Block 4 Lab Practicum

***UPDATE 100% ***


Is today. Which should consist of a written exam worth like 16-18 points or something, that does not count for your grade, until you pass lecture.

It should also include the ECG,ABG & Critical Care calculations.... please make the calculations as easy as that formula I discovered.

Of course I also learned another way last night as well for some ACLS math... which I thought was pretty cool.

After the practicum is more lecture... she wants to get through neuro and onto shock and emergency management before next week's test and FINAL!

Tomorrow we are all supposed to present a 5 minute EBP (Evidenced Based Practice) question... hummmm... maybe I should really get started on that :-)


PS... Are these cute or what?

Drug Calculations Made Easier...?

I stumbled upon a formula for Dopamine and Dobutamine dosage calculations based on a CONSTANT. You know the mcg/kg/min..... ones.... Has anyone heard of these?

I tried it out a few times and BINGO... it worked.

So it is based on Single and Double Dose concentrations.

Dopamine Single Concentration = 13.3
Dopamine Double Concentration = 26.6


Dobutamine Single Concentration = 16.6
Dobutamine Double Concentration = 33.3


Sooooo... what does that all mean?

Well if you use the formula of:

Dose x kg
_________ = you get the amount in ml/hr to set on the pump

constant


Example 1:

Order: Dobutamine 5 mcg/kg/min
Solution: Dobutamine 500/250 ml D5W (HINT: Conc. is considered DOUBLE)
Pt wt is 176 pounds

Step 1 you know is to convert lbs/kg = 80kg


Formula is:
5(80)
----- = 12 ml/hr
33.3

Ok do it your way... what did you get?

Example 2
Order Dopamine 2.5mcg/kg/min
Solution: Dopamine 800mg/500 ml
Pt wt 75kg


What is the concentration? Single? Double?

2.5 x 75
________ = 7ml/hr

26.6


long way 800mg x 1000 = 800,000 mcg / 500ml = 1600mcg/ml
2.5mcg x 75kg x 60min = 11250

Dose
11250
---- = 7 ml/hr
Conc. 1600



Of course follow the rounding rules for your Program/Policy/Pump

My first Troll...

Ah I have arrived I guess.

Please excuse the typos and grammatical errors... as this is simply a quickly written experience of MY personal journey, for ME to look back on.

Glory be to you, if you so chose to search out nurse blogs, especially us less than intelligent, apparently looked down upon, and considered ignorant, ones.

With that being said, comments are always welcomed... whether you are a douche or not.

Et c'est fin

With that said critical care clinicals are finished for the semester.

Next week... that Med/Surg written practical (EKG,Critical Care Calculations & ABGs)

The week after next... Exam on Neuro, exit HESI and the FINAL!!

Wish me luck!

CPP = MAP - ICP

T minus 18

Days till the final... I was in the car today on the way home from a road trip with hubby.. studying my notes and reviewing NCLEX questions for tomorrow's test... when it hit me... and my stomach actually did a butterfly flip and my pulse started racing.

I thought I was pregnant,,,

Course then I realized that I don't have a uterus anymore... but when I commented on someone's post those silly "you are not a robot" codes popped up with what appeared to be 2 pink lines in a verification picture (apparently it meant I should type in the number 11)

**Guest Post** What is the Value of an RN to BSN Program?

"What is the Value of an RN to BSN program?"

By Vera Mosely, Lover of education with a passion for people.

The role and responsibilities of nurses are changing as healthcare reforms are creating an increased demand for nurses with Bachelor of Science in Nursing degrees. It has been recommended by the Institute of Medicine that by 2020, 80% of all nurses should be expected to have a BSN degree. It's already started in most areas with and the abundant amount of new graduate nurses being spit into the job market at alarming rates are met with job postings saying, BSN preferred.

With these expectations in mind, along with the ever changing complexities to the healthcare system, now is the time to decide if the transition from being an RN to one with a BSN is right for you. There are many RN to BSN online programs that allow a person who is working full time and who may have family responsibilities, the flexibility to make the transition. You may ask yourself what is the value of obtaining a BSN? Here are just a few advantages of considering an RN to BSN program.

