squishy11

Thank you SO much for your reply. You have really helped me. Last semester we didnt have to do a care plan so I kind of forgot about the diagnosis that are not strictly related to the illness.. such as pain, constipation, fall precautions due to the meds... etc... you have helped me to have a more overall view of the patient. So thank you so much!! I appreicate your help. I really do!!!

Hi All! So I am in my last year of nursing school. Hooray . Anyway - I have care plans down pretty well. However, my problem is that my pediatric patient I am doing a careplan on is pretty healthy. The reason for her admission was an infection in her earlobe. (Piercing of cartilage gone REAL bad) . I am having trouble because I need to come up with 10 diagnosis! I just can't do it. Everything was normal on her. Except for the obvious infection of her ear. She was on Vanco and Percocet. She is 12 years old. When I saw her she was going to be scheduled for an MRI as well as surgery to drain the ear. (which she ended up having but when she was still there a week later she was no longer my patient). Most of her care happened after I saw her because she had just been admitted that morning. Any ideas for diagnosis that I can use? Other then that - there is much to this case. (That I can see) I would obviously use infection , knowledge deficit, and disturbed body image ... perhaps? Thanks all!

Thank you for your help ... The care plan is due the 13th, and we will get it back the following week .. I will let you know what I have come up with and how it went :)

Hi all.. I jsut wanted to check to see if my list of diagnosis are in the correct priority. I am a little confused because in my last semester I was told that a "RISK" diagnosis NEVER comes bfore and actual.. but I have seen some risks diagnosis come beofre actuals in a few different books. So now I am a bit confused... can anyone let me know if this list looks like it is in the correct order? 1) ineffective airway clearance r/t retention of secretions AEB non productive cough 2)ineffective breathing pattern r/t respiratory muscle fatigue AEB shortness of breath 3)Impaired gas exchange r/t ventilation-perfusion AEB hypoxemia 4)Imaired cardiopulmonary tissue perfusion r/t decreased hemoglobin in blood AEB dyspnea (or could I write AEB decreased hemoglobin level on lab?) 5)Impaired physical mnobility r/t lower limb weakness AEB pt states legs feel weak when standing 6)Activity intolerance r/t imbalances betqween oxygen supply and demand ARB exertional discomfort (also.. is this the same as the cariopulmonary?) 7)Acute pain r/t inflammation of lung tissue AEB pain is a 6 on a scale of 1-10 8)Risk for deficient fluid volume r/t diarrhea 9)Risk for falls r/t generalized muscle weakness 10)Risk for injury r/t altered clotting factors Thanks for any help in advance... I have 5 of these written up, but I am worried about the priority... Like I said - I was told that the RISKS always go last -- but it seems like a Risk for deficient fluid volume should be a little higher in the list... Thanks again all.. and Happy Nursing!

Hi all, I am in Med Surg, and am finding that on the tests (real ones and practice ones) I ALWAYS get the right answers down to 2. And more then half of the time I pick the wrong one. Obviously, my critical thinking needs some help. I have purchased a couple of books in addition to the med surg book that I had to buy for my class. Can anyone suggest a couple of good books that will help my process of critical thinking...? Perhaps something that has rationales for correct answers. My problem is that I seem to pick the answer that you would do second. Never the one that you need to do first. So I am obviously missing something. I would like to improve my grade from my last test, as well as develop my critical thinking... (I am assuming and hoping that critical thinking is something that evolves over time... ) .... Any suggesitons would be very helpful! Thanks everyone and have a great day! J

thanks for the advice. I am guessing a lot of my classmates maybe put too much into it. So I have it written, and we shall see how it goes. It was shorter then my classmates, but is right to the point. I started at the head, and went down to the toes.. Kinda of nice tho, my last instructor just wanted SOAP notes, and those, I can do in my sleep now... so I am hoping narratives will become my friend the more I do them :)

Life.. what life?? LOL... I am a nursing student in my 30's though, and trust me, I wish I had done this when I was 18.... It's tough, but if you manage time well, and really enjoy what you are doing then you will be fine... Ya know the saying what doesnt kill you makes you stronger? I am only in my second semester, but I think that saying was made for nursing school! Good luck !!

