littlelight98

Can you please send your renal notes to me through my e-mail in my profile page ? As I have a 78.75 avg going into this last (Renal) test before the final. I would greatly appreciate it!

Thank you, I will definately just leave those out. Ok, just for my own knowledge, if I touch the pt with the ball of my hand over his heart that will be a way to ascertain heart arrhythmias, right? And taking BP will reveal hypotension as evidenced by a low BP reading, right?

thanks so much. i'm confused about your comment regarding #1 intervention? you said that "hypotension and arrhythmias are not a symptom of hypocalcemia" in my "fluid and electrolyte book made incredibly easy" page 150, it says that "other signs of hypocalcemia include: -diarrhea -hyperactive deep tendon reflexes -diminished response to digoxin -decreased cardiac output and subsequent arrhythmias -prolonged s segment on electrcardiogram -lentghened qt interval on ecg, which puts the patient at risk for torsades de pointes (a form of ventricular tachycardia) -decreased myocardial contractility, leading to angina, bradycardia, hypotension, and heart failure. , am i missing something? can i state my #1 intervention as follows and be on the right track: [color=#632423]monitor vs q2h (bp for aggravated arrhythmias secondary to decreased cardiac output; pulse for hypotension secondary to decreased myocardial contractility. [color=#632423][color=#632423] [color=#632423]concerning intervention #4 my pt was given calcitiol po which can cause gi constipation. am i on the right track by wording #4 intervention as follows: [color=#632423] [color=#632423][color=#632423]monitor intake of calcitiol (0.25 mcg t.i.d po) for constipation. if pt becomes constipated, notify md and request orders for pt. [color=#632423]thank you again. i'm really sweating this. i have to do well. i'm trying so hard, and you have taken alot of time to help me. i do appreciate it! [color=#632423]

please tell me if i'm on the right track with my priority nursing interventions i.e., correct in order of importance, and proper time parameters for the following 6 nursing priority interventions. my priority nursing diagnosis is 'risk for unstable blood calcium related tothyroidectomy secondary to thyroid cancer' #1 interventionmonitor vs q2h (bp and pulse) for aggravated arrhythmias, and hypotension #2 interventionmonitor daily total serum calcium levels (normal is 8.0 mg/dl-10.4 mg/dl, panic level is #3 interventionmonitor q day to see that baseline levels of the following have been established: serum phosphate (2.4 mg/dl-4.7 mg/dl, panic level is 5) and ionized calcium (4 to 5.6 mg/dl). if not, notify md and request orders for pt. #4 interventionmonitor to see that pt is tolerating [vitamin d] (0.25 mcg t.i.d po) as per doctor's orders. if not, notify md and request orders for pt. #5 interventionmonitor the patient q shift for any of the following signs/symptoms/complaints: vomiting, diarrhea, nervousness, weakness, paresthesias (a sensation of numbness, prickling, or tingling), muscle stiffness and muscle cramps in the face or fingers, headaches, dysphagia, abdominal pain #6 interventionperform the following specific assessments q8h: chvostek's sign - tapping the person just in front of the earlobe & below the zygomatic arch and the corner of the mouth will produce twitching of that corner of the mouth to twitching of all facial muscles on that side of the face. trousseau's sign (carpopedal spasm) - a blood pressure cuff is inflated to between the diastolic and systolic pressures and allowed to remain inflated for 3 minutes while watching the patient for evidence of carpal spasm in that arm which is positive evidence of trousseau's sign if [+] signs appearnotify md and request orders for pt.

in your opening statem you helped me to see that, "for actual nursing problems, the sequence of interventions is always: assessment, nursing care, teaching, management." i have a question regarding "management." you mean to say that the patient is the one who will manage his/her situation, right? otherwise, if the rn manages care after teaching the patient then it's more of a rest-home or retirement-home, or rehab type setting, right? i mean to say that from the little i've seen the hospitals are trying to turn out the patients as quickly as possible. thanks again for all you do.

