kimber1985

Ok, so to keep a line primed, I suck the air out of it and put in 45 mls? I am confused. You are saying that sucking the air out makes a vaccuum that will keep the pump from pushing out the last 5 mls? But the pump still knows not to suck out 5mls? Most of the time when I hang an ongoing piggyback the line is still primed and I just stab it. Quick easy no fuss or muss. Otherwise you are repriming and getting air bubbles out and losing med anyway. I've only back primed once with a nurse, but not sure I could do it alone. I think you just lower the line and let the primary fluid run in?

You are hanging an IVPB 50 mls You lower the Primary. You only punch in 45 mls to keep the line primed. How does the Baxter pump stop pumping the IVPB with 5mls left over and convert to the primary if gravity has anything to do with it?

Ineffective coping Disturbed Body image In OB I would make up my own Dx and we were suppose to, because the book (Cox) is not directed at OB. I had a pt whose significant other was in prison at the time.... That was Interrupted Family Process. It is still from the book, but not often used. Since birth is a normal life process and not a disease it is hard to come up with useful Dx, go with psychosocial. Even a C-sect is a Distrubed Birth Process. Sleep Deprivation from nursing the baby and being awake for hours of labor. Maybe you could use Exhaustion. You said she doesn't speak English....does she have Health Care??? You could use that.

Are doctors quick to diagnosis pneumonia without data. My asthma patient has had cold like symptoms for a week and is diagnosed with pneumonia. But I did not see a chest x-ray or a culture to diagnosis. It may be there tomorrow morning, but I think I have seen this before. Labs were Reactive protein high and Influenza A and B not dectected. On Zithromax

100lbs sounds good to me, but I am seeing in peds rotation a 83lb getting adult doses. I have Solumedrol 25 mgs for a 34.8kg 10 year old, q 6 does - that sound high? Book says 835mcg/kg q 12-24 34.8 x 835 is 29mg. but what about the q 6 versus q 12-24.

I am in Peds and my 15 and 17 yo are on adult meds....is there some common age or weight in which a child is medicated like an adult.

I felt intimidated by OB, because I am a female who never had kids. I've had an equal amount of gyns that where male and female and it never bothered me what sex they were. Most of these women are so use to showing there gentials I don't think they care. My first patient asked me if I wanted to cut the cord? Her husband wasn't present and he was in jail and we developed a good relationship during her hours of labor. Maybe a male figure would have been comforting to her. I think it could go either way. Just get what you can out of it and be professional.

Blow off class and spend the three useless hours of lecture reading the material. I had this sort of class and this sort of instructor. I don't need anyone to read my power point notes to me. I had the highest grade in the class and barely showed up. Most of the class failed. You would think that the goal was to teach the material and get a high percentage of passing students. Some instructors, particularly in the beginning think their job is to criticize and weed out. Suck it up and read the entire book. But I would also complain, and don't be surprised when nothing happens. Perry and Potter, read the boxes, as they summerize well. Good Luck and look at it as challenge, like climbing Everest. In fact thay might be easier than nursing school.

Thank You, you have me on the right track. His mental age is minimal but hard to really determine, since he doesn't speak, but will be helpful when changing his diaper or he may squeeze my hand during Physical Assessment. I like Deficient Diversional Activity. I think I am going to go with that one. Thanks again.

I've know people cerebral palsey and he doesn't have down syndrome. It is really just the severity that stumps me. The hospital wasn't addressing any Physical Therapy issues, which would be my choice for short term goal. He stayed in his crib all day, and I thought he should get some kind of stimulation, but this wasn't the case. All the other kids get to go to the play room or watch videos or play video games. There was nothing implemented for this child in terms of child life activities or therapy of any kind. That makes it hard for me to come up with a short term goal, as none appeared to exist. He only weighed 80 lbs, which I am sure is due to lack of muscle tissue not necessarily nutrition or knowledge deficet on the part of the mother. I can't come up with a way to improve his growth. We are going to a school for developmently delayed children in a couple of weeks, and I am sure I will get insight then, but the careplan is due now. Researching CP or MR is not helping me with this particular child. It's the combination and lack of experience that makes me ask the question, not laziness. It's not like I am finding anything that gives specific examples of how to improve gross and fine motor skills with a child like this. I am not an occupational therapist. I am looking for realistic nursing goals for improving the psychosocial development of this child while he is in my care.