Hi all, I got a tremendous amount of help here my last semester, so I am back :). I have a pt and our care plan is of course supposed to be more involved I suppose then last semesters.. I just wanted to know if these diagnosis look ok... I am not sure if you are allowed to include lab numbers in your diagnosis or not.. Here is some info about my client that I thought would be relevent. 80 yr old with pneumonia her h&h are low her bun and creatnine are high (still trying to figure out what that means to her system as a whole.. know its the kidneys.. thinking a volume prob?) umm and everything else is ok cept her glucose is 137.. Can someone just let me know if these diagnosis make sense... I am pretty confident they do.. here they are in no particular order ineffective airway clearance rt/ retained secretions AEB nonproductive cough impaired gas exchange r/t ventilation-perfusion imbalance AEB tachycadia deficient fluid volume r/t active fluid volume loss AEB diarrhea acute pain r/t inflammation of lung tissue AEB pt's report of pain at a 6 on a scale of 1-10 deficient knowledge of pneumonia and treatment r/t lack of information AEB pt states "this is the first time I have had pneumonia" risf for infection r/t hospitalization. risk for injury r/t altered clotting factors (she is on coumadin) imbalance nutrition : less then body requirements r/t illness AEB pts consumption of less then 50% of her meals (that one I am not sure about... dont know if I can blame it on the illness.. she just told me she doesnt like hospital food) hyperthermia r/t illness ARB increase in body temp above normal range Ineffective cardiopulmonary tissue perfusion r/t hemoglobin in blood AEB dyspnea and low hemoglobin level of 9.3. I am sure there are many more that I can use. We need to write 10 and choose 5 to write up. I had a patient last semester with Pneumonia as well that I had to write up 3 on.. so I am trying to expand my horizions and use totally different diagnosis so as not to right up the same ones. Any thoughts on these? good..? bad?.... any help would be appreciated! :heartbeat Thanks everyone! j

Hi all-- Just looking for a little help... I made it through my first semester with flying colors, however now I am in Med Surg. I felt I was doind well and getting the concepts, but then.... our first test.. sigh... I did pass with a 76 (passing is a C in our program) , and 50% of the students were below a 66. So I am not sure how I feel about this... Anyhow... I have to write a narrative note (which is my worst enemy at this point.. still) on my patient who has pneumonia -- a few people have handed in notes already, and were reamed for having 'too much info' on them. And I think that is because we are also in Health Assessment.. and that instructor wants about a page of assesments on each system.... so.. my quesiton is this -- how do I write a narrative note for an elderly woman who was admitted for pneumonia... ? Thanks you

Can I just get a wording check? I have some diagnosis... and they are coming from the info I gathered from my pt. I know you cant tell me if they are appropriate to the patient, but is the wording OK for a priority list...? 1) Ineffective airway clearance r/t excessive mucous AEB inability to cough effectively. 2) Impaired skin integrity r/t tissue breakdown AEB redness on sacral area. 3) Impaired physical mobility r/t impaired balance AEB limited muscle strength in lower extremities, pt states “my legs feel very weak when I stand”. 4) Activity intolerance r/t generalized weakness AEB pt states “I feel very weak all the time and don’t get out of bed much”. 5) Risk for deficient fluid volume r/t diarrhea. 6) Risk for falls r/t diminished mental status. 7) Risk for infection r/t IV lock. thanks again! (slow day at work :) )

Another question :) ... could I have Risk for infection r/t IV lock... or would I have to add more into that? thanks!

Daytonite, I would like to officially hire you as my nursing care plan tutor! I really can't tell you how awesome you are, and how thankful I am to be a part of this message board! Have a great holiday... and I am truly thankful for you!

