Nursing Diagnosis?

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Hello,

I got into an argument with my physical assessment lab instructor and I want some feedback. Okay, we did the "ear, nose, throat" lab last week and my partners tonsils were swollen, she said her throat was sore and complained she wasn't feeling good. So in the write up we have to fill-out these sheets and on the back is a SOAP format, which means we have to list the subjective, objective, assessment, and I think the "P" is for plan of care or something, this is were we give the "diagnosis." So in the last part, I said I would collect throat cultures and send them to the lab to be examined to determine if the infection is bacterial or viral. Then I said that once I get the results I would suggest an antibiotic, such as azithromycin, if the infection is bacterial. If the infection was viral, I would recommend an anti-inflammatory agent or pain killer, such as aspirin, and remind the patient to drink plenty of fluids and get bedrest.

Anyway, next lab when I walk into class the instructor was going off about how we, as nurses, don't order medications. I knew she was talking about my paper. So before I sat down I said "well can't we suggest a course of therapy

or medication to the doctor?" She then said that we couldn't because the patient could be allergic to a particular medicine. I then told her that one of the first pieces of information we collect in an assessment is the patient's allergies. The teacher then kinda yelled at me and said, quite frankly, "YOU'RE

NOT A DOCTOR."

This is rediculous, Med-students only take 1 pharmacology course too. I've talked to med-students and they say that alot of the knowledge involved in prescribing a certain medication has to be learned on their own. Some nurses have 20 or more years of experience, I'm sure they can offer insight by suggesting medications to a Doctor. Am I wrong?

The teacher told me that what she was looking for was "nursing diagnosis's."

She suggested things like "adjusting the patients pillows." I'm not paying $500 a credit to learn how to fluff pillows! I want to be an active member in the healthcare process, not some ******* orderly. Does anybody feel me, or am I just going nuts? I think I'll get a prescription for xanax. This really gives me aggita. :angryfire

Hello,

Okay, we did the "ear, nose, throat" lab last week and my partners tonsils were swollen, she said her throat was sore and complained she wasn't feeling good. So in the write up we have to fill-out these sheets and on the back is a SOAP format, which means we have to list the subjective, objective, assessment, and I think the "P" is for plan of care or something, this is were we give the "diagnosis." So in the last part, I said I would collect throat cultures and send them to the lab to be examined to determine if the infection is bacterial or viral. Then I said that once I get the results I would suggest an antibiotic, such as azithromycin, if the infection is bacterial. If the infection was viral, I would recommend an anti-inflammatory agent or pain killer, such as aspirin, and remind the patient to drink plenty of fluids and get bedrest.

I'm not a nurse (or nursing student) so I'll defer that part of your post to others with more experience with this matter. (then why am I posting? - I think this is a great teaching case - oh, the rest of this post will be in the style of socratic teaching, i.e., mostly questions but think of them as prompts to get you thinking and go "hmmmm")

So you have a patient in front of you complaining of sore throat, "not feeling good", and has swollen tonsils. What do you think is the most likely diagnosis? What else would be in your differential?

(setting aside the proper roles of nurses/doctors) - so you would swab the throat and send to the lab for culture. How long will it take for the labs to send you results? What do you do with the patient in the meanwhile? What are the consequences if you delay treatment? What other in-office test can you do? What is the sensitivity and specificity of this test? What other physical findings will help in the diagnosis?

Lastly, under what circumstances do you think will warrant hospitalization/admission? Under what circumstances is taking a throat swab a bad idea?

Specializes in ER.
I think you are going nuts. Go to med school if you want to prescribe meds, or be a Nurse practitioner.

I am confused by your response here. This is a forum where students come to ask questions and be supported in their schooling process. There is no cause for such inflammatory remarks here. This student is asking a valid question!!! It's very true that in the real world nurses suggest things to doctors - it is not always well taken, but it happens, often with the best outcome for the patient. This student is not saying that she is wanting to prescribe meds - she's just asking where she went wrong and asking how to do it better! Obviously, she knows that nurses do not prescribe meds - she is going on what she knows will most likely be ordered to be done. Just because she got a little off track in that on this one assignment does not mean she needs to be attacked.

Can a nurse perform a throat culture as an independent nursing action, or does it need to be ordered?

It seems grey to me.

Specializes in Geriatrics.
Can a nurse perform a throat culture as an independent nursing action, or does it need to be ordered?

It seems grey to me.

Any place I have ever worked it must be ordered by Dr. Don't know for sure if that applies to everyone, this is just my experience.

