tumblr dot com
noise dept.
Today's Document
Origami Around
#extradirty
h
sheepfilms
Claire Keane
wallacepolsom
"I'm Dorothy Gale from Kansas"
Aqua Utopia｜海の底で記憶を紡ぐ
occasionally subtle
Monterey Bay Aquarium
Product Placement
let's talk about Bridgerton tea, my ask is open
RMH
titsay
Cosmic Funnies
$LAYYYTER
Sweet Seals For You, Always
seen from Germany
seen from United States
seen from Türkiye
seen from Singapore
seen from South Korea
seen from United Kingdom
seen from Malaysia
seen from Netherlands
seen from Sweden
seen from Argentina
seen from Türkiye
seen from Australia
seen from Türkiye
seen from United States
seen from Malaysia
seen from Germany
seen from Malaysia
seen from Singapore
seen from United States
seen from Saudi Arabia
@dininnursingschool
confession: the nurse in me is deathly afraid of the word quiet even if i’m nowhere close to work.
I don’t mention that word in every day life. Usually say something like “oh it isn’t very busy down the shops” or or “it’s really not loud is it?” 🤣🙄
“The level of noise here is nice”
P R O D U C T I V I T Y
30/30* - personal favorite, I always use this to study and manage time.
Essential productivity apps for any student*
Top 5 productivity apps for iOS (video)*
Top 5 productivity apps for Android (video)*
StayFocusd*- limits the time you can spend on time-wasting websites
Time Warp* - keeps you from procrastinating
Self Control* - blocks websites
The science of productivity (video)
The science of procrastination and how to manage it (video)
7 brain hacks to improve your productivity (video)
The simple science of getting more done (in less time)
Productivity tips
About power naps
How to pull an all-nighter effectively
O R G A N I Z A T I O N
My Study Life* - It’s a planner to help you remember when your homework is due and stuff like that
Free printable planner
To do list
How to make a study schedule
Class folder organization
S C H O O L // S T U D Y I N G
Inkflow Visual Notebook* - I haven’t used this one, but it’s for note taking (if you’re a visual learner it’s probably quite useful
Free Flashcards Study Helper* - Create flashcards and carry them around to study anywhere
Apps for students*
Tips and trick to help you get good grades
Learning how to study
Cornell note taking method
BBC Bitesize
Studyblue - flashcards, quizzes, review sheets, study guides, etc.
Essay writing
Textbook masterpost (and other stuff too)
Wolfram Alpha for research
Memorizing dates
Making a good study guide
Note taking like a pro
Online calculator
Finals survival guide
How to survive finals
School survival guide
Free online courses
Scholarpedia
Mathway
Khan academy
Quizlet
Homework help
Exam survival tips
Studying for an important exam
Answering multiple choice questions
Guide on punctuation
Science simplified
How to answer exam questions
How to study
Useful websites
CrashCourse
How to write an essay
Duolingo
P R O J E C T S
Public speaking
Annoying Power Point presentation mistakes
Power Point presentations
Prezi
Emaze - similar to prezi
Rawshorts - video presentations
If it has * it’s an app
Preparing for the NCLEX-RN Exam
What is the NCLEX-RN
The NCLEX-RN or National Counsel Licensing Exam for Registered Nurses is a standardized exam that all nurses in North America, and many other countries, must take before they can work as a Registered Nurse. The test is taken after graduating from a Bachelor of Science in Nursing.
The test uses Computerized Adaptive Testing (CAT) to score the exam. The NCSBN illustrates how CAT is used, and why it works for the NCLEX through the following explanation:
Why CAT? CAT is used for the NCLEX because it:
Reduces the number of “easy” items that high-ability candidates receive; “easy” items tell little about a high performing candidate’s ability
Reduces the number of “difficult” items low-ability candidates receive; candidates tend to guess on items that are too difficult which can skew results
Reduces item exposure and subsequent security risks
Improves precision of measurement of the NCLEX candidate’s ability related to nursing and
Provides a valid and reliable measurement of nursing competence
How Does CAT Work?
Every time you answer an item, the computer re-estimates your ability based on all the previous answers and the difficulty of those items.
The computer then selects the next item that you should have a 50% chance of answering correctly.
This way, the next item should not be too easy or too hard
The computer’s goal is to get as much information as possible about your true ability level
You should find each item challenging as each item is targeted to your ability
With each item answered, the computer’s estimate of your ability becomes more precise.
(Source)
The NCLEX decides if the test taker passes or fails based on the following three caveats:
1. 95% Confidence Interval: Questions 1-75 are evaluated to determine if you passed or failed based on if your answers fell above (right answer) or below (wrong answer) the 95% confidence interval (red line on the chart). If a pass/fail cannot be determined by this measure (because there were some questions above and some below the confidence interval) then the next evaluation criteria would be used.
2. Maximum Length Exam Rule: If the 95% confidence level is too close to determine a pass or fail then the computer will allow you to continue answering questions, up to question 265. The first 60 questions are disregarded, and the pass or fail determination depends on questions 75-265. These questions are still judged by if they fall above or below the 95% confidence interval, but they may give a clearer picture than the first grading test because there are more items to answer.
