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
Pain scale is subjective, the patient may be comfortable with a 6/10.
also she just got pain meds two hours ago, should we dose her again? No.
I also don't believe that pain is a First Level priority.
And you may not think this is first level priority, but it is. And with every pain scale assessment there is a portion that is "what is your acceptable" level of control question. As notably, we can not get everyone to zero.
You could ask a billion questions--was the patient jaundiced, history of hepatitis, viral illness in the recent past? Were there rule outs--ie: mono for instance, tick borne disease--kids at home who have been sick...
But the question is regarding a nursing diagnosis, and not a medical diagnosis. So you have to look at needs at present, and what nursing diagnosis fits those needs. And the most obvious is pain.
And for some medications, a practitioner will order q 2 hour timeframes. So never say never.
But again, your goal here is a nursing diagnosis. There are others ie: alteration in health, discharge plan, if a BMP/CMP warrants fluid care plan as appropriate.....you could go on and on....and a twist in all this is a bowel protocol plan....which IS something the joint commission can look for with all patients on a narcotic pain regime.
Critical thinking, advocating, studying the case---all good things, all necessary things. However, the question was regarding nursing diagnosis/care plans.
Akin the the almighty NCLEX--there are 2 right answers, one is more right, and don't read into the question beyond what is being asked.
Hyperthermia related to illness, as evidenced by Vital Sign 100.1 Fahrenheit and patient complaint of fever.
Yes, this is one possibility however, 100.1 is not considered hyperthermic in most facilities. And the one ibuprofen may or may not have altered this number. How was the temperature taken is another factor....large margin for error unless one takes a rectal temp.
In my honest opinion, this is not the first priority. You can certainly include it, but there's a lot more to add to your diagnosis.
(diurnal range for some can be over 98.6.....so be mindful of those things which claim "normal"...it usually means the patient's normal)
I will just add that increased body temperature is an expected finding when the patient is in a lot of pain. Look up the correlation between pain and body temp because you need to know that information for this very reason. Fever isn't the top priority. Pain may be subjective but 6/10 is still REALLY high, and unless the patient literally said "I like being in a lot of pain" then a 6/10 would not be OK. Most people would not want to be in that much pain without treatment. Basically this is the equivalent to seeing that a patient is one pound heavier in the afternoon than in the morning and treating them with diuretics. Gaining and losing weight all day is normal, just like temp going up and down is normal and it is all being affected by something. In THIS case, I can almost guarantee that her increased temp is being caused by her pain, so treating the symptom rather than the causation.
also, just a little info: Many pain meds will treat a fever anyway, so you can treat both at once with one med. So, knowing that the med in your hand will treat both, which would be the bigger reason for giving the med: a very slight fever, or severe pain?
Pardon me if I go back 34 years. I was dazed and confused with the minimal guidance I received from both classroom lecturers and clinical instructors. OP is trying.. needs assistance from us, as she is NOT getting it in the real world.
There is a difference in assistance and just actually completing the assignment for the OP. I'm all for helping but they are responsible for what they learn. I am happy to guide the OP into forming an answer but the orginal post gave up no information as to what they actually did. It's the way that you need to go about it. Should you come here and say: I had this assignment, I gave this answer and this is why I chose this answer but my teacher didn't like it. Does anyone have any suggestion as to what other alternatives there might be as I'm thinking X, Y, and Z but I'm unsure if they apply. Here is the question, any feedback appreciated.
Do you see how that translates vs the original post? I would have had no problem helping a person out if they can prove they are trying. I'm not here to help people finish thier assignments if they don't put in the effort. If they don't show it now, what makes you think they will show you when they graduate? We need strong nurses, not lazy ones.
OP, take this advice for the future. I would have more than helped but this is what I would expect on a help type question. Put more into it and provide details, give us an example of what you are thinking. Show effort. Learn to work hard and be receptive to criticisms. I'm not here to drag you by the hair, I'm here to help but you gotta show you're in it as well!
Any diagnosis would include PAIN, at least initially; once you have the lab results and the pain has somewhat subsided, the diagnosis may be re-evaluated and include Temperature/Fever, as well.
You never stated what your diagnosis was, so, we have nothing to review/evaluate.
Eating the young , before they are hatched. I have no problem guiding a student . It's called mentoring.
I don't think anyone has a problem guiding students. I can't speak for everyone, but what rubbed me the wrong way was I got the idea that s/he came in wanting confirmation that s/he was right. Then got a little snarky when corrected.
