Paperwork

I have a love-hate relationship w/ clinical paperwork. Tonight is my 1st night w/ two patients worth and it is pretty extensive. Anyway, I love having the information all organized and knowing what I am doing, but I hate the hours I have spent working on this stuff. At least now it takes about 4-5 hrs as opposed to the 8-9 hrs it used to take me.

Today my CI tracked me down to tell me my patient from last week passed away the day after I cared for her (I was supposed to be reassigned to her tomorow). She was a gastric cancer patient and things went quickly. All I know is she was a very graceful person...I hope I'm as kind and peaceful at my end. Amazing the things you learn from those you care for when they are dying. She is the second CA patient I have had who has passed away shortly after my caring for her. I can see how rewarding, if sad, oncology can be. Say a little prayer for her family if you think of it--I'm not sure they were really ready to say good-bye.

Tomorrow: more cancer (this time hepatic) and an MVA. Bring on the broken bones!

so, you are about to start nursing school...

i remember my first semester of nursing school and how excited/nervous/weird i felt. i thought i would put together a few posts of things i have learned so far in school--items i have needed, books i have loved, advice i should have heeded (oh, i rhymed). if you are out there and getting ready to start school, say hello in my comments section!

books i have used over and over again and would recommend strongly:


Math for Nurses by mary Jo Boyer
ISBN # 0781753724
This little pocket book taught me all I know about dosage calculations. I love that it has a pull out plastic card to put in your scrub pocket, and that it goes through a step by step math review before getting to the good stuff. If you are having dosage anxiety, pick this guy up!



NCLEX-RN Made Incredibly Easy
ISBN # 158255451X
One of the best things you can do for yourself is pick up a good NCLEX book--this is the big lisencing exam you will take after graduation. Before each exam, answer NCLEX questions based on what you are studying. This books has very straightforward Q&A with well explained rationales. I even had teachers pull test questions from this book! It is THAT good!


Saunders Nursing Drug Handbook
ISBN# 1416040633
I have a couple different drug handbooks and some drug cards, yet I always come back to this book while doing my research and writing up my care plans. The drug definitions are clear and concise--you actually understand what the meds do to the body after reading the description! Side effects are laid out in order of how frequently they occur, and how to correctly assess your patient while they are taking a specific drug is outlined. This is an easy-peasy non-intimidating handbook. I have the 2003 version (and I havent used the CD on this but have heard it is nice, too).


Handbook for Brunner & Suddarth's Textbook of Medical Surgical Nursing
ISBN#9780781747035
This little handbook lists pathophysiologies in alphabetical oder and is the size of a scrub pocket. I love, love, love that it gives nursing diagnosis w/ related to's after each patho!! A must have for clinical and paperwor, but also GREAT for exams--the info is clear, concise. Wish I had it at the very beginning. Dang it!


Nursing Diagnosis in Psychiatric Nursing: Care Plans and Psychotropic Medications
by Mary C. Townsend
ISBN# 0803611668
This little pocket book was also a lifesaver in mental health, a class and clinical I loathed. It is difficult to find nursing diagnoses for MH in other Nanda books, and this has everything you need to understand the disease processes, assess, diagnose, etc. This even outlines the meds in depth for each disorder so you can write out your med sheets/cards w/out the use of another drug guide. We passed these back and forth throughout my rotation and they were a God-send. Really.

Delmar's Maternal-Infant Nursing Care Plans
ISBN# 0766859932
I think I mentioned this in another post, but I really like this book in that it has specific care plans for OB. Delmar also makes one for pediatrics which would be highly useful. The nursing diagnosis books we were to buy in my school bookstore did not have care plans laid out by specialty, which is why these books are handy. You can see how things like fluid volume deficit affects a laboring mom or newborn baby instead of a comatose patient. We all pitched in and bought one of these and passed it around so we could share the expense. It was well-worth the money!


