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Hi all, I'm a 3rd year nursing student, doing my (hopefully) last assignment of the course!! This assignment is about prioritisation of nursing care plan. I've got a case of a 34 year-old lady, who was diagnosed with a meningioma and had c-section 5 months ago. She is admitted to hospital for revision of the shunt and for a possible gastic ulcer. She has been experiencing increased nausea and vomiting over the last few weeks. considering all her current condition physically, psychosocially, nutritionally etc., I came up with 5 nursing diagnoses. that includes; Deficit fluid volume Imbalanced nutrition, less than body requirements Risk of falls Activitiy intolerance & self-care deficit Ineffective coping Now, I have to prioritize those nursing diagnoses and provide rationale for that with supportive evidence from recent literatures. According to Column, prioritizing care is an essential nursing skill and it is differentiating between problems needing immediate attention and those requiring subsequent action requires great skill and judgment. So it can be done by dividing and putting the care practices into three levels. 1. Immediate first-level patient problem: emergency life-threatening and safety situations (e.g. ABC system) 2. Second level: concerns such things as mental status change, acute pain, acute uinary elimination etc. 3. Third-level priority: those that do not fit into the above two categories (e.g. lack of knowledge, loger-term problems with living activities etc) According to that three levels of prioritization, I tried to differentiate my nursing diagnoses. 1. Deficit fluid volume 2. Imbalanced nutrition, less than body requirements 3. risk of falls 4. activity intolerance 5. self-care deficit 6. ineffective coping Is this right??? please help me out with the assignment gimme some tips in prioritizing care from you experiences or if you know any good literature/websites about prioritization, please let me know! thanks heaps always!!:heartbeat

Hi all I'm a 3rd year nursing student I wonder if anyone can help me out with this questions if a patient with MI is deteriorating; complaining about chest pain and difficulty in breathing, suspected complication pulmonary oedema. what would you assess as a RN and what interventions would you initiate in that situation?? also, which health care team would you involve and collaborate? i always thank for your help! this is such a great site!!

thank you very much for your replies! it was a much help to start with! thanx alot:p but ive got afew more questions i still don't know why the patient bruise so easily? what's the reason behind that? also, she states that menses have not returned since the baby was born.. what does it indicate? also, as cmonkey stated, i suspect recurrence of meningioma.. but then that is a medical diagnoses isn't it? is there a nursing diagnoses for that?? thanks again for all your help! I really appreciate it

hello! i'm 3rd year nursing student. i've got an assignment and its about analysing patient's data to come up with nursing diagnosis to deliver appropriate care for the patient. there is a given scenario. i used the gordon's functional health patterns to classify the data, but then i'm not sure whether im doing it right or not. :confused:and also, it is still hard for me to look at the patient's situation in a holistic way.. such as physically, emotionally, financially etc.. can you please help me out to put things on the right track? here is the case scenario that is given: susan ryan, 34 year, works part time as a personal assistant. last year, during her pregnancy, she was diagnosed with a meningioma. the tumour was removed and a c-section performed 5 months ago. since then she has been hospitalised on a number of occasions for revision of a cerebral shunt. she is being admitted to hospital this time for revision of the shunt and for a possible gastric ulcer. she has been experiencing increased nauea and vomiting over the last few weeks. due to her illness, she has been medically retired from the army. her husband's (real estate agent) income and her military disability pension are the family's source of income. susan appears to have a strong spirituality and believes in prayer as being a great support. she appears slightly introverted and quiet. susan verbalises: "fear and guilt" over her illness, the delivery of her baby prematurely at 8 months and the fact that she cannot independently look after her child. the thought of coming into hospital again "makes me sick". susan understnads she is coming into hospital for a shunt revision. she believes this revision will alleviate the nausea and vomiting. lab results (si units) haemaglobin: 11g/dl haematorit: 0.35 na: 150 mmol/l k: 3.2 mmol/l cl 90 mmol/l glucose: 6 mmol/l cholesterol: 4.6mmol/l triglycerides: 1.0 total protein: 88g/l albumin 53g/l further assessments are done and here are the information given (ill just write only that i think considerable) reason for visit: nausea and vomiting, spasticity and weakness of right side allergy: erythromyacin childhood illnesses: measles, mumps and chicken pox family history: mother uterine cancer; both prents have gastric ulcers; two maternal aunts breast cancer nutritional: not feeling hungry due to increased nausea and vomiting for last 3 weeks following integumentary: dry sknin and says bruises easily gastrointestinal: increased episodes of nausea and vomiting; experiencing pain 1-2 hours after meals, burning gaseous pressure urinary: voids several times per dya, smaller amounts than usual; dark yellow in colour; strong odour musculoskeletal: feeling clumsy and body is always weak; uses a four-point cane when walking neurologic: states difficulty in finding words sometimes affect/ mood: quiet, slightly introverted mobility/gait: ataxic obvious deformities: jerking right arm symmetry of body: right sided hyperreflexia dry tongue some altered balance on standing; ataxia; uses 4-point cane to ambulate so, all the relevant information should be clustered and make nursing diagnoses about that. and i have to write validations about that and give references as well. for example: cluster of cues: -hx of falls; dizziness; older age; medicaton; disorientated and confused nursing diagnoses would be: risk of falls validation: older age groups are ar high risk of fall injury (nsw department of health, 2005) this is supported by..... please help me out with this it would be very much appreciated!! many many thanks!:redpinkhe

