July 11, 2011

Critical Care Dosage Calculation Questions

Nursing Nerds | What Is A Complete Medication Order?

A completed medication order has to have SIX THINGS!

1. Drug Name - Tylenol
2. Dose - 650 mg
3. Route - PO
4. Frequency - q6h PRN
5. Qualifier (if PRN orders) - For pain or temp > 101
6. Signature

FULL TEXT: Tylenol 650mg PO, q6h PRN for pain or temp > 101
Dr. John Smith, Critical Care, Physician # 123456

Nursing Nerds | How To SBAR Report To Physician

Holy crap, I've never done this and the very thought scares me! But learning the SBAR protocol will help you to convey a confident, professional form of communication. These tips will keep you organized and help to minimize the time you have the physician on the phone, ultimately getting you back to your patient quicker.

1. Assess the patient! When you're calling the physician, will need the most recent vitals and labs. Presenting the blood pressure or labs you received four hours ago isn't the patient's current state. Remember MOST RECENT/UPDATE information when calling. If labs help to support your recommendation, by all means use them. But the physician will need evidence (documented issues or patient's history/background) to support the current issue you're calling about.

2. Call the RIGHT physician! Is it nephrology or critical care? If you don't know, ask your charge nurse. Nothing is more annoying than wasting time paging a doctor and then you’re told, they aren't the person hanging that particular issue. For example, you want to use the patient's hemodialysis catheter to draw blood. You have no other lines and the patient is hemodynamically unstable, so you call the critical care physician. WRONG, when it comes to anything hemodialysis related, it's nephrology always (or at my hospital anyway). It can get confusing sometimes.

3. Know the admitting diagnosis! The physician you're calling as tons of patients, just because the patient has MRSA now, doesn't mean that was the reason for the admission. Check the chart, come prepared!
4. Review the progress notes! Yes, you're the patient's nurse for that day. But to get the big picture, get the progress or surgical notes. This will help you to develop a plan of care or the recommendation needed in SBAR. Plus, this will help you to be proactive in finding any problems you patient might soon face. For example, your patient had hip surgery 2 days ago. You would make sure the patient is using the incentive spirometer and get an order for the patient to get out of bed.

5. Have available: computer (electronic chart), hard-copy chart (physical chart) and notes... in case the physician has any additional questions or if other physicians have written orders that haven't been added to the electronic chart. Have all aspects of information available at the time of the call.

Graduate Nurse Moment | Planning Your Clinical/Working Day?

Being a new nurse is mind blowing but my employer has provided me with some really great tips for success. These tips can also be used when you're in clinicals. This will help you to be organized and decreased the # of tasks you forget to do during your shift.

When you hit the floor, VISIT THE PATIENT! Go see the patient. Introduce yourself and explain you're going to get report. But you CAN NOT ask questions, if you DO NOT know the discrepancies. Now, let's get the history, progress notes, surgical notes, consultations and physical information on your patient. Find out what type of lines/drains your patient has (central, peripheral, jackson pratt drain), body system issues (no bowel movements, thready pulses, weak muscle strength) and medications (PO/IV). This will give you a full picture of what your patient looks like. Once you have that full page, does it match what you saw initially? If not, ask the previous shift nurse for any additional details. This is why seeing before writing is important. You won't know what is an issue, if you don't put your eyes on your patient first.

After you have your visual and have your report, it's time to find out which patients are most critical. Which patient do you want to do your assessment on first? The one that will require the most time and needs the most care. Plan your first few hours doing your assessments and finding out when your medications are due. What's the point of giving medications first... such as Colace, if your patient doesn't need it. Always make sure you assess BEFORE you implement! Or you'll be running back and forth from the Pyxis.

Once you have your assessments and your medications in orders, start to plan your day. Make short term goals in two hours sections. For example, from 8:00AM-10:00AM: I will do all my assessments, assessment charting and give my morning medications. If you don't have any goals, you'll be behind the entire day. It will be overwhelming at first, but you'll get into a rhythm and find your groove. Throughout your day, keep planning events in two hour sections. This will keep your organized and prepared for your day. We all know nursing isn't this simple but with a plan of action, hopefully your day will be easier.