Mosby's Diagnostic and Laboratory Test Reference
ISBN# 0323046347
Do you know what BUN is? What about Total Protein?
Do you know why it would be elevated in your patient with renal disease?
Do you know what a CAT scan or MRI is, why it is ordered and what it does exactly?
Well, you will have to know what these tests are, how they are used, and WHY your patient needs them (which is the hardest piece of the puzzle). I love that this book tells you the WHY of it all! My classmates love to borrow this book from me because we haven't found a comparable one. It is GREAT!

I have many books, yet these are ones that specifically got me through rough spots in the program. Hope this little list helps you as you wander through B&N and peruse Amazon. Let me also say that you can find almost EVERYTHING at half.com or alibris.com and you will save a TON of money buying your books there. I have saved over $1000 on books and I have twice the books because I have bought them there--also I have bought older editions and have had no problem using them in my classes (like instead of the new 8th ed I will buy the 7th ed--usually NOTHING has changed!).

Um. Another one:

I apparently "need help with my critical thinking and organizational skills."

Got my paperwork back today and my CI really knocked my skills. This is the 1st time I have had criticism on my stuff. Kinda threw me for a loop and I just keep asking myself why I am doing all this when it is making me absolutely miserable. I only have 2 weeks left of this clinical. *sigh* I don't know what will happen next. Maybe I'll have a good week. Someone throw me some positivity.

I was so distracted by my bleeding paperwork, I could barely concentrate on my exam, and then I left soon after because my gastritis was killing me (stress and caffeine will do that). Now I am home and very nervous and unhappy--took some Protonix.

Checked my grade (it is up already)and got the proverbial 90%. Eh, who cares.

How many RN's does it take to...

Had a really sick patient last week who was very unsteady on her feet. She had TPN, a Power PICC, and was on 5L of O2. She also had to be transfused w/ a HGB of 7.1. It was all she could do to get up and make it to the bathroom. Had an interesting moment:

After getting her up and into the bathroom at one point, I quickly changed her linens, which meant my putting her bed in high position so as not to strain my back. She waited patiently for me to get her back up and out of the bathroom, and I said:

"Ok, lets get you back into bed--it's all nice and clean."

I turn to lower the bed and it won't go down--it will go up, though, and raises to be about 5 feet in the air. All kinds of "lock" lights are blinking, but I can't get the bed to unlock for anything. I turn to patient:

"Well, we will have to get you into a chair while I go find the nurse and try to figure this bed out."

Patient tells me she has had issues with the bed as well. Get patient into chair, go find RN, she comes to the room and also can't figure bed out. At this point, it is about 5.5 feet off the ground and at its highest position. I turn to patient, and with a deadpan face, say:

"I am sorry ma'am, but we are going to have to ask you to get up, walk to the other side of the room, and run and make a flying leap into your bed."

Nurse looks at me in horror, patient looks at her IV pole in horror, and it takes them a minute to realize I am joking--they both crack up and patient laughs so hard she starts to cry. I go get a tech (and techs know EVERYTHING, so this was a good nursing intervention) and she shows us that you have to hold down three buttons all at once to get the bed down.

Get patient back in bed and all is well.

Other highlights of clinical: had a doc snip at me (jerk), had a horrible time with the pyxis and basically decided that I hate computer charting. Oh, and did 8 hrs worth of paperwork and a teaching project. Have never been so tired in my life and almost threw in the towel, again. Thankfully my MIL and husband talked me through it--and my classmates are all in the same boat...

Back to the books.

VD?

Happy Valentine's Day.

DH gave me a pretty necklace and this DVD. I love the soundtrack to it and think it's pretty appropriate for this holiday! One of my kids made me a valentine that had him in jail on the front and it said, "I am trapped in love." Tehe.

Hope you have someone to love today--even if it is just someone in your life who you just really appreciate and care for. Romance ain't the end-all, be-all, kids. It's a fleeting nicety and it's the people that stick with you for years and years and years through life's dullness that count. Being married to a best friend is rad. Constancy is a good thing. Anyway.