I actually love helping students. I would consider teaching part time if I didn't get so nervous speaking in front of groups (and if I had a desire to get my MSN, of course LOL). But when told in effect "you're alllll wrong, and besides none of your answers were actual nursing dx'es anyway," yeah that's irritating. I didn't know about this site when I was in school if it even existed, (early 2000s) but I can't imagine any of my classmates ever getting snarky if asking for help on a site like this. Well maybe one gal would; she failed during last semester though. But otherwise, any of us would have said "thank you" if told that no, this pt is not "hyperthermic" at 100.1 and that pain control is the first priority--and NDx's are based on priority.
In fact I remember for my OR day, we had to make drug cards for the drugs the anesthesia team used. I wasn't trying to be lazy but for some reason didn't know that I could find anesthesia drugs in my drug book. I was thinking of that as more of an acute/LTC reference. So I asked the CRNA stuff like "What are the main side effects? What is the onset, peak, and duration?" She said "I think they want you to look these up yourself in your drug book." My response: "Oh, I can find that info there? I didn't know that. Thank you for your help!"
OP's attitude was definitely not a humble or teachable one. That was my issue...not that she needed help.
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.
Hppy
Right...I think I said it, but we don't even treat fevers in my ICU until it hits 38.6/101.5. My first day, a pt had a temp of 43/109! It was neurogenic from a GSW to the head. 100.1 is nothing. Heck, the RNs who cared for the ebola pts wouldn't even have needed to report a temp of 100.1
please can you help me out with nursing diagnosis for this case study!!!!!!
Kathie is a 30-year-old G1 P0 with no medical history admitted to the hospital at 39 weeks of gestation in early active labor. Her cervical examination is 3/100/-1 vertex. Her membranes are intact. Her contractions are every 4 minutes × 60 seconds. Fetal heart tones are 140 with moderate variability, accelerations present, and no decelerations. She declines medication for pain at this time, but states she might want something later. Her partner is at the bedside and appears anxious.
Write a priority nursing care plan for Kathie taking into account that this is her first pregnancy.
please can you help me out with nursing diagnosis for this case study!!
Kathie is a 30-year-old G1 P0 with no medical history admitted to the hospital at 39 weeks of gestation in early active labor. Her cervical examination is 3/100/-1 vertex. Her membranes are intact. Her contractions are every 4 minutes × 60 seconds. Fetal heart tones are 140 with moderate variability, accelerations present, and no decelerations. She declines medication for pain at this time, but states she might want something later. Her partner is at the bedside and appears anxious.
Write a priority nursing care plan for Kathie taking into account that this is her first pregnancy.
Here's a bit to get you thinking: just because someone declines pain medications, doesn't mean pain isn't an issue and do nothing. She's simply choosing to forego pharmaceutical pain interventions. Is there something else the nurse could do?
This is her first birth; can there be some knowledge gaps you can nursing diagnose?
Many hospitals are moving to a patient and family centered care model. What do you notice in the partner that you could assess?
I don't know much at all about fetal heart tones (except that some decelerations are bad.) so don't know if the above is concerning.
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!
I don't think you quite understand how nursing dx & care plans work yet. Just because an intervention was implemented for one dx (meds given for pain) does not mean that dx is now inactive & something else is priority. It stays active & the nurse continually reassesses & applies multiple interventions as needed. Typically a care plan will have 4-5 dx & each one is addressed & re-evaluated on a continued basis until completely resolved (or discharge).
I find that if there are no severe or life threatening issues regarding ABC's, pain (if present & significant enough to medicate) will most often be the primary dx.
jadelpn, LPN, EMT-B
9 Articles; 4,800 Posts
And you may not think this is first level priority, but it is. And with every pain scale assessment there is a portion that is "what is your acceptable" level of control question. As notably, we can not get everyone to zero.
You could ask a billion questions--was the patient jaundiced, history of hepatitis, viral illness in the recent past? Were there rule outs--ie: mono for instance, tick borne disease--kids at home who have been sick...
But the question is regarding a nursing diagnosis, and not a medical diagnosis. So you have to look at needs at present, and what nursing diagnosis fits those needs. And the most obvious is pain.
And for some medications, a practitioner will order q 2 hour timeframes. So never say never.
But again, your goal here is a nursing diagnosis. There are others ie: alteration in health, discharge plan, if a BMP/CMP warrants fluid care plan as appropriate.....you could go on and on....and a twist in all this is a bowel protocol plan....which IS something the joint commission can look for with all patients on a narcotic pain regime.
Critical thinking, advocating, studying the case---all good things, all necessary things. However, the question was regarding nursing diagnosis/care plans.
Akin the the almighty NCLEX--there are 2 right answers, one is more right, and don't read into the question beyond what is being asked.