Agggghhhhhh!!!!!!! I Feel Like I Am Losing My Mind!

xtendedmind · Jul 15, 2008

Mindy,

I am sorry you are having to deal with all of the things you are going through right now. I must say I can totally identify with what you are going through. I have a house to run with all the cleaning, laundry, cooking, etc.. I am also raising my 6 year old step-daughter who suffers from ADD. I have 2 grown sons, 22 and 24) My mother had to move in with me because she has severe emphysema and many other medical problems and can not care for herself. My husband works 12noon until 10pm so he is really not able to help much. On top of all this I am taking classes, my pre-requisites for nursing and suffer from bipolar and panic attacks. I definitely feel like screaming. :banghead: :cry: :crying2:

Just hang in there girl. Keep your head up and keep reaching for the stars.

You are definitely in my prayers!

Your new friend,

xtendedmind

chevyv, BSN, RN · Jul 15, 2008

I'm sorry to hear your having such a stressful time. I'm going into 4th semester and I was hoping it was going to get easier, but I fear that is not the case. Sending you hugs and a small glass of wine or maybe a huge chocolate martini :icon_hug:

rnmomtobe2010 · Jul 15, 2008

wow!!! Let It All Out!!! Better Out Than In...god Bless

Daytonite, BSN, RN · Jul 15, 2008

i can help you with the case study. you didn't say what the 5 questions were that you had to answer, but mentioning that it is a case study and critical thinking gives me pretty good ideas. in general, a case study is a care plan written in a narrative form, kind of like an essay. you need 3 pages. a care plan always follows the steps of the nursing progress in its development--always. there used to be a nursing school that posted a whole bunch of its nursing student's case studies on the internet that you could look at as examples, but they were recently removed, doggone it.

the steps of the nursing process with regard to care planning are:

assessment (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
- also the usual tests ordered, and medical treatment for the medical disease or condition that the patient has. this includes knowing about any medical procedures that have been performed on the patient, their expected consequences during the healing phase, and potential complications.
[*]determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
[*]planning (write measurable goals/outcomes and nursing interventions)
[*]implementation (initiate the care plan)
[*]evaluation (determine if goals/outcomes have been met)

for a case study you really only need to focus on steps #1, #2, and #3, unless your instructor has given you directions that indicate something different.

you will find information on the cause and pathophysiology of hypothyroidism in the article on emedicine that i listed below. if you have difficulty understanding it, don't despair, re-read it since the article was written for doctors or ask me. i have two other pathophysiology resource books here at home that i can look this information up in for you.

assessment - you need to make a list of all the signs and symptoms of hypothyroidism. you also want to include information on the tests (labs, x-rays) that are likely to be ordered to diagnose this condition. you also want to state what will happen if the disease progresses without treatment. and don't forget to include the complications of hypothyroidism.

patient's problem(s)/nursing diagnosis - these are determined and based upon the signs and symptoms of the disease. there is a very nice list on the medline plus site link i listed below. you will need a nursing diagnosis reference book to help you with this, or ask me for help. i do a lot of care plan writing and have a number of references for thyroidectomies. this is also where you want to consider the thyroidectomy, which is a medical procedure, in the care planning. you need to know what the postop care of the patient having a thyroidectomy is going to involve. there may be a care plan for this on this website:

http://www.pana.org/ - generic care plans for all kinds of surgeries - to access the care plan bank, click on the "student activities" link at the left side of the home page. when the pana student resources page comes up, scroll down and click on the "care plan bank" link. these are intraoperative care plans.

you must also remember to consider complications of the thyroidectomy when developing nursing diagnoses. i've had 2 thyroidectomies. i know what a patient experiences with this surgery.

here are links to free online nursing diagnosis and nursing intervention information:

planning - these are the nursing interventions and nursing care. this is all based upon the signs and symptoms that the patient has.

i frequently used my computer and started a word document to help organize a paper that i had to write. i started by listing all the main subjects that had to be a part of the paper on the word document. then, i started filling in the information under those headings as i got it. the headings can be removed later when you clean the paper up before handing it in.

here are links that i think will be helpful to you.

http://www.emedicine.com/med/topic1145.htm - hypothyroidism
http://www.merck.com/mmpe/sec12/ch152/ch152f.html?qt=hypothyroidism&alt=sh - hypothyroidism (merck manual)http://www.nlm.nih.gov/medlineplus/ency/article/000353.htm - hypothyroidism (from medline plus encyclopedia)
http://www.surgeryencyclopedia.com/st-wr/thyroidectomy.html - thyroidectomy
http://www.nlm.nih.gov/medlineplus/tutorials/thyroidsurgery/htm/index.htm - thyroid surgery interactive tutorial on medline plus

Lamie · Jul 15, 2008

Daytonite, I'm sure you've heard this before, but I think it is awesome how detailed you always answer questions and how very helpful the information and links you post are. I've bookmarked a ton of links you have posted throughout this forum and I'm sure they'll come in very handy once I start my LPN program.

