fizzgigger

So if I have a schedule that looks like this: 0w1, 2w8, 0w1, it would be written like this: effective 03.27.2011 2w8. In this instance the Recert is on April 23th, and no visits are scheduled the week of April 24 until April 29 which would be in the next certification period of 04.28.11 tp 6.26.11 (assuming they recertify). How would you write that remaining 0w1?

I think i got some: STG: Pt and Family will identify at least 2 negative effects of drinking on each family member in the home drinking by end of day. LTG: Pt and family know of 3 of 5 places to seek help, support and rehabilitaion within a 10 minute counseling. 1) Nurse will encourage pt to talk freely and reflecting 2 reasons he thinks his drinking affects each family member by the end of the day. 2)Nurse will provide 5 in community support groups names, numbers and brochures: AA, self help groups, Alanon, family therapy, and pastoral. 3) Nurse will establish a rapport with the families and provide a brief 5 minute one on one with family members to encourage feelings each time they visit. Any suggestions?

oKAY I am about to pull my hair out. I've been working on a master care plan for hours! I have my other nandas already. I have to have a psychosocial nanda and goals. Pt is an alcoholic and came in for respiratory failure secondary pneumonia. so i am putting, interrupted family process: alcoholism r/t alcohol abuse. I have my aeb. But these nanda books are killing me, I can't for the life of me figure out how to make a measurable short term goal and a measurable long term goal out of these things as well as Nursing interventions. I' am very weak in this part of my planning process. Can anyone please help? I'm really sorry for asking for help again, I've just been on this for all day long. Not to mention a test tomorrow. Geez lol. thank you so much in advance.

I have a pt who has hypochloremia and hypokalemia along with hyponatremia. I don't under stand the relationship between hypochloremia and hypokalemia. I did write that hypokalemia is related to my pt by: drugs can cause decreased levels such as heparin. Tissue injury, such as pneumonia, can cause fluid and sodium to shift to the interstitial space. Kidneys problems can cause problems with the ability to reabsorb sodium, as indicated by this pts GFR. Can anyone help me figure out the hypochloremia and hypokalemia and what the relationship is?

I see! Okay, I was really confused. My book was not giving any explanations, just facts. I'm the type of person who digs deeper. As for the DM answer, your right. It was a test question and I put stomach ache because in class my teacher said any child with DM will be throwing up excessively. I have it on tape too, but when I go the answer wrong I was like WHAT? I wanted to clarify it before I took it up with the teacher. I forgot that polyuria was a s/s. I wonder how many other people missed it due to her lecture? Hmmm. Thanks so much again, your always a wonderful help. Sorry I don't post much to help other or just to communicate but I'm so busy with school. I do hope you understand.

If you have Diabetes Inspidus you have a increased urine output and hypernatremia. How is this possible? I think I am confused, I thought sodium follows water so wouldn't the sodium be excreted through the urine as well? Also a question about a school age child before being diagnosed with Diabetes Mellitus: Would the child first experience: stomach pain or bed wetting suddenly?

