surviving

I may be late replying, but this is the same as Lap Nissen Fundoplication. I had this procedure myself. Nissen is the surgeon who invented the procedure.

I am studying diabetes mellitus. In our lecture, my instructor indicated Rapid-Acting Lispro cannot be mixed with anything. My text indicates when Humalog or Novalog are mixed with shorter-acting, draw the shorter-acting dose in the syringe first. To me, this means it can be mixed. When I asked the instructor, she said "YOU NEVER WANT TO MIX RAPID-ACTING WITH ANYTHING!!" I am confused. Help?

Thanks! I wish you were my instructor!!!!! You make this so clear - as if I am sitting here carrying on a one-on-one conversation with you. You have really helped me resolve my issues. I know this will all come in time. I have a much better grasp on it now.

In my assessment, my main concern is safety - I am thinking Risk for Injury r/t Impaired Gait. My instructor stressed that I need to include items such as monitoring for s/s of DVT, his turning schedule, post-op teaching, incentive spirometer, etc. I know what I need to do as a nurse, but I have a hard time matching an approved NANDA diagnosis to it. I am using Taylor and Sparks Nursing Diagnosis Reference Manual, and I just have a very difficult time matching my assessment and nursing interventions to an approved diagnosis. Would Risk for Injury r/t postoperative complications work as a nursing diagnosis? And the following interventions: monitor for s/s of anesthesia complications (I could address the hypotension here), turn schedule, incentive spirometer, ambulation, etc. I just can't seem to focus on one diagnosis. This is my 3rd care plan - I am struggling to match assessment data, and interventions with NANDA.

I guess I was pretty vague with my first post - this is all new to me. First semester student and new to this site.... Reason for surgery - arthritis, other hip done previously. Meds: Morphine PCA (he only hit it once all day while PT was doing ROM on leg), Lovenox 30 mg q12h, Celebrex 200 mg q day, Ancef 1 gm Duplex x 4 doses, PRN pain meds - did not give because he never complained. Pain Assessment: Everytime I checked on him, he said he did not have any pain. He complained of level 5 when PT was working with him - he hit PCA pump once. He said it eased off within 10 minutes. I instructed and monitored deep breathing and coughing, as well as incentive spirometer q2h all day. Lungs clear, respirations 16. Active bowel sounds x 4 qdts, HR 80 and regular, 02 100%. I prepared his food tray and he feed himself. He was given a bed bath. He had a catheter and had not had a bowel movement since before surgery. He was NPO until the morning after surgery (which is when I got him as a pt). His electrolytes were within normal ranges, his U/A was normal. His incision is very clean - his drain only had 40 cc total before they removed it. He was getting D5NS at 200 cc/hr. He has a history of hypertension - went hypo after surgery. I am thinking Impaired Physical Mobility r/t ___________________. I also want to address the hypotension. Not sure exactly how yet....

I am in my 1st semester of nursing and on my 1st week of clinicals I had a post-op pt with an elective total hip replacement the prior day. He was 80 and had no additional health concerns over than high BP. His Hgb, Hct, WBC were low, and his BP was running 90/52 (normally takes hypertensive meds/BP dropped post surgery). He received 1 unit of blood while I was there. Surgeon's rpt indicated less than 200cc blood loss. His incision looks good - no swelling, dressing was clean, dry, entact - drain was removed prior to my shift starting. He was not ambulated following surgery d/t low BP, and was not ambulated the next day d/t the same. PT did ROM exercises with him. I am completely lost about a Nursing Dx. I thought about Risk for Infection or Impaired Skin Integrity d/t surgical incision but I have used these Dx's already. My clinical instructor will not let us use the same Dx's back-to-back (even if it fits). Any suggestions?