hello~ i'm a 2nd year nursing student :) i'm doing a subject called cellular alteration and there is an assignment due next week. your help would be very much appreciated! :) it's a question-answer format and few questions are a bit complicated. these are the case scenario and questions! jo is a 40-year-old mother of two teenage daughters who is employed as a barista at a local cafe. she consulted the family doctor after moticing a lump in her left breast during her monthly breast self-examination (bse). a mammogram revealed a 3 cm lump with irregular borders in the upper outer quadrant of her left breast. jo was referred to a surgeon who performed a fine-needle aspiration biopsy. two days later, the biopsy result came back positive for invasive ductal carcinoma. after much discussion with the surgeon and her husband, jo agreed to have a modivfied radical mastectomy with lymph node dissection. there is a family history of cancer. jo's father died of lung cancer at age 65. jo's mother and one of her maternal aunts died of breast cancer in their late 50s. her twin sister also had breast cancer diagnosed two months ago. question1: what is bse? discuss the best time of the month to perform bse. question2: explain the procedure and discuss the accuracy of mammogram and fine-needle aspiration biopsy. question3: what is invasive ductal carcinoma? question4: explain the meaning of modified radical mastectomy with lymph node dissection. the surgeon ordered a whole body bome scan and a chest x-ray before the surgery. question5: why were a bone scan and chest x-ray ordered? jo returned to the ward after the operation. apart from an iv infusion and a morphine pca, there was a jackson-pratt drain coming out from jo's breast wound. question6: discuss two actual and one potential nursing problems and their evidence-based interventions in the first 48 hours after the surgery. the pathology report confirmed that the tumour is hormone sensitive and that 8 our of 15 lymph nodes were positive for cancer. based on this report, the oncologist recommended four cycles of combination chemotherapy (iv doxorubicin and cyclophosphamide) and hormone therapy (oral tamoxifen for four years). question7: discuss the specific nursing care in each treatment approach. two weeks into her treatment, jo is having trtouble coping with her diagnosis and treatment. question8: describe possible support mechanisms that could be provbided to jo and her family. jo completed her first cydcle of chemotherapy and is ready to go home tomorrow. while you are preparing her discharge papers, she asks you the following two questions. what information would you provide to jo? question9: "what long-term issues will i have to deal with?" question10: "it looks like breast cancer is part of the family legacy. when will it happen to my daughters? what should we do?" (you are expected to know more than just referring jo to the cnc/oncologist in your answer.)

I'm sorry to bother you so much..but I have one more question. When the question asks how the nurse collaborate with the consumer, the family and the community mental health urse to address the problem, the nurse definitely need to educate the consumer and the family, rite?? but Jack's family live in a remote country town and Jack lives in a hostel in the community, so I thought the nurse can provide the family information about Jack's medical conditions and how to manage and things like that by calling them or writing a letter or sending an email. Is that ok? also, since they are not living together, the family wouldn't be able to help and support and take care of Jack effectively, would they? So I decided to focus on collaboration with the community nurses more as they can support Jack better than the family do. Am I right? Then, what can I do as a resistered nurse to collaborate with the community mental health nurse? all I can think of is that RN provides information about Jack to the community nurse and suggest or discuss any community support services that would be needed by Jack. is there anything else?? thanks for your reply. I really appreciate that :)