Daytonite> I'm sorry, I thought I had listed the assessment from my previous narrative notes. You actually were the one that helped me rewrite and correct some of my notes. It was as follows: 7:05 Standard & contact precautions maintained. Lying in bed in supine position, resting with eyes closed, mouth open. R-15, equal and unlabored. IV patent & intact on right inner forearm. Free from redness, edema and drainage. Infusing 40cc/hr of 1000ml D-5-W. O2 2 liters by nasula cannula. Foley draining by gravity. Urine reddish brown. Both feet in foot pillow under bed cradle. Large left toe with dry dressing, no fluid or drainage present. Bed alarm on, side rails up x2. Remains in bed with eyes closed. Reported urine color to nurse. - s. butler svn 8:30 In bed, supine position, eyes open. Son and daughter-in-law present. No acute distress noted at this time. NPO due to EGD 11.12.2007. VS t -96.6, p 102, r18, bp 123/65. Pulse oximetry 100%. Orientated x2, disorientated to time. Responds to verbal loud stimuli, hearing aid x2. Incomprehensible speech. Head atraumatic, free of infection and normocephalic. Flat affect - Bell's Palsy. Eyes symmetrical, sclera white, pupils irregular and sluggish. Possible cataract surgery. Conjunctiva moist. Drainage bilaterally. Nasal patent bilaterally. 02 at 2 litters by nasal cannula. Buccal mucosa dry, oral mucosa pink and dry. Upper and lower dentures present. Lips dry. Ears symmetrical, dried drainage present. Carotid weak bilaterally. No bruits or thrills present on neck. Full Rom in neck. Breath sounds clear to auscultation. No cough present "She only coughs to clear her throat" states daughter-in-law. R-18 even and unlabored. Apical 65, rhythm equal, s1 and s2 noted but irregular. Skin warm to touch, thin, hyper pigmentation present. Multiple bruises bilaterally on inner and outer forearm and upper arm in various stages of healing. 3 cm bruise noted at old iv site on left hand covered with cotton ball and transparent tape. Iv site patent on right inner forearm, site free of redness/edema/warmth. Dressed with transparent tape. Iv infusing 40cc/ml of 1000 ml d-5-w. Complains of no pain in area. Capillary refill on nail beds 3. Toenails splintered and thick. 2X2 dressing on Greater Large Left toe, no drainage present. Small necrotic tissue present on second left toe 9:15 Standard and contact precautions taken. Assisted can in changing chux. Loose light brown stools. Skin bruising and moist skin on sacral area, >10X10 cm. No skin breakdown at this time. Peri care provided. Moisture Barrier Cream applied to sacral and buttock area. Explained reason for sacral area and rational of cream protecting skin and repelling moisture. Instructed family to use call bell for needs or assistance especially when BM has occurred. Explained keeping her dry will help to prevent skin breakdown from runny stools. Verbalized understanding. Bed rails up X2, bed in low position, bed alarm on. - sb svn 9:30 resting, eyes closed. Family stated "comfortable". Iv site patent, no signs of distress. Will continue to monitor closely. - sb svn 10:42 eyes closed in bed. Family reading. Nurse infused piggyback piperail 2.25g @ 75ml/hr. Awoke to stimulus. C/o "dry mouth". Explained she cannot have anything to drink because of procedure scheduled today. Insistent on "dry mouth" Explained again she can't have anything to drink but I can return with mouth swaps to help relieve the dryness. Son voiced concern on what time they will be coming to get her for the procedure, "11 hours is a long time to go without water or food, she must be miserable". Told son I would relay the message to the nurse to call doctor and find out time. 02 at 2 liters, pulse oximetry 98%. Reported to nurse. - sb svn 11:05 back to room with oral care pack. Pt eyes closed, r even and unlabored. Instructed family how to use swabs and tube of lip care upon her awakening. Explained not to allow her to swallow. - sb svn 12:15 pt in bed resting, eyes closed, family present. "Didn't like the swabs, but better than nothing. Still complains of dry mouth." Instructed family to swab again in 30 min to help relieve dryness. Reported now news of doctor call back. - sb svn 12:26 call be rang, "she need to be changed" states daughter-in-law. Called for can. Standard and contact precautions maintained. Brown runny BM. No odor. No consistency. Changed chux. Peri Care provided. Moisture barrier applied to sacral and buttock area. Pt's words incomprehensible. Family states shes "mumbling." Bed rails up X2, bed in low position. Iv site patent, site free of complications. - sb svn 1:20 Nurse in room assisting change to stretcher for EGD. Family "relieved" to finally get her to procedure. Reported off to nurse. - sb svn Again I'm sorry for that.

Thank you so much, I got a much better on my last care plan! I bought 3 books and studied all weekend long. I prolly killed half a tree redoing it over and over. So the top 5 NANDA for this person would be: Diarrhea R/T infectious process secondary to C-Diff enteritis AEB constant dribbling of stool, positive stool culture Deficient Fluid Volume R/T active fluid volume loss AEB frequent loose liquid stools, weakness, decreased skin turgor and decreased urine output Risk for skin integrity r/t moisture AEB loose liquid stools, physical immobility and age Acute confusion r/t fluid volume loss AEB misperceptions and fluctuation in level of consciousness We have to have 5 top priorities for our master care plan. Do you think these are okay? I need one more, I'll keep thinking and looking through my books. But so far the number one top priority would be (the one that would possibly lead to death as said by my teacher) either the diarhhea or the fluid loss? But then again diarrhea leads to fluid loss so that would be the top priority? Again I talk out loud and to help myself! Thanks again!

My pt had c-diff. I'm thinking more along the lines for my nanda to be dehydration r/t infectious disease or bowel incontinence r/t infectious disease However my teaching for the stg is the standard and contact precautions. My long term goal would be something like pt will have normal bowels, or will have no skin breakdown ,or will stay hydrated while in care facility? Any other ideas? This is my last care plan and I've been working on it for 2 days.

. It's apart of my whole care plan. Sorry i did not make it clear. Since the patient is unable to speak with me since I do not know spanish my teacher told me to use the family's quotes.

so would this nanda be: bowel incontinence r/t infectious disease?