Flexibility. There are programs that offer complete online classes, while there are others that require some on campus attendance. Be sure to research several online programs before deciding which one works best for you. You may also wish to evaluate your own schedule to see what program best suits your needs, both economically and availability.

Increased Employment Opportunities. One of the greatest advantages is the one employers give nurses who have a BSN. They prefer them. Further, many employers require their current staff to obtain a BSN through continued education in order to retain their position – and will often pay toward that extra qualification.

More Responsibility Equals More Pay. As you would expect, an increase in education allows for greater responsibilities which leads to a higher pay scale. A BSN program provides the necessary skills for positions that require greater critical thinking, along with decision-making, along with leadership skills, and the opportunity to advance in management.

Career Specialization Tracks. Most nurses, whether they have a BSN or not, all usually start out as staff nurses. However, those with a BSN degree have more opportunity for rapid advancement. One simple reason is that, in order to continue on to a master's degree, which would allow for you to become a Nurse Practitioner, you must first have a BSN. Also, if you wish to pursue a specialty certification such as a Certified Registered Nurse Anesthetist, which is a nurse who assists with the anesthesiology prior to and during surgery, you must also have a BSN. With a BSN continued advancement is unlimited. So is there a benefit to continue from RN to BSN? The answer is yes.

So with all of the advantages outlined above why not choose an RN to BSN online program that works with your schedule and make the transition to a more prestigious career today?

***** Post Note*****

As you all may know, if you have been reading this blog for long, I have been going back and forth between which BSN program to go into, which LPN to RN path to follow. I have made a few stops and starts over the past few years and have change my mind more times then most of you change your fonts. I have bounced around between so many options for years, but after reading through the curriculum and speaking with the representatives at this College, I can tell you that I have found my choice. No waste of classes, no filler fluff, just career advancement at my fingertips.

Mini Medical School

Nursing is Mini Medical School or maybe it's more like a crash course in everything you need to know that medical school school should teach you crammed into a few semesters.

Why? Because as a nurse you need to know the pathophysiology of a disease process, the normal medical management of the disease process, and what to look for when said medical management does or doesn't work, so when shit hits the fan, or a doctor makes a mistake with an order, you are there to catch it.

So with my studying for Cardiology, I have been looking for some supplemental information to get all of the 79 pages of study guide, 1000 pages of reading, and numerious medications and side effects memorized... I have stumbled upon the medical school exam prep guru... and I think I am in love ;-)

Needless to say, if you need some help with the concepts in Cardiology take a look at this guy. CONRAD FISCHER
As I was sitting in my Cardiology lecture I realized that she was teaching us everything that he was teaching medical students... hummm... go figure.

Preceptorship Info

***updated**** Subject to change... may actually get something else. I will know come 11/9!


Med/Surg at LARGE hospital,I have been previously done a clinical rotation at during Block 2, but would have preferred not to go, because they are NOT hiring outside candidates with only an RN-ASN Degree. But anyway...

Good news... well, since I am seriously considering putting my time in on a Med/Surg position after graduation, instead of trying directly for a specialty, perhaps it'll give me a better idea of what I will be in for. 2 12 hour shifts a week during the day.
Plus 2 days of professional development classes on campus that are required and yet another 8 hours of SIM. I freaking HATE SIM!!

Is this real?

All this cardio studying and I am actually for real having chest pains. Is it somatic or actual? Heartburn or GERD or ischemia? I mean I am old and full of stress, but seriously?

WTF?

Self Doubt

I don't think I have ever felt like this when it comes to a class, ever. The total lack of confidence, the feeling like a failure all the time.

I second guess my choices and my skills and feel like an idiot right now.

Why? Because for the first time in my nursing school career I am playing catch up to get a passing grade and feel like I may be letting everyone down, because, hey with everything going on, I may end up having to repeat this semester if I can't nail this shit down and get a little help around here.

