RNConnieF

Deb, Too busy for words. One husband, 2 kids still at home, 2 jobs- full time in CC, part time as a clinical instructor, and still in school for my BSN. In my spare time I'm still a band mom and an active school volunteer. I don't get as much time as I'd like here but I do try to check in every few days. Good to hear from you, hope all is well.

Thank you for speaking with my voice. My husband suffered an MI with follow up stent placement at age 46. We had four children, the youngest not quite two. Your voice speaks for all of us.

Can't go as a witch, it's supposed to be dress up not another day!

I'm going as a nurse. White dress, white hose, white shoes, and cap. I did it last year and everyone- staff, pts., security, housekeeping, food service- had a great time with it. Our entire floor is considering doing it this year. Except for a few very elderly co-workers everyone got the joke. When I came home I took my son out trick or treating in the same outfit, my neighbors thought it was funny.

Meltdown is part of the job (I'm hoping.) I had a near melt down all week! Too much stress, kidney infection, dysfunctional uterine bleeding (welcome to the wonderful world of menopause), and families who need a full time, 24 hr nurse all to them selves. This has been one of the worst weeks I've ever worked. My co-workers all understand, they've done the same themselves. It happens to all of us.

I started an LPN program just past my 40th birthday with 1 husband and 4 kidw (2-12). I started the RN program at age 46 still with 1 husbane (he's understanding), 4 kids (none ran away) and 2 jobs. Now at almost 49 (next week) I am in a BSN program with 1 husband, 2 kids still at home, and 2 jobs (1 full time and 1 part time.) 26 is sooooo young. If you want it go for it. It's never too late!

Any patient has the right to refuse care. They also are then obligated to accept the ramifications of their refusal. If you refuse care because the assigned care giver is of color then you are refusing care, period. This is no different than signing out AMA. In this care the pt. had every right to refuse care, the hospital went wrong by making allowing alternate providers.

As of 1/1/2004 ,in the facility I work in, acryilc tips, silk wraps, or any type of nail overlay are all banned for people providing direct pateint care. There are no restricitons on natural nails or nail polish on natural nails.

I just found this thread. I even read most of the posts (OK as soon as it gets nasty I skip to the next post). I started my career as an LPN. I knew that with my last child starting school in 2 years I needed to have something to look forward to. I went to nursing school because people kept telling me I would make a good nurse. I went to LPN school because they had a part time nights and weekend program. Oddly enough, the folks who told me I would make a good nurse where right, I am a good nurse. As time went on I decided to go to RN school for no other reason than to expand my knowledge within my now, chosen profession. I went into the ADN program because there where very few diploma programs left around here. I have just started the BSN program for the same reason I started the RN program, there is still so much I want to learn about ALL aspects of nursing. Some of us need to go slowly, succeed, and then advance. While I was working as an LPN in PA I was unable to do INITIAL assessments, hang blood, push IV meds, or take verbal orders. I also had to have my assessments and notes countersigned by the RN who was covering me; in PA LPN's have dependent licenses, RN's have independent ones. One of the LPNs I work with now has the most professional way of involving me when I cover her patients that I have ever seen; she gives me a copy of her working care cardex noted, in writing, with anything that I have to do i.e. if blood is ordered. She also gives me a cover sheet that includes the pt's VS, IVF, access, current labs and all the information I need to know about the pt. to cover her. I wish all the RN's I work with did this before signing off to me for lunch or meetings. Nursing is not a matter of individual tasks, nursing is all about competent pt. care. We all do the same THINGS, I clean poop and so does the LPN. It's time we accept each other (and NAs) as the pt. care professionals we all are.

One way to get around the no medical dx is to say R/T "disease , process". I'm pretty sure the decreased gastric motility would fly it's not a diagnosis. For diabetes you would have to say something about "ineffective metabolism of carbohydrates". It sounds silly but it works. As for interventions, you should be basing ALL your nursing care on a care plan, even if it's in your head, all the time. As you go on in the program you'll have to turn in your care plan at the end of the clinical day so start thinking now about using care plans in practice and not just as a paper that's due. It comes with practice, and I'm sure you're already doing it. When you first meet your diabetic pt. you know right away that diet teaching is going to be a priority-that's using a care plan. See, it's not as hard as it looks.

You can't use a medical diagnosis as part of your diagnosis- it HAS to be a nursing diagnosis. Some instructors won't let you use a medical diagnosis EVER, some are more reasonable-it depends. Your diagnosis is MUCH better than mine in not using a medical diagnosis. Sounds like you did a great job. Way to go.

The goal of a Care Plan is to meet your pts. needs, as you define them (Diagnosis). The short version of this is: What is the problem? Diagnosis What makes this the problem? Related To How do I know this is the problem? As Evidenced By What nursing care do I need to provide to solve this problem? Implementation. Why do I want to do this? Rational for Implementation. How do I want this to end? Outcome How fast? Goal How do I know I did a good job nursing this pt? Evaluation. I start by getting my Diagnosis, Related To, and As Evidenced by. Then I jump to my Outcome. After I know where I want to go I can develop a plan to get there (Implementation) and why I am going to do these things (Rational). Now I do my short and long term goals and Evaluation. For your pt. it would look like this: Diagnosis: Self Care Deficit-Nutrition Less Than Body Requirements ,R/T Dietary Restrictions of Diabetes and Gastroparesis; AEB:1) Hospitalization for N/V, 2) Electrolyte Values (here list the abnormal values you have that are related to N/V), 3) Change in Normal Bowel Patterns. From here it's easy- what do you want to have happen? (Outcome) 1)Pt. tolerates kCal intake of 1500 calories/day (or whatever works for you)prior to d/c, 2) Electrolyte values return to pt's baseline, within 3 days, 3) Bowel function returns to pt's norm, prior to d/c, 4) Pt.verbalizes understanding of dietary restrictions, by end of shift, What do you have to do to make it happen? (Implementation) 1) Provide written diet education materials, (Rational: education is necessary to develop plan),2) Provide socialization during meals,(pt may eat better if meal time is a social experience, 3) Pt. participates in the development of a plan to meet nutritional needs after d/c, within 4 days. And so on, I think you get the idea. Now, go back and evaluate your interventions, all you have to do is go down your list of Outcomes and state either "Met" or "Unmet". If unmet you have to revise your outcome or intervention. Once you get the hang of it it's easy. Keep working on it, you'll get it.

I once saw an assessment that stated "PP x 4" only problem is that the pt was a double BKA. Not sure exactly where the BLE PP where, guess with the pts legs.

We draw from the PICC. Our PICC protocol calls for referral for a PICC line for "poor venous access", meaning no peripheral veins for blood draws.

I'm not making this up, really. I got printed orders today from... Dr. Hardy Bang. I swear! That's really the name. I would HAVE to chang my name. :roll