Nursing Tips

Hi! There are a couple of paths that a person can take to major in nursing.

There are two different types of nursing: LVN (License Vocational Nurse) or RN (Registered Nurse).

Both have to take the NCLEX (board exam), but it's slightly different. RNs can do assessment and teaching on patients, but LVNs can only take care of patients with stable, predictable outcomes (hint: this is on the NCLEX!). Both can administer medications, but there are specific things that an LVN can and cannot do.

I believe you can get your LVN license from training schools. I am not very sure where, since I never got one, and I don't have any friends who are LVNs...

Well, as for RNs, you can choose one of the two paths: ADN or BSN.

I'm mainly going to focus on BSN, because that's the degree I received.

ADN is the degree that you can get in a community college, and BSN you can get in a 4-year college, aka "bachelor's degree" (but is usually more expensive). I would recommend getting your BSN, because a lot of the hospitals now are becoming Magnet hospitals, which require more and more nurses to have their degree in BSN; some hospitals even stopped hiring new grads with their ADN.

For either BSN or ADN, you can apply when the school's registration opens, and the times are different for every school. So make sure you check on their website or call their registrar office.

If you already started a 4-year college and is not currently majoring in nursing, you can still apply; but be sure that you met the major's prerequisites. Our school had a really low admitting percentage for transfers, but that's really because most of the applicants did not meet the prereqs.

Also, some schools (like mine) even opened up another application process for those who already graduated with a degree (mostly in Biology, or Health Sciences). So if you have already graduated from a college, make sure to check back for any news.

In general, no matter which path you choose, I'm sure a lot of nursing students, new grads, and nurses will agree with me on the following.

Nursing school takes a lot of time, socializing, dedication, determination, energy, money, gas, and maybe for some, tears (I'm just going to admit it, I did cry a couple of times). The classes are very dense, filled with so much information, that you might wonder, "How am I going to remember all of this?"

But in the end, I think if people are truly passionate about this career, they would find it all worth it. I guess I can say: no pain no gain.

Use

Type II DM (ONLY)

Action

stimulates insulin release from the beta-cells in the pancreas

In case you want a detailed mechanism of action, then here it is!

Examples

Diabinese

Drinas

Dymelor

Micronase

To be honest, throughout all my rotations in various hospitals, I still haven't encountered a patient taking one of these agents.

Side effects

hypoglycemia (AGAIN!)

allergic skin reactions

GI disturbances/upset

Nursing considerations

take before breakfast (tell patient to eat afterwards)

monitor glucose levels (normal = 70 - 110 mg/dL)

avoid alcohol

be careful when taking with aspirin, sulfonamides, oral contraceptives, and MAOIs (increase the chance of hypoglycemic reactions)

Insulin is used in both Type I and Type II Diabetes Mellisuts (will go over these in future posts); but they act differently in each disease.

In Type I DM, the pancreas does not produce insulin at all, so these patients REQUIRE insulin.

In Type II DM, the pancreas does produce insulin; but the insulin augments the production of it.

When taking the NCLEX-RN/PN, or being a nurse, it is important for us to know the onset, peak, and duration of the various types of insulin.

This is really important because one of the major side effects/complications of insulin is hypoglycemia.

And by knowing the onset, peak, and duration, nurses can monitor for symptoms (or even predict) of hypoglycemia.

The peak usually indicates around what time the signs/symptoms (s/sx) of hypoglycemia will occur.

Action

reduces blood glucose levels by increasing the transportation of insulin across cell membranes

enhances the conversion of glucose to glycogen

Glucose is secreted by the liver into the bloodstream in order to main a constant level of blood sugar. The liver, muscle, and other tissues store glucose as glycogen.

[FAST-ACTING INSULIN]

Example: regular insulin (IV or pump), humulin R

Onset: 0.5 - 1 hour

Peak: 2 - 4 hours

Duration: 6 - 8 hours

The peak is 2 - 4 hours. This indicates that the s/sx of hypoglycemia will occur 2 - 4 hours after administering this insulin.

[INTERMEDIATE-ACTING INSULIN]

Example: NPH, humulin N

Onset: 2 hours

Peak: 6 - 12 hours

Duration: 18 - 26 hours

Sometimes the reaction and peak time might show early in the evening if the insulin was given in the morning.

[SLOW-ACTING INSULIN]

Example: Ultralente, humulin U

Onset: 4 hours

Peak: 8 - 20 hours

Duration: 24 - 36 hours

If this insulin is given today in the morning, s/sx of hypoglycemia will likely be seen around late evening of today or early morning of tomorrow.

[COMBINE INSULIN]

Example: Humulin 70/30

This insulin is already pre-mixed, so the patient doesn't have to mix two insulins together before administration.

