mickle

I left nursing school in my first semester a little over a week ago. I've decided to work toward Med Lab Tech. Its less money and fewer vacancies are out there, but I just don't need the stress. I would say nursing school is hard. Some get through it and some don't. Some quit and some are failed out. (I was actually doing well, but the suspense of wondering when I was going to mess up was killing me. The last time I ran around in such a state of fear was when I was on probation loading trucks at UPS and they were paying me instead of vice versa!) Everyone says nursing school just gets harder (than the first semester). I'd have had to put in 2 more years on a med surg floor to get the experience I'd need to do the home health care I wanted to do. That would be 4 years of an experience worse than this semester and I just decided....enough for me. (I was a CNA years back. I enjoyed the work but could not support myself and daughter on the wages so I went to other work that paid better.) Best of luck to all of you.

I've spent at least 5 hours flailing around with this. I'm not asking for an answer, but any explanation or direction would be appreciated. This is my second concept map for my second clinical day. I have been assigned HTN as the medical dx. I need to come up with a nursing problem (since I'm a student) related to HTN for a pt whose HTN is already successfully controlled with a calcium channel blocker and a beta blocker. Pt is in the late stages of AD in a nursing home. Has pressure sores R & L trochanter - stage 1. Right arm in contracture. (If I work very slowly I can extend it a little.) Pt has said "I don't want to eat" and makes it clear doesn't like being turned. Did a poor assessment last visit. Pt nurse said should be starting on hospice as pt is anorexic. BMI is 17, but pt is skin & bones. Pt also has DM. Anyway, I'm in a quandary because her HTN is controlled, but I still need to come up with a nursing dx (problem), related problem and 8 interventions on this concept map related to HTN. The 4 nursing dx in Ackley for HTN don't seem to apply: 1) Disturbed Energy Fields - not qualified to determine or intervene 2) Imbalanced Nutrition - more than body requirements (she is anorexic) 3) Ineffective Health maintenance - duh, she is in late stages of AD 4) Noncompliance r/t side effects of tx, lack of understanding regarding importance of controlling HTN - She is in a nursing home being cared for so this doesn't seem applicable either. I'm tempted to just come up with a plan following Ackley even though it doesn't apply and then do one that addresses either tissue perfusion (did that last week for DM), so don't think it will be well received by CI a second time or go way out on a limb and search for how anorexia (imbalanced nutrition: less than body requirements or Adult Failure to Thrive) might be related somehow to HTN or a threat to the effectiveness of her HTN meds. Plan to spend more time on the pathophys of HTN and her drugs and see if I can weave something together. Anyway, insight or encouragement would be appreciated. Already met with another classmate who was also assigned HTN w/ a pt in similar situation (except completely non-verbal) and we wasted 2 hours trying to figure out a way to make the rote use of Ackley work for us. We can't use any "risk for" dx either. Anyway, I'll check back tomorrow.

Hi! I'm working on a nursing diagnosis for a pt whose HTN is controlled but have been assigned HTN as the medical diagnosis to work with. She is anorexic and in late stages of AD. I hope you have better luck than I'm having. Anyway, maybe the NANDA dx listed below will help. Good Luck In Ackley there are 4 choices listed under HTN(hypertension) 1) Disturbed Energy Field r/t pain, discomfort 2) Imbalanced Nutrition: more than body requirement r/t lack of knowledge of relationship betweeen diet and disease process 3) Ineffective Health maintenance r/t deficient knowledge regarding tx and control of disease process 4) Noncomplicance r/t side effects of treatments, lack of understanding regarding importance of controlling HTN If you don't have an Ackley book, this link will give NOC, NIC http://www1.us.elsevierhealth.com/Evolve/Ackley/NDH7e/Constructor/