I am doing a care plan on an MR, CP with a possible partial bowel obstruction, with a G-tube, age 15. Bowel ostruction self resolving. I have Acute Pain and Nutrion Imbalance. But one of the diagnosis has to be pyschosocial. I was going to Delayed Growth and Development. But I am having a hard time coming up with realistic goals. 1 short term 1 long term. He is like a big baby..... had to change his diapers, does not speak. He does go to school, I don't know what he does there? Anyone with this experience, who can give me some insight as to realistic goals for someone like this? He may have been regressing in the hospital as he was sucking his hand and the IV tubing. Generally a happy kid, very amiable and cooperative, obviously well taken care of. Suggest another diagnosis, or give me a goal please.

I am just a student, but certainly Chemo would affect Monocyte levels. What other meds is she on? Antibiotics, Steroids, Immunosurpressents? What is her Dx? Check the drug book on labs to consider for her drugs.

GPA is a GPA.

I always count for 30 secs for a well patient with regular breathing pattern, a full minute if they have any sort of irregular breathing. I just don't feel responsible with 15 X 4.

I've seen instructors like this. Instead of encouraging you they try to break you. Don't let one instructor ruin your dream. You'll get through it if you practice the skills until you are confident. You can do this!!

No lupus. She does have FSGS, Focal Segmental Glomerular Sclerosis. The doctor was on rounds with about 6 med students and I was too gun shy to interupt, and they always treat me like a complete plebe anyway. I do not believe she was on this drug at home. The nurse gave me a vague response that it was a preventative drug. My guess is that it is just an agressive treatment, maybe based on a theory that the cause of idiopathic NS is actually a due to some immunologic response, that antibodys can be harmful to the kidneys? Thank you all for all of your intelligent responses!

Thanks, I sort of bombed in pre-conference this morning, but it was because my instructor didn't think that nephrotic syndrome patients lost immunoglobulin, she was wrong and apoligized later. But I still didn't have a good reason for giving the Cellcept as she is not having a transplant. We spent a half an hour and four references in clinical today trying to piece together a theory as to why. Any ideas? Still very curious.

I loved OB. My final day I had 5 patients. 5 Assessments, 5 chartings, 1 admission, not too many meds, d/c a foley, d/c an IV. Also had two babies to take care of, barely came up for air. The only day I had 1 patient was L&D and I helped with a lady partsl birth. I had 3 babies in NICU, the Nursery was really busy that day I was there and got to give Vitamin K shots. If you want brownie points ask your instructor for another patient. If all else fails, study.

Super info! How about why are they on a immunosurpressent (Cellcept) which is prescribed for a kidney transplant she has not had? Does this have to due with the immunoglobin?

Yes, I just don't understand the patho of the risk for infection. "Humoral and cellular immune responses are altered in nephrotic syndrome and .....infection is an important cause of morbidity and mortality." Why?

Why are they are risk for infection? And any other help you can offer on the subject!!! Other diagnosis?

As a student, I think I will appreciate listening in 5 places when I actually encounter a murmur. I think in the beginning you feel like "I have no idea what I am doing or looking for". I just had a patient with slow capillary refill. I was pressing on his nail beds like 5 times, then pressing my own to be sure. You feel like you are just going thru the motions until you catch something. Then you've got this time constraint balanced with being thorough. How much time should I spend on PERRLA with a guy who has a broken ankle? The doctor comes in and listens to the heart in couple of places and the lungs a couple of places and takes off. I've never seen a nurse flash a pen light in someones eye. I am a student, I do everything because that is my responsibility and I have the time. Its a good thing, but is it reality?

Thank you for the excellent advice.

There are alot of things, as a student, that I don't like about physical assessment. 1. why am I listening to the heart in 5 places? Am I not a cardiologist 2. why am I listening to the lungs up top first when adventious sounds are usually at the bottom? 3. If the guys been in the hospital for 1 day, why am I testing for Homan's? 4. Unless he has a GI problem, bowel sounds are heard and move on. 5. If pulses are felt strong in extremites why go further up the body? I do focus on the diagnosis and try to hear what is not right, and I have caught lung sound and heart sounds not regular that were not charted. I can do it in 5 minutes, but I prioritize the assessment. But I always have to go back for capillary refill. I always forget that, unless my patient has an O2 issue. I find that I do it quick, but I am trying to find something wrong at the same time. I am learning, so I focus on what I can hear or see that is going to be good for my patient or a learning experience for me.

Med errors will fail you. But, I wouldn't think she would have to check with the doctor on the lab result? The instructor did not fail her, so she will probably make it. These instructors all are so different and each has their own peeves. Personalities do come into play.