3. Run Out of Time Rule: The NCLEX-RN exam has a maximum time limit of 6 hours. If the pass/fail determination has not been decided by the 6 hour mark then the last 75 questions will be graded to determine pass/fail. If all of the last 75 questions are correct, then you pass. If even one is wrong, then you fail.
Read more about the NCLEX-RN format and grading scheme here.
How Do I Prepare:
Here are some resources compiled by the University of North Carolina (Source):
NCLEX Review Resouces Here are some current review materials to help you prepare for NCLEX. An NCLEX review book is a helpful tool to have throughout the curriculum as it provides additional practice with multiple choice test items.
Saunders’ Comprehensive Review for the NCLEX-RN by Silvestri, 6th edition
Saunders Q & A Review for the NCLEX-RN Examination by Silvestri, 6th edition
Saunders 2014-2015 Strategies for Test Success – Passing Nursing School and the NCLEX Exam by Silvestri, 3rd edition
Saunders Q&A Review Cards for the NCLEX-RN Examination by Silvestri and Silvestri, 2nd edition
Davis’s NCLEX-RN Success by Lagerquist, 3rd edition
Davis’s Q & A for the NCLEX-RN Examination by Ohman, 2010
Mosby’s Comprehensive Review of Nursing for the NCLEX-RN Exam by Nugent et al., 20th edition
Kaplan NCLEX RN 2013-2014 Edition: Strategies, Practice, and Review
Lippincott’s NCLEX-RN Review Made Incredibly Easy, 5th edition
Lippincott’s NCLEX-RN Questions and Answers Made Incredibly Easy, 5th edition
Lippincott’s NCLEX-RN Alternate-Format Questions, 4th edition
Mobile Apps
ATI Mobile Mentor
HESI Q&A for the NCLEX-RN Exam
Saunders Mobile Review Questions for the NCLEX-RN Exam
Saunders Mobile Review Questions for the NCLEX-RN Exam Lite (FREE)
Tips for Buying NCLEX Review Materials
Purchase the most current edition. The NCLEX test plan changes periodically and your review book should be consistent with the latest test plan.
Many books have CD’s with extra questions or may provide links to extra questions on-line. The more practice questions you do, the better prepared you will be for the NCLEX exam.
Question and answer books should include rationale for each answer; look for resources that also include other helpful information with each question, such as testing strategies.
And finally, here are some of the (FREE) resources that I’ve compiled from around the web:
NCLEX Studying and Test Taking Strategies
When it comes to studying, remember to do what works for you. If you are a visual learner, get a white board and draw the physiology diagrams. If you prefer to listen find books on tape, audio lectures, or find other audio learners in your program and get together to study by explaining question rationales to each other.
Brilliant Nurse - NCLEX Strategies and Study Tips Blog
How to Pass the NCLEX-RN Exam
Tips from Grads for Preparing for the NCLEX
NCLEX Mastery App (free)
Nursing Show -Breaking Down NCLEX Questions
Free Practice Tests and Sample Questions
Practice tests are key. The questions on the NCLEX are known to be a bit different to the multiple choice you are used to. First, understand how to answer multiple choice questions (see this resource if you need help with that). Then use these resources and time yourself to get an idea of how your body will react to the pressure of being timed.
Mighty Nurse - NCLEX and HESI Practice Questions
4Tests - Free NCLEX Practice Exam
Test Prep Review - NCLEX Practice Test Questions
NCLEX Practice Quiz and Study Questions
Brilliant Nurse - 75 Free NCLEX Questions
Study Guide Zone - NCLEX RN Study Guide
Quizlet - NCLEX Questions
Tests.com - Free NCLEX-RN Practice Test
ProProfs Webschool - NCLEX 150 Questions, Answers and Rational
RNpedia.com - NCLEX Exam
NCLEX-RN Review
Exams for Nursing
NCLEX-RN Exam Cram
Nurse Labs - NCLEX Practice Questions
Remember, as with everything on the internet, use with caution. Just because a website states something as true, it does not mean that it is the most correct answer. The idea behind providing these links is to guide your studying and to gain a feeling for the style of the NCLEX questions.
Good luck everyone!
Bringing this back because ‘tis the season
EKG tips
Hypokalemia: ST depression, shallow, flat, inverted T wave, prominent U wave Hyperkalemia: tall, peaked T waves, flat P waves, widened QRS complex, prolonged PR interval Hypocalcemia: prolonged ST and QT intervals Hypercalcemia: shortened ST segment, widened T wave Hypomagnesemia: tall T waves, depressed ST segment Hypermagnesemia: prolonged PR interval, widened QRS complexes
a rant about nursing
It upsets me that nurses are notorious for “eating their young.” There is NO REASON for a nurse to be like that. I don’t care if your assignment sucks and you don’t want to work with a student. I don’t care if you think the student shadowing you is too quiet or doesn’t have the “right personality” for your certain setting: chances are they are quiet because they can sense the disdain oozing from you, and they probably don’t want to specialize in whatever area you’re in anyway!