Daytonite thanks very much for your posting. It really helps! :wink2: but I still have got few questions, in the case study, it doesn't tell us about that Jack is anxious because of the pressure by his family wanting him to get married or he wants to please his family or anything like that. When we determine the nursing problems, is that ok to make an assumption because we don't have enough information?? Also, for the nursing diagnosis, I have difficulties finding the evidences of the nursing diagnosis from the case scenario. I tried write nursing diagnoses, could you please check it and tell me anything to add into or take from? Ineffective coping related to inadequate coping method, personal vulnerability, poor self-esteem, inadequate social support as evidenced by inability to keep regular employment, hesitancy of applying for a job for fear of being rejected or eventually sacked, expressing feelings of intimidation and anxiety when approaching women and the symptoms of Schiziophrenia like delusion and hallucinations. Ineffective health maintenance related to lack of ability to make deliberate and thoughful judgments, perceptual or cognitive impairment, ineffective coping, ineffective family coping, inability to seek out help to maintain healthlack of material resources as evidenced by frequent stopping of medication because of the side effects, having ambivalent relationship with his family. The rationales that you have given me were great, but I also have some rationales from the Nursing diagnosis handbook. Can you please check these are right? Ineffective Health Maintenance: -assess for family patterns, economic issues, and cultural patterns that influence compliance with a given medical regimen -identify support groups related to the disease process -assist the client in reducing stress -refer the client to community agencies for appropriate follow-up care -provide the family with information about the client's disease Ineffective Coping: -assess the risk of the client's harming self or others and intervene appropriately -use empathetic communicatoin and encourage the client and family to verberlize fears, express emotions -refer for counseling as needed -provide the client and the family with needed information regarding the condition and treatment -work closely with the client to develop appropriate educational tools that address individualized needs -teach the client about available community resources What is difference between rationale and the nursing interventions? are they the same? cuz the rationales that I have listed are like interventions.. Last question! Im still not sure about those nursing diagnosis are the priority problems.. bcuz my tutor said the priority is anything that is threat the patient's safety. Is there any other problem that is more urgent than those two? Once again thanks for your help. I really appriciate that!:)

Daytonite Thank you very much for your help but I think I need to change the case scenario as I found the previous one so hard. :yldhdbng: I'm sorry.. Please help me again with this.. that would be very much appriciated! I hope this one is easier than the other one. Case Scenario Jack Jones is a 42 year old man who has had several psychiatric admissions, his first when he was 18 and in his first year at university. Over the past 9 years he has been declining in his ability to live in the community. After a 10-day admission, Jack is almost ready for discharge from the psychiatic unit in which you are working. Prior to Jack's admissions to hospital he has had a pattern of similar experiences. That is, he often ceases to take his medication, stating that he stops the medication because of the extra-pyramidal side-effects, dry mouth and blurred vision, that are "unbearable, and I'd have to say, they are worse than the psychotic symptoms". Shortly following this, he begins to believe that he is being talked about on the radio (derogatively) and hears voices telling him that the government is monitoring his every move via a tracking device. When Jack is ill, he believes this device was implanted during his first admission. Just before this admission he went to the police to ask them to "find out who put it there and to lock them up in prison". Jack lives in a large hostel in the community supervised by an unqualified home care assistant. "I like it because it is cheap, I can spend my money on what I want, and they don't hassle me". He has recently been unable to keep regular employment as a labourer on building sites, and is hesitant to apply for any job for fear of being rejected or eventually sacked. Jack also believes that he should have a girlfriend but often expresses feelings of intimidation and anxiety when approaching women. He has a highly ambivalent relationship with his family, whom he says "shout and argue all the time". They live in a remote country town and keep asking me "when am I going to find a nice girl and get married, and have someone to look after me". Following a team meeting, the Psychiatric Registrar has ordered that he be recommenced on Flupenthixol Decanoate 20 mgs 2nd weekly and Cogentin 2mg mane Briefly describe the problems that Jack is experiencing that impact on his health and well-being. Then, identify two priority problems and state them as nursing diagnoses, briefly outlining your rationale for each diagnosis. Discuss how you as a registered nurse would collaborate with the consumer, the family and the community mental health nurse to address the two identified priority problems and facilitate continuity of care, after Jack's discharge. the problems that I have found include; -the fact that he often ceases to take his medication -he believes that he is being talked about on the radio (delusion) -and hears voices (hallucinations) -he is unable to keep regular employment as a labourer on building sites -he often expresses feelings of intimidation and anxiety when approaching women I though the priority problems can be the fact that he often ceases the medication and the being intimidated and anxious when approaching as these feelings can be the source of harm people especially women. I think it is more likely to be a psychologists' or a doctor's responsibilities than nurses' to deal with the schizophrenic symptoms like delusion and hallucination. Am I right?

