BSNNursingStudent

So our instructor chose a new textbook. It seems very nice, until you have to look for the answer to a problem. It doesn't give any. It tells you to assess for things, but doesn't give you the intervention. It's already driving me crazy. Sooo....here is the problem. I need to catheterize a patient during labor. How do you do that? Do you do it in between contractions or at the peak of a contraction? The first makes more sense to me, but I can't find it in the book. Anyone have the answer, please?

That would be in relation to being at risk for atelectasis, right? It sounds good to me, but I might also say besides anesthesia, immobility as evidenced by (hip replacement surgery). Just a thought. It sounds good to me, though...I am only second semester so you might ask someone more experienced.

I do know that it is important to get the parent's view of circumcision because not very many Hispanics circumcise their baby boys. (about 29%) I also think that depending on their religion, they may want their priest to visit. Most Hispanic women breast feed their newborn and maybe that is because of cost issues with formula, so you might want to ask them about that...whether they can afford formula or prefer to breast feed. Social services would be helpful for a first time mother, as many "old wives tale's" are passed down from one generation to another. I am not sure if these are the type of things you are looking for. I am only second semester, but I am just going by what happens in my family at the birth of a child. Not much consideration was given to me at all regarding culture, so I am not sure what more needs to be done above teaching the client how to care for the infant and also convincing them of procedures that should be done.

Ok...I was fine. Now, I have this question that I cannot find anywhere. I can't find it in my textbook, my Drug Book, or my PDA software or even in Google! Someone please help me or at least give me a hint! Here is the question: Identify how erythromycin interacts with tetracyclines I know they are contraindicated, but I don't know why!

Wow...that's cool! Thanks! What semester are you in?

Thank you! I e-mailed it to my instructor and according to her it is all wrong. Goal should be short term, broad with no time frame. Intervention is long term with time frame. She ones one goal and two interventions. She said they don't do it right in the real world. She's driving me nuts. Told you...no matter what I do it is wrong! I will do it her way and turn it in. If it's wrong, oh well. criminy....4 more weeks with this instructor...thank GOD! Now...where can I find a really good form for the glasgow coma scale?

Oh I am with you. If the patient doesn't want drugs, don't make him take them. I just feel that this is one of those classes where I have to give my gear everything to my instructor's opinion. She does not seem to allow free thinking. grrrr How about this one? Remember though...I have to remove 2 of these interventions. I have to only use 2. He obviously needs much more than that. Assessment 88 yo male Social: lives alone, son lives nearby and checks on client 1X per day Medical History: Oa X 5 yrs Pain Scale: 6/10 Medications: Celebrex Physical Activity: walks 2 miles X3 days per week ADLs: Independent Nursing Diagnosis Chronic Pain r/t inflammation of the joints aeb client report of pain in neck and right hip Intrapersonal: Believes pain is a normal part of aging Dx: osteoarthritis Pain level: 6/10 Fear of becoming addicted to pain medication Uncomfortable rating pain on pain scale Interpersonal Son lives nearby and checks on him daily Extrapersonal Celebrex Pain Scale Goal The client will report improved pain in the neck and hip by 12/01/08 AEB a verbalized level of 4/10. Outcome Criteria Pain Control: Client will use Abbey pain rating scale comfortably to identify current level of pain intensity, determine comfort/function goal within 1 week. Client will demonstrate understanding of plan for pharmacological and non-pharmacological pain relief by end of doctor visit. Client will function on an acceptable ability level with minimal interference from pain and medication side effects by 12/01/08 Client will demonstrate compliance with treatment plan by making appointment with massage therapist within 1 week and by keeping the appointment. Nursing Intervention Instruct client on importance of ability to express pain level in order to help care providers adjust treatments. Discuss the client’s fears of addiction and use of nonpharmacological pain relief. In addition to the use of analgesics, support the client’s use of nonpharmacological methods to help control pain, such as massage therapy. Make a referral to a massage therapist for recommendation for treatment and ask that attention be made to the neck and hip areas or other areas of pain brought about by the inflammation. Rational The pain rating that allows the client to have comfort and appropriate function should be determined: this allows a tangible way to measure outcomes of pain management. Because of the many misconceptions regarding pain and its treatment, education about the ability to control pain effectively and corrections of myths about the use of opioids should be included as part of the treatment plan. Cognitive-behavioral strategies can restore the client’s sense of self-control, personal efficacy, and active participation in his or her own care. It is within the scope of the RNs practice to refer the patient to other professionals for treatment. Massage stimulates the release of endorphins by the body, a natural pain killer.

