Joy Shepard!!

  1. thanks for solving that syptom thing i posted.... i was wondering if u would be interested in more senerios?? i'm sooo stuck *giggleS*
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  2. 17 Comments

  3. by   daz
    senerio 2:

    ms. wolfer has been admitted to emergency because she is in acute respiratory distress. Earilier in the day she was playing softball and was hit in the chest by a wild pitch. She presents with markedly diminished to absent breath sounds on the left side, and her distress in increasing rapidly. Her nailbeds and lips are blue. You notice that her trachea has shifted oiff the midline toward the right.


    scerario 3:

    markie jones is a 7 year oild boy admitted through emergency becayse of bilateral rales, ascites, and ankel edemia. His history reveals that he recently had a severe streptococcal throat infection. His urine contains considerable protein and is brownish in color. The onset was sudden

    Scerario 4:

    mildred is a 32 year old women complaining of constant severe cramping pain in her RLQ that started 2 months ago. Her stools are frequent and occasionally bloody. She has lost about 7kg in the past two months and has frequently had pyrexia. She has been bvery tired and listless


    Any ideas??? thanks in advanced... i'm just stunned! *giggles*
  4. by   Miss Mollie
    Daz,
    I will probably get quite a few negative comments here, but isn't this your homework? I know the answers to all three of the scenarios- they are not difficult, and are all easily looked up in a text book. I'm not going to post the answers though because I think part of going to school is learning this stuff, by looking it up in books- not by having the answer given to you. WHile you might have doen some work on your own, you don't give us any idea of what you think these pt's problem are in your post. I'm happy to help students, but I am not going to do your homework for you.
  5. by   daz
    Originally posted by Miss Mollie:
    Daz,
    I will probably get quite a few negative comments here, but isn't this your homework? I know the answers to all three of the scenarios- they are not difficult, and are all easily looked up in a text book. I'm not going to post the answers though because I think part of going to school is learning this stuff, by looking it up in books- not by having the answer given to you. WHile you might have doen some work on your own, you don't give us any idea of what you think these pt's problem are in your post. I'm happy to help students, but I am not going to do your homework for you.
    if they were that easy i would nt be posting this... i've been searching 4ever and sure its prob easy for u cuz u are older and have more knowledge on this stuff... i'm new, i'm trying to learn and i'm gone through my books and all i wanted was to see what diseases they are and i am doing the rest on my own (describing the disease and ect) sorry!
  6. by   janine3&5
    Have to agree with Miss Mollie- I'm also a nursing student and knew 2 of the Dx of the last three scenerios right away. Try to understand WHY the patient is having the Sx in order to find your Dx. For example, looking at the anatomy and phys., along with the pathophys., what could cause the to trachea shift? When would you hear decreased breath sounds? What would cause the cyanosis? When you critically think through these problems, applying what you have been taught-YOU LEARN! This is so important, and when just given the answer you will not understand the WHYS. These types of questions can't be memorized-there are too many variables, so try to think it through rather than searching in your book for an answer. If someone gave you the Dx here online, would you understand why? I know how frustrating it can be trying to assimilate all of the information that you are taught-there is so much and it's very overwhelming, but hang in there and USE what you've learned. Also, maybe post what your thoughts on the Dx are and why, and maybe some of the nurses could give you direction in what you're not picking up on or in how you're thinking it through. Remember, study FOR THE PATIENT, NOT FOR THE TEST! Good luck!

    [This message has been edited by janine3&5 (edited February 21, 2001).]
  7. by   chili2641

    We all need help sometimes. I am glad to see the nurses helping you out.

    ------------------
    Nursing assistant
  8. by   MollyJ
    I'm planning to not be much help either since i agree with the other posters, too. But, Daz, don't worry about making the medical dx; that's not your job. Now I know all of us are racing ahead to the medical dx but remember your job is nursing dx. From a nursing perspective what futher assessment and planning will you do and how will you support each of these clients?
    CT 2
    She has an alternation in what function? How might you do a targeted assessment on her based on the system/s being affected. Are you going to let the doc see the little kid with a sore ear and sew up the 3 year old with a lip laceration FIRST or are you going to go tug on his/her shirt sleeve about this? What nursing measures are you going to do in the interim in terms of assessment and treatment? You are permitted to think you are an ICU nurse. Don't think medical dx, think nursing dx.

    CT 3
    your seven y/o is presenting with symptomology often seen in old folks. He's sick. Again what nursing things will you do? will you answer his request for a drink of water? Let me tell you something. The doctor, based on hx and that urine lab ALREADY KNOWS THE DX. So don't worry about it. What will you do as a nurse for this kid?

    CT 4
    We don't know about your client's setting in scenario #4, but again it doesn't matter. If she's your neighbor or someone that's calling into the doctor's office where you work at 4:30 pm what will you do for her? Will you tell her to see her doctor next week or facilitate her care for a shorter time frame? Is her need chronic and long term, urgent or emergent? What needs do her weakness suggest to you? Her bloody stools? Think nursing interventions. Good luck and be patient with yourself.
  9. by   daz
    see thats what i gotta doo,.,,, find the dx and then explain what i'm gonna do.....
    i just cant figure out the dx out thats why i'm just asking for help *cries* sorry i was just asking for help but i guess not *runs away*
  10. by   janine3&5
    While I agree that the most important ramifications of a Dx to a nurse are the nusing implications, in our nursing program, we often have a few questions like this on each test re the medical Dx. It IS frustrating because we are not being trained to diagnose medical conditions, but the rationale in our program is that we should be able to anticipate Dr.'s orders to a certain extent (when presented with classic Sx of a case). I think that this is good because it makes you understand WHY you are carrying out these orders. There is a very strong emphasis put on the pathophysiology, etiology, diagnostics, and medical treatment of everything we study. But I certainly agree that as a nurse, the focus should be on nursing interventions and nursing Dx.

    [This message has been edited by janine3&5 (edited February 21, 2001).]
  11. by   daz

    hmmm i still cant et it.... can some please help?

  12. by   JulieW
    Daz,

    Focus on what unit your class is on right now. Read class notes. I'm sure your homework correlates with the lessons being taught, and if you compare sympoms to those things you've recently learned about, the right thing will click.

    Another thing you could do is start on the homework by doing it in reverse order. Begin by making a list of all the nursing diagnoses you can think of for each scenario. You don't need the medical dx to do this. Think of all the things you'd do for those people just based on the objective data, and once you have them all written down, reread class notes and you may be surprised at what jumps out at you.



    [This message has been edited by JulieW (edited February 21, 2001).]
  13. by   daz
    Ok guys... for the 1st senerio is it a rib fracture?????
  14. by   Jenny P
    Daz, everyone of these nurses is giving you some help; now think it through. It is possible that you have the correct medical dx on the first one, but the patient has a deviated trachea and her lips and nailbeds are blue; something else is going on here, and she has an alteration in---------- and what needs to happen? This is part of the nursing process you are being taught. Learn to think it through one step at a time.

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