I really need some help here, can someone please give me some assistance please

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I am practicing for my first clinical that is taking place next week, am I scared..........................

Here is a situation that I have made up

Can you please help me?

Patient is 98 years of age

Diagnosed with dementia, rheumatoid arthritis, Acne Rosacea, Squamous cell Ca of (L) ear

Basline vitals

Temp 36.6 oral

Blood pressure lying down 156/80

Pulse 56

resp 44

Alergies is unknown

Previous medical/surgical Hx

G.I Bleed 2005

Recent Diagnostic Tests/Blood work: none

Treatmenst

Easy slide

Hygiene

Resident can wash hands and face

Daily hygenic care required

Groom (hair) total assist

* dress warmly (wears easy living clothes)

Bath Day: Bath (sling) or basin tub (am and pm) Tuesdays

Mouth care: staff cleans dentures (upper, lower)

soak overnight

Shave: total assist

Other: Staff cleans glasses

* talk directly and use simple sentences (poor hearing)

Mobility: Lie down in afternoon *especially if up in chair for breakfast

Transfer/Lift: Bath sling

2-person transfer (total lift)

Turn/Position: by staff every 2-3 hrs * use turning sheet

Activity Devices:

Wheel chair

* mold back of gel (jay cushion)

staff mobilizes

Safety:

risk of falling

full-side rails

seat belt when in wheelchair

Oxygen therapy:

N/A

Nutrition:

* does not like milk

Type of diet:

Regular does well with finger foods

reglar liquids, nourish meet am/pm

Assistance required

Supervision and reminders eats in room or 3rd floor dining room

Problems: likes ice-cream/ keep water handy when up

Blood glucose: N/A

Elimination:

Total assist (toilet)

Last BM: small/loose Feb 1

Bowel Care order:

Senokot when necessary (Briefs day)

*Night briefs (night)

Urination: incont/accidents

night incontinent

Toilet schedual when necessary

Social history

Married, husband is deceased

has a son.

Recent diagnostic tests: none

Recent Blood Work Results: Normal

Medications:

Fentanyl -for chronic pain- Critical nursing responsibilities-monitor reliefof pain, resp, rate, nausea, constipation, sleep patterns

Risperidone- Psychotic disorders and schizophrenia-Critical nursing responsibilities- vital signs, lipid, fasting blood glucose, mental status,

extra pyramidal symptoms, (ESP) orthostatic blood pressure changes for 3-5 days after starting or dose increase, weight should also be assessed.

Acetaminophen- for mild to mod pain/fever. Has no anti-inflammatory effects- Critical nursing responsibilities- watch for resolution of symptoms- relief of pain or fever.

Dimenhydrinate (gravol) - relief of vertigo, motion sickness and nausea - Critical nursing responsibilities - resolution of symptoms (observe)

Fucidin - used for treatment of skin infection such as impetago and infected wounds/burns - critical nursing responsibilities - watch for resolution of infection

Nursing Interventions

risk for skin breakdown r/t immobility

- turn and reposition q2h

- assess bony areas for redness

At risk fo weight loss r/t forgetting to eat

- remind client to eat

- supervise client while eating

- offer finger foods

At risk for muscle deterioration r/t to immobility

- range of motion exercise

- massage to keep circulation moving

At risk for dry skin r/t forgetting to drink

- offer water throughout day (remind)

- massage with lotion

From all this information how would I make an evaluation?

Any ideas about how I can make a concept map for this would be appreciated thank you all for you time

God bless you all:)

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Specializes in critical Care/ICU-traveler.

There is a reason they make you do this stuff. It is designed to help you learn the nursing process. We would be doing you no favors if we did your homework for you.

BTW, I dont believe for one minute that this is a situation that you have "made up."

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There is a reason they make you do this stuff. It is designed to help you learn the nursing process. We would be doing you no favors if we did your homework for you.

BTW, I dont believe for one minute that this is a situation that you have "made up."

actually this is from my nursing workbook, it is not homework. If it was I really would have been honest and said so, I am not scared to admit when something is homework.

I am just trying to get some help so that I can understand how to do it, before my actual clinicals start that is all.

I don't think that it is fair to make assumptions. :o

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I did stay up all night racking my brains, with frustrations that I do not know how to do the nursing process, I simply make a mistake, I am human, I m apologizing now so sorry.

There is a reason they make you do this stuff. It is designed to help you learn the nursing process. We would be doing you no favors if we did your homework for you.

BTW, I dont believe for one minute that this is a situation that you have "made up."

OOOOOOOOOOps I need to make a correction- I did not make it up, sorry about that, but it did come from my workbook:up:

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Specializes in critical Care/ICU-traveler.

