Soap note nursing | | Support and knowledge about breastfeeding

These are the things I learned about residency that I wish I could tell myself as a July intern on wards service. I know many of y’all here will disagree with a few, but this is how I see it. There’s definitely quite a few missing, so y’all fill in what I forgot.

You earned the right to be here. You’ve proven you can do it so don’t doubt yourself.
You’re not expected to know everything on day 1. Your job is to show up with a good attitude and ready to work hard.
Listen to the nurses. Some of these critical care nurses, especially. Ask for their input and don’t brush them off as mere nurses.
Write things down. Print a list and make check boxes by each patient for what needs to get done that day. There are interns who forget things and interns who write things down.
The first thing you need to learn is to tell sick from not sick, and that can be tricky at times. Later on you refine that until you see a whole spectrum of how sick a patient is.
Don’t waste too much time pre-rounding. Brief pertinent exam, ask patient about changes in symptoms, but the highest yield is asking the nurses.
Call consults before noon if you can. It’s a courtesy to the consultant/their team plus they’re far more likely to be seen that day, avoiding a delay in workup for the patient.
Your note doesn’t have to be an essay. Keep things simple and don’t get bogged down in eloquent explanations.
However, document your reasoning well. Especially in tough cases, drop a paragraph about why you’re doing what you’re doing and the patient agrees.
Auto text or whatever your EMR uses. Make an arsenal of these. Use them for everything. If you have a kind of case you see a lot, template out a note so you make sure you’re documenting all the important stuff in an efficient manner.
Be cool to your co-interns. Y’all are about to spend the next few years together. Don’t leave them in a lurch or punt to others all the time.
Call the seniofellow/attending, especially at first. Even if they give you attitude, it’s ultimately their responsibility and they should know that.
Try to update families daily if you can, especially for your ICU folks.
Never, ever lie. Even once will destroy your credibility.
Have a good attitude in a way that refuses to be bullied - don’t take that shit.
Read all your own images. Then when rads drops a report, read that and see if you can find what they’re describing for every notes finding. It’ll make you a better doctor.
Get to your new city as early as possible. Do things like car inspection, dentist appointment, vet appointment, etc. before July kicks off.
Our profession has a high rate of substance abuse. Do what that what you will.
Sit down with your family and SO and let them know what to expect and try to explain how intense this job is. When there’s a difference between expectation and reality, you have problems. Either way, it’ll strain your relationships.
Because of this, be deliberate on spending time with your SO/friends/family even if you’re dead tired.
Wear comfortable shoes
Scour the hospital for the best restroom. Sometimes having a proper relaxed shit can turn a day around.
Get to know your chiefs. Go to them with problems earlier rather than later.
Use every minute of PTO
Step outside the hospital for a few minute a day when you can. See the sunshine.
Make friends with the cafeteria staff and they’ll hook you up to no end.
Make friends with the transporters and techs - they will save you.
Appreciate the hell out of what PT/OT/SLP do.
Know how to tell a patient no.
Pharmacy is your friend - they know things
If something is emergent, keep calling to follow up. If your crashing patient needs abx, it’s not like some doctor video game where you put the order in STAT and everyone goes rushing. Call down and check the status, let them know it’s needed now.
Don’t order everything STAT
Calling people in general gets so much more done and avoids so many headaches.
You’re going to lose your first patient. Remember how you feel, and make sure you never forget it. You’ll need it later.
Hang out outside of work, invite the nurses as well.
Election ‘24 is coming up in November so work is a great place to talk candidly about politics and try to change others’ beliefs /s
If you’re struggling, reach out to someone.
Try to get outside on your days off
It’s not uncommon to end up on an SSRI
Take the stairs places as much as you can. Cardio and a nice lower body workout.
Answer pages as they come in. Anything STAT call back the moment you see it. Aim to get back to everyone within 5 minutes if you can.
Day to night nurse shift change. Wait 30-45 minutes, then go around and talk to the nurse for all your patients. Let them get report and see if they have questions. Explain the plan, agree on when to call you, make sure orders all look good and make sense. We even used to bring candy from the physicians lounge to pass out for this.
Put the diet order in
Keep your presentations short and to the point unless someone wants them longer. Know the details, but you don’t have to recite them. You don’t have to say all the exam findings that were normal and not related to the patient’s disease
Always be prepared to dodge a punch when near a geriatric patient
Even a 5-10 minute phone call with your loved ones on a frequent basis can do wonders
Some people are just assholes and you can’t take things personally
Other people are mad at something else and want to take it out on you.
Be cool to the med students
Get good at delivering bad news
Celebrate delivering good news
Fuck prior authorizations man
When calling a consult, have a specific clinical question you need help answering. Know the patient well. Keep the call centered around what you need from them but be ready to provide details if needed. “Dr. X wants you on board” is resident code for “I know it’s bullshit but my attending made me call.”
Delirium and sundowning are real af. The trick is to get them home.
Benzos aren’t just “settle down” drugs. It’s like a whisky shot through the vein in the sense that it can also disinhibit people and make wildness worse
Get to know 1 thing about each patient other than what’s in their chart. What job did they have? What’s their favorite team? Do they have pets? You’ll remember them better when the list is large and it can make the job more rewarding
If the nurse is worried ALWAYS go to bedside
If you feel the urge to get a tattoo, do it
Read everyone’s note each day on your patients
Case managers and social workers are heroes. Get to know them and work together to get patients proper dispo
Don’t wear your damn shoes in the call room bed
Sit down in patient rooms if you can. It shows you’re listening, it’s less intimidating for them, and they’ll tell you more.
Talk louder to older patients
Sternal rub like you mean it
Sit done one day, caffeinate, and do all those stupid compliance modules in a single bolus.
Never make the same mistake twice
If things don’t add up, your math is wrong
Some patients don’t care about their health and won’t look after it after all you do. That’s just the gig.
If something adverse for residents goes into place on a “temporary” basis, it never goes back the other way. Fight for your rights.
You’re not crazy - the patient always tells the attending something completely different or remembers some important detail. We get it.
Have a good comfort show to stream when you come home half dead.
Trust but verify (that’s actually a Russian proverb Reagan borrowed when speaking about the USSR)
Remember to love it more than you hate it. Find a way to make it fun. They say it’s the best time you never want to have again. You get to save and improve human lives. There’s no greater calling in the world than that.

