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@sothisisnursingschool
Come to the ICU & I will give you a life-saving Tylenol!
Got a transfer to the ICU from Medical for “fever & possible sepsis”. Patient was tachycardic, hypertensive, & temp was 102.8 F. Checked when he had his last dose of Tylenol & it was 15 hours before he came to me. Gave him 650 mg of Tylenol & his fever broke an hour later. Patient was transferred out of ICU less than 10 hours later. Family thanked me for “saving his life” & doctors said “I did a good job”.
Dear Burned-out Nurse,
I am with you my friend. Work has been rough lately, right? Leaving it at the hospital isn’t always possible. It stays with you, keeps you up at night, as you replay “what ifs” and “I should haves.”
You’re dreading the next time you have to walk into that hospital. You’re tired of getting the sickest patients, or the ones with the angriest families. Because you’re great at your job and you’re nice, you get the difficult assignments. Part of you wishes you could quit caring and then maybe you’d have the easy patients for a change, then you could sit there on your phone, laughing with the rest of the group. But, you won’t do that, because you’d have to live knowing you didn’t do your best and that would feel worse than this.
You’re a good coworker. You are the one that helps everybody, the one other nurses get excited to see as a neighbor. Even when it’s 6 hours into your shift, you haven’t sat down, and you have hours of charting to do, when that coworker asks something of you, you say “Yes,” without hesitation. Do not change that either. It’s worth it to be the one the baby nurse goes to, just to give her a bit of confidence. It’s worth it to help that mama nurse and hear some of her wisdom.
Maybe this job has broken your heart lately, like it has mine. Today was the first time I set foot into bed eight since she died in there one week week ago. I entered the room and the flashback of her husband crying at the bedside, her laying there unresponsive, knocked the breath from my lungs. I paused, coming back to reality, before I could address the new patient in front of me. Caring hurts sometimes, but don’t give up you sense of empathy and compassion.
It’s hard to find people at home to listen, to explain the horrors you went through. Even when you don’t want to talk about it, what you saw at work is still playing in your mind. Your family doesn’t really understand, or they don’t want to hear gory details of someone else’s tragedy. They do not understand that it’s your tragedy too.
I hope you have some good days at work, sweet nurse. I hope you take care of yourself at home. I hope you’re reminded in little ways why you do this job.
Love, J-
Face I make letting the resident know I see him in the room and he better talk to me when he leaves it
The optimism of ICU and ED nurses
Finished the NCLEX in 75 questions
A lot of SATA and priority questions. Hopefully that’s a good sign. Didn’t feel great about it, but we’ve been told that getting SATA questions is a good sign. I’ll find out tomorrow.
Okay, couple of myths have been perpetuated in the comments to this. So here we go. OP, I very much hope you passed, GOOD LUCK!
SATA does not mean the question is above passing standard. Per NCSBN, there are alternative format questions (SATA, hotspot, math, audio) across ALL estimated ability ranges.
Directly from NCSBN:
There is no established percentage of items with alternate formats that will be administered to candidates. The NCLEX is computer adaptive and items are based on the candidate’s ability. There are alternate item types in all areas of the test plan, across all difficulty levels.
I’M OVER AT @SOTHISISNURSING NOW! <3
Getting ready to go in to orientation!
You guys you guys you guys
- somehow I passed NCLEX
- somehow I snagged a new grad position on the unit (med/surg/tele) I precepted on
SO EXCITED AND GRATEFUL!!!
I’m gonna move on over to @sothisisnursing now that I have letters behind my name! <3
Interview #1
Sigh. I don’t think it went very well. It was a panel, and that always stresses me out -- so many people to read while you’re answering! Questions from ALL AROUND!
There are definitely things I wanted to say and didn't. Things that I wish I hadn’t said or could have said better/more definitively and clearer. I just hope I made a good enough impression combined with my recommendations to get a spot on the program (new grad residency).
Will know within 2 weeks.. maybe even before I sit the NCLEX. Argh!
My Amazon recs; you guys this isn’t even funny anymore..! I AM DONE, I HAVE A BSN, WHYYY must you be haunting me?!
SOMEONE SEND HELP!!!
I AM NOT READY!!!!! AACCKKKK!!!!
scheduled for 1/27. LET’S DO THIS.
My life for the next few weeks. 😁
I have an interview for a new grad residency program.... FREAKING OUT!!! Help, nurblrs of the tumblrweb??! Interview tips..? Questions to make sure to ask them..?
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.
When the question bank only gives you generic drug names
Just so all of you know, the NCLEX only uses generic drug names now. Make sure you learn them.
YES YES BOOST THIS COMMENT! that wasn’t clear in my original post but DEFINITELY make sure you know them. Learn the ‘biggies’ to recognize without hesitation. Know your endings and classes.
( however much you’re convinced that it’s just a string of random letters ;P )
When the question bank only gives you generic drug names
Waiting for your ATT so you can FINALLY be done with NCLEX... but it’s the holidays so everybody’s closed...