I have been a registered nurse now for seven years. I have mentored new grads, I have worked with students going through their clinical rotations, and I have worked closely with students in their final year as their preceptor. I have not been rude to a student or made them feel insignificant or talked down to them.
You know what I do when I see a student in our PICU looking like a frightened fly on the wall? I walk up to them, smiling! I tell them my name, I ask theirs, and ask them if they have questions, what things would they like to see, and ask them if they would like to come see one of my patients later (if it’s okay with the family members) because I am caring for a child with a rare genetic disorder or taking care of an infant on a high frequency ventilator that they may not ever see again in their career. Later in the shift I like to show them the resources we have both online and as reference guides on the unit, or ask them about medications my patients are on to boost their self confidence, because hey, they know what that medication does and why the patient would be on it!
The same goes for any of our new hires. I like to try to mentor those who are open to it, and grab them when I can to help them practice their skills (central line dressing changes, helping to turn an intubated patient or retape an ET tube, etc). If the older / experienced nurses aren’t passing on their knowledge to the new people, how can they expect them to know about things? It irritates me when I hear someone talking badly about a new hire or a student because they didn’t know about X Y or Z. Like NO KIDDING?!? they’re new!! TEACH THEM. HELP THEM. Luckily, the unit I work on has a team of amazing people who all try to teach one another and not be complete dickwads.
I hope that in 10, 15, 20, and maybe 30 years from now I still approach new hires or students in this same manner. The last thing I want in my career as a nurse is to become one of those nurses that treats the new generation of nurses as a burden and doesn’t “have time” for students or for teaching new skills,
To all you nursing students out there right now who are experiencing the feeling of being “in the way” or are being looked down upon by other nurses, I’m sorry. All I can ask is that you forgive them for their lack of compassion. They don’t appreciate all the sleep-deprived nights you have as you spend 10 hours on your care plans, and the sacrifices you made with your social lives, and the anxiety you have over next week’s midterms. They must have forgotten what it was like to be in your shoes.
When you student nurses become seasoned nurses, please remember what it was like to be a frightened student and do your best to mentor and teach the new generation.
Students of all health professions must be taught, not tortured.
What type of schooling is required to become a registered nurse?
There’s a few types, depending on what you’re planning on doing and where you may want to work.
It still exists, but it is going away quickly: certificate/diploma RNs. Back in the day, a large amount of nurses were trained in hospital, and not taught “formally”.
Associate’s degree RNs: a 1.5 to 2.5 year program (or a 12 to 18 month bridge if you’ve previously gotten your LPN license) that gives you more or less all the things you need to pass the NCLEX. If your area has mostly Magnet hospitals (or hospitals striving to become Magnet designated) you may have difficulty finding a job, because they must have a certain amount of Bachelor degree RNs.
Bachelors degree RN: your typical 4 year degree in nursing. May make it easier to find hospital work and/or managerial type work. Basically everything you learned in an ADN, plus english, algebra, and electives to round out your education. It is worthwhile to note that many people get their ADN and begin working as a nurse while they complete an RN-to-BSN course to get their Bachelor’s degree.
Accelerated Bachelors/2nd degree Bachelors: This is becoming more common. If you already have a Bachelors degree in a different field, you can take an “accelerated” course to become an RN. These programs are usually 1 to 1.5 years and move extremely fast.
———-
No matter which route you take, you must pass the NCLEX-RN to become a real-live registered nurse.
This was a quick and dirty run-through, but I hope it helps a little :)
Good info!
What Do You Do: ICU Nursing, Hour One
I’m an RN in a 18-bed Med/Surg ICU. Intensive Care units are for the sickest patients in the hospital. You get sicker than we can handle the only step up is to meet your Maker or have said Maker do a miracle.
This is our Mantra:
We care for people in Septic Shock, with CVAs, DKA, decompensated heart failure, post cardiac arrest, COPD exacerbation, ARDS, drug overdose, and the post-ops of every discipline (except the open hearts who have their own CVICU). We manage treatment modalities like CRRT (continuous dialysis), hypothermia protocol, and LV assist devices like the Impella and balloon pump. Highly technical and lots of variety, which is what attracted me here.
I originally was going to write about an entire shift in the ICU but found that the first hour of a recent shift gave a decent representation of what we do. Not terribly eventful or comprehensive, just typical.
Hour One went as follows:
I walk on the unit for the first of my three 12 hours shifts. Check the board for my two assigned patients, find the nurse who had them for the day and plop down next to her. Yes, only three shifts, and yes, only two patients. Trust me, it’s enough.
The “Day Babe,” as we night shift nurses affectionately call day nurses (do they have a name for us? The walking dead……) fills me in on each patient: history, hospital course, treatments, status of each body system. I fill out all the little boxes on my report sheet in an attempt to grasp an entire patient’s health and plan of care in less than five minutes in a way that somehow qualifies me to be responsible for them. It’s always astounded me how short, random, and unregulated this process is.
