Telemetry HR - 170, within minutes 199, and stabilized in the 160s for 30+ minutes
Supine BP (L) - 163/102
RR - 60/bpm & shallow
O2 sat (NC 4L/min, but she was mouth breathing)- 96%
I'd like to use a diagnosis of Risk for Hyperpyrexia, as opposed to Hyperthermia (which the pt actually was experiencing). It's silly, but mostly because I have never heard of hyperpyrexia until I started doing research for the care plan, it sounds cool, and I kind of want to impress my instructor with something I found on my own. Hyperpyrexia is a temp of 106.7F. My pt was scary close to that temperature, so I believe it is appropriate.
My problem is, that Dx is not in NANDA, and I've never been taught whether RNs are allowed to use a Dx outside of NANDA. My instructor allows us freedom with our choices, so long as we show that we are able to stand by our choices in en educated way (evidence, goals, interventions, etc.). That being said, I don't want to just start making stuff up! I'd rather use the Hyperthermia, than make something up--even if that something is pretty damn cool.
So, short story turned long... Are RNs allowed to use non-NANDA diagnoses? and also, What do you think of my choices of diagnoses?
Thanks!
Ps. This was the most exciting situation I have ever seen in the hospital! I even got to transfer the patient to the ICU. I'm borderline obsessed with this situation, and it makes me want to work in the ICU STAT! Of course I feel bad for this person, and I hope they get well, but I learned so much by observing this crisis!
Thanks for that very in depth explanation and using items specific to my situation to help my understand! I appreciate your time.
Im super tired from today, but I will really look into it tomorrow.
I will say that I never got to actually assess her. I did witness the vitals, so I wrote them down, and I assessed by inspection from across the room. I tried to gather as much information from her since I knew she was going to ICU and I had to do this assignment regardless.
From what I skimmed through your explanation so far, I think it will be very helpful.
Thanks a ton.
I love your name, btw. Makes me think of the "mom" in Twilight. That may not be a compliment to you, but it REALLY is!! Lol.
I'm sorry you have been sick, and I hope that you continue to get joy from helping all of us out. :)
I don't have any care plan books. In fact, it's not really something that's been focused on. I'm an A student, so I would have noticed. So far, it's just a small part of our much larger online documenting assignment. It's my first time really even thinking about care plans (not just the generic structure of them in the abstract).
I assumed I had it all correct because so far no one has even critiqued saying, "if they have it, it's no longer a risk--try again" I mean, it makes so much sense, but *I* had never thought of that. I guess I was using it as like an exacerbation risk, but in this case, there are more pressing issues. I'm going to use this thread as a study guide
I wonder if they will focus us more onto the specifics of care plans when we know more about health problems. This is our first real clinical, and my instructor said today that we were mostly supposed to learn how to do a good quality assessment, and document it. SOOO much documenting. I spend about 2 hours a patient at home after the shift.
I just don't like to do anything half-assed, so that's why I came on here. I didn't want to bother my very busy instructors with things that we're not even focusing on yet. They literally have called me "anal" (in my presence) and I don't want to get a reputation, so I'm trying to pull back my questions and the detailed information that I provide while in pre/post-conference--but I still like to know for myself.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Anal retentive? Then you will make an excellent nurse.
Thank you it has been a tedious recovery.
Think of the care plan as a recipe so others who follow can use the recipe to care for the patient and optimize their stay in the hospital. Organize your thoughts as to what can kill the patient first or......what would concern you if this was your family member.
((((Esme12)))) So glad to see you! I am sorry your health is still so poor.
I didn't even know a heart could beat that fast (199 bpm!)! I mean, how fast can it go? What happens when it hits that one extra beat per minute that it takes to, what ?, Stop?... Is that what happens? No explosion, like an engine... just stopping?