At my hospital, when you give an IV/IM opioid... you have to re-assess the patient 15 minutes, another 15 minutes, and another 30 minutes after the medication is given. Sounds simple enough but during my clinicals, I'd forget all the time. To make my life easier, I've added check boxes on my shift change report. Any time I gave those types of medications, I knew... hey I have these check boxes, an assessment is needed. This just makes my life easier and keep me on track.

In the end, it comes down to being organized and taking the time to remember the little things. The devil is in the details and these things have helped me to be more organized and hopefully will help you!

July 10, 2011

Graduate Nurse Moment | What Am I Legally Obligated To Do?

Every state has it's own form of a practice act. It spells out what you need to know and what you're expected to do as a now licensed, registered nurse. I know what you're thinking... I already learned that in nursing school, right? Wrong! I just read, you will get fined and your license will be suspended (in Florida) if you misrepresent yourself. Sounds vague right? Well if you're a registered nurse (with no certifications) but you advertise yourself as a diabetes nurse, that's a violation. Something simple as that, will get you into a pickle. To be a specialized nurse of diabetes, you have to be certified and there is a protocol. There are rules to nursing and going over the rules BEFORE you hit the floor is a good idea. Don't sweat the legalities word for word but, know what is expected of you.

Weekend NCLEX Questions Challenge!

Correct Answer: 3

1: Assessment: Outcome expected but not priority, could be due to appetite issue. No time frame given
2: Assessment: Outcome expected but not priority, could be due to other causes such as change in position
3: CORRECT | Assessment: Outcome priority, reason for diuretic therapy. Diuretics reduces alveolar edema and pulmonary venous pressure
4: Assessment: Outcome expected but not priority, will increase but may not change heart failure

July 9, 2011

Nursing Student | You Have No Support System?

Try focusing on yourself and don't let your family issues mess up the great opportunity you've been given. I'm not going to go into detail but my mother and I aren't remotely close. When I started nursing school and told her I was accepted, she wasn't too impressed. I could have cried, been dramatic and let my emotions get the best of me. Instead, I focused all my attention on my goal... completing and graduating nursing school! I figured if this is what I really wanted, having a support system isn't really of necessity. It would be nice but not having one isn't going to ruin this for me. What I did was, I made tons of friends in my nursing program. You're going to be around this group of people for about two years, spark up conversations and create those bonds. Create your own support system with people who understand where you're coming from (since you all are in the same program). When you focus on your objectives, you'll build your self-esteem up and learn more about yourself. Having family is a great thing and even better when they are positive and support the decisions you've made. But when you are lacking that support, try building your own. You will be surprised just how strong you are and what you can accomplish. All and all, you're never alone and your support is a click or smile away. You determine who you surround yourself with, make them positive people only!

Nursing Student | You Failed A Course, Now What?

This happens to everyone at some point in their nursing journey, no one get straight A's forever. For me, it was in the very beginning. I failed my college algebra class, four times. Yes, four times! At the time, math wasn't my strong suite. If I would have given up the first three times, I wouldn't be where I am today. If I could give you any advice, it would be don't give up! Re-register, scrap together some money, wait the semester, wait the year... do whatever it takes but get your butt back into that program as soon as possible! Nothing worth fighting for comes easy. It's going to be a hard road, just don't give up on yourself. I've had my lows, days when I didn't think I was going to make it. Exam days when I studied for two full weeks and received a NOT passing grade... but you have to keep going! You have to fight for what you want. If you don't fight, you're stagnant and nothing happens when you're not moving. You want to be a nurse? Take it one day at a time. I didn't expect to graduate when I was accepted into my nursing program. I thought it would be a great experience but I didn't put pressure on myself. All I did was give it 110% and never miss the opportunity to show my professors and co-workers how much I wanted this. I literally never missed a clinical, class or presentation day. Do you know how many school days I missed of high school? Too many to count! When you work for something, you'll get the results. Hang in there, we will do it together! Failing a course doesn't make you any less of a nurse in the end either. If you make it, you've made it! As long as you pass the NCLEX, the result is the same. There's no shame! Take the time you have available, to perfect your studying habits and come back with guns a-blazing!

Nursing Student | What To Do After You're Accepted Into Nursing School?