Hemodynamic monitors placed around the unit display heart rhythms and vital signs on each patient. They alarm and flash with increasing levels of dismay when something is out of range. This varies from little peeps and flashes for something minor (O2 sat probe is off) to the From Hell noise that awakens your hindbrain to mortal danger (your patient’s heart has stopped beating.)
Both of my patients have heart rhythms that are compatible with life and no alarms. Yay. I fill out a quick little schedule for myself for each patient and then go to see the sicker one first.
Patient One: Small bowel obstruction status post Exploratory Lap, went into respiratory failure on the hospital floor after developing pneumonia. Came up to us to be intubated, diuresed, and get IV antibiotics until the invading organisms are killed to death. She’s in septic shock on several pressors, Cardizem and heparin drips for AFib, fentanyl for sedation.
I assess her, making the million little observations that tell me if she is really doing as well as the monitor might lead me to believe. Vital signs can be very deceiving, nowhere more than ICU. Lung/heart/bowel sounds, ET/OG tubes, pupils, hand grips, pulses, skin integrity, IV access.
She’s severely edematous. Her flesh puckers under my finger like that green brick material flowers are arranged in. I wonder what she does for a living, if she has kids, pets, if she’s married? Read any good books lately? Details of personal life are UTA (Unable to Assess) when the person is I&S (Intubated and Sedated) and there’s no family around.
I ensure all her drips are running correctly and calibrate the arterial line, which tells me her MAP is 68. Beautiful. Only as much Levophed as she needs, no necrotic fingers and toes for her. She looks good. Stable-ly unstable, we call them, when their vitals are normalized on medicated drips.
Patient Two: Older gentlemen, VFib arrest, visited the Cath lab for a variety of stents then hypothermia protocol. He’s past all that now and has just been extubated. The day nurse told me he looked good respiratory-wise. I don’t agree.
He’s tachypnic taking shallow breaths. Weak cough that isn’t getting the job done. He’ll be reintubated within 12 hours if he keeps this up. I call my friends in Respiratory Therapy for ENT suction. It helps, but he HATES it. He asks me why I like to torture him. I tell him that I don’t, that I’m trying to get him better. He scowls. He’s over it. I don’t blame him.
The rest of his assessment is WNL, and that’s not “We Never Looked,” it’s “Within Normal Limits.” Because I looked. Except…….I can’t help but notice that he doesn’t move his left side as much as his right, and his hand grip on that side is just a tiny bit weaker. Am I imagining it? His pupils both react to light but don’t look exactly the same…..and he’s not really answering my questions. He’s probably just being difficult….right?
Come on man, don’t do that. Let’s not take an emergent trip to CT and do TPA protocol right now. Fast as I can, track down the NP. He has a history of right CVA with residual left-sided weakness. The day nurse didn’t tell me that in report.
I push some IV hydralazine for his BP of 180/70. He asks for a beer. I feel foolish for worrying about him so much a few minutes ago.
The hydralazine helps for only a few minutes so I chase it with 5mg of metoprolol, pushed over two minutes because I don’t want to stop his heart, just slow it down. I make peace with the fact that I’m going to be chasing his BP with IV meds all night long.
I set the bed alarm. Dude’s awake now and I don’t trust him, even as weak as he looks. You know how 100 lb. moms can lift cars when their kids are in danger? Elderly patients can do astounding things when the delerium sets in.
Overall a pretty easy ICU assignment.
I leave his room and hear a plea for help from a nurse at the end of the hall.
I know this patient, Heroin OD. Tattoos everywhere. When I say everywhere I mean it. Many of the nurses had speculated about whether or not certain tattoos look differently when certain body parts were in certain anatomical configurations. If you know what I mean. If you don’t, don’t think about it too much.
We don’t mean to belittle people or treat them as objects. We can’t help but think these things.
The nurse called for help because he’s been on tube feeding for over a week and his Dignicare fell out. You can imagine the consequences. If you can’t imagine them because you don’t know what a Dignicare is don’t worry about it, innocence being bliss and all. I help her get things straightened out. She grateful. I promise to help her with his bath later. He’s a big dude.
Quick stop at the Accudose, grab my meds and waste Versed and Fentanyl for another nurse. We chat and make fun of the NP who’s working on the other side of the glass, not noticing us. We’ll tell him about it later.
I give Patient One’s meds after deciding that they’re all safe and appropriate for her. A few IV pushes, hang an IV antibiotic, crush up the pills, mix them in some water, flush down the OG tube.
I most definitely never pretend I’m a wizard making a magic healing potion when I do this. That would be childish and I’m a professional.
Her MAP is 64. Borderline but I’ll ride that out another 10 minutes before titrating her Levophed; you learn after a while not to micromanage your pressors……
Then the monitor starts alarming THAT alarm, the hindbrain one. Bed 24, and judging from the trace on the monitor it’s legit VTach. I start to run to the room but two steps in the alarm stops. Just a run of VT, not sustained, 20 beats or so.
I grab the rhythm strip that’s printing out and go to the room to give it to the nurse, a friend of mine who just got back from maternity leave. She turns to me and takes the strip.
