intense0120

I am so shocked to hear about this! She has impressed me with all her knowledge and I could always count on her to help me out with difficult case studies and other homework problems. She is really going to be missed.

Not sure what I was thinking or not thinking at all, cuz I truly try to follow your previous demonstration of assessing pts with the abnormals first, and go from there, so I'm not sure what happened here. Maybe its having the summer off, but your previous feedback has really helped me out with past case studies, and want you to know i so appreciate the time involved you take to help us students out. You just really made this look so easy, and I really made this more difficult than it was and missed the obvious of pain and nausea. I was looking more for priority diagnosis of post op pts without assessing THIS patient. With the labs, I jumped to conclusion with dehydration and totally overlooked the blood loss with the low Hgb. Anyway, I can't thank you enough for your help. You always come through! thanks again

i'm struggling on this case study on a make believe pt, due on monday and would greatly appreciate any feedback, critiquing, help, thoughts, etc. been working on this all day and i'm tired so maybe i'll think of some better answers hopefully in the morning. this semester is med surg 1 and emphasis is on the perioperative interventions.:hdvwl: a 70 year old female is admitted for changes in bowel/bladder function. initial lab work was wnl. baseline vital signs were 124/62, hr 84, rr 20, t 98.4. a bowel resection is performed after the pt was diagnosed with colon cancer. postop, the pt is taken to a med surg unit. post, she has an iv of ns at 100ml/hr., an ngt to intermittent suction, a foley catheter, and a midline abdominal dressing that is d/i. you are the nurse caring for this pt her first post op day. at 0700, the bp was 100/60, hr 104, rr 24, t 99.2 orally. the pt is a & o; her color is pale. the ngt tube is draining brownish-green mucous, abdominal dressing is d/i, and the iv is at 100 ml/hr. the pt says, "i'm so tired and i feel so nauseous, and it hurts to move." what would you do first with this pt? list 3 priority interventions you would implement at this time. i would call the surgeon to report a decreased bp and increased pulse rate which could indicate hemorrhage, or shock. interventions should assess the position of person for patent airway, safety, and comfort. assess the urine output and color. check foley catheter site for signs of infection. list 2 categories of medications that you may be administering to this pt. give an example in each category. (remember, the pt has an ng tube) it doesn't say pt is npo, but not sure why she stressed the ng tube. narcotic possibly morphine sulfate sr and msir for breakthrough pain. antiemetic: reglan or metoclopramide liquid for neausea state 2 priority nursing diagnoses and 2 collaborative problems that you identify for this pt. impaired gas exchange r/t the effects of anesthesia, pain, opioid analgesics, and immobility impaired skin integrity r/t surgical wounds, decreased mobility, drains and drainage, and tubes. pc: hypoxemia pc: dvt this is the 2nd part of the case study the physician ordered the pt to be out of bed. when sitting at the bedside at 1000, the pt states, "i don't feel very well." after waiting 30 seconds, the nurse assists the pt to the chair. the pt becomes dizzy and her bp is 90/64, hr 114, and the urine output has been 70 ml since 0600. what could be happening to the pt in relation to this new data and what data supports your conclusions? what would you do first in this situation? at first i thought orthostatic hypotension, but 30 secs at the bedside should have been enough time, and the bp decrease is typically greater than 20/10 mm hg. because of the decreased urine output of 70 ml in 4 hrs when it should be 30 ml every hour would suggest dehydration, along with the increased hr and decreased bp. i would contact the physician for a new order to increase iv fluids?? this is the 3rd part of the case study labs pre-admission labs from the first post-op day rbc 4.3 rbc 3.29 hgb 12.5 hgb 9.2 hct 37.5 hct 48.8 bun 16 bun 35 cr 0.8 cr 1.0 serum osmo 280 m/osmo/l serum osmo 345 m/osmo/l spec. gravity 1.024 spec. gravity 1.034 on the first post-op day, what could be happening to this pt? address each lab value that is abnormal to support your conclusions. decreased rbc's is symptom of blood loss. decreased hemoglobin symptom of blood loss, or anemia. increased hematocrit is a symptom of dehydration. increased bun is a symptom of dehydration. increased omsolarity and specific gravity is when the urine is concentrated another symptom of dehydration. what orders do you anticipate the physician giving to manage this pt now? what nursing interventions do you anticipate implementing? physician would get the patient rehydrated by increasing iv fluids. nurse would continue to monitor labs, maybe give ice chips and provide frequent oral care. based on evidence to achieve positive surgical outcomes, what other issues will address in the subsequent days in taking care of this pt to prevent complication? other issues that need to be addressed are pulmonary complications after surgery, so the pt need to be assisted out of bed and to ambulate as soon as possible to help remove secretions and promote lung expansion, and to also keep blood flow going to prevent dvt. assess the incision, tube, and cath sites for signs of infection. to prevent forceful coughing, emphasize importance of early deep breathing exercises.

