Fatigue r/t inadequate rest As Evidenced By poor exam performance

Outcomes:

Client will:

• maintain regular sleep pattern of 8 hours each night.
• state feeling rested upon waking.
• state methods of relaxing prior to bedtime.
• return to baseline level of mental functioning
• state methods that can be taken to better manage time so all-nighters are not necessary
• achieve a satisfactory score on all future tests resulting in passing her class.

Interventions:

• Provide education on how to use a calendar to plan tasks and keep track of when assignments are due.
• Administer Xanax (or other anti-anxiety medications) as ordered to treat symptoms of freaking the fluff out.
• Work with client to design a plan of study that allows for a balance between work, school, sleep, and personal life.
• Provide resources that will aid client in achieving time management and study goals (i.e. scary conversations with instructors t discuss performance)
• Assess level of consciousness, be alert for the following: droopy eyes, excessive dietary intake of vending food/starbucks, dead stares, excessive yawning, drooling on desk, snoring, sudden smacking of head into desk, etc.
• Assess quality and quantity of sleep achieved each night.
• Hide school books, keys, wallet, computer, phone, notebooks, TV, etc from client to prevent temptation to stay up all night.
• Put sedatives in "coffee" they drink to stay up all night.
• Play lullabies in background.

Evaluation:

• To Be Determined

So, from last week, its been sort of up and down, up and down, and up and down again for me.  Wednesday was our first exam of the semester, I panicked and ran out of time, but I didn't think I did that bad.  Spent the rest of the day meeting with my mentee, and preparing for our simulation the next day.  MI/Code simulation went WELL.  Even though my partner changed at the last minute, and was a dud (no prep on his part WHATSOEVER....how are you in 4th semester and have not learned the importance of atleast looking up the meds?!?!).  I wasn't perfet, but I didn't freak out, I assessed, I listened to what the patient was telling me, and I took actions to address their complaints.  I needed guidance on the exact steps to take (like ALWAYs tabs before starting a Nitro drip, even though they just had an inch of Nitro paste applied).  I left feeling good about simulation, which is truly a rare event in my nursing school career.

Fast forward to later that day, and I failed my exam.  By 3 questions.  I was trying to come up with all of the questions that I had doubts on, and really started freaking out because there must have been more that I was unsure on that I didn't even know I had wrong!!

Then I had a really great day at work at the hospital.  It was busy, but I had amazingly awesome patients, was working with great nurses, and it just went smoothly for the most part.  Then Sunday, I got my clinical evaluation back from my instructor and made a boo-boo and felt like such an idiot.  I was crying because I was just overwhelmed with how much of an idiot she has to think I am after being so confident that I wasn't worried about failing my test and then I failed it, and now I am screwing up my evaluation and doing a poor job in figuring out what she wants to see from me.  So, I am freaking out and e-mailing her to apologize, and frantically trying to create a hybrid of my evaluations to fix my mistake while I am crying.  Then she e-mails me that it was OK.  So, I felt better.

I was on time for class today!!  And my instructor wasn't giving me the sitnk eye when I was talking to her about an assignment, so I was all like "YAY!".  Then, she explained that she knows a lot of people were disappointed in their scores, but that its ok, we are all gonna graduate!  "SECOND YAY!" Then after lecture we got to look over our exam, and I was all "DOH!!!" I missed a WHOLE PAGE OF QUESTIONS!  Who does this!?!  I seriously lost 10 points from SHEER STUPIDITY from freaking out at the end.  My nerves caused me to fail.  But, at least, I didn't fail because I didn't understand the concepts, I just made dumb-brainless mistakes.  Which I am ok with, and hoped this would reflect to my instructor when I met with her later.

So, I met with my instructor, and of course, she stated she was surprised, and she stated that she can't put me in ICU with performance like that.  I explained to her what happened, this is not typical of my performance, and I even showed her my notes that I used to study with.  So, I think it showed that I put in the effort.  I assured her that it wouldn't happen again, and I was able to discuss with her my problems with my care plan, and felt assured that it was ok to look at big picture problems for my patients instead of just what I assess (a cardiac patient who is well managed will not necessary reflect a problem from a head to toe assessment, however their diagnosis, results of diagnostic procedures like cardiac catheterizations revealing 100% blockage in the right corornary arteries in someone who is Right artery dominant  does!).  It's more clear to me now what I need to work on, what is expected, so I absolutely can fix this!

So, I felt a bit reassured after meeting with my clinical instructor and discussing my concerns with her.  I also got a really awesome letter of recommendation from another of my clinical instructors.  So, like I said, a lot of ups and downs for me this past week, but I am feeling ok.

Me and some of my classmates are all signed up to attend a meeting of the Association of Women's Health, Obstetric, and Neonatal Nursing coming up in a few weeks to as part of an assignment in our Roles Transition class.  I am excited to see what it is like to attend meetings like this, as well as learn more about labor & delivery.

So, I am going to bed early tonight after making sure I have everything prepared for clinical in the morning in order to implement my care plan from up above.  My goal for tomorrow is to spend less time with my instructor, and more time with my patient so I can actually get my LAST HOLISTIC done!  I want to pick it tomorrow because we have to turn it in within a week of the actual day we provided care, and I don't want to spend the day after my birthday working on it to turn it in on the 16th.  Anyway, get my holistic done, come home, work on my clinical eval including the responses to my instructor's questions from last week so that I am NOT working on both days at the last minute, so that I can spend more time studying for my next test!

Oh, and if you are not my husband, do NOT ask me to do anything non-school related until after I have passed the class and know my schedule for Capstone.  Its just not gonna happen!!