DChristine

I do have a nursing lab book, but could not find anything on two interventions for LK Esterase with trace instead of having the normal negative for results. It does not even say what it is. I think it has to do with WBCs? I am suppose to have 1 intervention for every normal value and 2 interventions for every abnormal value. It is really hard to write intervention, when you are unsure of what you are looking at.

I love OB. We are doing peds now and I find it hard. Communicating with sick children is not easy. My patient was two, so he was not really fearful of me, but the 4 year old in the other room would not say a word to me.

i think if i had more sleep this would not be so hard, but looking at labs and trying to make sence of abnormals, such as the ua lk esterase. my pt is 2years old and has cystic fibrosis, i am trying to figure the order of nursing dx. as well. was going to group all my oxygen needs into dx(1) and then nutrition less than as dx (2). he is in for iv antibiotics. i was looking at his labs and trying to determine if i should have infection higher up. 1. ineffective airway, breathing, gas exchange r/t excess mucous secretions (maslow's physiological need for oxygen; breathing) 2. imbalance nutrition (maslow's physiological need for food and water) 3. risk for fluid volume imbalance r/t inadequate intake, iv fluids and tube feedings (maslow's physiological need for fluid) 4.risk for decreased cardiac output r/t electrolyte imbalance (maslow's physiological need for circulation) 5. risk for infection r/t decrease in ciliary action and increased pulmonary secretions (maslow's physiological need for physical body regulation) 10/06/08 test result reference ua pediatric dipstick color: yellow yellow clarity: cloudy( ) clear spec gravity 1.019 1.007-1.030 ph 6.0 5.0-8.0 glucose negative negative reduce subst negative negative bilirubin negative negative ketone negative negative blood negative negative protein negative negative urobilinogen normal nitrate negative negative lk esterase trace (high) negative microscopic rbc rare 0-2 / hpf wbc 0-2 0-5 / hpf squam cells rare variable/hpf caox crystal few /hpf ua amorphous light /hpf 10/13/2008 test result reference ua pediatric dipstick color: yellow yellow clarity: clear clear spec gravity 1.009 1.007-1.030 ph 7.5 5.0-8.0 glucose negative negative reduce subst negative negative bilirubin negative negative ketone negative negative blood negative negative protein negative negative urobilinogen negative negative nitrate negative negative lk esterase negative negative microscopic rbc 5-10 (high) 0-2 / hpf wbc 0-2 0-5 / hpf squam cells 0-2 variable/hpf 10/06/08 test result reference cbc wbc 20.0 6.0-17.0k/ mm3f rbc 4.47 3.90-5.20 m/mm3 hgb 13.0 9.8 - 14.5 g/dl hct 38.7 32.0- 43.0 % mcv 86.5 70.0 - 86.0 fl mch 29.1 23.0 - 29.0 pg mchc 33.7 30.0 - 36.0 g/dl rdw 13.6 11-15 % plt 465 150-400 k/ mm3 mpv 7.5 7.4 - 10.4 fl gran % 37,5 15.0 - 35.0 % lymph % 50.5 40.0 - 75.0 % mono % 7.2 2.0- 14.0 % eos % 4.2 0- 6.0% baso % 0.6 0-2.0 % absolute count abs diff gran # 7.5 0.9-6.0 k/mm3 lymph # 10.1 2.4 - 12.8 k/mm3 mono # 1.4 0.1 - 2.4 k/mm3 eos # 0.8 0 - 1.0 k/mm3 baso # 0.1 0 - 0.3 k/mm3 10/06/08 test result reference pt 11.6 9.5-11.0 seconds inr 1.2 0.9 - 1.2 ratio 10/06/08 test result gram stain final test not performed cystic fibrosis resp culture normal oral flora (heavy growth) 10/07/08 test result rad chest 1 view ap/pa evaluation of picc placement l arm 1) portable supine view of chest at 1221 compared to ap supine view dated 5/5/08 2) interval advancement / replacement of the centrally located left approach early picc line. the tip overlies the superior atriocaval junction. redemonstrated are mediastinal vascular clips. 3) the lungs are clear of focal opacification, effusion, or pneumothorax 4) redemonstrated is mild indentation of the right trachea suggestive of a right -sided aortic arch. remaining cardiomediastinal structures are stable 5) osseous structures and overlying soft tissues are unremarkable. 10/07/08 test result adenovirus direct fa negative for adenovirus hmetapneumovirus direct fa negative for hmetapneumovirus influenza a direct fa negative for influenza a virus parainfluenza pool direct fa negative for parainfluenza virus pool 1,2 and 3 rsv direct fa negative for respiratory syncitial virus (rsv) 10/07/08 test result nasal culture organism 1 streptococcus, alpha- hemolytic (light growth) organism 2 rothia species (scant growth) test result reference ige 32 0-49 units/ml 10/07/08 test result reference tobra trough 10/13/08 test result reference bmp na 137 134 - 144 meq/l k 4.9 3.5 - 5.1 meq/l cl 105 96 - 108 meq/l co2 22 22 - 20 meq/ l anion gap 10 4-14 bun 10 7 - 18 mg/dl creatinine 0.3 0.2 - 0.4 mg / dl glu 96 65- 110 mg/ dl calcium 9.4 9.0 - 11.0 mg / dl other lab or diagnostic not found but essential not sure if has had flu shot 10/14/08 test result renal function panel (rfp) results not back yet tobra trough results not back yet

i am trying to list my nursing dx in order using maslow's. my pt is a nonenglish speaking postpartal cesarean. she is breastfeeding and husband translates. fundus firm at umbilicus. her blood pressure was low and given iv bolus to bring up. rbc 3.86 low hgb 11.6 low hct 34.5 low problem list 1. fluid volume deficient r/t blood and electrolyte loss associated with surgery, postpartum hemorrhage. 2. risk for infection r/t delivery and secondary to surgical incision, decreased hb, indwelling catheter, anesthetic administration, breastfeeding, spinal analgesia injection, and i.v. lines 3. impaired tissueintegrityr/t surgical incision and itching from spinal analgesia 4. acute pain r/t surgical incision and trauma 5. imbalanced nutrition: less than body requirements r/t lack of intake prior to surgery and patient's unfavored post surgery clear liquid diet and by physiologic response to abdominal surgery 6. impaired urinary elimination r/t results of l&d 7. knowledge deficit r/t lack of english, misinterpretation 8. breast feeding ineffective r/t mothers dissatisfaction in providing total nutrition from breastfeeding and supplementing with formula 9. sleep deprivation r/t breast feeding and care of infant needs 10. risk for constipation r/t decreased muscle tone, analgesia, lack of intake, breastfeeding do i have these problems in the right order????