Knowing Your Vitals Is Vital

For about a month the first thing I did after I got up every morning was test myself on all these values. 

I wish I had of done it sooner than I did.  During the break between the second summer and fall semester you should make sure you learn these values if you didn't memorize them already.  You will be starting Med Surg I and you will be in specialty areas like the operating room, post anesthesia care unit, telemetry unit, intensive care unit, emergency room, and other areas as well.   

You will absorb way more information if you understand your vitals and where the patient is at.  

Knowing your vitals is also very important when giving meds.  You don't want to give a patient anti-hypertensive medication if their BP is 90/50, or their heart rate is below 60 beats per minute.  They can bottom out and code on you.  And if you are implicated in accidentally killing a patient you can get the daylights sued out of you.  Even as a student.  They don't require you to have insurance for no reason.

I have all these values in a little notebook I carry around with me at all times when I'm in clinicals.  

I got these values from out of the assessment textbook, but organized them in a way that makes sense.  This should be a help to students in the first summer semester as well.  These values are important for your Physical Assessment Class.


TEMPERATURE

Axillary       36.0-36.5 C   95.0-98.9 F
Oral             36.5-37.0 C   96.0-99.9 F
Rectal          37.0-37.5 C   97.0-100.9 F
Tympanic    37.6-37.8 C  97.4-101.3 F  

Stick the thermometer in the patients mouth before you start on anything else.  This will save you time. 

When you're in clinicals some hospitals use 3M brand disposable thermometers.  Be sure to read it within 10 seconds of taking it out of the patient's mouth.  Some nurses will say to wait.  That's wrong.  The temperature reading on the dots will begin to change once exposed to the cooler air.  For all the nerds out there, you can click on the link below:  

http://solutions.3m.com/wps/portal/3M/en_EU/Healthcare-Europe/EU-Home/Products/InfectionPrevention/SingleUseThermometers/

RESPIRATORY RATE     12-20 breaths per minute

Older Adult                        15-22 breaths per minute

PULSE RATE/HEART RATE  60-100 beats per minute


In a previous post I recommended you get a semi-decent watch.  This is what it's for.  You need an old school watch with the hands that count seconds.  30 seconds for pulse 30 seconds for respiratory rate.  Double both those values and you've got your times.



BLOOD PRESSURE
Hypotensive:   < 90/60 mm HG           Low Blood Pressure
Normotensive:    90/60-120/80            Normal Blood Pressure
Prehypertensive:  120/80-140/90         Borderline
Stage I HTN:      140/90-160/100          High
Stage II HTN:   >160/100                       Very High

After you graduate from the program you will likely never use that BP cuff again.  Actually scratch that.  After you are finished with Assessment class you will likely never use it again.  All the hospitals have electronic machines.


Questions, comments, suggestions: ramonbritt@gmail.com

Library Printers??? Cant Trust em'!!!

It's costs 15 cents per sheet to print in the library.  And no.  There is no place cheaper on campus to print things out.

Never put yourself in a position where you have to rely on a library printer to print something.

Like coming in early in the morning and having to print something out or else you're screwed.

You could get caught out there if you do.  Sometimes the entire printer system doesn't work.  If it's off hours, then no one can help you.

Weekend library staff don't know how to fix glitches in the printer system.



Question, comments, suggestions: ramonbritt@gmail.com

Get a Library Safe!!!

In case you didn't see my post on the freezing classrooms.  Get a library safe.  

How do you do that?

Go in the library and ask them for one.

You can charge your cell phone in the library safe or stash a sweater.

A book or two.  Nursing school books tend to be big and chunky, and the library safes are tiny, so you can't fit too many at one time.

None the less.  Get a library safe and get it early if you can.

You Need $800+ Extra For ATI!!!

I tried to come up with a cool acronym for ATI, but I couldn't.  If I did, the acronym would be something about how ATI costs you that A.  For all of you obsessed with getting an A, this will consistently be the biggest wall blocking you from success.  Want to get into a CRNA program?   These exams will be the bane of your existence.

Why!!! Oh!  Why do they put me through this????

Well after they incorporated ATI into the curriculum the NCLEX pass rate shot through the roof.  And so it's here to stay forever...

ATI is a set of nursing textbooks with online coursework that goes along with it.  The textbooks cover pretty much the same material you are learning in your MEDSURG, PEDIATRICS, and OB/GYN lecture courses.  

There is an online ATI exam that is given after you take every Med Surg, Peds, or OB,  final exam.  