What a great experience to observe during nursing school! Well not great for the pt obviously, but you know what I mean. How long someone can sustain such elevated HRs varies. Their baseline: a 22 yr old athlete has more wiggle room than a 70 yr old with CHF. One whose "only" problem is sepsis with proper treatment is going to have more wiggle room than one with sepsis and multi-organ failure.
Quick side story about fast heart rates: I am reasonably fit out of sheer will to be...I am not a natural athlete at all. This past summer i took my kids to visit this cave that had a 225 ft walk down...which meant a 225 ft walk back up. Inside the cave was 95% humidity. I also have asthma and had forgotten my albuterol at home. On the way out, we were allowed to walk back the same route we came, at our own pace; the tour guide went last to make sure everyone was out. My family's pace was quite fast, as my 11 yr old son really had to pee. Did I mention my 3 yr old son had fallen asleep and I was carrying his 30lb self, speed walking up 225 ft in 95% humidity?
I counted my pulse after we exited. I did't even have to find the pulse -- it was very palpable inside my chest. It was around 188.
This should be a permanent thread. Not the Esme-being-sick part {{esme}}, the nursing diagnosis part. I think when students see the term "care plan" all they can think about-- meaning, they don't think any farther than-- is the assignment for school. Or they think it's some stupid-*** busywork, because, like, they already know all the nurse does, they just need the credential. Or all the nurses they know say that care plans are just for school / all automated with electronic charting / just academic rhymes-with-wool-shirt that has nothing to do with "real world nursing." Whatever that is.
NOTHING COULD BE FARTHER FROM THE TRUTH.
Your faculty want you to develop plans of care for sick people to teach you how to assess them, how to think about your responsibility as a nurse completely separate from your legal obligation to implement parts of the medical plan of care, and how to see your patient as a whole person and member of a family group or community in the same way you are. In short, developing plans of care as a student, with all those details and "as evidenced bys" is to teach you how to think like a nurse.
Believe me, there isn't a student alive who really gets that in her first year of school, and sometimes not even in students' third or fourth year of school, and sometimes it takes them years of working in nursing jobs before some patient, some mentor, or, god forbid, some personal tragedy teaches them what it's like to see a nurse that has it all together.
Nursing is so much more than manipulative skills-- we can teach anybody to suction a trach or put in a catheter, but that doesn't make them nurses. It's not just "caring" or "compassion" or "passion" either. It's the ability to take a dispassionate look at a lot of things going on with your patient that might or might not have anything to do with his medical diagnosis, and then decide, as a professional, what he needs from nursing that's uniquely ours.
Sure, we have ot know a damn lot of medicine and hard sciences too. But don't you dare think for a minute that nursing assessment and diagnosis is fluff, or academic B.S., or a silly exercise to be tolerated and then discarded when you graduate. Wait until it's you in that bed, and then you'll look back and kick yourself for all you could have done and BEEN for your patients before you learned what it is to really think like a nurse. Developing plans of care at the student level is how we teach you to begin down that path. Be smart and pay attention. IF YOU REALLY want to BE a nurse with your own professional licensed responsibilities and not just like a medical assistant working under somebody else's professional license, that is.
Who are you talking to, Ali? Certainly not me because I never once said any of the things that you are claiming that students think. I also have never heard a student mention care plans as BS or nurses as medical assistants or simple task-pushers... Maybe you are venting, but this seems like the wrong place to do it. You may be jaded from some students that you didn't like, and therefore feel the need to group us all together and degrade us, but I really don't think it's necessary here.
This thread was created because I wanted to do the right thing BECAUSE I take these care plans so seriously. I want to know, if I were a nurse, what would the right thing to do be? In fact, I take this assignment more seriously than my instructor requires at this point, which is why I did not ask for help from her. Maybe your post was just meant as a general vent that happened to end up in my thread, but if not--you're barking up the very wrong tree.
Esme12, ASN, BSN, RN
20,908 Posts
Check out this thread
https://allnurses.com/general-nursing-discussion/sepsis-a-syndrome-653341.html