So even though I'm not the OP, let me tell you "thank you" anyway for this and all your other responses.

shifty1 · Jul 15, 2008

I go to school at Kaplan University and I just got dismissed from my first few weeks of clinicals. The first time I didn't know all 20 of my meds well enough to pass them (uses, actions, side effects, and nursing precautions), so I got sent home, the second time I was on my way to clinicals and I had a bad case of diahrrea in my uniform ! The third time I stayed up way to late trying to memorize my patient's meds and ended up sleeping to late to get there on time! So, needless to say I will have to repeat the second term ! Hopefully, it will only consist of clinicals and not include pharmacology which I'm failing!! I can relate, as I too am a wife (13yrs.), a mother of two and Bi-Polar. I also work part time at a medical agency when I can find the time between studying, projects, and care plans that went along with clinicals. Sometimes I wonder what in the world I'm trying to pull. Here lately I've been wanting to give up, But I'm going to finish this. Hang in there ! Confidence is Key! Even if you don't really believe it! FAKE IT TILL YOU MAKE IT !! Strap a smile on as you would your own clothes. You're naked in a negative world without it ! :wink2:

mgalloLPN · Jul 15, 2008

Thank you guys all so much. Now that's it's morning, I'm feeling a little bit better. I guess I just had a bad day yesterday. Most of my case study questions aren't too bad, it's just the dragging it out to 3 pages that I am not sure where I am going to get that kind of info from....I will definately look at all those sites that Daytonite posted. And thank you for that. I just had a bad day all around yesterday. I dropped off my capping dress last week to have altered and I went to get it yesterday and it wasn't ready. AND CAPPING IS TODAY! So I had to wait about an hour for her to finish it.

The first question on my case study was:

What would you expect doctors orders to be for this patient?

Thank you to everyone that was there to listen to me.........my poor hubby has heard it over and over so I didn't want to bother him again with it even though he says it's ok if I need to:loveya:

mgalloLPN · Jul 15, 2008

i can help you with the case study. you didn't say what the 5 questions were that you had to answer, but mentioning that it is a case study and critical thinking gives me pretty good ideas. in general, a case study is a care plan written in a narrative form, kind of like an essay. you need 3 pages. a care plan always follows the steps of the nursing progress in its development--always. there used to be a nursing school that posted a whole bunch of its nursing student's case studies on the internet that you could look at as examples, but they were recently removed, doggone it.
the steps of the nursing process with regard to care planning are:
assessment (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
also the usual tests ordered, and medical treatment for the medical disease or condition that the patient has. this includes knowing about any medical procedures that have been performed on the patient, their expected consequences during the healing phase, and potential complications.
[*]determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
[*]planning (write measurable goals/outcomes and nursing interventions)
[*]implementation (initiate the care plan)
[*]evaluation (determine if goals/outcomes have been met)
for a case study you really only need to focus on steps #1, #2, and #3, unless your instructor has given you directions that indicate something different.
you will find information on the cause and pathophysiology of hypothyroidism in the article on emedicine that i listed below. if you have difficulty understanding it, don't despair, re-read it since the article was written for doctors or ask me. i have two other pathophysiology resource books here at home that i can look this information up in for you.
assessment - you need to make a list of all the signs and symptoms of hypothyroidism. you also want to include information on the tests (labs, x-rays) that are likely to be ordered to diagnose this condition. you also want to state what will happen if the disease progresses without treatment. and don't forget to include the complications of hypothyroidism.
patient's problem(s)/nursing diagnosis - these are determined and based upon the signs and symptoms of the disease. there is a very nice list on the medline plus site link i listed below. you will need a nursing diagnosis reference book to help you with this, or ask me for help. i do a lot of care plan writing and have a number of references for thyroidectomies. this is also where you want to consider the thyroidectomy, which is a medical procedure, in the care planning. you need to know what the postop care of the patient having a thyroidectomy is going to involve. there may be a care plan for this on this website:
http://www.pana.org/ - generic care plans for all kinds of surgeries - to access the care plan bank, click on the "student activities" link at the left side of the home page. when the pana student resources page comes up, scroll down and click on the "care plan bank" link. these are intraoperative care plans.
you must also remember to consider complications of the thyroidectomy when developing nursing diagnoses. i've had 2 thyroidectomies. i know what a patient experiences with this surgery.
here are links to free online nursing diagnosis and nursing intervention information:
http://www1.us.elsevierhealth.com/evolve/ackley/ndh7e/constructor/
http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm
planning - these are the nursing interventions and nursing care. this is all based upon the signs and symptoms that the patient has.
i frequently used my computer and started a word document to help organize a paper that i had to write. i started by listing all the main subjects that had to be a part of the paper on the word document. then, i started filling in the information under those headings as i got it. the headings can be removed later when you clean the paper up before handing it in.
here are links that i think will be helpful to you.
http://www.emedicine.com/med/topic1145.htm - hypothyroidism
http://www.merck.com/mmpe/sec12/ch152/ch152f.html?qt=hypothyroidism&alt=sh - hypothyroidism (merck manual)http://www.nlm.nih.gov/medlineplus/ency/article/000353.htm - hypothyroidism (from medline plus encyclopedia)
http://www.surgeryencyclopedia.com/st-wr/thyroidectomy.html - thyroidectomy
http://www.nlm.nih.gov/medlineplus/tutorials/thyroidsurgery/htm/index.htm - thyroid surgery interactive tutorial on medline plus

thank you sooooo much! the main question i am having a problem with is

what doctors orders would you expect to be written for this patient?

Daytonite, BSN, RN · Jul 15, 2008

the main question i am having a problem with is
what doctors orders would you expect to be written for this patient?

you also asked this in another post that i found after i answered this one. because i had to do something this morning i couldn't complete the answer that i had started last night until this afternoon, but it is now posted. please see this thread: https://allnurses.com/forums/f328/thyroidectomy-case-study-help-317197.html

these are actually collaborative nursing interventions which you would have eventually come across in writing a care plan as part of step #3 of the nursing process.