Thank you very much for the reply. I really appriciated that :) I really need more practice on the critical thinking and planning nursing care for patients. However, Im just wondering, the risk of harm to family or others can be the one of the priority problems although it is an anticipated problem, no?? cuz my tutor said if there is any risk of harm to himself of others, that would be the priority problem, anything that is associated with harming anyone. Also, could you please explain me how to collaborate with the consumer, the family and the community nurse to address the two problems and facilitate continuity of care after his discharg. I think the most important thing is to educate the patient and the family to enhance the family supports. the education can include the information about the drugs and the side effects and how to deal with his abnormal behaviours and what to do in emergency situations. Am I right?

Hello I'm a second year nursing student. I'm doing a subject called Mental Health Nursing and I have an essay to write. These are the case scenario and the essay question. Case Scenario Roberto Roma is a 25 year old man who has had several psychiatric admissions over the past ten years, his first admission to an adolescent mental health unit for a brief psychotic episode after using marijiana. He is almost ready for discharge from the psychiatric unit in which you are working and he has asked for your help "in making a better go of living and to re-establish relationships with my family". He was admitted by the acute care team, and accompanied by the police who were called by his parents. His parents stated that, "he went crazy and threatened to kill us". Prior to Roberto's admissions to hospital he often ceases to take his medication, Olanzapine 5mgs bd. He also states that he has been drinking alcohol and smoking marijuana on an increasingly regular basis. He tells you that, "it helps me to deal with the terrible situation I am in". Roberto has been assessed by the Richmond Fellowship assessment team for the first vacancy in one of their community residential houses. Roberto has been living with his parents and two younger brothers and has been unable to keep regular employment as a clerk in the public service. Briefly describe the problems that Roberto is experiencing that impact on his health and well-being. Then, identify two Priority problems and state them as nursing diagnoses, briefly outlining your rationale for each diagnosis. Discuss how you as a registered nurse address the two identified priority problems and facilitate continuity of care, after Roberto's discharge. the two priority problems that i think are the fact that he is at risk of harm his family or other people and he has been drinking and smoking marijuana on an increasingly regular basis. Am I on the right track?? because my tutor said the priority problems include the person's behaviour (suicidal/homicidal) "Is there any risk of harm to himself or to others?" "Is the person engaging any harm?" If the two things are the priority problems, what are the nursing diagnosis related to those problems? and how can I address the problems and facilitate continuity of care?? Please help me to get the ideas to start with. Thanks alot!

When the question asks about the nurses' responsibilities involved in the IV administration, does that mean the procedure of the administration of the drug??

I thought the antibiotics are to be given because the patient's having symptoms of infection like the fever and diarrhoea. am I on the right track?

Hello I'm a second year nursing student Ive got a case study of a 27-year-old man called Jeff. He presented to the ED with a bleeding gum cavity after a tooth extraction. He was diagnosed with acute myeloid leukaemia after all the blood tests. He has done chemotherpy and he tolerated well. However, on day 10 post chemotherapy, Jeff spiked a temperature of 39 degree with rigors and profuse sweating. He also experienced two episodes of watery diarrhoea. The doctor prescribed antibiotics. Gentamicin 80mg IV 8 hourly. Explain why antibiotics are to be given. Revise the nursing responsibilities involved in the IV administration of medications. Please help me with this. I need to present this in front of the class on Monday Thank you~

Hi. I'm a 1st year nursing student. During the clinical placement, I came up with a few questions. Please help me out with those questions:p 1) Why is it important to introduce myself prior to providing care?? 2) What is Isotonic IV fluids?? example?? 3) What are the 3 phases of wound healing?

This elderly patient(82) was admitted to a hospital and catheterized (indwelling catheter). so, what things would you be telling to her- in terms of patient education?