Ok, I see what your saying.. I dont have my plan in front of me... but I know I wanted to incorporate dementia into it... so I suppose a more appropriate dx would be impaired physical mobility r/t impaired balance AEB limited muscle strength in lower extremeties, pt states "My legs feel very weak when I stand". right? :) Thanks Daytonite, as I have said, you really helped me get thru my last 2 plans, and for some reason the task seems a little more daunting now because I have 3 to write up.. I don't understand it.. I did very well on the first two.. it's strange.. I almost feel more lost this time which is crazy becuase I have my first two to go off of. (Altho these 3 include meds...) Thanks again! J

I just have a quick question. I asked my professor this question, and she did not give me a satisfactory answer. I have a patient with dementia and was wondering if I could use the word dementia in my dx. I see in my care plan book that it is listed as r/t factors as well as AEB. My instructor said that it is a medical diagnosis and I shouldnt use it but if it is in the book its ok to use it.. (she often says things like this and then will mark everything wrong when you do as she tells you..) ... I was looking to go the route of something like impaired physical mobility r/t dementia aeb altered mental status.... (havent finalized yet)... but the word dementia scares me since it is medical... thanks! jj

This letter is for Dayonite.... I wanted to THANK you for all of your help with my initial care plan. I was SO confused and didn't want to end up with info that didn't make sense, follow the process etc... I just got my firt 2 care plans back on my pt and wanted to let you know I got a 32/32 and was told that the professor was impressed with my care plans and that I showed great critical thinking and my plans were beyond a novice nurse's level. I attribitute this to your help! THANK YOU SO MUCH! Jjaye

I thank you again for your insight into the nursing process. I didn't mean to sound insensitive to my patient. I am veyr sorry to leave, because I almost feel as if I could really do a lot for her. More than she is getting in the LTC.(Of course, when I was there she was my only patient) I think what is making it difficult, is becuase she has had MS for over 20 years, and it seems to me that along with the nursing diagnoisis that could fit with MS, it seems as though she is ready for some wellness dx's and I don't think we are able to use those yet, and am not sure how I would go about measuring a goal for those. I guess what my problem is, is that to say she has a self care deficit with eating, seems like it is a dx that would be ok for someone who has just become diagnosed, or even a self image or depression type of dx. She has expressed that she knows she is not going to get better, and that she is having a hard time being in the LTC (she was just admitted becuase her parents could no longer care for her) because of the age differences as well as the other patients having dementia or the like. But, I also suppose that in a fundamentals course, we are trying to get the gist of writing the plans, so using very simple dx's are what I should make my goal in order to get through the care plan. My pt only has use of her left hand and head, so an immobility diganosis just seems like a given I guess is what I am trying to say. Again, since this is fundamentals, I suppose that is how I should be looking at this.. (That's what I figuered out last night and actually was able to write a list and prioritze it...) Thanx again! Every word you write enlightens me :)

Thank you so much. I think the reason I am having such a problem is because we only had 4 nights with these patients, and we are supposed to be doing gerontology, but the patient I ended up with is only 50 years old. She is only able to move her head and her left arm, so it seems as tho my diagnoses should be pretty simple, but the interventions are what is giving me trouble. She hasn't spoken much about the MS only to say that the doc wants her to goto physical therapy but she sees no point since she has a disease that will bot get any better... I guess its my interventions that I am having trouble with... Your info has definatley helped, and I thank you for your time!

Hi all! I have to write my first nursing care plan and I am having a hard time. My patient is in a LTC with MS. She is 51 and I am having a real hard time with the care plan.. usnure of the priority diagnoses... Then I have evaluation which includes effectiveness of intervention and then attainment of expected outcomes.. I am at Suffolk Community College, so if anyone has had any experience with these things any help or ideas would be appreciated :) (Even if you arent in Suffolk.. the help would be great! ) thanks!! A struggling and tired nursing student

Hi, for those of you know about a PICO Research Paper... I need you help!! My topic that I would like to deal with has to do with induction of labor. The benefits. Induction vs. spontaneous labor... Can anybody input some PICO question formats with this.. I am in my 3rd week of nursing school and going insane with everything - and now this. Paper is not due until December, and I have no problem writing researching and citing.. my problem is forming the question.. I don't feel I have enough experience to form a question... any help would be greatly appreciated.... maybe... Induction for first time mothers safer then spontaneous..? Is that a right question?? thanks for any help!!! Jill