Onset: 0.5 hour

Peak: 2 - 12 hours

Duration: 24 hours

Side effects

HYPOGLYCEMIA

Nursing considerations

Know the onsets, peaks, and durations of each insulin

monitor blood glucose levels (long-term and short-term)     * long-term: glycosylated hemoglobin A1c     * short-term: AccuCheck ("finger-sticks")

Uses

manic episodes

Since bipolar has two phases - manic and depressive. These meds aim to calm the patient down during mania.

Action

reduces catecholamine receptors

Catecholamines are hormones. They are produced by the adrenal glands. These hormones control emotional and physical stress.

[LITHIUM]

control manic phase - need to assess patient first to see if they are depressive or manic at the moment

small therapeutic range - blood draw every 2 - 3 weeks, and let MD adjust dosage

encourage fluids - remember that lithium is a salt, acts like sodium

evaluate patient every 1 - 2 weeks - again, to see if they need adjustment of dosages

[TEGRETOL & DEPAKOTE]

stabilizes mood

dosages are not changed - different than lithium

pay attention to liver and kidney functions - lab tests: AST, ALT, BUN

given over time

General Side effects

GI distress/upset

tremors

polydipsia & polyuria - remember we need to encourage fluids for lithium, and watch for kidney function in tegretol and depakote

Nursing considerations

monitor serum levels for Lithium - just like how we measure all the other electrolytes

take with food - to avoid GI distress (esp. with depakote and tegretol)

increase fluid intake (3000 mL/day) - esp. with lithium

The way I remember this group, is that these meds DO NOT BELONG to the other groups - as in, they are uniquely unique!

Uses

depression

smoking cessation

Action

alter (but may not inhibit) serotonin reuptake in CNS

Examples

Wellbutrin (bupropion)

Desyrel (Trazadone)

Side effects

These 2 meds are in the same group, but have completely opposite side effects!

Wellbutrin - hyperresponse    * agitation    * insomnia

Desyrel - hyporesponse    * sedation

Nursing considerations

do not take with alcohol and CNS depressants (whatsoever)

wean off in a timely manner

Uses

depression

sleep apnea

Action

inhibits reuptake of neurotransmitters (ring a bell? action same as MAO inhibitors!)

Examples

Elavil

Tofranil

Norpramin

Side effects

sedation

anticholinergic effects (this again!)

confusion

postural hypotension

The way I remember this:

"Tri"cyclics = "tri"-effect for anticholinergic effects (dry mouth, urinary retention, blurry vision)

  Nursing considerations

suicide precautions (peaks at 2 - 3 weeks)

takes 2 - 6 weeks for antidepressant effects

take during the night

monitor VS

wean off slowly

do not take with alcohol

do not take with sleep inducers (these also have sedative effects)

avoid sun exposure; or use sunscreen

Uses

depression

OCD

bulimia

Action

inhibits CNS reuptake of serotonin (as implied by the name of this subcategory of antidepressants)

Examples

The frequently used ones are:

Prozac

Paxil

Zoloft

Side effects

anxiety

GI upset

change in appetite

change in bowel function

urinary retention

pink urine

Nursing considerations

suicide precautions   *  greatest risk is around 2 - 3 weeks (pt has a lot of energy)   *  the only time when you can ask yes/no questions

takes around 4 weeks for antidepressant effects

take in the morning

Uses

depression

chronic pain

Action

increases concentration of neurotransmitters

Examples

Nardil (phenelzine)

Parnate (tranylcypromine)

Marplan (isocarboxazid)

Side effects

hypertensive crisis when combined with tyramine-containing foods    * severe headaches    * palpitations    * diaphoresis (excessive sweating)    * stiff neck    * intracranial hemorrhage

photosensitivity

Nursing considerations

avoid tyramine-foods    * aged-cheese    * bologna, pepperoni, salami    * bananas    * raisins, yogurt    * beer/wine    * liver    * pickled products

monitor urine output

takes 4 weeks to work

do not combine with other CNS depressants or cold meds

The main use for antidepressants are, of course, depression.

Just like antibiotics, antidepressants also have subcategories:

Monoamine oxidase (MAO) Inhibitors

Selective Serotonin Reuptake Inhibitors (SSRIs)

Tricyclics

Heterocyclics

To tell you the truth, there is no easy way to remember these subcategories. But you can start by looking at their mechanisms of action. The side effects are also really unique to each subcategory.

The following are key points that you MUST know about antidepressants:

some take a couple of weeks for its full effects

do not combine antidepressants with alcohol (alcohol is also a CNS depressant)

suicide precautions - there is this period of time when the depressed patient shows a sudden surge/increase of energy, this is the critical time when the patient might be highly suicidal

some antidepressants should be weaned off slowly

Uses

peptic ulcers

indigestion

reflex esophagitis

In a related subject, one of my friends take antacids before drinking alcohol, otherwise her face will become very red - a phenomenon we like to call "Asian Glow".

