid

-Cipro

-Zofran

-Lopressor

-Lortab/Vicodin/Percocet

-Zosyn

-Nitro

-ASA

-Tylenol

Working on a floor, or in rehab you would want a different list of drugs to memorize normal dose ranges, side effects etc. But this may be something to get you started.

toosweet · Apr 1, 2011

I'm in clinicals right now, doing them for a few months now. My advice is to make sure you have your head to toe assessment down and don't miss any areas. Take special care when doing your Nursing Notes. We always get to look at our pt's charts on the first day for a few hours, write down EVERYTHING, labs, meds, diagnoses, medical hx etc. even social history. We have sheets that we can fill in info for ourselves to keep, nut nevcer write pts name on anything like that. In my school we have to make drug cards for any meds your pt is on even PRN. Also Patho cards, we will and do get quizzed on them from our instructor. We have to answer questions about the meds before we can pass them. ( therapeutic ranges, adverse effect, what to monitor for etc.) It depends on what the instructor feels like asking at the moment. HaHa it can be overwhelming but it REALLY helps. If your instructor allows it, ask a staff nurse or even a CNA if you can tag along with them for a bit and observe. I might think of more.... I'll let you know :) Good Luck!

apocatastasis · Apr 1, 2011

I'm a med assistant for J1 students.

What you need to know is dependent on your patient, and I wouldn't you expect to be able to recall e.g. normal urine specific gravities on a patient if they were post-op CABG. Unless they needed a urinalysis for some reason.

I expect my students to know:

Diagnosis (and the pathophysiology and implications)

Comorbidities (and their patho and implications)

Significant lab values coordinated with the diagnosis/comorbidities.

Meds, including why the patient's on them, class of meds, mechanism of action, contraindications, and side effects (especially major side effects).

And if the patient has 10 comorbidities, my students know they'd better have looked them ALL up, cuz I ask them about ALL of them.