Jessicalk05

Hello, I'm in nursing school in Mi right now, but I hate it here. I'm thinking about working here for a year or two to get some experience. But after that I'm out of here. All this snow is not for me. I'm thinking about moving to NC and I was wondering if anyone knew a good place to work. I'm not sure yet but so far I like the ICU. I work now in the MICU at a local hospital as a CNA and love it. I have a while yet but I'm just checking around to see if I find anything I really like before I relocate. I've heard some horror stories about patient ratios so I'm wondering what the ratios are. Where I work they are 1-1 or 1-2. Does anyone have any suggestions. Thank you.

i forgot to add that she is on a nimbex and ativan drip

i'm looking for a little help with my care plan. here's a little bit about my patient. patient is a resident of an extended care facility (ecf) where she was in her usual state of health previous to admission. patient had been alert and oriented over the previous weekend. oxygen saturation suddenly dropped to 58%, patient presented to the emergency department with a chief complaint of mental status changes, difficulty in breathing, and dropping oxygen saturations. patient is confused to person, unable to respond to questions, or verbalize problems. patient vital signs are: blood pressure (bp)- 90/59, temperature- 98.1 per oral (po), pulse- 103 and regular, respiration 18, and oxygen saturation of 86% on 4 liters (l) nasal cannula (nc). upon assessment the patient is alert and orientated x4, no motor or sensory deficit, denies any distress. sinus tachycardia, s1 and s2 present. pulses 2 + bilateral radial and 2+ bilateral pedal. bilateral foot drop noted. upon auscultation anterior and posterior breath sounds were diminished throughout with bilateral diffused crackles throughout. abdomen obese, soft, tender over right upper quadrant. a colostomy noted in the right lower quadrant. bowel sounds active x4 quadrants. skin color ethnically normal, warm, no tenting, no rash. the medical treatment for respiratory failure and uti include broad spectrum antibiotics, vasopressors, and critical care consultation. patient was placed on acute bed rest and transferred to intensive care unit on 3/18/09 for further treatment. on 3-19-09 patient was experiencing dyspnea, diaphoresis, tachycardia, o2 sat of 85%. patient was placed on the vision bipap to prevent intubation. bipap settings of 15/5 titrate o2 to keep spo2 greater than 92%. the bipap was tolerated for a few hours then patient became tachypneic, rate 40-46 and tachycardic, heart rate greater than 140 with frequent premature ventricular contractions, the decision was made to intubate the patient. orally intubated with # 8 french et tube and placed on the vent with settings of tidal volume- 500, rate-30, fio2-65%, peep of 12. a #18 orogastric tube (ogt) was inserted and connected to low suction to prevent aspiration and placement for both were confirmed by x-ray. braden score of 10, patient is turned every 2 hours, a skin bundle is used to protect his heals, and skin barrier cream is used for the patient bony prominences. patient's height is 5'7", weight is 244 lbs, and the body mass index (bmi) is 38.2 which is considered morbidly obese. the patient's glasgow coma scale (gcs) is 3 due to sedation and paralytic agents. patient's 24 hour i & o: 2571ml of fluids in and 1400ml of fluid out. patient's abgs were ph-7.39, pco2-38, po2-57.1, o2-86.3, hco3- 22.6, patient did not tolerate lowering peep. patient's computed tomography (ct) image showed air space disease with in both lungs, left side greater than the right, and most prominent in the bases. this correlates clinically for potential of pulmonary edema rather than bilateral pneumonia. ct also shoes enlarged heart, atrophic pancreas, and moderate amount of free fluid in the pelvis. relevant laboratory tests on include chloride 121 (101-111); bun 33 (8-26); creatinine .45 (.44-1.00); phosphate 201 (32-91); calcium 7.7 (8.9-10.3); cholesterol 267 (142-200); cpk 13 (38-234); protein 5.4 (6.5-8.1); albumin 2.8 (3.5-5.0); hemoglobin 8.5 (11.0-16.2); hematocrit 24.5 (36-46); wbc 16.9 (4.5-11.0); rbc 2.80 (3.30-5.30), platelet 121 (140-440). i have impaired gas exchange related to ventilation perfusion imbalance as evidence by respiratory rate of 38, oxygen from 4 l nc to vent support, lasix, breath sounds are diminished throughout with bilateral diffused crackles throughout. i still need three more one being psychosocial. thanks for all you help!

Patient complained of decreased energy, decreased appetite, and increased lower extremity swelling. Had no chest pain, no N &V, some fever, normal BM, cough with sputum, no increase in fluids or diet intake. Smoker and drinker. When I took care of him he was alert, no jvd, normal heart rate, s3 not present, rhonchi and rales present, abdomen was slightly distended, he had 2+ pitting edema in his lower extremities, and generalized edema, he was recieving tube feeding through an OG tube. His ABGs were pH-7.55, PO2-58.7, PCO2-35, HCO3-30.8. His vitals were 98.4, 89, 14, 112/73. EKG shows a 1st degree AV block. I'm not sure what other information you need. The nursing Dx I have are: Decreased cardiac output r/t imparied cardiac function AEB 2+ lower extremity edema, generalized edema, and an ejection fraction of 25%. Excess fluid volume r/t impaired excretion of sodium and water AEB edema, pulmonary edema and rales. Ineffective health maintenance r/t deficient knowledge regarding self-care and treament AEB (I still have to find a way to phrase this. But him and his family didn't realize that water was a fluid and thats one of the reasons why he wa fluid overloaded when he came into ER) Imaired gas exchange r/t inadequate cardiac function secondary to heart failure AEB rales and pulmonary edema. I need at least the 1 pychosocial. Thanks!

Hello, I'm looking for a little help with my care plan. My patient had a STEMI a month ago and underwent surgery, had a balloon pump and stenting done. This time he came in with lower extremities swollen. His DX is CHF. His ejection fraction is 25%. His BNP was 3035, troponins positive. He has pulomonary edema and is intubated. I have some nursing Dx but I'm not sure they arethe priority Dx. Can anyone please help me?