I’m a 18 y/o fem dating a 20 y/o male. we’ve been dating for a year. I am a nursing major and he is elevator mechanic still in school. I convinced him to move in together but I deeply regret it because we agreed to rent out his parents basement. His dad built a private section for us. It’s small but nice. The only thing is..it’s dark, outdated and stuffy. We agreed to start splitting rent which is $2000, 1000 each.
My family is upset because I have inherited a rent stabilized apartment in a nice neighborhood for only $750+ utilities. If I move there, I would not be required to work. I would only have to focus on school and my scholarship which would pay my expenses. Due to working and having to tend to the house to make it more comfortable and home-y, I am not prioritizing school. I am struggling to be w my boyfriend, take care of myself, and do well in school as well as work. My grades are struggling and I fear I will not get into nursing school
I asked him to support me , he said no. He said he will not move in with me because his name isn’t on the lease and my family could kick him out at any time. He does not want to go from a private home to a busy apartment with no privacy. I just feel overwhelmed. I’ve always wanted my own apartment before a house. I’ve wanted to decorate it girly , have sunlight and lots of plants. I regret moving so fast and giving up my dream. He is a great boyfriend and drives me everywhere I need to go. I appreciate him greatly and have bought him things to fix the car up. I always cook his favorite meals on the weekend to make up for it he believes we should work hard and go to school but he doesn’t understand how hard my science pre reqs are. I feel like I can’t work and study enough hours to get As and get into a program. I might have to pay for nursing school out of pocket. Which I am slowly accepting.
Due to having to split bills he mostly covers groceries and we split chores. I do 70% of cooking and he helps around the house. He also pays his whole car note + insurance.
I regret telling him to move in together because we are not saving. I am not doing well in school either I am stressed.
I have 5k saved, he has 40k saved btw. He wants to buy a house so I get it. I feel like he wants to pay his family house off faster with me there. If I move out he will break up with me and he will probably be forced to go back upstairs due to the rent bring too expensive alone. We’ve been down here a year. I feel like his parents will be confused / upset.
Aita for wanting to move into the cheaper apartment and live alone until I get my degree so I can focus.? I do not want to break up though so I am staying. But am ungrateful and lazy for just wanting to focus on school?

