care plan

Published

im having a problem.....

i am doing a case study on a patient that has been in a mva. he is stable now, but has fractured ribs, r radial and ulnar fracture, and open r femur fracture. he wasnt wearing a helmet. isnt following commands and not oriented.. a chest xray shows large hemothorax on right. chest tube inserted and drains 750 ml of blood. he has an etoh of 125 mg/dl. and tested pos. for cannibinoid. after several days he is awake and answers questions but is very angry and abusive to mom and gf. he is also very short with you (the nurse). his r foot is weak and he is unable to pull toes up. it is flaccid. chest xray shows atelectasis. chest tube removed day before. remains on 4l o2 per nasal cannula. what are his psychosocial concerns regarding his behavior with nursing diagnosis goal, and 3 interventions???? also, what concerns about his r foot and what to do to improve it????? help!!!! is he detoxing??? what is the diagnosis for that????:confused:

so....

fear r/t hospitalization AEB shortness and verbal abuse of family members???

Up Vote Up Vote ×
Specializes in Addiction, Psych, Geri, Hospice, MedSurg.

these case studies are helping us with the critical thinking. i am in no way a critical thinker at this stage of the game. it is only our 5th clinical week and we are only 2 tests in. it's probably easier said than done considering you are already a nurse, but you need to be a little more compassionate and think back to a time when you didnt have those critical thinking skills yet. trust me, ive always been a straight A student, and being this stressed is very hard for me. it's unlike class ive ever taken. thanks for your help tho!

(You may take this the wrong way because you can not emote in writing or on the computer, so take this in the light hearted way I am saying it - cause if you get defensive, it is a waste of energy).

Well, time to get the big girl panties on because Nursing school will always be unlike any class you have ever taken... and will only get more difficult. You will never have a moment where there is no stress until you graduate, and then the stress only gets different and worse when you go on the floor as a GN and realize people's lives depend on you... so welcome to the world and career field where stress is a way of life... Suck it up sweetheart :D

Personally, I don't see the big deal with the whole "critical thinking" thing... Really? You are new to critical thinking? How old are you? Have you never had to face a problem, ever in your life? That is critical thinking skills... I had no problem with the whole "critical thinking" thing. A lot of people/students/nurses I know didn't... They use the words "critical thinking" like it is something new, but it is old as dirt... it is called common sense in lay terms. You know, you are putting together a dinner for Thanksgiving, what all do you need to do? Make sure you have room, plan seating, get invitations, plan a menu, go shopping, figure out you PRIORITY in making the food (which takes longer).... etc... once you get that in your head, you won't worry so much about those big words "critical thinking" and will latch on to things easier.

I am VERY compassionate (one of the reasons I am a nurse); compassion does not mean give a fellow nursing student answers - that is dangerous and will put you on the floor unprepared. But, as you see in this post: https://allnurses.com/general-nursing-discussion/question-re-posts-629129-page2.html (where *THIS* very post is mentioned) there are many people that are aggravated by students coming here for nothing more than homework help :) Not saying you have, I just wanted to see where YOU are in this, as you offered no assistance at first just "what is the answer" basically.

Anyhow, I hope I was able to provide some guidance... you seemed to get it pretty good after you talked your way through it, and sometimes that is all it takes (you admitted you worded it wrong - next time, offer your own rationals and ask for someone to help talk it through with you).

Good luck, and don't put so much worry into what critical thinking means.

Up Vote Up Vote ×
Specializes in Med/Surg, Ortho, ASC.

"you need to be a little more compassionate and think back to a time when you didnt have those critical thinking skills yet."

please take this in the most effective, helpful spirit possible because that is truly how it is meant. i hope that you will learn from this thread.

no one owes you homework help except your instructor and your school. no one here has any responsibility to provide your homework answer or indeed to aid in your development of critical thinking skills.

believe it or not, we (most of us) developed those skills without the aid of the internet (i know, i know - we're really old!). and when you make sweeping statements such as the one quoted above (even after help has been offered), you will only alienate those who might be inclined to help you. this post by demylinated should serve as a sticky post for students:

well, time to get the big girl panties on because nursing school will always be unlike any class you have ever taken... and will only get more difficult. you will never have a moment where there is no stress until you graduate, and then the stress only gets different and worse when you go on the floor as a gn and realize people's lives depend on you... so welcome to the world and career field where stress is a way of life... suck it up sweetheart :D

personally, i don't see the big deal with the whole "critical thinking" thing... really? you are new to critical thinking? how old are you? have you never had to face a problem, ever in your life? that is critical thinking skills... i had no problem with the whole "critical thinking" thing. a lot of people/students/nurses i know didn't... they use the words "critical thinking" like it is something new, but it is old as dirt... it is called common sense in lay terms. you know, you are putting together a dinner for thanksgiving, what all do you need to do? make sure you have room, plan seating, get invitations, plan a menu, go shopping, figure out you priority in making the food (which takes longer).... etc... once you get that in your head, you won't worry so much about those big words "critical thinking" and will latch on to things easier.

i am very compassionate (one of the reasons i am a nurse); compassion does not mean give a fellow nursing student answers - that is dangerous and will put you on the floor unprepared. but, as you see in this post: https://allnurses.com/general-nursing...129-page2.html (where *this* very post is mentioned) there are many people that are aggravated by students coming here for nothing more than homework help :) not saying you have, i just wanted to see where you are in this, as you offered no assistance at first just "what is the answer" basically.

anyhow, i hope i was able to provide some guidance... you seemed to get it pretty good after you talked your way through it, and sometimes that is all it takes (you admitted you worded it wrong - next time, offer your own rationals and ask for someone to help talk it through with you).

i sincerely hope that you read and internalize the advice given.

Up Vote Up Vote ×

hey there-

just had a couple of thoughts about your case study.

I agree it is always helpful to use Maslow's Hierarchy.

So let's think about your pt. for a minute, just consider his airway breathing. Is he at risk for impaired gas exchange? You bet. What about pain? Pain definitely interferes with breathing. How are his O2 sats. That could be one of your goals- keeping his sats up and weaning his O2.

What about circulation? Is he at risk for pressure ulcers? Is he moving independently?

So, think for a moment about why he's mad. How old is he? Has he lost some independence? What about helplessness? Does he need the nursing staff to help him with ADL's?

I think it always help to think about the things you can actually control. What is he at risk for right now? The psych/soc stuff comes later...

Is he using an IS?

good luck!

Up Vote Up Vote ×

thank you for responding! i think i figured it out.... it doesnt mention his o2 sats for this second part. this is almost a week out. his admitting sats were 88%, but this is now several days later. i put fear. i was thinking about pain too, but was having trouble prioritizing between the 2. the reason i didnt put the impaired gas exchange as a priority was because he is answering my questions and is verbally attacking his gf and mom and i figured he would have a very hard time doing that if he was horribly sob. he's also on 4L of O2 nasal cannula, so i figured his o2 needs are being met? the question specifically asks about what psychosocial concerns i have for him, and to identify an appropriate diagnosis, interventions and goal. i came up w fear r/t hospitalization AEB shortness with nurse and verbal abuse of mom and gf. i also came up w 3 interventions. havent done a goal yet, but ill think of one. i guess i dont know if that sounds right or if i should use acute pain instead. he's immoble also. he's 19. he now has a weak foot and cant pull his toes up. im sure that he is being helped w his adls. that's why i put fear..... i really appreciate your time and kindness!!!

Up Vote Up Vote ×
+ Join the Discussion