I don’t know this patient. Septic on CRRT, came in yesterday.
“She looks like shit, ” my friend says. She does indeed.
Now that’s not some random or insensitive insult. It’s a thing we ICU nurses say when we get that vague unsettling feeling in our perceptive gut that even though this patient looks okay on paper or computer screen they’re going to go downhill, soon. And now here she comes with the increasingly-long runs of VT.
“I told them,” she says, shaking her head. I tell her to let me know if she needs anything, I have my unit phone.
Then I go get a unit phone and sign into it since I forgot to do it earlier. My manager runs a report every week that tells her when we forget to sign into a phone within five minutes of starting our shift. I’ll get a strongly-worded email.
Check the monitor, Patient One, MAP 72. Hah! Peek in on Patient Two. Still in bed. BP 200/103. Awesome. Bust out the IV labetalol. Take THAT. Back down to around 180/70. Sigh. NP says to give it a half hour.
Grab the aide, both patients get repositioned. Sit down to chart. Barely get logged on.
Good buddy nurse sticks her head outside the curtain and gives me The Smile. She’s helped me so many times, she knows I’ll do anything for her. Not that I want to go into that patient’s room. I do not. But we’re nurses, and we do what needs to be done.
I enter the room of the patient who solidified my belief that ultimately ICU nursing is not for me.
Now, I love intensive care. I love helping someone right in the moment they need it most. I’m good at my job and I love using my head and my heart to do it. But I can’t stay here. I’m willing to walk with a patient through difficult and painful treatments to get them better but I didn’t sacrifice my time with my family and go to nursing school to put people through hell for no meaningful recovery. I have an ethical aversion to a good 40% of what I do at my job now and that percentage only seems to be growing.
Her history is too long to recount. Her body had lost the ability to heal a long time ago. Every organ failing, even her skin. Her skin would break under our hands no matter how gently we would move her.
Her BKA stump has been infected for months. The flavor of this month was Pseudomonas. The nurse was asking for help changing the dressing. We remove the old dressing to find her stump disintegrating into the telltale light green of raging Pseudomonas infection. It looked like pea soup. We were keeping this woman alive so she could turn into pea soup before our eyes.
I couldn’t look at her face anymore. When I had first taken care of her I had paid very close attention to her face, trying to read her expression for anything I was doing that she found painful since she was nonverbal at baseline after massive stroke. Eventually I figured out everything we did caused her pain.
We still warned her of what we were going to do, still apologized. The family had instructed that no pain medicine be given “because it makes her less interactive with us.” The family wasn’t even here. Sorry she can’t entertain you like you want because of the tremendous pain she’s in. I try so hard no to judge them as I’m sure they’re are suffering too. But I fail every time and every time I get angry.
Ethics consult was “pending.” Meaningless, we have no teeth, no real influence. If the family says treat, we treat. What does “treat” even mean, then? If all we do is…..
I stop myself from going down that mental road, again. It simply isn’t up to me. What is in my power to do for this woman, right now, that will help her? I can think of nothing but to treat her gently and say a prayer for her relief.
I don’t know if it helped.
Dressing done, I leave the room with ice in my gut and go back to charting.
A few clicks done before Bed 24 alarms again.
VTach, really fast and not stopping this time. Everybody runs for the room. I’m first so I go to grab the cart with the Resus meds and Life Pack but it’s not there because my friend with the bad feeling already has it in the room. She’s been feeling for a pulse while we ran to her.
“No pulse,” she says as I walk in. I start CPR while she digs out the defibrillator pads. She puts them on around my hands and starts charging the Life Pack. “Clear!,“ I back off, she discharges the shock.
(Ahhhhh sorry. I can’t help it, it’s exactly what we’re doing when we shock someone.)
Sinus rhythm restored.
“Maternity leave didn’t slow you down, did it?” I say to her. She shrugs. Intensivist walks in and starts barking orders about STAT labs and electrolyte replacements. “Need something, call me,” I say as I walk out.
Check the monitor. Patient Two’s BP is 190/90. *sigh*
All things considered, not a bad hour. My scrubs aren’t covered in anything. I didn’t get any indecent proposals. Nobody tried that hard to die.
Eleven hours to go.
…patients like little pseudomonas lady are why I left ICU. SOMETIMES, I miss the adrenaline rush of critical care… then I remember my very own patients who I tormented for far too long with futile medicine. After so many years in the ICU, I’ve found my home in hospice. ❤️
This is one of the most enjoyable, well-written “day in the life” accounts I’ve read. This is accurate as all hell, and was eye opening for me as a resident to learn more about the baller ICU nurses and the work they do. Check this out!!
ICU Nurses are heroes. Period.
Excellence.
As @md-admissions said, this IS every eye-opening, which is appropriate… cuz now ICU better.
(That metaphor comparing edematous flesh to “the green brick material flowers are arranged in” was SO perfect it gave me the shivers!)