I wish I didn't have to work for this next month, but alas there are bills to pay and people counting on me.

But if ever there was pressure before, there is a CRAZY amount of pressure now... and it will not be cool to have to tell people I didn't pass.

FML!

Issues

This is the first semester that I am having testing issues. I can not believe this. I have no idea why I am having issues either studying the material or coming up with the answers that they want. I have no idea exactly how I need to fix this, but maybe it is just being too tired!?!

I know this shit but the SATA questions are really my downfall right now. Ok moving on. I did the math and broke down the points, and well time to buckle down.

See ya in 31 days I guess.

Testing Season is upon us...

Today is the first Med/Surg (Critical Care) exam of the semester.

We have a total of 3 of them to be exact, then the cumulative for all 4 blocks HESI, then the cumulative FINAL!

All in the span of exactly 30 days!!

From today October 8th to November 8th there is pretty much a test or two every week.

Up first is Respiratory and Burns

Next is Cardio and Neuro

Then looks like we end with Emergency Management/Trauma and Multi-system Dysfunctions.

Currently I am sitting at a teetering B but at this point am just looking for that PASS!

Wish me luck!

Test Taking Tips for Nursing School

1. ABC = Does the question contain Airway, Breathing or Circulation and is it appropriate to the question being asked? Many questions are tricky because we are taught if there is an airway question chose it... however, if the question is asking about urination or something like that, would airway be the proper answer just because it is listed as an option? I would hope an instructor or NCLEX test maker would not include that type of question... except we know better.

The nurse identified the client problem “decreased cardiac output” for the client diagnosed with a pulmonary embolus. Which intervention should be included in the plan of care?
1. Monitor the client’s arterial blood gases.
2. Assess skin color and temperature.
3. Assess urinary output is >30 ml hour
4. Keep the client in the Trendelenburg position.


Page(s): 204, Med-Surge Success'' A Course Review Applying Critical Thinking to Test Taking by Ray A, Kathryn Caddenhead Colgrove and Hargrove-Huttel, F A Davis
. This material is protected by copyright.

The client diagnosed with ARDS is transferred to the intensive care department and placed on a ventilator. Which intervention should the nurse implement first?
1. Confirm that the ventilator settings are correct.
2. Verify that the ventilator alarms are functioning properly.
3. Assess the respiratory status and pulse oximeter reading.
4. Monitor the client’s arterial blood gas results.

Page(s): 207, Med-Surge Success'' A Course Review Applying Critical Thinking to Test Taking by Ray A, Kathryn Caddenhead Colgrove and Hargrove-Huttel, F A Davis
This material is protected by copyright.



2. Nursing Process- ADPIE... Is there a questions that asks what would you do first? ASSESS is always the first step in the nursing process. Usually these questions contain all of the steps or a few of the steps of the nursing process. Which we know all may be right, but we must assess before we take action.

Which intervention should the nurse implement first for the client diagnosed with a hemothorax who has had a right-sided chest tube for three (3) days and has no fluctuation (tidaling) in the water compartment?
1. Assess the client’s bilateral lung sounds.
2. Obtain an order for a STAT chest x-ray.
3. Notify the health-care provider as soon as possible.
4. Document the findings in the client’s chart.

Page(s): 207, Med-Surge Success'' A Course Review Applying Critical Thinking to Test Taking by Ray A, Kathryn Caddenhead Colgrove and Hargrove-Huttel, F A Davis
This material is protected by copyright.



3. Maslow - Of course physiological needs come first, but generally if there is a Maslow question, it's about safety. Always err on the side of safe nursing practice and patient safety.

The unlicensed assistive personnel (UAP) is bathing the client diagnosed with acute respiratory distress syndrome (ARDS). The bed is in a high position with the opposite side rail in the low position. Which action should the nurse implement?
1. Demonstrate the correct technique for giving a bed bath.
2. Encourage the UAP to put the bed in the lowest position.
3. Instruct the UAP to get another person to help with the bath.
4. Provide praise for performing the bath safely for the client and the UAP.