Action

neutralizes gastric acids

Examples

Amphojel (aluminum hydroxide)

Milk of Magnesia (Magnesium hydroxide) - don't really need prescription; I've seen it in dollar stores

Maalox

Both Milk of Magnesia and Maalox are common in the med/surg units.

Side effects

constipation and diarrhea (both extremes can happen because we're dealing with the GI system)

acid rebound

Nursing considerations

interferes with the absorption of meds (antibiotics, iron preps, oral contraceptives, and INH)

do not combine with other meds - give 1-2 hours after eating a meal or taking other meds

monitor bowel function - may have "bowel addiction"

monitor signs and symptoms of lab shifting (we're dealing with Magnesium, "Mag's a drag") - monitor electrolytes

Uses

anxiety

anxiety disorders

manic episodes (of bipolar disorder)

panic attacks

Action

affect neurotransmitters in the brain

Examples:

Benzodiazepines (usually end in PAM)

Librium (chlordiazepoxide)

Xanax (alprazolam)

Ativan (Lorazepam)

Valium (Diazepam) - frequently used to keep patients sedated at a specific level

Non-Benzodiazepines

Equaril

Buspar

Vistaril (hydroxyzine)

Herbals

Melatonin

Kava

Side effects

CNS depression (too calm) - causes sedation and confusion

hepatic dysfunction

Nursing considerations

potential for addiction or overdose (watch for additive issues and potential suicidal tendencies)

avoid alcohol (alcohol is also a CNS depressant)

monitor liver functions (LST, ALT, LDH)

gradually wean off

decreases effectiveness if smoking or caffeine use

I have always struggled with note-taking ever since I had to take notes. I've been through so many types of note-taking and I still don't know which one's the best for me. Below is a compiled list of note-taking, and links that will help you with note-taking. Hope this helps.

[MATERIALS]

Binder + binder paper Binder paper is easy for organizing your notes. I personally like the college-ruled more, because I can write more info on one page. Deals can usually be found in dollar stores at all times.

Notebooks People who don't like binder paper (like me!) can use notebooks. Notebooks is more light-weight compared to binders. I just never liked the idea of my binder being uneven when I shove them in my bookshelf. If you are in a hospital during rotations/preceptorships, use smaller notebooks (easier to carry and to find notes).

Blank pieces of paper This is super useful when you have to draw out something. And you can organize your notes by blocks, circles, or whatever you like.

Flash cards Flash cards are useful when you want to remember something short. These worked for me when I had to study for medical terminology or medications. After using paper flash cards throughout my entire high school, I switched to online flash cards durign college. FREE sites for online flash cards      * StudyBlue (can download phone app)      * Quizlet (can search for others' flashcards)      * Cram      * BrainFlips   My favorite one so far is StudyBlue, because it looks fancy! (:

Highlighters and colored-pens Since I kill highlighters pretty fast, I buy them at dollar stores. A pretty-nice brand usually comes with 4 different colored highlighters. My favorite colored-pens are the Japanese brand "uni-ball Signo DX". You can use them to color-code. I think the most important thing for me when I color-code is being consistent, so my brain would recognize the themes faster. I use pink for super important stuff (like unique side effects and nursing considerations). But you are the king/queen of your notes, choose your colors!

Sticky notes I usually find these deals in Big Lots, Walmart, and sometimes even dollar stores. I use them when I want to remember something SUPER important. Or when I need to insert a note.

Computer programs I use a PC, so I don't know if MACs have same or similar programs. * Microsoft Word * Microsoft One Note (can create a "notebook" and have sections) * Notepad

[GOOD NOTE-TAKING SKILLS - according to a lot of online sources]

Don't write down everything you hear or read (This actually doesn't work for me :(  I use bullet points, but I almost write in complete sentences. Otherwise I'll forget why I shortened my sentence...)

Structure and organize your notes    * start a new section or lecture in a new page    * use abbreviations (use your nursing terms!)       - GLOBALRPh (Clinician's Ultimate Reference)       - Cuesta College's RN Abbreviations

Compare notes with your buddy, your roommate, your classmate, or online! I found that Quizlet has a lot of notes on nursing lectures. Try it!

Things you must write down    * definitions (I try not to use phrases for definitions)    * medical terms (important when charting)    * examples (helps association things together; creates a map)

Write legibly My friends who fell asleep in class (shh) started taking notes subconsciously - not a good idea; he couldn't understand what he was writing. So I guess another lesson here is: don't fall asleep during class!

