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OCD_Mom 3,274 Views

Joined: Aug 13, '09; Posts: 181 (9% Liked) ; Likes: 32

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  • Mar 7 '10

    Our Nursing Resource Center Library has dozens of Care Plan books. I just grab a big stack of random ones when I have care plans assigned and they help so much. It is one case where too much information is better!

    Your case makes me think, Risk for impaired Skin Integrity r/t immobility, incontinence, etc. My goals would be PT will be clean and dry and free of pressure sores by end of shift...
    My interventions would involve turning and positioning q 2h and maintaining clean dry skin in the perineal area and around the PEG site.

    Risk for nutritional deficit or fluid volume deficit or fluid volume excess r/t PEG feeding - I would want to monitor F&E levels, assess skin turgor, mucus membranes etc

    Self care deficit r/t immobility, PEG feeding, inability to perform oral hygiene...
    I would perform good oral hygiene on Pt, check mouth for sordes, keep lips hydrated etc.

    Risk for immobility r/t being bed bound - to avoid further contracture perform ROM exercises q 2h...

    For my rationales I just look up my interventions or one word from the Dx in my Clinical Skills textbook or Med-Surg txtbook and I can usually find a relevant citation.

    I know these are incomplete and hopefully by now you've had your lightbulb moment. I usually get over the hump just after I vent that the task is impossible!!

    Good luck!

  • Mar 7 '10

    Just wanted to add, my one and only med error occurred because I signed off the med seconds before taking the meds out of my cart and before giving them. Before I was able to pop the meds and give them, I noticed someone walking around who's very unsteady and supposed to an assist x1 w/walker, I locked up the cart, ran to get the person back in their w/c, then a phone call from a doc came in, as I hung up the CNA wanted to show me something, then a family member was chewing me a new one for something another shift did/didn't do..when I went back to my cart, I clicked to the next person and gave them their meds..I NEVER gave the meds to the person who I signed off on. I didn't realize it until the the 2nd med pass at 9pm when the resident said, "haven't seen you all day been busy?" I laughed and said Ms Jones you saw me right before dinner when I came in to give you yourr......" I stopped and realized I hadn't given her the med! Thankfully it was an OTC med that is only given once a day and nothing that would cause her harm if not given or given on time.

    I called my super, notified her of what happened. She called our staff doc and informed him that Ms Jones hadn't received her med, he ok'd that the med be given at that time. I was given "verbal education" and not a write up. And of course that education was, don't click off meds you haven't given, because there will come a time you do, you get distracted and you will forget to give the med..and next time it could be a very much needed med (BP pill, insulin, etc)..lesson learned.

  • Mar 7 '10

    First of all, Thank you for all your replies. I am going through what I hope are the right channels. I have contacted the head of the nursing department. She is going to the hospital liason. I am told this is how it is done. Now I am going to do a lot of praying that in the end that nurse is no longer in her position(or any position). The whole thing has depressed me. I feel sick to my stomach. I keep thinking that this nurse has been working there a long time (she must be in her late fifties or early sixties). So If you pray please add this one to your list.

  • Feb 23 '10

    Hello McMaster,

    I was accepted into the Banner Bilingual Nursing Program on 1/2009 Traditional semesters (which I love since it gave me the opportunity to develop my excellent bedside manner). I received my Associate of Applied Science in Nursing on 12/2009.
    I obtained my RN Licensed on early 2/2010 (this was the earliest I could find a testing date). I was given the greatest job offer on late 2/2010 as a RN with Banner Health (It did not hurt that I was a Banner Fellow for more info here are some links that may help you:

    I went to Community College Week and found that GateWay C.C. (the community college I graduated from) in Phoenix, AZ. was ranked 37 nation wide in successfully graduating AAS RNs ... here is the link

    The pay rate is the SAME for a BSN or for an AASRN when you are FIRST hired.
    I will continue with my BSN at ASU on the Fall of 2010 (because I will need the Spring 2010 semester to learn my practice and go to RN new graduate training)

    I did work while I was going to nursing school, but I did it as POOL PCA/HUC/Monitor Tech all of these positions I crossed trained since I first started working as a NA on 5/2007 for Banner Health. The POOL Department was the best option for me because I only scheduled myself to work when I knew I could work, leaving me plenty of time to study and care for my family; As well as receiving a paycheck every other week too.

    I have a few friends that took the 16-18 months accelerated Banner Fellows Program and they are doing well too (They have been working for about 8 months already).

    The Very Best of luck to you and my only words of advise are, if you find a hospital willing to recruit you and pay for your education it is the best way to reach your goals and have a somewhat of a guarantee that you will employed when you finally graduate.

  • Feb 6 '10

    You said in your first post that you are writing a research paper, not an argumentative paper. You don't need pros/cons for a research paper, research papers are statements of facts.