Page(s): 207, Med-Surge Success'' A Course Review Applying Critical Thinking to Test Taking by Ray A, Kathryn Caddenhead Colgrove and Hargrove-Huttel, F A Davis
. This material is protected by copyright.




That's it for now... back to studying I suppose!

Just blame nursing why don'tcha...

Everyone has heard about the spread of infections in hospitals... MRSA for example, UTI, line infections to name only a small few. Now how does it spread like wildfire?

Oh it's the nursing staff. They don't wash their hands, they don't clean their equipment. They aren't cleaning the lines. Nurses, nurses, nursing, nursing. PFFT!


In the 12 hours I was in the ICU I witnessed this...

1. RT placing his stethoscope on the bed of a precautions patient then placing it around his neck. Followed by suctioning patient without goggles or mask in a sputum MDRO, then take off gloves then gown and NOT wash his hands.

2. Doctor's going from room to room and never once using the gel, or washing their hands after assessing the patients. (Hint: its the old timers)

Side note: Med students gel like fiends... as do nursing students who are gel addicted! Nursing students ask yourself this... when was the last time you passed a gel stationed outside a patient room and not used it? If you can answer this... you are not using it enough! LOL

3. Doctor going through the laundry bin of a precautions patient with bare hands searching for a missing item, and NOT washing his hands before leaving or even attempting to use the gel outside the room.

4. Every single nurse, either washed their hands prior to leaving a room, or washed and gelled their hands after leaving a room!!

5. On the flip side I did see a few not gel before going in a few times, but overall this was limited.

6. Every single nurse Cavi wiped their computer outside the rooms prior to using between shifts as well!



There was more but at this you probably get the point... it's all nursing's fault! Urgh!

ICU love

Didn't think I would like it... but I LOVED it. I love the total care of the TWO patients. The staff today that I worked with was amazing. What started off slow and low acuity turned into high maintenance and circling the drain.


So the nurse did her assessment, I did mine. I couldn't put into words the sounds I heard, I forgot them. I did mention that the rt lower lobe sounded like crackles, but sounded pretty loud. If that made since... not clear, just louder than I had expected. Now mind you I listen to kids lungs every day and they do sound loud pretty much everywhere, but with adults they sounds quiter, where I can never really hear breath sounds at the bases and for me they always sound diminished.

So anyway, I asked her what she thought, "She said the left sounded worse to her and both sides were diminished." But also said,"... that I should trust my assessment, because it is my assessment, and most times the nurse is right, even if the doctor hears something else sometimes."

So by this afternoon, guess which lung was consolidated w/ infiltrates and upon x-ray completely whited out at the base to through middle lobe? Which did not result in a great expected outcome for said patient. PaO2 50

Not that I don't have enough to worry about...

But I need some extra cash now that I bought a brand new car. 2013 Kia Forte

I needed one and it isn't all that expensive or over my head or anything... it's actually only $73 more than my current payment... but the down payment put a little dent in my wallet because I was upside down in the old car.

So never the less, I decided to apply for a PRN/Part-time position at another HomeHealth agency but this is just doing a few visits to the LTC crowd.

I know, I know, when will I find time? Well since my client at work spends an awful lot of time in the hospital these days, I need a back-up plan to pay the bills just in case. The client I usually do as back-up is going back to their parent's so there will not be any hours there.

I figure I have a few shifts in me somewhere... if I can push all my full-time hours in 3 days then have clinical 1 day, that still leaves me 3 whole days available.

What about family, what about studying? Well studying I got covered in my full-time job, plus in 30 something days hopefully I will have passed and will be done... freeing up more time! On the family front, right now it's a few hours here or there and I don't see that changing much.

It's not a done deal, as I just applied last night... but sometimes there just has to be a time where you have to spread yourself a bit thinner to get the finances straightened out.

Speaking of thinner... the trainer and gym are put on hold too... but the biking and hiking seasons are upon us finally... and there will be a treadmill in my living-room soon enough as well :-)