Nearing the End

I’ve had this blog quite awhile. And I obviously haven’t posted since forever ago. To catch up:

  • RN year classes = passed
  • Kaplan review course in Box Office building over University Field (what an odd location . . . ) = done
  • Boards = scheduled
  • Wedding = 18 days away

Needless to say, planning a wedding while trying to pass nursing classes can be a death sentence if pressure isn’t your thing. Though – pressure isn’t particularly my thing, and I managed. (Trust me when I say that there’s hope for anyone because of that.)

QUALIFIER! I only managed with the help of my wonderful fiance, family, friends, and teachers. They helped me remember why I was doing this (Soli Deo gloria, of course), and that, in the words of our Kaplan instructor, “I am more than minimally competent”.

Speaking of “minimally competent” . . . really, nursing board? I know that’s a perfectly good (and reasonable) goal for the nurses you want to license and set loose upon the floors of many a facility, but way to make us feel terrified and potentially stupid. Maybe next time just keep that to yourselves. Tell us that . . the test determines if we learned what we ought to have learned in school. I suppose that’s the same, but it’s all in how you say it. If I want to tell a mother that she shouldn’t let her child have quite so many unhealthy foods, I’m not going to patronizingly tell her that, “When you bring Johnny here for a checkup, you’re letting me see if you’re capable of feeding him like a nurturing mother should.” Noooo way. Maybe something more like, “When you bring Johnny in for a checkup, we’re just making sure that he is healthy. Would you like to talk about appropriate nutrition for a five-year-old?”

That makes perfect sense to me, but it might seem far-fetched for everyone else. Excuse the wild mind of a boards-studying bride-to-be.

But here’s something that I was chuckling at: Wiki teaches us how to pass the NCLEX-RN.

I like the first step. “Pay attention in nursing school.” Oh! Right! Of course. What a good idea. If you’re wiki-ing how to pass this test, chances are you didn’t pay attention in class or when your teachers taught you how to apply and the requirements. I’ve gathered that it’s pretty common to see boards requiring a boards-prep class before becoming eligible to test at all.

Step three is, “If you are unclear on a concept, be dogged about learning it.” Now, as I understand the word “dogged”, it is akin to words like, “obstinate”, “stubborn”, “pertinacious”. I don’t know about everyone else, but when I start getting “dogged”, I start getting “mad”. And yes, I mean that in the true sense of the word. At least at this point, I really would rather not get dogged about anything. Determined, yes, because I’m more level-headed at that stage.

The last step – Thank you, Wiki. That sounds like a good idea. And then I’ll hit refresh every two minutes after midnight on the state board site. Maybe a Red Bull would be a good treat.

But enough of that.

I don’t plan to keep this blog up. I haven’t decided whether or not to delete it, but I’m certainly leaning towards that. We’ll have to see what the next couple of weeks bring.

Happy test taking – You are more than minimally competent!

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School’s Alive . . . and Probably about to Kick.

Well. It’s been forever and a thousand years since I’ve posted. Yikes . . . It’s not for lack of things to say, but for lack of mind to say it.

But here we are again. School’s up and running, and while the class was open online last week, I light-heartedly went about writing up my own notes. But with today here . . .

* insert cannon boom from Hunger Games *

Yup. I can’t decide whether that boom’s to alert me that things are serious, that my daydreaming career has died, or that I just need to wake up and smell the coffee. Before it burns.

Eh, take your pick. Perhaps it’s E (as in all of the above).

All that being said, I’m actually having fun writing everything down. It gets a little tedious at times due to my having just read it in my book and notes from the professor and then writing it again, but there’s no way I’m going out without a hard-fought fight.

The first two weeks are mental health (joy!), and this week’s assignment’s the first nine chapters of the mental health book. I’ve really come to appreciate the notes provided to us by the instructor. They’re not only the sort that highlight the important things that one’s read, but she encourages us to think about how various things are applicable. Mental health isn’t my forte, and that’s for various reasons, but I want to learn what I can well.

I’m still planning on working throughout the semester as a part-time LPN at the nursing home. Things could change, but I’m hoping not too much.

(Any and all people who love the English Language can collect a garbage can to pick up the litter that I’ve strewn about here. It’s pretty wild.)

I know there are plenty that read this little corner here, and I’m hoping to keep it up. But, alas, it shall mainly be about school – and that because of the fellow students that visit. I’ll try to keep up, and even post some things that I’ve learned or have been confused over. We’ll see where things go.

Making Sense

Now I see why I didn’t work last year.

