kpmadden83

Thanks. I'm an LPN bridging for my RN. We're writing a paper and doing a presentation about change, quality care, and/or improvement. It should be based upon something we've seen in clinical or at our jobs. We saw that nurses would delay giving PRN meds (like pain meds) at the end of their shift because they were busy, charting, etc and they would just wait for the nurse on the next shift to give it. I was hoping there would be some sort of research out there about delays in care towards the end of a shift, during change of shift reports, etc.

Hello, I'm wondering if there are any articles (particularly any research papers) discussing delayed pain management (or simply delayed care in general) prior to the change of shift? For instance, a patient asks for some form of analgesia at 6:30 pm and the shift ends at 7:00. Rather than doing it, the nurse leaves it for the following shift. So the patient doesn't get their treatment for another hour. I'm writing a paper about this and am curious if anyone has any research they've seen they could point me to? thanks, --KP

I just explained how the book is formatted up above, but it's not written in a clean, succinct way. And this is for a paper that the teacher says is a requirement that shouldn't be a huge area of focus for our time, that we should be spending every day working on the practicum instead. She also stated that they're completely changing the class next year.

The book doesn't list normal findings anywhere. You'd have to go through, not just chapter by chapter, but section by section within the chapter. For instance, there is a single list of all the systems, but it doesn't have a list of normal findings. It simply states abnormal things to look for. For instance, the peripheral vascular section states "coldness, numbness and tingling, swelling of legs (time of day, activity), discoloration in hands and feet (bluish red, pallor, mottling, associated with position, especially around feet and ankles), varicose veins or complications, intermittent claudication, thrombophlebitis, ulcers." That's a list of abnormal things to look for, not a list of the normal findings. So you can turn to the peripheral vascular chapter and look for a list of "normal findings" there, but there's not really a list there either. Instead, what you find is twenty pages with half of the page saying "normal findings" and the other half that says "abnormal findings." An example of the "normal findings" section I just randomly picked says "The modified Allen test is used to evaluate the adequacy of collateral circulation before cannulating the radial artery. Firmly occlude both the ulnar and radial arteries of one hand while the person makes a fist several times. This causes the hand to blanch. Ask the person to open the hand without hyperextending it; then release pressure on the ulnar artery while maintaining pressure on the radial artery. Adequate circulation is suggested by a palmar blush, a return to the normal color of the hand in less than 7 seconds. Although this test is simple and useful, it is relatively crude and subject to error (I.e., you must occlude both arteries uniformly with 11 pounds of pressure for the test to be accurate." All of that for "Allen test positive." And even within that, it's never written as a simple, succinct finding you'd write as a note. And this goes on for 20 pages for a single system. There is no list along the lines of "Tendon function is normal. Capillary refill is less than 3 seconds in all extremities. Pulses palpable. Steady gait noted." And this is for a paper that the teacher says is just a requirement and we should really be spending our time focusing on the practicum. She said they're completely changing the class next year. That's close but not quite in-depth enough. I think I can start with this and add more detail.

Hello, I'm bridging to my RN and currently taking a class about physical assessments. We have to write a paper that's a head-to-toe assessment with 8 pages describing the normal assessment findings. Our book lists the ABNORMAL findings, but we're supposed to write what we'd be seeing on a patient who had no health problems, basically listing all the normal findings. Is there anywhere I can find a list of the normal findings of a head-to-toe physical exam? I.e. I need to know the physical findings for skin, nails, and hair; then the eyes; then the neck; then the breasts; etc etc. Hopefully this makes sense, thanks!