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  1. MassADNstudent

    Pt with CHF, COPD and edema!!! HELP?!?!

    My thinking is that if you have edema, third spacing. That means fluid from your veins have escaped into your tissues. If you can promote fluid to return to the venous blood flow, I would think it would be a good thing. As far as promoting venous blood flow back to the heart, why do you think any blood needs to get to the heart in the first place? Or even, what in the blood do the lower exteremities need to be perfused with exactly? Blood flow to the heart is ___, and blood flow leaving the heart is ___ is one clue. Part of the battle in nursing school is trying to think this way. I'm still working on it myself!
  2. MassADNstudent

    Pt with CHF, COPD and edema!!! HELP?!?!

    Hmm...I wouldn't think compression stockings would be as effective. When I think of lower extremity edema, I think of the whole foot and up half way the calf having edemous. The compression stockings only wrap around the calfs. I have also seen nurses use the elastic ace bandage to wrap tightly around the lower extremity. Ace bandage seems even better then TEDS to me!
  3. MassADNstudent

    Pt with CHF, COPD and edema!!! HELP?!?!

    Oh...some other tidbits I thought of off the top of my head. If he has poor peripheral tissue perfusion to his extermities, he might not be able to sense whether or not water is hot or cold. Teach him other ways to test for water temperature to prevent him from burning himself, which could lead to skin breakdown. And of course, teach him the importance of good skin care as he is more prone to skin breakdown with poor perfusion to his extremities.
  4. MassADNstudent

    Pt with CHF, COPD and edema!!! HELP?!?!

    I would go with your first diagnosis of: Ineffective peripheral tissue perfusion r/t compromised blood flow secondary to congestive heart failure, chronic obstructive pulmonary disease, and thromboangiitis obliterans manifested by lower extremity edema, cool hands and feet, and diminished peripheral pulses. However, that one seems a little lengthy to me with the secondary to list. I think I would just go with CHF and thromboangiitis obliterans. As far as interventions: TEDS for edema, teach low salt diet to prevent further water retention, his legs should be kept elevated. I would think he would want to do ROM exercises to promote circulation (passively or otherwise), stopping of course if the patient experiences any pain. The only time I would think not to do exercises would be if the patient had orthopedic surgery in which the joint needs to stay aligned. That's my thought as a fellow student anyways. Good luck.
  5. MassADNstudent

    How did you manage your anxiety during clinical?

    Just being as prepared as possible. Reviewing my meds and labs, have an idea of what I need to do during clinical specific to my patient(s), and just skipping coffee in the morning. I have difficulty sleeping at night, especially before and after clinical. I read about a breathing technique that helps to calm me down, at least a little bit. What you do is alternate your breathing through each nostril. You might press one finger against one nostril, only breathe in deeply through one nostril and breathe out through the other by switching the side of nostril you are pressing against. This apparently is suppose to stimulate one side of your brain at a time. Also it slows down your breathing which will naturally help to calm you down.
  6. MassADNstudent

    Help with Sterile Dressing Change

    We were also taught not to reach over the sterile field. Otherwise the field would be considered contaminated, so set up would be important.