Wow! Those interventions are not even in my book! You know...I get confused with the outcomes, as well and it is not really being explained very well. I will try again...thank you so much!

haha...no I did not give up on him! I get confused because my instructor will only allow 2 interventions, but this man has so many issues regarding his pain! AND....she is big on dispensing narcotics for pain. Personally, I would like to talk to him about nonpharmalogical interventions and about pacing himself during his physical activity...but there are at least 4 more interventions that I can think of...including using a different pain scale that is acceptable to him, having him keep a pain diary, dispelling the myths around addiction in pain management and so on. I am trying desparately to gear this toward what this instructor wants because she won't come right out and tell us what she is looking for and just expects us to know which TWO out of the dozen or two possible interventions SHE wants us to focus on. This is so hard! I decided to go with the following and tell me if they are alright: Nursing Dx: Chronic pain r/t inflammation of the joints aeb client report of pain in neck and right hip of 6/10 Goal: Pain will be less than 6/10. Target Date 12/01/08 Outcome Criteria: Clent will use Abbey Pain scale rating comfortably to identify current level of pain intensity, determine comfort/function goal within 1 week. Client will demonstrate understanding of plan for pharmacological and nonpharmacological pain relief by end of doctor visit. Nursing Interventions: Nurse will questions the client regarding the level of pain that he believes i approprite to achieve a state of confort and appropriate function. Discuss clien's fears of addiction. In addition to use of analgesics, support the client's use of nonpharmacological methods to help control pain, such as physical therapy, guided imagery, relaxation and application of heat and cold. Does that sound better? Thank you so much for your help. I really appreciate it!

Oops...the case study part didn't copy when I copy/pasted. Sorry! Case Study R.R. an 88year-old, a widower for the past year, lives alone in his home of 60 years. He is healthy and independent. He has a history of OA for the last five years and is on Celebrex. R.R.’s complains of pain in his neck and his right hip. He walks 2 miles a day, five days a week. He is independent in all ADLs. His son lives near and checks on him daily. He rates his pain 6/10, but he really is uncomfortable rating his pain with the numerically scale. He has taken Darvocet N-100 in the past, but does not want any pain medication for fear of becoming addicted. He thinks his pain is part of aging and he will have to “live” with it.

Ok...these are my instructions...and my careplan. Trouble is...I have a hard time doing only 2 interventions! So which should I use? Also...I am unsure how to write goals. I keep getting dinged on that. Directions Read the following case study. After reading, complete a nursing care plan. Write the care plan on the form included in your syllabus. The nursing care plan needs to include major assessment cues, identification of the intra, inter, and extrapersonal stressors, the most relevant nursing diagnosis, one goal, one outcome criteria, and two nursing interventions including referenced rationales. Use provided form to document your nursing care plan. This is your work and is not a group assignment. Late papers are not accepted. The nursing care plan is worth 10 points. See syllabus for grading criteria. Assessment 88 yo male Social: lives alone, son lives nearby and checks on client 1X per day Medical History: Oa X 5 yrs Pain Scale: 6/10 Medications: Celebrex Physical Activity: walks 2 miles X3 days per week ADLs: Independent Nursing Diagnosis Chronic Pain r/t dx of osteoarthritis aeb client report of pain in neck and right hip Intrapersonal: Believes pain is a normal part of aging Dx: osteoarthritis Pain level: 6/10 Fear of becoming addicted to pain medication Uncomfortable rating pain on pain scale Interpersonal Son lives nearby and checks on him daily Extrapersonal Celebrex Pain Scale Goal Client will function at pain level that is acceptable to him. Outcome Criteria Pain Control: Client will maintain a pain diary for 1 week. Client will function on acceptable ability level with minimal interference from pain and medication side effects within 30 days. Client will use pain rating scale comfortably to identify current level of pain intensity, determine comfort/function goal within 1 week. Client will demonstrate understanding or plan for pharmacological and non-pharmacological pain relief. Nursing Intervention Nurse will ask the client to maintain a diary of pain ratings, timing, precipitating events, medications, treatments, and steps that work best to relieve pain. Nurse will review the client's pain diary, flow sheet, and medication records to determine the overall degree of pain relief, side effects, and analgesic requirements for 1 week. Nurse will question the client regarding the level of pain that he believes is appropriate to achieve a state of comfort and appropriate function. Discuss the client's fears of addiction. Rational Studies have shown that systematic tracking of pain was an important factor in improving pain management. Systematic tracking of pain was found to be an important factor in improving pain management. The pain rating that allows the client to have comfort and appropriate function should be determined: this allows a tangible way to measure outcomes of pain management. Because of the many misconceptions regarding pain and its treatment, education about the ability to control pain effectively and corrections of myths about the use of opioids should be included as part of the treatment plan. Thank you!

Wow. We paid over $400 for ours. We have all of our textbooks for the whole program and the ATI books, CDs are included. Only trouble is, it feels like independent study. There is no class for ATI or for Medical Math. We have the books, but we have to teach ourselves! There is no flippin time to read the ATI books! AAAHHH....and they don't tell you which ones to read when! I better get crackin.:imbar

Yes, I believe that is what she meant. I am trying to figure out how to do that, now.

:confused:Ok....I don't understand. I did an assessment and turned it in, but the instructor is saying that she wants a one-page paragraph as the completed assessment. Did I miss something? What is she talking about? I am so confused. Someone please help me!