Balancing School and work and family and friends is starting to get to me. It’s starting to get to nearly all of us, and we’ve already had one dropout due to it. The wind sings outside with the huge temptation to just sit and look at all of the beauty, and we put in earplugs or ear-buds to tune it out.  Oh well. It’s only till May, right?

On a slightly different note, I have a question for both patient and nurse(ing student).  In my last post, I mentioned a cardiac case study that I needed to have completed, and now’s the time people are required to post “peer responses” to them on the class discussion board.

Here’s the case with the specific question I’d like your input on:

You are the charge nurse working in a long term care center. Mabel is an 85 year old resident with a long history of congestive heart failure, a myocardial infarction 3 years ago, COPD, hypertension, and degenerative joint disease. Her medications include: furosemide 20 mg QD, enalapril maleate (Vasotec) 5 mg QD, digoxin 0.125 mg QD, KCL (potassium chloride) 40 mEq QD, and ibuprofen (Motrin) 200 mg QID. 

Today, Mabel (who is consistently alert and oriented x3) complains that she “just doesn’t feel right.” The nursing assistant reports that Mabel’s pulse is weak and irregular at 116 bpm and her skin feels cooler than usual. You go to her room for further assessment.

After reviewing the ECG, the physician decides that Mable is in atrial fibrillation. Mabel is again alert and oriented and her daughter is with her. 

6)    How would you explain atrial fibrillation to Mabel and her daughter?
Because the condition is being explained to those outside the medical field that are most likely frightened at this diagnosis, it is important to bring the explanation to their level of their understanding. An important thing to make sure of before explaining what afib is is to provide any education (if needed) on how the heart works – its parts, what they do, etc..

Atrial fibrillation is the fibrillation of the atria of the heart. Fibrillation resembles a sort of quivering. The heart rate is quick and irregular. This means that instead of moving all of the blood from the atria, the atria will have some significant pooling. The ventricals of the heart can beat more rapidly, causing the ventricals to have decreased filling. Because of this, there is a decreased cardiac output. (Iggy, 745)

Atrial fibrillation can be caused by many different things:

  •  High blood pressure (hypertension)
  •  Diabetes
  •  Congestive heart failure
  •  Valvular disease
  •  Male gender

We can assume that Mabel’s atrial fibrillation is due to her congestive heart failure.

Another important thing would be to discuss the treatment for atrial fibrillation.  But this education would probably be best provided when the doctor orders the treatment(s).

There is no offense implied in “bringing the explanation to their level.” I know that it would be difficult to have an explanation of something I didn’t understand in the most complicated unfamiliar jargon presented to me. I’m hoping that this part isn’t insulting anyone’s intelligence.

Now, some of the peer responses I’ve gotten back are saying that I should include things like how atrial fibrillation can increase Mabel’s chance of death, and stroke (she already has CHF). I didn’t add this at this time, quite frankly, because this was what I believed was the initial explanation.

But what do you think? Is this an explanation that is easy to understand or no? And, what should I add or take away from it to make it more beneficial for Mabel and her daughter?

Thanks!

(P.S. Don’t read into any incorrect form of grammar here . . . I didn’t exactly take the time to iron out all of the wrinkles.)

 

Update Time:

I’m sitting comfortably in my room right now. There are books on the floor by my feet, pencils and post its on the shelf and table next to me, a Denver II test set to the side that can’t seem to shut up . . . and in front of me is my whiteboard with my “To Do” list on it.

  • Cardiac Case Study #3 (nearly done)
  • Denver II test (just did today, but haven’t written anything down)
  • Community Paper
  • Adult Nutritional Assessment (1/4 of the way through it)
  • Lab reading Assignment
  • Finish studying Resp./Cardiac Reading Assignment
  • Cardiac Reading Assignment

And, to prove that I have a life:

  • Crochet 3 rows on blanket

Ha. Aren’t you convinced.

Anyways, school stops for nobody, and faint heart never won nursing degree. Grades are becoming more consistently pass-worthy (yes, there were a couple of complete bombs), and while I wanted Dean’s list, I’ve since been convinced by past RN students and current experience that 80% C’s are beautiful.

Hope all of the other students reading this are having a good year so far!

 

If It Was Easy, Everyone Would Do It

I guess I’m not so good at posting on here. And, from what this school year has already entailed, I’ll not be posting as often as I’d like.

Registered nursing coursework is in full swing. I’m only taking nine credits this semester, and one of those credits is a med ethics class that doesn’t start until October 17. It’s hard to believe that we’re already into week three. I’d have a countdown till Christmas break, but that would just make things more stressful. Focusing on the current coursework is enough work.