Review regularly I guess the key point here is try not to procrastinate when reviewing your notes. I used to do this a lot in nursing school - definitely not a good idea. Here are a couple of suggestions from online resources on reviewing notes regularly:    * right after lecture    * do not review the night before your exam (or your NCLEX!)    * rewrite important key points    * have a buddy and quiz each other

[THE CORNELL NOTE-TAKING SYSTEM]

Of course, you don't have to follow this format completely. You can add your own taste and style to it. 

I have complied these note-taking-related points from various internet sources. Please feel free to use them. They may help you a lot, or they may totally not work on you. Just remember to find the best way for you to study.

If you are a solo-studier, study by yourself. If you like hanging out with people, study in a group. But evaluate the effectiveness (like we do in the real nursing world, always evaluating the effectiveness of our treatments and therapies) of your studying time - are you actual studying? or did you end up talking to your friends?

I know some people like listening to music while studying. But think about if music actually helps you focus, or does it drift your concentration away? I like listening to instrumental music (piano, jazz...), otherwise I'll start singing along if the song has lyrics; and that's not very helpful.

  NOW...

Uses

Atrial fibrillation (Afib)

Atrial flutter (A-Flutter)

Tachycardia

Premature ventricular contraction (PVCs)

I will cover EKG strips in another post. So hang on! :)

Action

interferes with the heart's electrical excitability

Think of it as you have a patient whose heart is pumping "weird", so you are trying to use an antidysrhythmic to slow down the heart and prevent it from getting too excited.

Examples

atropine sulfate

Lidocaine

Quinidine

Isuprel (isoproterenol)

Pronestyl (procainamide)

Side effects

lightheadedness

bradycardia and hypotension (the other extreme of heart issues; since we tried to calm it, now it's too calm, oh no!)

urinary retention

may cause bronchospasm if using beta-blockers (the LOLs)

Nursing considerations

monitor VS (especially BP and P - don't want the patient to go into hypotension and bradycardia)

monitor EKG (want to make sure patient gets out of the Vfib or Flutter they were in)

position patient slowly to avoid orthostatic hypotension

Uses

COPD (lungs)

cardiac arrest (heart)

Action

stimulates beta-2-receptors in the lungs

increases peripheral resistance and causes bronchospasm

Examples

Levophed (norepinephrine)

Adrenalin (epinephrine)

Intropin (dopamin)

Dobutrex (dobutamine)

All of these meds were pretty common when I was rotating through the ICUs. Even though the patient might not need them, you mostly likely will see one of these sitting in the patient's chart just in case.

Side effects

dysrhythmias (heart)

tremors

anticholinergic effects (esp. dry mouth and urinary retention)

Nursing considerations

monitor BP and peripheral pulses (since it's targeting the heart)

monitor urine output (one of the anticholinergic effects)

provide safety during ambulation (patient can fall)

instruct patient not to drive

Uses

vomiting

Action

increases GI motility

blocks effect of dopamine in chemoreceptor trigger zone

Examples (italics are common meds)

Tigan

Reglan

Antivert

Compazine

Side effects

sedation

anticholinergic effects

Nursing considerations

commonly used before initiating chemo therapy

may cause Reye's syndrome if patient has a viral infection :(

Use

diarrhea

Action

slows peristalsis

increases tone of sphincters (in the GI system)

Examples

Kaopectate

Lomotil

Imodium

Paregoric

Side effects

constipation (wanted to stop diarrhea, but now the med has completely stopped bowel movements :O)

dizziness

drowsiness

anticholinergic effects (dry mouth, blurry vision, urinary retention...)

Nursing considerations

do not use if patient has abdominal pain (do not want to stimulate peristalsis or use of sphincters, because it might make the pain worse)

monitor for urinary retention (anticholinergic effect)

do not combine with other meds - take it alone

Uses

seizures (convulsions)

Action

decreases the flow of Calcium and Sodium ions across the neuronal membranes

Examples (italics are the more common ones you'll see)

Dilantin (phenytoin)

Depakote (divalproex sodium)

Tegretol (carbamazepine)

Konopin (clonazapam)

Lumino (Phenobarbital)

Side effects

respiratory depression

aplastic anemia

gingival hypertrophy

ataxia (aka uncoordinated movements)

Nursing considerations

do not discontinue anticonvulsants abruptly

monitor I&Os

careful when using medications that lower seizure threshold (ex: MAOIs, antipsychotics)

take with food

provide oral care - be gently

avoid alcohol (may cause severe respiratory depression)

urine may become pink - let patient be aware of this (we don't want them freak out when they go to the bathroom)

[DILANTIN]

IV can cause cardiac arrest if too quickly - monitor HR

urine turns pink

do not combine with other meds - should be given through its own port

[MAGNESIUM SULFATE]

this is a common med in OBGYN

observe and evaluate for deep tendon reflexes (DTRs)

monitor for respiration depression

[DEPAKOTE]

do not take with carbonated drinks (sodas)