from the information you gave this is how i did my nursing interventions. am i on track? thanks again: #1 intervention: monitor daily total serum calcium levels (normal is 8.0 mg/dl-10.4 mg/dl, panic level is rationale with reference & pg. #: pt is at risk for hypoparathyroidism secondary to total thyroidectomy. therefore it is essential that calcium levels stay stable. calcium plays a major role in transmitting nerve impulses and helps regulate muscle contraction and relaxation, including cardiac muscle. calcium is instrumental in activating enzymes that stimulate many essential chemical reactions in the body, and it also plays a role in blood coagulation. [smeltzer’s pg325] evaluation: blood ca levels rose from 7.9 – 9.0 mg/dl 3 days postop #2 intervention: monitor to see that baseline levels of the following have been established: serum phosphate (2.4 mg/dl-4.7 mg/dl, panic level is 5) and calcitriol [vitamin d] (0.25 mcg t.i.d po). if not, notify md and request orders for pt. rationale with reference & pg. #: a risk after thyroid surgery, hypoparathyroidism impairs synthesis of pth. when less pth is synthesized, less phosphorus is excreted from the kidneys. the result elevated serum phosphorus levels which put the pt at risk for cardiac irregularities, hyperreflexia, muscle weakness, and olguria. vitamin d plays a role in calcium metabolism and utilization in the body. [williams, pg 172,173] [smeltzer’s pg325] evaluation: phosphorus levels [2/11 4.3 mg/dl, 2/12 3.0 mg/dl]. calcitriol [vitamin d] (0.25 mcg t.i.d po) given on schedule #3 intervention: rationale with reference & pg. #: monitor the patient for any of the following signs/symptoms/complaints: vomiting, diarrhea, nervousness, weakness, paresthesias (a sensation of numbness, prickling, or tingling), muscle stiffness and muscle cramps in the face or fingers, headaches, dysphagia, abdominal pain. rationale with reference & pg. #: these signs are indicative of hypocalcemia. [williams, pgs 149,150] evaluation: no complaints or signs of hypocalcemia #4 intervention: perform the following specific assessments q8h: chvostek's sign - tapping the person just in front of the earlobe and below the zygomatic arch and the corner of the mouth will produce twitching of that corner of the mouth to twitching of all facial muscles on that side of the face. trousseau's sign (carpopedal spasm) - a blood pressure cuff is inflated to between the diastolic and systolic pressures and allowed to remain inflated for 3 minutes while watching the patient for evidence of carpal spasm in that arm which is positive evidence of trousseau's sign rationale with reference & pg. #: testing for trousseau’s and chvostek’s signs can help diagnose tetany and hypocalcemia. [williams, pgs 149,150] evaluation: trousseau’s/chvostek’s signs not indicated because by postop day 3 serum calcium levels reflected improvement from 7.9 mg/dl to 9.0 mg/dl. #5 intervention: report serum calcium 10.4 mg/dl to the surgeon immediately. rationale with reference & pg. evaluation calcium levels above 10.4 indicate hypercalcemia. calcium levels below 8.0 indicate hypocalcemia. [williams, pg 26] evaluation: on postop day one pts serum calcium levels reflected 7.9 mg/dl. by postop day 3 serum calcium levels reflected improvement from 7.9 mg/dl to 9.0 mg/dl. #6 intervention: document and report positive results of either/or trousseau’s or chvostek's sign to the physician. rationale with reference & pg. #: trousseau’s and chvostek’s signs can help diagnose tetany and hypocalcemia, and any positive signs must be documented and reported at once. reporting to the dr. ultimately benefits the pt. the dr. needs this information to properly tend to the pt. the hospital and the community benefit from prompt reporting and documenting. documentation provides necessary information to the pts insurance provider, government agencies, and when necessary, law enforcement personnel. [kozier, pg 74] evaluation: trousseau’s/chvostek’s signs not documented because by postop day 3 serum calcium levels reflected improvement from 7.9 mg/dl to 9.0 mg/dl.

I read and reread everything you said and all your links, and you are very helpful. Thank you so much!

i can't thank you enough for your help!!! can you tell me more about how vit. d plays a role in calcium metabolism and utilization in the body?

Please help. I have to redo my concept map assignment and I have to get a high score or I fail out of the RN program. It's my second semester, and I've worked so hard. Here's what I have done so far but it seems to wordy and I fear I'm missing something? Can you help? Priority Nursing Diagnosis Risk for unstable blood calcium related to throidectomy secondary to thyroid cancer #1_InterventionReview lab Ca­­+ levels as soon as received from lab for ↓ blood Ca+ as ordered by the MD. #2_InterventionIf ↓ blood Ca+ is indicated administer Calcium Carbonate 500 mg 2 tabs t.I.d. per M.D. #3_InterventionImmediate and ongoing (with every entrance into pts room) observation for signs and symptoms of hypocalcemia are indicated (I.e., tetany symptoms: muscular twitching and tremors, spasms of the larynx, paresthesia [tingling in and numbness of fingers], facial spasms, and spasmodic contractions). #4_InterventionIf no hypocalcemic signs appear, implement immediate q day or PRN for positive Chvostek's/Trousseau's signs e.g., spasms of the cheek and the corner of the lip, carpal spasms. Continue until lab result show Ca­­+ levels 8.5 - 10.0 mg/dl. #5_InterventionOnce pt Ca­­+ has stabilized teach him to avoid overuse of antacids, avoid chronic laxative use, consume foods ↑in Ca­­+/protein, avoid hyperventilation/crossing his legs, and how he can observe for tetany symptoms #6_InterventionConfirm that pt understands instruction by having him explain in his own words all you have taught him.

Thank you so much, actually I need to know what there meaning/significance is in relation to the pt.

My pt had a thryoidectomy, and my instructor wants me to do a concept map over Risk for fluid and electrolyte imbalance. But there is not NANDA for a listing for this. My instructor knows this. But after some brainstorming we both agreed that the calcium levels are likely the culprit and the cure. The only thing close we found in NANDA was Risk for unstable blood glucose. I was wondering if I would be better served in suggesting that I come up with a Nursing Diagnosis of Risk for unstable blood calcium?

Thank you. I have already downloaded a copy of the Critical Thinking Flow Sheet for Nursing Students. I will review it again.

this is only my second semester in rn school (i am currently focusing on urinary and gi), and i have noticed that the lectures and the required reading do not sufficiently prepare me for my exams which are largely over nursing interventions. i'm passing, true, but i no sooner finish doing all my book reading and assignments than i have an exam over nursing interventions. given the plethora of information that i must absorb it seems to me that my time would be better spent towards studying with a focus on application & nursing interventions. i ask that you please offer me guidance and insight as to how better make us of my time? any help in the from of resources, advice, and direction would be greatly appreciated and taken to heart. thanks so much. sincerely, stan snvc

Thank you a lot. I really appreciate it

Hi everyone, I need a clinical lab sheet with normal lab values and spaces to put in the abnormal values of the patient. Can anyone help me with that or direct me to a website that may be useful. Thanks so much! Stan sncv