This year, the teachers made it extremely clear that we wouldn’t be focusing so much on the data and information that needs memorized as we did last year. Instead, we’ve to learn to think in a whole new way. Yes, we have to remember the information from last year, but we have to use that knowledge and apply it to critical thinking.

And here I thought we were doing a good deal of that last year. Guess not.

The tests are amazingly difficult. The questions are all testing our ability to think critically for different scenarios. I have yet to see a question that simply had to do with knowledge of the material we covered. Last year, we had questions like “Below are listed various lab values. Match them to the appropriate lab tests.” This year, we have questions like:

“Day 1, noon. Jake is a 55-year-old Caucasian male admitted to acute care with a respiratory infection. Jake has a 50 pack year history and a diagnosis of COPD. He awakened this morning with increased shortness of breath and coughing up greenish- brown sputum. Vital signs are BP 146/84; P. 92; R 30; T 100.2 orally. Physician orders include:
– ABGs stat
– Sputum for C&S
– Ampicillin 500 mg IV q 6 hours
– IV D5W at 100mL/h
– Albuterol 3mg per nebulizer qid and prn for acute dyspnea
– 02 at 1.5 – 2 L/min per nasal cannula

 Relate this clinical data to the diagnosis of COPD. What other sings or symptoms would you expect this client to exhibit? In what order would you implement the physician’s orders?”

And that still doesn’t quite seem like the best example. But you get the idea.

The first two weeks we covered mental health. I thought that it would be pretty easy, but – again – I was proved wrong. The question you see quoted above is from a case study for our week 3 respiratory unit. I’m looking forward to these units. Even that question has an answer that makes more sense to this overloaded head of mine. :)

We’ve had labs on starting IVs, changing central line dressings, NGs, assessing the adult from head-to-toe, communication, and miscellaneous other information. Tomorrow, we’ll cover the pediatric assessment.

Speaking of, I’d better get back to reading for it.

Happy September!

 

“Not Returnable” Lab Kit

1 Penlight (Oh good grief. If I’d only known.)

1 Central Line Dressing Kit (!!?)

4 IV Catheter

1 6″ Extension Tubing

4 Plastic Cannula

1 Latex Free Turniquet (* large gulp *)

10 Sterile Alcohol Pads

1 Bacteriostatic Saline Vial

2 Latex Free Bandaids

2 3mL Syringes (I hope this doesn’t mean that we’re practicing blood draws.)

2 10mL Syringes

1 Small Underpad

 

**********************************

Oh. Boy.

August

It’s rather shameful to not be posting anything lately. Especially with so much going on.

I got the job that I mentioned in my last post. And, while I love the job, I can see why some CNA’s never want to become nurses.

The CNA has a lot of the “dirty work” and more physically demanding work at a long-term facility. It hurts your back, it takes a lot of time, and occasionally becomes somewhat tedious. It’s a wonderful job to help people, and it requires an extreme amount of patience and humility. Lights are going off all of the time, residents can become angry with you, you often go home with soiled scrubs, and if the nurse isn’t a fair and good one, you’re in for a long shift. You watch the nurses as the move about the halls only walking, usually with no need to run. They sit behind the high-countered desk so that you’ve no idea what they’re doing. They ask you to answer the call lights when their ten-minute pager goes off, and if they come in to give pills or insulin while you’re working, you need to stop and step aside. I’ve seen countless aides become bitter with their nurses or nurse managers – and I can see why, though if they only knew . .

Responsibility jumps up about thirty notches, pills have to be given by a certain time, phones ring and ring until you answer them, ostomy bags of various types need changed, notes need written, orders recorded, each little bruise, skin tear and trip need recorded on not one but many forms, and so on. You need to keep track of the groups and aides, and that often means interrupting their work to remind them of something. There are no case studies, but case studies weren’t nearly so threatening.

The first few shifts were a bit daunting even though I was being trained. I’ve flown solo a few times now, and this weekend will mark the beginning of the rest of my job there. I’m still learning a lot about the various medications, what can and can’t be crushed, who likes applesauce or pudding, who exactly needs just a blood sugar check and not insulin, and what reputation the residents and aides are giving me.

I really am enjoying it, and hope that I’ll get the hang of everything quickly for the rest of my coworkers and duties’ sake. I’m still a bit slow and somewhat clueless, so the quicker I get things down, the better.

I’ll be switching to part-time beginning on Monday. I was able to get the position with forty hours per pay period, and that allows me the scholarship the home offers. I still need to order a rather large amount of textbooks, pay tuition and finalize the last details for school on the twenty-second. But with the scholarship, the money spent will all be reimbursed.

Here’s hoping I don’t leave for so long next time.