    Since you're interested on intraoperative care, then you could write a paper on sterile technique and focus on med/surg complications when contamination occurs.

  • Feb 6 '10

    Hospice, morphine, pain? sounds like pain would be an excellent NDX. Pain is now considered to be the 5th vital sign and pain assessment and control are very important. Also, the pt has low sats- remember A-B-C?

    This pt may be non-verbal, but all pts communicate- with their V/S, their labs, grimacing facies, muscle rigidity, guarding, and by pointing at their head "site of tumor".

    This pt is on palliative care- what is the number one goal of palliative care? These things show what your "high level" NDX and goals should be.

  • Feb 3 '10

    To those of you who were supportive and helped me to think through this, I really appreciate it. :-) I think I just had to process it, reflect on it, and decide how I would handle this in the future with patients of mine who did this kind of thing. I was kinda in shock when I started the thread but since then I have calmed down and been able to think more clearly.

    We are studying the stages of grief/coping and I think some of the nurses (and me) were going through those. When I left many were still in the "anger" stage, some had passed through to the acceptance stage, some were sad for the man and his family. As professionals they have probably seen more than I have, but even then, this pt was a once in a lifetime deal they were saying. It was not the fact that he had this condition, it was the degree to which he was causing harm. It went beyond the usual ones you read about involving fecal matter or picking at wounds. I can't go into details, but it was just shocking. Also, to think a person is being a rational, calm, friendly patient, and then to realize they are very irrational, you wonder how could you have not known? What did you miss? The nurses all realized they saw clues of this before but they were explained away by the patient and they seemed to make sense at the time because those things sometimes happen. The degree of deception was also shocking. This person was very educated on how to create the health conditions and it was complex, and if they had not found direct evidence of it, it would have been hard to believe.

    Anyway, I'm ready to move on. Thanks again for providing a forum where I can vent my feelings and get feedback.

    To those who expressed strong opinions-- don't judge me. I'm new at this. Even the seasoned nurses were having strong reactions. Don't assume we won't treat the person with the same professionalism that any patient deserves, regardless of if they treat us badly or show gratitude. I was the mother of a sick baby, and I had PPD, and when she was in the hospital I was dealing with a lot of emotions and was not always kind to the staff. I am grateful to those who did not take it personally. And in the same way I can't take this patient's actions personally. He's in his own private hell and that's a tragedy.

  • Dec 6 '09

    so, think about how this information

    • reliant on staff to perform her adls (self-care deficits)
    • has full use of her arms but refuses to do her own hair, showers and oral care (bathing/hygiene self-care deficit)
    • history of choking (risk for aspiration)
    • has a colostomy and the staff does the colostomy care (risk for impaired skin integrity or ineffective health maintenance)
    • refuses all therapies (speech, ot & pt) (impaired verbal communication, impaired physical mobility, ineffective health maintenance)
    • erickson stage of development...integrity vs. despair - what does she show more symptoms of? integrity or despair? how? what are her symptoms? (ineffective coping, chronic sorrow, hopelessness, social isolation)
    translates into nursing diagnoses? every one of the above can be turned into nursing diagnoses depending on her symptoms. don't let her attitude be too influencing on you when diagnosing--look at facts. you need to look at a nanda list that includes the taxonomy and look at the definitions of the diagnoses to help you decide what applies here. the appendix of taber's cyclopedic medical dictionary includes the nanda taxonomy. there is also evidence you would have collected that supports using these diagnoses. you don't just diagnose a bathing/hygiene self-care deficit for no reason. the etiology may simply be her lack of motivation or that she is stubborn. it doesn't matter. the problem is that she won't do it herself and she has to be assisted because she won't do anything to initiate a bath, remove her clothes or wash her body. because she won't otherwise bathe, her problem is an impaired ability to perform or complete bathing/hygiene activities for self (page 153, nanda international nursing diagnoses: definitions and classifications 2009-2011) and that is what a bathing/hygiene self-care deficit is.

  • Dec 5 '09

    i am a first semester student..i am also a wife, mother, employee (you get the point)...we are all adults and should be teated as such...i dont beleive in the view just stay under the radar, this too shall pass!! thats be on the phone requesting a meeting immediately with the director and her! therefore you are not going behind her back....why do clinical instructors think that harassment, humiliation is the way to teach!! absolutely NOT....i would report this behavior immediately....thats why they continue to do, b/c we dont stand up to them...thta may have been acceptable 30 years, but not now! she is not creating a conducive learning environment, further she sounds hostile and agressive...pretty scary stuff...sort of harassing and menacing? physicians shouldnt do it to nurses, and clinical instructors should not do it to nsg students!!!! stick up for yourself....if you absolutely dont feel comfortable talking to your director, the next time she starts up, politely walk close enough to her face, and ask her exactly who does she thinks shes talking to so rudely, if this continues we may need to meet with the department head, blah get the point.... either way you need to do something about dont deserve this!