NCLEX Pharmacology Medical Suffixes
-amil = calcium channel blockers
-caine = local anesthetics
-dine = anti-ulcer agents (H2 histamine blockers)
-done = opioid analgesics
-ide = oral hypoglycemics
-lam = anti-anxiety agents
-oxacin = broad spectrum antibiotics
-micin = antibiotics
-mide = diuretics
-mycin = antibiotics
-nuim = neuromuscular blockers
-olol = beta blockers
-pam = anti-anxiety agents
-pine = calcium channel blockers
-pril = ace inhibitors
-sone = steroids
-statin =antihyperlipidemics
-vir = anti-virais
-zide = diuretics
Most bang-for-buck things every intern should know before starting inpatient wards
Source. A collection of Meddit resources and advice on what bread-and-butter topics interns would most benefit from brushing up on/memorizing prior to the beginning of their internship. 1) Fluids. How and when to use them, dosage, timing and other pearls.
Review of fluids (not how to use them per se) by Dr. Strong /u/ericstrong
Maintenance Intravenous Fluids in Acutely Ill Patients - NEJM.
Pretty thorough review of fluid management on openanesthesia.org
2) Nausea. When to treat, how to treat and at what dose.
3) Standard pn orders: pain killers, sleep aids and antiemetics aka how to reduce nighttime calls from nurses by 25%
4) “Reflex” antibiotic choice for routine inpatient infections.
http://www.bpac.org.nz/Supplement/2013/July/antibiotics-guide.aspx /u/ChristianM and /u/ive_been_up_allnight
5) Initial work-up and treatment of dyspnea. (more realistic to approach by symptoms as, unfortunately, you first have to diagnose whats wrong. E.g. heart failure, pulmonary edema, embolism, COPD, pneumonia).
6) Initial work-up and treatment of oliguria/anuria.
7) A sensible initial approach to suspected ileus.
8) Blood. When, how, why to replace.
9) Pain. Optimal management without inducing narcosis.
Managing cancer pain: Frequently asked questions: CCJM
10) Potassium. When, why and how to shift or replace.
A review on both potassium and sodium disorders by Dr. Strong /u/ericstrong (Not reposted in 12) hyponatremia but applies there as well) https://www.youtube.com/playlist?list=PLYojB5NEEakXVIAapcSEleP4doUdHVtld
11) Hyponatremia. Most common electrolyte disturbance, commonly mismanaged.
12) Resuscitation aka commit the ACLS algorithms to memory.
Current ACLS guidelines. https://www.acls.net/aclsalg.htm
Would love a video series, interactive cases etc.
13) Basic EKG interpretation.
Whole EKG video courses
A whole free youtube EKG video review course by meddit’s own u/ericstrong
An alternative EKG course that takes you through all the basics. This however has no free version and costs 96$ a year. The quality is amazing. Here are 6 basic sample videos on youtube. The paid course is available on http://www.ecgteacher.com/
I have to admit I haven’t used this course personally but his free youtube videos are on-point and he seems like a good teacher. Also behind paywall. Free youtube samples are here. The full course can be found here https://www.ecgacademy.com.
EKG video cases
Amazing case-of-the-week emergency medicine EKG videos on youtube by Dr. Amal Mattu
– If you like Dr. Mattu’s cases (and you most certainly will) he is still posting every single week on his new site https://ecgweekly.com. It costs 4 starbucks coffees a year and is going to save someones life.
Practice EKGs with answers
Watching videos isn’t enough, you still have to grind out EKGs to keep your game strong. Visit http://ecgmadesimple.com and http://ecg.bidmc.harvard.edu/maven/mavenmain.asp for this.
EKG blogs
I recommend signing up for some kind of RSS feed (e.g. https://feedly.com/) and subscribing to the following EKG blogs:
http://hqmeded-ecg.blogspot.is (Dr. Smiths ECG blog)
http://www.ems12lead.com
http://ecg-interpretation.blogspot.is
http://jhcedecg.blogspot.is
EKG resource libraries
Life in the fastlane has a nice resource to look up a specific EKG finding, criteria or concept.
http://www.practicalclinicalskills.com/ekg.aspx /u/collidge
14) Know when to order ABGs and how to interpret them.
Almost too detailed video lecture series on ABGs and how to interpret them by Dr. Eric Strong (/u/ericstrong)
Practice makes perfect. ABG interpretation generator. https://abg.ninja/abg
Bonus 15) Basic CXR interpretation
CXR video lecture course
Again, Dr. Eric Strong has an excellent video course for free on youtube
Step-by-step guides to basic CXR interpretation
The Radiology Assistant: Chest X-ray - Basic interpretation
Radiology Masterclass step-by-step basic CXR
University of Virginia’s step-by-step basic CXR
All inclusive resources
The art and science of thoracic imaging All inclusive resource for all things thoracic! Jokes aside amazing resource.
UPenns CXR learning website
Loyola Universities excellent CXR Atlas Most outdated look but amazing content.
Checklist approach to CXR
Bonus 16) Overnight o-shit-what’s-that Head CT interpretation
Midnight radiology: Emergency CT of the head
University of Virginia’s guide to the Head CT
Hey, self: review before NCLEX. Xo, me.
Oh hell yes
For future reference.