Trying to figure out what to take to clinical with me to write up my paperwork. I need my lab book, my nursing diagnosis book, my pediatric med book, and I need something with some Patho in it, but I don't want to lug my textbook there (it has 2000 pages because it is a combo Peds/OB book). Plus I have to find a big enough bag to bring it all--my new clinical bag would break with the stuff.

I don't know how today is going to work because I spend so much time writing my stuff up--how much time is she going to give us, I wonder? Most likely I will have a lot to bring home and do tonight and tomorrow morning. I hope she gives me a somewhat interesting patient, ya know?

I am still coughing and feeling kinda yucky. I am on antibiotics, and this has lasted since Christmas!!!!! Kick me. Plus I went off Diet Coke for a few days and now I have the withdrawal headache.

Gotta pick the house up a bit and get my scrub-on. Have a good day!

Ringy-dingy...

Did I mention that my CI (clinical instructor) is going to call everyone who is on paperwork clinical probation this weekend? So, if I have less than 80%, I'll get a REALLY FUN phone call. So far so good...one more day to go w/out a call!!!!!!!

Found out today that we lost two students to the dosage calc. test. They didn't make it and are now a semester behind 'cuz they have to repeat the whole process. How awful is that?

I am not studying like I should, BTW. Stupid, stupid me.

Wow

Clinical kicked my butt yesterday--it was soooo good and so sad at the same time. Long story, and I'll probably go into it more later, but suffice it to say I fell in love with my patient and had a good cry over her. *sigh*

Speaking of good cries, we all cried in post conference last night when we found out most of us will be on clinical probabtion for paperwork. We need an 80% at midterm--I thought last week was the grade we needed but the 80% is for THIS week!! I don't know if this week's set will get me that grade or not. It would suck to go from 100% to less than 80%. I will have a really hard time if I go on probabtion. My classmates are all struggling and worried. Guess everyone is below the mark with one person in particular at a 30% still. Yuck.

I stepped down from my class office on student council today. I just don't have time to deal with all the drama.

Too tired to write more...

Peds Clinical Week One

Well, I think I may actually like Pediatrics. Had a good day on the unit--even though I still have NO IDEA what I am doing. Was able to jump right in with my patient and do a tube feeding, strip a Blake tube, perform some ADL's, assessment, stuff like that. We didn't give meds yet because our drug calc test isn't until Tues, so we aren't "safe."

I definitely need to keep my pockets more organized! Ha.

The paperwork is really, really hard. And extremely time consumming. I know it teaches critical thinking, but I wish they wouldn't cram everything into a two day period like that. It would be great if we could start all our paperwork but be able to revise and turn it in later? Anyway, that is the worst part of nursing school. Honestly, I learn A LOT from doing it, but it is probably the hardest thing I have ever done.

Lots of really, really sick kiddos with NO parents or visitors WHATSOEVER. It is so sad. These little guys just want love and attention--and they get TONS of it at the hospital I am at, which is great. I have a whole new apprciation and love for Peds nurses. WOW! Maybe if OB doesn't work out I will migrate into Peds or Peds Nursery or something...I like the babies, especially. Teenagers not-so-much.

Ok, not much more to say as this was an introductory week. Lots to learn and do. And my CI is FAB--she is so real and funny. Cracks me up!

Reading and drug calc studying this weekend. Feeling pretty good and was able to use my metrology in clinicals yesterday without problems. Need to practice though--don't want to rest on my laurels.

Nap time today. YES!!!

Currently in paperwork hell...

4 hrs research at hospital (learning new computer and all) yesterday.

7 hours last night and 3 hours this morning doing MASSIVE amounts of paperwork and concept mapping.

Now, tell me why I am doing this again? This might just be the end of the whole thing. I. am. losing. it.

Off to clincal to take care of my Down's baby who just had open heart surgery to corect her AV canal.

Good times.