I am sorry that I made an unfair assumption about your situation.....however....that scenerio happens here frequently.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

if you are being asked to make a concept map, then you are being asked to make a care plan. a concept map is merely one type of physical presentation of a care plan. the basic care plan is still present within the concept map, or they are also called care maps. there is a sticky thread on this forum that has information on care maps:

a care plan is the written documentation of the nursing process. the nursing process is nothing more than how we solve patient's problems. it has five distinct steps and you must follow them in sequence:

  1. assessment (collect data from medical record, do a physical assessment of the patient, look up information about your patient's medical diseases/conditions)
  2. 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 diagnosis to use)
  3. planning (write measurable goals/outcomes and nursing interventions)
  4. implementation (initiate the care plan)
  5. evaluation (determine if goals/outcomes have been met)

we use a form of the nursing process to solve problems in our lives all the time although you may not be aware of it. let me give you an example and show you how it also relates to the nursing process:

you are driving along and suddenly you hear a bang, you start having trouble controlling your car's direction and it's hard to keep your hands on the steering wheel. you pull over to the side of the road. "what's wrong?" you're thinking. you look over the dashboard and none of the warning lights are blinking. you decide to get out of the car and take a look at the outside of the vehicle. you start walking around it. then, you see it. a huge nail is sticking out of one of the rear tires and the tire is noticeably deflated. what you have just done is step #1 of the nursing process--performed an assessment. you determine that you have a flat tire. you have just done step #2 of the nursing process--made a diagnosis. the little squirrel starts running like crazy in the wheel up in your brain. "what do i do?" you are thinking. you could call aaa. no, you can save the money and do it yourself. you can replace the tire by changing out the flat one with the spare in the trunk. good thing you took that class in how to do simple maintenance and repairs on a car! you have just done step #3 of the nursing process--planning (developed a goal and intervention). you get the jack and spare tire out of the trunk, roll up your sleeves and get to work. you have just done step #4 of the nursing process--implementation of the plan. after the new tire is installed you put the flat one in the trunk along with the jack, dust yourself off, take a long drink of that bottle of water you had with you and prepare to drive off. you begin slowly to test the feel as you drive. good. everything seems fine. the spare tire seems to be ok and off you go and on your way. you have just done step #5 of the nursing process--evaluation (determined if your goal was met).

the information you have posted is a case scenario. it has information in it that you need to extract in order to create a care plan and present it as a concept map. you start by going through the information and picking out the abnormal data. these will be the patient's signs and symptoms. a symptom is an objective observation or a subjective perception of the patient. i see a good many symptoms listed in this scenario. what you need to do is find them. that is step #1 of the nursing process. you also need to look up information about dementia, rheumatoid arthritis, acne rosacea, and squamous cell cancer of the ear (or skin). if you cannot find this information in your books, you can find it on the internet by using the links on this thread:

in researching these diseases you are specifically looking for information on their signs and symptoms, about the pathophysiology of each disease and the treatments (medications, therapies and treatments) that the doctors will normally order for them. you may want to add some of the signs and symptoms of these diseases to the list of signs and symptoms that you are going to create for step #2 of the nursing process (see next paragraph) since this is a case scenario of an imaginary patient [note: you would only use a patient's actual symptoms if this were a real patient.] .

you then need to put all of this assessment information into a list, step #2 of the nursing process. there will also be boxes on your concept map where you will need to place this information. (see the information on creating care maps on the link to the above thread i listed.)

i am not going into nursing diagnosis until i know you have created a list of symptoms since that is rather involved. for now, i think you need to just stick to picking out this patient's symptoms and putting them into a list and looking up information about his diseases.

if you want more information on writing a care plan, you can read these two recent threads of mine:

there are also two stickys on allnurses on writing care plans:

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Anyone with resp's at 44 doesn't care about your plan, they need action, now!

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Specializes in psych..
I did stay up all night racking my brains, with frustrations that I do not know how to do the nursing process, I simply make a mistake, I am human, I m apologizing now so sorry.

OOOOOOOOOOps I need to make a correction- I did not make it up, sorry about that, but it did come from my workbook:up:

Good luck on your clinical. I am getting ready for mine too, but to unprepared to set a date yet. I got a lot of help from your problem, after, Daytonite carefully explain it step by step. Very good teacher, Daytonite...thanks again, and again

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Specializes in Acute Care.

@Daytonite; Thank you for your post! You explained the nursing process very well! I'm starting my clinicals and I'm having a hard time trying to figure out how to do this. I feel lost!

Nursing is my dream but I feel like I'm learning Japanese! It really is a whole other language. Fortunately, because of working as a MA for so long, some of the terminology is familiar but they didn't teach us the reasoning for what we do in Medical Assisting school! Well, at least not to this degree!

I am a lot scared and overwhelmed with all the homework. I'm on information overload and I feel like I might crash! It's a lot to process and no time to do it. :uhoh3: Not to mention, we are in between instructors and the administrator is filling in. It seems like she's kind of lost too. The blind leading the blind situation, really. There isn't any real consistency or structure for our class and we are ALL struggling. :confused: Quality instruction is out the door right now. SO, I really am going to depend on this community for as much as I possibly can! :up:

I just really hope I can make it! I have a passion for being in this field and I really don't know what I would do if I couldn't do what I love! I really am scared! :crying2:

Wish me luck people! I'm going to need it!

Thanks for listening to my rant!

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