I don't have that pt anymore...so I'll never know. Being a new student, that never occurred to me, but from reading a lot of the posts on constipation, it looks like nurses run into this issue all the time. Thanks for your help. I'm leaving the quote off of my diagnosis.

I have to come up with a care plan for this pt I had several weeks ago. Has to be nutrition/elimination diagnosis. 82 year old female, was admitted with pneumonia, COPD. When I interviewed her, she said her normal bowel frequency was three times daily, has hemorrhoids, date of last BM 2 dys ago. She said probably because she is not at her home. Her bowel was distended, and I did listen to her, she did have bowel sounds x4. medications: asa, blood thinners, vasotec, mvi, oscal, theodur,lasix, and administered senokot that morning to her. Intake-800ml Out-500ml 4 hrs. Hgb 10.1 hct 30.3 Na 141, cl 104, K 3.0 I've come up with constipation, r/t decreased peristalsis secondary to: stress AEB last bm 2 dys ago, bowel distended, and pt states, "probably not going, because I'm not at home". can someone critique this before i turn it in, please. Any suggestions would be appreciated, thanks.

Thank you so much for breaking this all down for me. I knew a priority usually includes pain, and right in front of my eyes was the sore throat....so simple, and yet I didn't see it. Every time I read a response from you throughout this site, I can only pray to someday be as good as you. Thanks again.

I have to list 3 priority nursing diagnoses for a case study 21 year old male, brought to urgent care by friend, sore throat past week. Always thirsty, has tried to drink fluids and sleep but wakes q 2-3 hrs to urinate. VS: BP 90/62, P 102, R 30 deep and labored, and enlarged lymph nodes in neck, lungs CTA, heart tones regualr, no murmur or rub. Abdomen is tense and slightly tender. Skin dry, turgor poor,decreased deep tendon reflexes. He admits to feeling tired past month, thinks he has lost weight even though he has been eating "a lot". He's requesting antiobiotics to make him feel better. Lab results: hgb16g/dl Hct 53% RBC 5.0 WBC 15,200/mm neutrophils 63% lymphs 27% Na 146 Cl 100 K 2.5 HCO3 2meq Glucose 782 Bun 48 Creat Urine specific gravity 1.035 Ketones large and throat culture strep positive. I know increased Na caused by fluid deficit, Bun high from dehydration because creat ok. WBC is because of the strep. [/url] I've come up so far with Deficient fluid volume r/t excessive urinary output AEB thirst, freq urination q 2-3 hrs, temp 102, sore throat, BP 90/62. HR 30, lethargic, dry skin, deep tendon reflexes, pt complaint "feeling tired past month". I'm pretty sure he has non managed diabetes from labs high glucose, concentrated urine, pot is low because of hyperglycemia so my next diagnosis would be: Ineffective Health Maintenance r/t insufficient knowledge of effects of diabetes not being managed AEB request of antibiotics to make him better. I was going to use ineffective breathing pattern r/t fatigue AEB R30 deep and labored breathing. I know I can't use r/t DK, or hypglycemia, but the fatigue is because of the fluid loss, so this diagnosis i don't think i can use because fatigue will be fixed once he receives fluids. Maybe acute pain from ketones,(abdomen is tense)? but it doesn't state in the case study he's in pain. I need help please, I've spent way too long on this 4 days and I have another due on monday as well, and 2 final exams in 2 weeks. I think i'm making this too difficult. any help would be appreciated.