This is my last care plan I have to do. I've had a few good ones but mostly NI. This is my last chance to prove myself. I've bought tons of books and studied and read all weekend on charting! I've read countless posts on this site and hope to gosh it has helped me. I would really appreciate critique on this last one. 7:05 Standard & contact precautions maintained. Lying in bed in supine position, resting with eyes closed, mouth open. R-15, equal and unlabored. IV patent & intact on right inner forearm. Free from redness, edema and drainage. Infusing 40cc/hr of 1000ml D-5-W. O2 2liters by nasula cannula. Foley draining by gravity. Urine reddish brown. Both feet in foot pillow under bed cradle. Large left toe with dry dressing, no fluid or drainage present. Bed alarm on, side rails up x2. Remains in bed with eyes closed. Reported urine color to nurse. -----------------s. butler svn 8:30 In bed, supine position, eyes open. Son and daughter-in-law present. No acute distress noted at this time. NPO due to EGD 11.12.2007. VS t -96.6, p 102, r18, bp 123/65. Pulse oximetry 100%. Orientated x2, disorientated to time. Responds to verbal loud stimuli, hearing aid x2. Incomprehensible speech. Head atraumatic, free of infection and normocephalic. Flat affect - Bell's Palsy. Eyes symmetrical, sclera white, pupils irregular and sluggish. Possible cataract surgery. Conjunctiva moist. Drainage bilaterally. Nasal patent bilaterally. 02 at 2 litters by nasal cannula. Buccal mucosa dry, oral mucosa pink and dry. Upper and lower dentures present. Lips dry. Ears symmetrical, dried drainage present. Carotid weak bilaterally. No bruits or thrills present on neck. Full Rom in neck. Breath sounds clear to auscultation. No cough present "She only coughs to clear her throat" states daughter-in-law. R-18 even and unlabored. Apical 65, rhythm equal, s1 and s2 noted but irregular. Skin warm to touch, thin, hyper pigmentation present. Multiple bruises bilaterally on inner and outer forearm and upper arm in various stages of healing. 3 cm bruise noted at old iv site on left hand covered with cotton ball and transparent tape. Iv site patent on right inner forearm, site free of redness/edema/warmth. Dressed with transparent tape. Iv infusing 40cc/ml of 1000 ml d-5-w. Complains of no pain in area. Capillary refill on nail beds 3. Toenails splintered and thick. 2X2 dressing on Greater Large Left toe, no drainage present. Small necrotic tissue present on second left toe 9:15 Standard and contact precautions taken. Assisted can in changing chux. Loose light brown stools. Skin bruising and moist skin on sacral area, >10X10 cm. No skin breakdown at this time. Peri care provided. Moisture Barrier Cream applied to sacral and buttock area. Explained reason for sacral area and rational of cream protecting skin and repelling moisture. Instructed family to use call bell for needs or assistance especially when BM has occurred. Explained keeping her dry will help to prevent skin breakdown from runny stools. Verbalized understanding. Bed rails up X2, bed in low position, bed alarm on.---------sb svn 9:30 resting, eyes closed. Family stated "comfortable". Iv site patent, no signs of distress. Will continue to monitor closely----------------------------------------------------------------------------------sb svn 10:42 eyes closed in bed. Family reading. Nurse infused piggyback piperail 2.25g @ 75ml/hr. Awoke to stimulus. C/o "dry mouth". Explained she cannot have anything to drink because of procedure scheduled today. Insistent on "dry mouth" Explained again she can't have anything to drink but I can return with mouth swaps to help relieve the dryness. Son voiced concern on what time they will be coming to get her for the procedure, "11 hours is a long time to go without water or food, she must be miserable". Told son i would relay the message to the nurse to call doctor and find out time. 02 at 2liters, pulse oximetry 98%. Reported to nurse--------------------------------------------------------------------sb svn 11:05 back to room with oral care pack. Pt eyes closed, r even and unlabored. Instructed family how to use swabs and tube of lip care upon her awakening. Explained not to allow her to swallow. ------sb svn 12:15 pt in bed resting, eyes closed, family present. "Didn't like the swabs, but better than nothing. Still complains of dry mouth." Instructed family to swab again in 30 min to help relieve dryness. Reported now news of doctor call back. ----------------------------------------------------------------sb svn 12:26 call be rang, "she need to be changed" states daughter-in-law. Called for can. Standard and contact precautions maintained. Brown runny BM. No odor. No consistency. Changed chux. Peri Care provided. Moisture barrier applied to sacral and buttock area. Pt's words incomprehensible. Family states shes "mumbling." Bed rails up X2, bed in low position. Iv site patent, site free of complications. -----------------------------------------------------------------------------sb svn 1:20 Nurse in room assisting change to stretcher for EGD. Family "relieved" to finally get her to procedure. Reported off to nurse. ----------------------------------------------------------sb svn

Ah.. I see. I was trying to add numbers that were not important.

Daytonite, thanks so much. I couldn't for the life of me figure it out. You exercise helped me. Thanks again. And for the most part, I hope I'm able to help to help other out when I get out of school.

Last time I put that in my notes because I learned that in med terms but I stood corrected, there was a huge line in it. I even tried pupura once and that was also marked out. My teacher said to use bruise. So i really don't know what the proper way is to use, I guess I'll keep using bruise in the school but when I get out I'll use ecchymotic area. Grr.