  • Dec 3 '09

    The attached link will satisfy the answer to your question

  • Dec 3 '09

    My first thought is that it stands for carb counting. Not sure though

  • Nov 28 '09

    Quote from brycemom
    Ok I have been reading this post and these replies and for most of them I am a little disturbed. Yeah she may have asked a simple question, at least she asked and got clarification, and a far as the NCLEX how can some of you say she and others like her won't pass (kind of judgemental don't you think). At the end of the day no patient will ask did you get an a on your tests, a "C" nurse has the potential to be just as good as an "A" nurse,it is all about skill.
    Yes, I agree that skill is definitely important; however, I'd like to throw a monkey wrench out into this forum space if I may. Making high grades in school will not make you a great nurse, however, understanding and the ability to apply complex concepts will. There are some students who do very well on nursing exams but who are unable to think their way through applying the concepts in real world patient care. How many of you have heard the phrase "C" = RN? I am agreeable with this statement, as long as that "C" student can safely care for me if I am sick and need a sharp nurse. Every patient deserves a sharp nurse!

    If you think the ability to follow a doctor's order, use good sterile technique, and add up I/O's is all there is to nursing, stop right here and go back to Nursing 101. Unique to the education and training of Registered Nurses is our firm grasp on the pathophysiologic basis for care and nursing assessment, upon which we should plan our interventions. Remember, more often than not, you will not have a doctor at your disposal. If we we really don't understand patho & also are not skilled assessors, we are little more than "order followers" and "pillow-fluffers" and we all know that Nurses are infinitely more!

    I'd rather train a sharp nurse over a skilled nurse because the most important processes a nurse performs happen in his or her cerebrum. I have come into contact with many students who have the excellent skills and an award-winning personality but are lacking in the ability to think their way through complex patient scenarios. A lot of this will come with experience as a nurse. This is why memorization can be a major problem for many nurses students. They memorize pneumonics to pass a test but they have a difficult time applying the knowledge to other body systems and in the hospital setting. These same students may do remarkably well on tests but poorly with the critical thinking needed to care for patients in reality. So, just my two cents, but the best nurse is one with great skills who can also think for themselves.

    Great discussion!

    Never, ever stop thinking, learning, and growing!

    I :heartbeat Nursing Students!


  • Nov 22 '09

    I don't feel having a Bachelors gives you one up. They have two entirely different programs. One for Bachelor holders only and one for us regulars. I am very sorry to those who were not accepted. I had a panel of 6 interviewers. I actually talked to the person in charge and she told me that they look for very sincere essays that make you stand out from the rest. ANYTHING personal, not the traditional "I'm a hard worker, I'm dedicated...yadda yadda. Everyone says they have those qualities,(not that they dont have those qualities) but they want those that stand out. I start in March at Gateway and my GPA is 3.0 and my Net wasn't anything to brag about. I think it was mid 70's. But I spoke from the heart in my essays, I did my best to stand out and show who I am. I needed to do well on those to make up for points lost in my GPA area. The interview I felt I did well on as well. I ran over the mission statement. Found times in my life where I have had given service and looked the panel in the eye when talking, never referring to the sheet of questions. All I can say is BE PERSONAL, show who you are, let them see not only that you will be a positive benefit to the program but you can handle the accelerated program and you will make a DANG good nurse. Don't be discouraged, get your stuff together and get going on those essays and really spice them up. Go re-take the NET to try and up your scores. Anything. My advice, good luck and congrats to the March cohorts!

  • Nov 15 '09

    did you know you can easily find previews of other nursing textbooks for references or just to supplement your own textbook.
    someone posted looking for maternal newborn careplans so my directions are written for their search but you can find a wealth of information this way.
    google has a feature that makes it easy and quick to find nursing material and you will know it is credible as it is from other textbooks.
    the directions may seem to have many steps but it is really very easy once you try this.
    this is how you access these books.
    in google you'll see the words web, images, videos, etc. and a drop down arrow at the top of the screen.
    --click the drop down arrow
    --choose books.
    --click on advanced search
    --in the top box type "maternal newborn careplans" (or the type of book you are looking for)
    --for search click "limited preview and full view"
    --for content click "books"
    --for language choose a language
    near the top of that page click "google search"

    here i found delmar's maternal infant nursing care plans book preview. click through the pages and you will find actual nursing diagnosis and care plan info.

  • Nov 14 '09

    This might help you with what to ask...
    It helped me when I was starting out figure out what kind of things fit into each FHP