It’s almost that time of the year!
Starting out at Nursing School: What you'll need!
Time management
Planner - 1 page per day.
Wall Calendar –for visualising what is coming up each month.
Weekly to-do List – it feels great to be able to cross things off each week.
Household Schedule – for keeping school in perspective with life.
Stationary
Paper - pocket notebook for clinicals, loose leaf paper, printer paper and index cards 3x5 and 5x8.
Folders - 3-ring binder, display folders with plastic sleeves.
Misc. - 3 holed punch, calculator, small stapler, staples.
Pens, highlighters and pencils– for note taking. Highlighting key ideas and for drawing diagrams for study aids.
Technology/ devices
Recorder – great for recording lectures and classes. Also comes in handy for recording any notes you make to so that you can reinforce concepts. It is important to make sure that your teacher gives permission for you to record as they may have a strict policy. More often than not they allow it for personal use and ask that you do not distribute it.
Laptop/Desktop computer – important for accessing online content, doing assessments and checking emails. It is important to have internet access while completing nursing school, however if you are unable to have it at home, most public libraries and educational institutes provide computer labs to their students
Printer/Scanner – for printing assessments and lecture notes. This is also convenient but not necessary, so if you are prepared to pay small fee at public libraries and other educational institutes they always have many on hand to access.
IPod/mp3 player – amazing for unwinding to your favourite music or even uploading recordings of notes and lectures for extra reinforcement while going for a run or walking the dog. I personally love listening while I’m cooking or washing up.
Nurse Stuff!!!
Water proof watch – must have a second hand
Stethoscope – Your school may have a particular one that they want you to use that is fairly cheap. If they allow other brands, Littman is very good and reliable and will definitely take you all the way through nursing school. However, make sure you have it engraved or don’t let it out of your sight as I have heard sooooooo many stories of them being stolen out of bags etc.
Comfortable shoes – this is a no brainer. Nurses are on their feet all day and night so it is important to splash out where comfort and support is needed. Klogs, despite being some of the ugliest shoes to exist, are wonderful. Dansko are also really comfortable, as well as the brand Sanita which offers cute prints and colours.
Durable bag - this one is also really important! A lot of people have said that a bag with wheels comes in good use when you’re lugging heavy books across campus. Please don’t use shoulder bags! You will wind up with an immense amount of strain on your shoulder, and they just aren’t practical.
Scrubs – Scrubs are a bit of a grey area as there will be variations in what is required of students from school to school. Mostly blue are used I believe, but I may be wrong.
Student uniform - this will be something you purchase from your school. It is important for when you are on placement so that you are recognised as a student from your school.
Long sleeve tops – nurses have early starts and finishes so it is important to stay warm. Hospitals often aren’t the warmest of environments so having a few long sleave tops to layer up with is definitely worth it.
Penlight – penlights are like pens, you’ll start off the shift with a few spares but by the end you’ll be trying to trace your steps back to find one! They aren’t too expensive so whenever you, replenish your hoard! Haha
Bandage/Dressing scissors – these will be your best friend. There’s no need to go out and by a ridiculously expensive pair. Just the basics that do their job!
Books
Medical Dictionary – every student needs one. It is so handy for looking things up and often they have small diagram explanations. I actually picked up a seventh edition Oxford minidictionary for Nurses which is great and it is the perfect size.
Latest Drug guide – this is an important friend to the nursing student as there are so many drugs that we come into contact with. Make sure that you get an up to date one as there are new drugs out all the time.
Thesaurus – this is just a helpful one for writing essays. I find myself looking for new ways to say something all the time and having a thesaurus gives you lots of options for words. Most computers have one built into their document writing system if you decide not to get one.
Referencing Guide – as soon as you find out what kind of referencing your course uses for assignments, make sure you get a guide on how to do it correctly. You may pick up on it right away without needing one, but if you’re like me, it’ll help to be able to look it up whenever you need to. Note: never leaving referencing til last. Do it as you go!
NCLEX Q’s book – the earlier you get yourself acquainted with NCLEX questions, the better. There are so many of these books out there. My advice would be to ask someone at school in a higher year, or one of your instructors, whether they can suggest a good one to you and go by that.
Required Textbooks – you will either get a list of these given to you or it will be in your course outline under core texts. Buying textbooks brand new can be super expensive so I suggest you try and get them second hand. There’s is absolutely no shame in this, in fact it is the smarter thing to do. Check textbook exchange pages for your school on Facebook, look at noticeboards, gumtree. EBay, craigslist and advertise on these that you are looking to buy. If you know someone the year or semester ahead of you, contact them and offer to buy them for a reasonable price. Unless the course changes dramatically year to year, you will be able to get away with having books a few editions behind. If you have the money and you want to buy them all brand new, then do so! There is something satisfying about accumulating textbooks… I myself have many!
In your bag
Wallet – make sure you carry your student ID card, bus pass, drivers licence, cash cards and loose change for printing. Keep a photo of someone or something you love or that motivates you to keep going.
Keys – don’t forget your house keys, car keys and if your school has lockers, get one and don’t forget to bring the key with you to school!
