Help me out if you can! I'm at disagreement with my teacher over what the nursing diagnosis is for the patient below. Now I don't want to give the answer away for fear of revealing to much, but I promise that I've already faced the repercussions for the Nursing Diagnosis that I made. Thank you for your input and I look forward to your response.
Thanks, E
Mrs. S. is a 28 y.o. African American female admitted to your floor with c/o RUQ (Right upper quadrant) abdominal pain, fever, and Rt. Shoulder pain. Mrs. S. states this started gradually 2 days ago but got worst last night. She rates the pain 9/10 and describes it as an aching pain that is constant. She denies any activity that could of brought it on. It is worst when she rides in a car and goes over bumps in the road. Mrs. S. tried taking Ibuprofen 200mg every 4 hours for the pain with slight relief. Her PMH includes Hypertension. Her current medications include Norvasc 5mg everyday & Lotensin 20mg everyday. Her LMP (last menstrual period) was 1/1/08. Her husband is away in Iraqand she has not been sexually active for 4 months since he was last home. Mrs. S. denies smoking cigarettes or using drugs. She admits to an occasional glass of wine. She was given Demerol 75mg and Phenergan 25mg IM in the ER about 2 hours ago. Her pain has decreased to a 6/10. The ER physician has her scheduled for an ultrasound of the abdomen. Her recent blood work in the ER showed to be normal except for an elevated WBC (white blood cell count) of 15. Her VS are 100.1, 85, 12, & 140/70. Wt. 205# & Ht. 5'5†Lungs are clear to auscultation & percussion. Heart is regular rate with normal S1 & S2. Abdomen is tender over the RUQ with guarding. Bowel sounds are present x 4 quadrants
Specializes in Psych, Addictions, SOL (Student of Life).
Emantsch said:
Would you be happier if my first post was about the most beautiful rainbow I saw?
I have to write a paper about this and before moving forward I wanted to be sure I was correct.
Apparently so far so good. I haven't seen an official Nursing Diagnosis from a book so I don't think anyone can beat my proper answer.
So since you are so defensive and dismissive in the face of opinions from experienced nurses I would really like to know what your original Nursing DX was and why your instructor told you it was wrong.
Looking at this thread the only advice I can give is: Humble yourself honey.
Also review the difference between actual and potential nursing Dx. And prioritization. It'll clarify why your teacher and us fellow nurses came to the conclusion that Hyperthermia is wrong. Good luck!
Specializes in Psych, Addictions, SOL (Student of Life).
Emantsch said:
I already posted my Nursing Diagnosis, it's the third posting in this thread
Sorry I missed that - however a temperature of 100.1 is not even a fever much less hyperthermia. When I was a very new nurse I got all excited one night about a post C-section patient with a temperature 99.8. Which to me indicated that the patient was headed into infection/complication territory. The other nurses on the unit were very kind and explained to me why I was most likely wrong and that based on her pain scale something like 6 to 7 out of 10 I should just give her the Vicodin which also contained Tylenol and see how the patient responded. I was so sure I was right that I called the physician at 2:00 am to let him know his patient had a FEVER. He was actually quite calm until I told him what the temp actually was (which by now was 100.2 or so) He then proceeded to lecture me quite loudly over the phone about the natural inflammatory response to surgery and pain and to follow the standing orders for comfort of the patient and not call him again until temp was 101.0 or higher. I learned something that night.
Some years later my son was sent home from school with a mild temp after taking a nap under blankets. 99.8. I received with my son a note that said he would not be allowed back at school until he had a normal 98.6 temp for 24 consecutive hours. MY pediatrician wrote a note stating the following "A temperature is not a fever until it is higher that 101.0 degrees, have a nice day."
I have in my career and as a mom dealt with really hyper thermic patients Kids with 103.0 or higher having febrile seizures, my own son with a swine flu temp of 103.4 who the doctor advised to keep home and alternate Tylenol and Motrin with lots of fluids.
100.1 is not hyperthermia nor is it even a medical emergency.
Specializes in MCH,NICU,NNsy,Educ,Village Nursing.
Emantsch said:
Would you be happier if my first post was about the most beautiful rainbow I saw?
I have to write a paper about this and before moving forward I wanted to be sure I was correct.
Apparently so far so good. I haven't seen an official Nursing Diagnosis from a book so I don't think anyone can beat my proper answer.
A better attitude towards those from whom you are asking for help would be wise...for this assignment....in the real nursing world. Or, you will find yourself adrift...often. This board is not here to do your homework, and many have been gracious in offering their advice which you seem eager to discount and toss aside. If you were one of my students, you'd be in my office right now for a discussion on professionalism, gratitude, and a string of other important life stuff. Good luck.....methinks you'll need it......
My patient comes in complaining of pain and a fever. The ER just gave her pain meds. Now while she is waiting for the ultrasound I should treat her fever.
That was my opinion.
the Nursing Diagnosis for treating fever, an elevated temperature is Hyperthermia: "Core body temp above the normal diurnal range due to failure of thermoregulation" -NANDA
sure sounds mumbo jumbo but this is an entry level nursing class. If I told my dad I have pain and a fever, he gives me pain meds, what would he do next? He would treat my fever.
overall I don't think anyone said the same as my college teacher so it's been great feedback! Thanks for participating! Have a great valentines weekend I'm off to Vegas!!!
Would you be happier if my first post was about the most beautiful rainbow I saw?
More about the rainbow please!
On a serious note though, I hope if this was a patient in real life (after hearing from all these experienced nurses) that you would want to reduce her 6/10 pain asap.
Why is there just one nursing diagnosis? You mean the most important one? Risk for infection or actual infection, Decreased Cardiac Output (htn), Pain. Maybe you mean her medical diagnosis?
Adding: I see fever/hyperthermia was "the" nursing diagnosis.
My patient comes in complaining of pain and a fever. The ER just gave her pain meds. Now while she is waiting for the ultrasound I should treat her fever.
That was my opinion.
the Nursing Diagnosis for treating fever, an elevated temperature is Hyperthermia: "Core body temp above the normal diurnal range due to failure of thermoregulation" -NANDA
sure sounds mumbo jumbo but this is an entry level nursing class. If I told my dad I have pain and a fever, he gives me pain meds, what would he do next? He would treat my fever.
overall I don't think anyone said the same as my college teacher so it's been great feedback! Thanks for participating! Have a great
valentines weekend I'm off to Vegas!
NPO and gently hydrate. A perfed gut is a surgical emergency.
hppygr8ful, ASN, RN, EMT-I
4 Articles; 5,212 Posts
So since you are so defensive and dismissive in the face of opinions from experienced nurses I would really like to know what your original Nursing DX was and why your instructor told you it was wrong.
Hppy