brs72007

I have discussed my situation with friends and family, but would like an honest opinon from fellow nurses. I just graduated in May, passed my boards and have been hired at an amazing hospital with the job I wanted. I'm suppose to start orientation next week. Now i'm having huge doubts on whether i can fulfill my obligations... Here's my situation (sorry if this may be long and confusing) I have a 5 year old son who will start kindergarten this fall, my 3 1/2 cannot get into preschool because our area's state funds are next to nothing and only taking 4 year olds and 3 year olds if they are really behind. I'm due with our 3rd child (unplanned) in september. I was very suprised that i was even hired b/c of my pregnancy and the fact that i will be just barely getting done with orientation before going on maternity leave and technically will have to be re-hired when i come back to work 6 weeks post-partum. I haven't had a job since pg with my son 5 years ago and have never had to go back to work/school that early from having a baby. Fortunately I have a great husband who supports what ever i do, but also works long hours and is not home very much. That leaves either me with my children or sending them to daycare (which we pay an obsurd amount for!) Thankfully we have been able to make it on just one income, but it's been tight so adding another income was going to help out a lot! 1. I'm super nervous about starting my job! (is this a normal feeling?) 2. I'm extremely tired all the time b/c i can't sleep due to being uncomfortable from the pg... i can barely make it through the day just running after my kids let alone working fulltime as a nurse in a busy high accuity hospital 3. Daycare while i'm at work... 3/4 of my income will be going to just that 4. My son is going to need a lot of support and help adjusting to kindergarten 5. My husband and I don't want our 3rd baby going to daycare at 6 weeks... and that is what i told my boss that i would do when i was hired BUT.... are any of these a good reason to quit my amazing job before i start? I'm worried that by doing this... another employer or the same hospital would never consider hiring me again. Also i'm very worried about loosing my newly learned skills and knowledge and be an unsafe nurse when i do go back to work. Anyone have any advice for me?? Thank you in advance :) *Becca

Hey i'm a first year nuring student and i'm having a little trouble with a chf nursing diagnosis. My patient was admitted for decompensated CHF, but the day i took care of her she wasn't experiencing a whole lot of symptoms. I need some help coming up with a couple of acceptable priority nursing diagnoses without a lot to work with. Her edema that she had 2 days previous was gone. She had no SOB and clear, but diminished breath sounds. Her pulse ox was ranging from 90-95%. Her BP was hovering around 140/80 and pulses within normal limits. With all the lasix she had been given in the last couple of days, her urine output was 1600ml in about 7 hours. She was having a lot of pain in her lower legs and feet...she attributed that to the swelling she had the last couple of days although, like i said, that was gone by the time i was taking care of her. I can think of a couple of nur dx but i'm having trouble completing them... I guess i'm not the best at this part of the care plan. 1. Decreased cardiac output r/t impaired cardiac function AMB ?? (i can't think of any manifestations that would fit this for her symptoms that day) 2. Acute pain r/t ?? AMB pain rating 8/10 with numerical scale (i'm not sure what would be causing the pain... my instructor said that r/t previous edema in the lower extremities she isn't sure that was the cause) Her pain was really the only syptoms i was treating that day... She was on bed rest so i was thinking about activity intolerance... and she c/o no bm's for 3 days so i could use constipation but i'm not sure those would be priority nur dx. Thank you in advance for any help!

Thank you for the info suehernando! He isn't on any of those meds you listed but i'm using the deficient fluid volume for his fever, infection, increased metabolic rate, and increased respirations. Do those fit for the dx? As for the risk for infection one, since his already has the infection... i didn't think i could use that one?

Thanks for your input deftonez188. I was thinking about the same thing with his BS levels (stress, breathing treatments) too. Is there any nursing dx for that though?

I'm a first year nursing student and I'm having trouble with my care plan. My patient is a 21 year old male who has pneumonia. I'm having a little trouble coming up with a couple of nursing diagnoses. 1. He has a glucose level of 163 but he doesn't have diabetes. Is there a nursing diagnsis that i can use to address this? 2. His 24 hour intake was 3878ml and output was 1232ml (although its not a whole 24 hours becuase he hasn't been there for a full 24 hours). Would you consider his intake and output appoximately? I'm saying no its not, but if thats the case, what nursing diagnosis should i use or is there one? Most of his input is from his IV intake. His oral intake was fairly low and i'm already using risk for deficient fliud volume? Is this right? I need some help! Thanks in advance