Hand sanitizer – at nursing school lots of people turn into crazy OCD hygiene gurus, and for good reason! Travel size hand sanitizer is perfect to carry around with you whether it’s at school or on the floor!
Lip balm/Moisturiser – because hospitals are cold and dry areas it good to make sure you have a chap stick or some paw paw ointment on hand to stop any wind burn, chapping or cracking. Moisturiser is a must. You will be constantly washing your hands and using hand sanitiser upon entering a room so it is important to put some moisture and life back into your poor little hand. Any vitamin E creams or aloe Vera based moisturisers will do the trick!
Headphones - make sure you have a spare pair of ordinary headphones. Preferably not the apple ones as they don’t always work on school computers. Some computer labs or libraries at schools will sell these or loan them to students for a few dollars. Sometimes you’ll find yourself at university with a few hour between classes and you might want to re watch a lecture, but you don’t want to disturb other students in their study. You may simply just want to watch silly things on YouTube to cheer yourself up after a terrible day so make sure you are prepared.
Tissues – make sure you have a travel pack of tissues. There may be day where you just feel like crap or have had very little sleep and just have a little melt down so tissues or face wipes can save the day!
Water bottle – stay hydrated!! Try to stay away from caffeine where you can. We all know that the caffeine high is fast in reacting, but when you crash you crash hard. Just starting your day with a big glass of water can set you up for feeling good all day so carry it on through the day too! My university has refill places where you can refill your bottle without having to buy it or go to a bathroom.
Lunchbox – Always pack lunch!! You will go through so much money buying lunch every day. If you don’t have time in the morning, prepare the night before or even cook for the week on Sunday and pop something into a microwave safe container to heat up at school. Make sure you have a few pieces of fruit, a handful of mixed nuts and some form of carbs and protein. Make sure you have a few muesli bars for back-ups, and I often freeze a little tub of yogurt for later in the day.
I hope this has been helpful people! Special thanks to peacelovekoala and nursekanika for their contributions to this post. Please reblog this so that any future nursing students can have a look at this and get some ideas! Also if you would like me to cover any other topics let me know and feel free to ask anything you like xx ourloveandtrials
This is exactly what I needed to see. Thank You!!
sami-lynnn I will probably post a more updated version soon xxx
Even ECG are also presented as relationship.. How cool is this to understand .
Are cardiologists more romantic than other professional 💕🏩?
#heart #heartblock #cardiology #ecg #ekg #cardiologist #romantic #love #usmle #university #usmlestep1 #usmlestep2 #doctor #doctordconline #nhs #nurse #nursing #hospital #hospitallife #patient #medicine #medlife #medstudent #mbbs #md #paramedics #amc #plab @doctordconline
Atropine overdose Mnemonics
Atropine is a medication used to treat certain types of nerve agent and pesticide poisonings, some types of slow heart rate, and to decrease saliva production during surgery.It is typically given intravenously or by injection into a muscle.Eye drops are also available which are used to treat uveitis and early amblyopia.The intravenous solution usually begins working within a minute and lasts half an hour to an hour.Large doses may be required to treat poisonings.
#atropine #mnemonics #pharmacology #drugs #pharmacy #pharmacist #usmle #university #usmlestep1 #usmlestep2 #doctor #doctordconline #nhs #nurse #nursing #hospital #hospitallife #patient #physiology #mbbs #md #medlife #medicine #medstudent #amc #plab @doctordconline
I passed it, yall!!!
NCLEX PN
Took it today. 85 questions: 1 math, 1 alternative, 15 select all.
ABGs: ROME - Respiratory Opposite & Metabolic Equal
If pH is UP and PCO2 is DOWN = Respiratory
If pH is DOWN and PCO2 is UP = Respiratory
If pH & HCO3 are EQUAL = Metabolic (Renal)
How I Format and Use Flashcards
1. Less is More: no need for a paragraph to define a term, choose the simplest and most efficient one. Also, don’t include common sense things or things you know by heart, you’ll waste time and space by writing them down.
2. Sketch it Out: Sketches can be helpful in allowing you to visualize the term/concept.
3. Say it Out Loud: When reviewing through the cards, try and say the definition out loud. It will require you to think about it more, and it also helps with memorization. If I try and define a term in my head I usually speed through it and leave something out.
4. Write them as you go: Don’t sit down right before finals and try and write down every term/definition from the course. It takes forever and you will kill your hand. As you finish a chapter in the course finish that set of flashcards. You will thank yourself later.
5. Repetition: I go through my flashcards before a test maybe a thousand times (exaggeration but very close). Remember to focus on the harder ones, you’ll most likely remember the easier ones during the test.
Here is my method:
Round 1: Go through every single card. Don’t set any aside. I usually don’t know a majority of the terms at this point, I most likely just finished writing them down.
Round 2: Go through every card again, this time setting aside ones I didn’t know or had trouble with.
Round 3: Go through the harder ones I missed.
Round 4: Add the harder ones back in with the original and shuffle.
Round 5: Go through them all and repeat the process until pleased!