it hasn’t even been 24 hours after surgery and I understand things take time. Right after surgery I could speak but in my lower pitch range. My pitch can’t go higher. Do you remember how long it took you after surgery to get your higher notes back? I was trying to sing carmina Burana to the nurse after surgery and that went comically badly lol

I know you be in here and I hate you. But those girls don’t deserve to be walking around with dirty matted hair, especially since you’re essentially FORCING them to wear their natural hair and not really using protective styles. Here’s some advice, with their texture hair, wash day should be taking the whole day. Have Niyah or Liyah read this for you:
-You need to put pre-wash in the hair
-part into 4 or more sections after combing the pre-wash through
-get some decent shampoo (such as Carols daughter, Auntie Jackie’s, Mielle, Shea Moisture, hell even Mane & Tail) not the dollar tree soap
-let the shampoo actually lather up in their hair especially at the scalp, then comb through it as it’s getting washed out (do this AT LEAST twice)
-make sure you’re using warm water, not too hot not too cold.
-after all their hair is shampooed, part their hair into sections again. Get some deep conditioner from any of the brands listed above and do the same process after letting it sit for at least 30 minutes covered in shower caps or plastic bags.
-ensure you wash the conditioner with cold water and thoroughly comb through it.
-after all their hair is washed, before you put it into those ponytails, put some oil in their hair and scalp and moisturizer. Blue Magic grease still works wonders and the pink lotion that we all used in our childhoods.
There’s no reason any of your kids should look the way they do Nika. Especially since you claim you’re a stay at home mom. Yes, you’re their mom and you stay at home, but you’re lazy asf. Also, teach the oldest Liyah and Kiyah how to properly take care of themselves and then you wouldn’t have to worry about the younger ones. If you taught them how to do their hair, that’s two less heads that you have to do. Stop being a poor excuse for a mother and at least do something right. You be wanting praise for the smallest things, but it’s always BELOW the bare minimum. If you’re not gonna get their hair braided at least keep it clean.
(Side note: it’s a damn shame Sy hair be looking the way it does. You really talking about her hair long, when it’s that one part. There’s not reason all of her hair shouldn’t be able to go into a ponytail. It looks like that baby has a nappy high top fade. 😭)

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I am a 39F Appx 160lbs Non smoker I don’t drink, ever (in recovery)
I worked the past few days on an outside patio (covered by a black awning). The outdoor temperature was around 80-85* and under the awning, the thermostat was reading 94. I’m a server so, the weekend was insanely busy (a lot of customers who couldn’t get a Mother’s Day reservation) and, in turn, didn’t get to eat or really drink anything besides a liquid IV because, I don’t have time to stop and eat or drink anything aside from a sip of water here and there. Yesterday I had a severe migraine all day, which carried into today, a temperature of 101*, that has subsided as of this morning, but today I can’t keep anything in me. I got some electrolyte replacement powder yesterday and drank 3 of those, alongside some plain water but, it doesn’t seem to be helping. Today is my only day off before I’m back to working on the patio for the next 6 days so, I wasn’t sure if I should go get some fluids so it doesn’t get worse. I was planning to, but then was reading on a nurse’s page that they get annoyed with people who come to the ER just because they haven’t drank enough water. Should I just bite the bullet and go? Note that I am still drinking electrolyte replacement drinks and water, as well as eating some food. Also, I take a potassium supplement but constantly test out of range for levels in my blood. Any suggestions on whether to go or what else I can do over the next 20 hours to get back to proper hydration levels are welcomed and appreciated. TIA

Hello Students
I am Mark Manuel a Seasoned academic writer with over 8 years’ experience. Are you struggling to beat your course/class deadlines due to taking two jobs? Are you a busy mum taking parttime classes? Do you need help in understand technical aspects of your courses? Worry No more because, Mark Manuel has got you covered. Just contact me through Email : [assignmentassists@gmail.com](mailto:assignmentassists@gmail.com) Or Discord: researchessaymarket for expert help from as low as $15 per page.
With my experience, I help, guide and support you in handling;
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· Narrative Essays
· Compare and Contrast Essays
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· Dissertations
· Weekly class discussions and Replies
· Video discussions and analytics
· Movie analytics and More
My subject Areas include;
· Information systems
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I wanted to give someone hope that it is possible to pass nclex. I have reading everyone comments either pass or fail nclex. Fast forward I graduated August 2023, took my first attempt August 2 because everyone was passing I thought I could just do it without fully review. I failed with 85q. Second attempt I use archer failed, third attempt archer failed. 4th attempt Uworld and archer I went up to 135, ran out time and I didn't passed.
But, my 5th I attempt I did it different. I purchased Uworld 60 days package finished everything, review the rational either I got it right or wrong, I wrote tons of notes two days before exam I review my notes.
I decided to purchase bootcamp after I finish Uworld. But, I only used case study and the 4 readiness assessment. After the struggle during my nursing school and life challenges I am glad to say that today RN is attached to my name. If you're a repeat test taker do not give up. You got it!!