First off, congratulations on getting in! Nursing school can be very competitive. Now, before your nursing orientation and the stress begins, you need to get your head wrapped around a few things. You should start off by getting certified in CPR adults/children (by American Heart Association). Most schools require this before you even go to clinicals, so you can handle a code (if the opportunity presents itself). After you've mastered CPR, the next thing you need to do is get your immunizations in order. You WILL NOT be able to go to clinicals unless you've had your PPD (TB skin test) and OSHA mask fitting done. These are for sure deal breakers! On top of those two, you need to get a physical done. This informs the school that you don't have any debilitating injuries that would hinder you from working at the hospital.

After all the tests and physicals are done, it's time to go shopping. Most nursing schools require you to wear certain type or color of scrubs to clinicals, get that out of the way. Getting white scrubs overnighted to you because, no uniform place in the area has your size is super annoying! Oh and grab some shoes too, all white usually. Now that you're all decked out, time to take those artificial nails OFF! Those suckers are bacteria pools! So get use to it early and learn to love your natural nails. Note: This might not apply to you but every hospital I've visited, it was required and only natural nail colors was acceptable.

Time for fun, go out and get a cheap stethoscope. You don't need anything fancy, just grab one from any uniform store. In your first semester, you're new to using one so... why waste $200 if you have no idea how to use it OR what you're hearing? Maybe around 4th semester you can invest in a quality stethoscope, I did. And let me tell you, there is definitely a difference. Once you have your stethoscope, try using it as often as you can. Ask your family members if you can listen to their heart sounds. Listen to the heat sounds, become familiar with them. You'll be ahead of the game in no time.

Now that you have all the real things down, now it's time for you to hit the books. Go out and buy a cheap nursing fundamentals textbook. Every night try to read the some content, learn how to do a head-to-toe assessment. Learn the foundations and skills of nursing BEFORE you have a test on it in 2 days! If it confuses you, don't worry about it. Ignore it for now... you'll be taught it soon enough. You could always buy a medical dictionary to help you out in this department, my favorite is Tabers.

That's really it, the rest is up to you! I'll see you at work!

Weekend NCLEX Questions Challenge!

 Correct Answer: 3

1: Assessment: Outcome not priority, heart failure and weight gain seen with chronic bronchitis. The highest priority is oxygenation
2: Assessment: Outcome not priority, dysrhythmias occur due to right heart failure. Priority is oxygenation
3: CORRECT | Assessment: Outcome desired, priority is to establish oxygenation status
4: Assessment: Outcome not priority, common reason for worsening status is respiratory infection, more important to establish respiratory status first

June 30, 2011

I Passed the NCLEX-RN Exam!

It's official, spread the word! I checked my exam status on Pearson VUE and I PASSED. I had 75 questions and the screen went blue, totally thought I failed. I mean come 'on now, who get's the minimum questions? Not little ol' me. This road has been a long one and I can't believe I made it. I've been fighting for so long, it feels weird to have made it. Can't wait to see that license number pop up. Now, the real fun begins. Strap on your seat belts people, the nursing profession is going into over drive!

June 18, 2011

Book Recommendations | Nursing & Pharmacology Made Insanely Easy!

Pharmacology Made Insanely Easy!
ISBN: 097610296X | 978-0976102960

Nursing Made Insanely Easy! 
ISBN: 9780976102939 | 978-0976102939

I was looking through the books in my bookcase and stumbled across these two books. These books got me through the last semester of nursing school. And now, they're going to get me through the NCLEX-RN exam. My favorite one is the pharmacology book. There are tons of medications (ones that, I've seen and was questioned on in Kaplan), that I know I will see on the NCLEX-RN exam. From antibiotics to antipsychotics medications, this book has it all. You get medication information, side effects, important labs, nursing inventions along with cute pictures (so you can remember them). I spent about three hours reading and tagging the pharmacology book.  Vancomycin causes red neck syndrome. I just typed that from the top of my head. How do I retain it you ask? There was a picture of a "redneck" reindeer. I laughed and now... I will NEVER forget it. I love this book. The nursing book is awesome too. It provides the same technique to studying. It also providing pictures and important information you will probaly see on the NCLEX-RN exam. Good luck everyone!