Hello! And glad to meet ya! Just accepted! Good for you! They dont give you much time huh.. altho, I am guilty of not having everything together yet... Orientation was not a big deal, you didnt miss too much. They did hand out the list of books, and the uniform code... but thats about it... I don't feel much more confident having gone to the orientation so you didnt miss anything in that way... I have been at Suffolk for 2 yrs (finished my associates last december), but I still feel as if I will be going for the first time ever!! Nervous, the whole bit. Anything you need... let me know... as I said I am still in the process of getting books, uniforms...etc. The only thing I did get was the name tag and that i bought off Ebay cuz it was under 8 bux... I think they said it was 20 at the uniform store... heheh.... The books tho, I have been looking and can't find them for much cheaper then the new ones at the bookstore, and the uniforms... I have been looking at different online places like Lydias, and other places to get cheaper sscrubs.... Good luck to you!!!

hi i checked the site and i see a maxiscope and an adult scope.. should i go with the adult scope?

thanks for the replies, I am a medical assistant and phlebotomist, so I am OK with the sounds, although It's been a couple of yrs since I worked as an MA. My other question is I see the ones with the double tubing and thhe single, which one do you prefer.. I almost bought a double, but I am thinking the single may be just as well...?I believe it was a sprague i was looking at... thanks again!

Hi all, I start school in sept at SCCC in new york, and at orientation they told us to purchase a stethoscope, they said nothing crazy but also did not specify what to get... I don't want to seem crazy or lackluster, ccan someone recommend a good stethoscope for a new RN student..? I wish they had been more specific. This is one of the many things driving me crazy that I need to buy and it probably shouldn't be. Thanks! Jill Hopeful graduate in 2012.

Hi all, I am starting Nursing school on Sept 8 and am already anxious! I just got a letter with my first reading assignments, I am still working on getting all of the books. I have a huge list of 'should haves' or 'optionals' and would like an opinion on what to buy from that list, or will they let me know that in class? I am so crazy, the only thing I have ordered is my name tag. I work full time at Stonybrook Hosp, and have a husband and 2 kids, the only thing I heard from orientation is dont work full time, I dont have a choice . My family is CRAZY supportive, but I am hoping that will be enough. I am already feeling as if I am in over my head and class hasn't even started. I have a decent schedule (I think), I am a certified medical assistant and phlebotomist so I am hoping this gives me a bit of an edge.. but not sure... I worked full time and went to school full time for 2 yrs at night to obtain my associates.. I wasnt sure what I wanted to go for, and I just am kickin myself for not going for the core classes and applying much earlier.. it is what it is... but I need a little bit of a cheerleading section here... Any advice would be so apprreciated, and am I being realistic in thinking that I can do this while working full time. So far I have class on Mon, clinicals on Tuesdays right after I get out of work until 11:00pm and lecture again on Wed. I am nervous and feel so lost.. and broke up until thiss point . I have been blessed to have been giving aid to get through the school portion, but I dont know how long that will last eithher. Stonybrook only pays for 4 credits per semester. The good thing is, all I have to take is my nursing classes, everything else is done. So I figure that gives me a free day that I donthave to take the other 3 credit courses... I graduated with a 3.9 and had a 4.0 in pre reqs.. My only regret is that I can't do the day program and it is going to take me 3yrs instead of 2yrs....I didnt evenrealize the evening one was part time until orientation... I was hoping to speed it up seeing as all my other courses are done, but I guess it doesn't work that way..... I am having anxiety over the books, the uniform, the shoes.. (which they said we were able to wear white snealkers for thefirst time ) but the mail they ssent home says otherwise... HELP...... much appreciated jj

Thanks, I have been searching those sites... I don't want to underbuy -- but I also don't want to buy books that may not be all theat necessary... Any info on what books are a MUST have..?? Thanks! Jill