Thanks student4ever. Haha I wasn't too offended though about the remark. My school is actually gonna let me start the nurse practitioner program before I finish my BSN because I already have a BS in Bio. I just don't understand why or how it's a whole different ballgame being a nurse practitioner? I mean it's a "nurse" practitioner not a "medical" practitioner or general practitioner or family, etc. Yet, as an NP, all of a sudden you're suppose to think medically. You have to know how to diagnose and what to prescribe, what tests to do, etc. However, as a nursing student, who's going to be an NP, I get repremanded for trying to think like an NP. That doesn't make sense to me. So basically they want you to learn all this in a 2 year master program. The physical assessment book has abnormalities at the end of each chapter, I think they could have included a section on treatments.

Anyway, thanks for all your responses. Coopergrrl, you have the same name as me, my last name is cooper. I'm not a "she" though. . .

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
However, as a nursing student, who's going to be an NP, I get repremanded for trying to think like an NP. That doesn't make sense to me. So basically they want you to learn all this in a 2 year master program. The physical assessment book has abnormalities at the end of each chapter, I think they could have included a section on treatments.

You answered your own question. You are a nursing student. Now is the time to think like a nurse. When you're in the NP level courses, then you think like a nurse practioner. Crazy huh?

Play their game Mr. Cooper, play their game. Life will be easier. Not that you can't be an independent critical thinker, because it's obvious you are. Just in your interactions with your instructors and on paper, think and act like a student nurse. Whether or not it makes sense to you. :rotfl:

Specializes in ER.
Thanks student4ever. Haha I wasn't too offended though about the remark. My school is actually gonna let me start the nurse practitioner program before I finish my BSN because I already have a BS in Bio. I just don't understand why or how it's a whole different ballgame being a nurse practitioner? I mean it's a "nurse" practitioner not a "medical" practitioner or general practitioner or family, etc. Yet, as an NP, all of a sudden you're suppose to think medically. You have to know how to diagnose and what to prescribe, what tests to do, etc. However, as a nursing student, who's going to be an NP, I get repremanded for trying to think like an NP. That doesn't make sense to me. So basically they want you to learn all this in a 2 year master program. The physical assessment book has abnormalities at the end of each chapter, I think they could have included a section on treatments.

Anyway, thanks for all your responses. Coopergrrl, you have the same name as me, my last name is cooper. I'm not a "she" though. . .

I appologize for assuming you are a "she." Congrats on going into the NP field! THat is my ultimate goal, eventually one day! As said above, the trick is to play by the rules. You will learn a lot from your nursing classes (and if you work as an RN before becoming an NP) that will help you to know what kinds of tests to order - nurses are on the front line in that department - they pay close attention to patients' symptoms, and communicate them with the doctor or NP. Watching what doctors order for the symptoms will help you develop that sense, along with the NP training you will receive. Good luck to you in all your endeavors!

You answered your own question. You are a nursing student. Now is the time to think like a nurse. When you're in the NP level courses, then you think like a nurse practioner. Crazy huh?

Play their game Mr. Cooper, play their game. Life will be easier. Not that you can't be an independent critical thinker, because it's obvious you are. Just in your interactions with your instructors and on paper, think and act like a student nurse. Whether or not it makes sense to you. :rotfl:

Well said, Tweety. It isn't only the skills, knowledge, and experience we acquire in school, but also an awareness of the social/professional behaviors expected in the working world. Because this education is interwoven throughout our programs, you won't find courses labeled "How to Keep Your Mouth Shut When You Know You Have Something Worth Saying," or "Communicating Tactfully With Pompous Blowhards." Nevertheless, you will be given ample opportunity to learn the material.

Specializes in med/surg, telemetry, IV therapy, mgmt.
Can a nurse perform a throat culture as an independent nursing action, or does it need to be ordered?

It seems grey to me.

Got me! The fact is that as a practicing RN I would probably do a throat culture, but I would also inform the doc, tell him what I had done and verify that it was OK with him that I had done that. If so, I would write a verbal order in the chart. If not, I would retrieve the throat culture and dispose of it. Besides covering yourself with a doctor's order, most insurance companies won't pay for any lab services without an accompanying doctor's order (just one of the business issues in healthcare), so it's best to get an order.

However, as a student, you need to follow the rules exactly. That means you notify the doctor and get an order for a culture first, then take the culture.

In actual practice you would often take a culture and then notify the doctor because the patient is going to be long gone along with his bacteria while you're still waiting for a return call from the doctor. But if this were a possible answer to a NUCLEX question it would be the wrong answer.

Daytonite,

Just wanted to thank you for your great SOAP description. I'm taking my pre-req's now but familarizing myself with things I'm going to need to know in the future. This is a big help. Again, thanx.

N.S.46

You THINK the P is for plan? Hmmmm.

Specializes in med/surg, telemetry, IV therapy, mgmt.
Daytonite, Just wanted to thank you for your great SOAP description.

You are welcome.

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