FTM here hoping that the experts can give me tips to help me stop my milk production. My LO is 10 weeks old and had exclusively breast milk until about 8 weeks. I was essentially exclusively pumping (only nursing like once a day—he was a NICU preemie so did much better with a bottle). Baby was incredibly colicky, gassy, had reflux, and basically cried all waking hours. After lots of back and forth with the pediatrician, we figured out that he has CMPA. I tried to cut dairy from my diet with no changes, so we suspect he has some other sensitivities, too. We switched him to a hypoallergenic formula (Nutramigen) at about 8 weeks, and the difference is truly night and day. He’s a completely different baby—happy, cooing, smiley, sleeps well, etc. I only wish we had done it sooner.
So, with that, I’m trying to wean from pumping. I’ve been weaning for about two weeks but am still producing a lot. I had worked really hard to get my supply up, so I’m sure my body is confused. Currently, I’m pumping every 6-7 hours to relieve discomfort for about 8-10 minutes. I was previously pumping every 3 hours for 15-18 minutes. Even cutting pumps in half, I’m still producing a lot when I pump and leaking like crazy in between. I sometimes have to hand express to relieve discomfort in between pumps. I’ve also been using ice and cold compresses. I ordered the “No More Milk” tea from Amazon to give that a try. Otherwise, I’m looking for more tips to try to stop my production and not have it take a ton of time…if that’s possible! Note that I can’t take Sudafed because I have high blood pressure.
Along the same lines, I’m also looking for ideas/thoughts about how to donate my frozen milk from the past 10 weeks and what I’m continuing to freeze as I wean. It all contains dairy, so LO can’t have it (and the pediatrician confirmed that we won’t be reintroducing dairy within the timeframe that the frozen milk will still be good). I’ve contacted a couple of milk banks (I’m in Ohio in the U.S.), and they don’t accept milk that contains blood pressure medication. I’ve been on blood pressure pills for my entire postpartum/pumping timeline because I had severe preeclampsia. Any other ideas about how I can make sure that the milk goes to a baby who can benefit from it? Being that I had a preemie (and probably a dash of postpartum anxiety…), my cleaning, sterilizing, labeling, etc. was really stringent.
Thank you in advance!
ETA: I also had a blood transfusion after my c-section (TLDR: things went completely off the rails, and I had a very traumatic birth). I understand that disqualifies me from donating, too. But I'm just wondering if there's some use for these hundreds of ounces of frozen milk. It feels so sad to throw them out.

I’m curious if anyone else has experienced what I experienced yesterday at my first ever OBGYN prenatal appointment. For context, I am 26 yo and did not plan nor expect to get pregnant ( I was on birth control ). However, when it happened, I decided to go through with the pregnancy. I work with and know a lot about children, but I have never done much research about pregnancy itself. I feel that the receptionists and nurses (but not the OB) at the OBGYN office I went to, were quite honestly treating me like I am dumb. I first called the office a week prior to ask what to expect and the receptionist said “umm.. you’ll have an ultrasound?” As if I should already know this. SPOILER ALERT, I did not get an ultrasound at my first appointment!! When I arrived, I told them I am 8 weeks pregnant and the receptionist acted like she was going to fall out of her chair because I waited so long for my first appointment. Side note: I went to the first available appointment and booked 2 weeks in advance, so that seemed silly to me. Then after the nurse asked me what I want to know and I told her I want to know that my baby is healthy, she scoffed at me and said we won’t know that today. (How was I supposed to know the process?? Especially after being told I would be getting an ultrasound.) Is this cause for concern, or should I chalk it up to a bad day? Should I be reconsidering my OB? The OB herself was lovely, her staff was concerning. Thank you ❤️💕