The ATI exams count for 10% of your letter grade.  And in case it didn't really sink in the first time I mentioned it.  I'm going to say it again.  The ATI exams are given after the finals.  As in the same day.  So you essentially take two final exams for every class.  One for the lecture.  And one online ATI exam.

ATI costs $800+.  Don't forget to have your accountant deduct it from your taxes at the end of the year.  The ladies in the nursing office let you you pay them over time for ATI.  Like you make a bunch of installment payments as you go along.  So for the start of summer semester I would budget about $300.  I can't remember the exact amount.  Once I find out I will post it.  They will want that dinero from you pretty much right away.  ATI is not optional.  It's not really mentioned anywhere on the Downstate website.  You find out about it pretty much at orientation.  It was a big surprise for all of us to say the least.    

The books are good though.  They are helpful at times when the textbook can kind of suck.  It can also confuse you sometimes because it has some information that contradicts what's in the MedSurg textbook.  

When the values for say electrolytes or BUN are different, go with the Med Surg textbook as these values will be closer to what you will encounter on the NCLEX exam.


Question, comments, suggestions: ramonbritt@gmail.com

Books! Books! Those Expensive Books!

Before you go crazy blowing your dough on books.  Wait!!!  Your upperclassmen will sell them to you way cheaper than Amazon, and some will even give you books for free. 

So save those dollars to pay for things the upperclassmen can't pass on to you like ATI access.  Yikes!!!

Kicking yourself because you read this too late?

Keep an eye out for the RN-BSN students coming in a couple of months after you do.  You can sell some of your books to them.

Uniform, Stethoscope, BP Cuff, Penlight

Okay so the uniform.  I got the top from the bookstore.  You will need it.

Make sure you don't wait to the last minute to order your top like I did.  The guy in the bookstore takes orders at the start of the semester and pays one shipping price to have all the uniforms sent in one shot.  So if you order after that, you have to pay an additional shipping fee.

Do not buy the pants.  They are horrible and don't fit right and made out thin material.  I didn't get a pair because I asked someone from the previous class about what to buy and what not to buy.  Some classmates bought it and regretted it.  Get a pair of white scrub pants that have pockets and fit comfortably.

I bought the Downstate patch, but never had it sewn on.  I intend to give it away to a student in the incoming class.  I was the only one who didn't sew mine on.  Some professors won't let you get away with that.  So I recommend getting it and sewing it on.  

I didn't get that blue tote bag with knick knacks either.  The students from the previous class told us not to.  I'm not telling you what to do on this because they ask you to take the items out during preclinical labs.  90% of us didn't have it though.

I bought my BP cuff from the bookstore.  It will run you about $25-$30.  Unless you are in extremely dire straights, I recommend you buy it and practice with it.  If you don't get one you can always use a classmate's for the final exam as you will be doing your final exam in groups of 2 or 3.  You will assess one another. You will need it later for Community. 

Penlight.  I bought the cheapy $3.00 penlight from the bookstore.  It was disposable.  I didn't realize that at the time of purchase.  Honestly I think it's a crime to sell them because it creates so much waste.  The disposable penlight doesn't last very long.  Mine last for 7 months, but I didn't use it that much.  I paid $4.68 for my new penlight.  It is brighter, slightly bigger, and the batteries are replaceable.

I bought a $2 watch from a 99 cent store.  It fell apart fairly quickly and I found myself using my cell phone.  Some professors will not let you get away with that.  I was lucky.  I would recommend spending a little money and get a semi-decent old school watch with second hands that tick.  

Go across the street and buy the $20 stethoscope from the bookstore.  I think I actually paid less than $20 for it.  I curl it up and stick it neatly in the right pocket of my uniform.  

When you get in the hospital you will see nurses using disposable stethoscopes as a lot of patients are on contact precaution.  They are not high quality and a lot of contact precaution patients have serious health issues, so unless you are a cardiologist, it's not that big of a deal to get a cheapy stethoscope.  

THE CLASSROOMS ARE FREEZING!!!!!

So if you didn't see my post on getting a library safe.  Get yourself a library safe.

In the library safe, you are to put a sweater and maybe even a long john top.

No joke!!!  In the summertime the classrooms are absolutely freezing, unless you have a really high tolerance to cold.  A couple of my classmates did.  But most of us were freezing our butts off.  

I would have to go outside and warm up in the middle of lecture because it was too cold.  Especially in July and August.  
The hotter it is outside the colder it is inside!!!!