marjibme

I'm pretty non-traditional too (50 - 2nd degree/career, etc.) and would be happy to answer the survey questions.

There's also a couple smaller places in the area: Doctors Hospital in Springfield - Skaggs in Branson & CMH in Bolivar (both towns are about 30 minutes out of Springfield). As a student in the St. Johns program (May 2011), I'm a lot more familar with folks that work there and 95% of the comments I hear are positive. I also have a few friends that work at CMH and seem to be pretty happy there.

I just got my patient assignment for in the morning. I need to write up a clinical prep with the patients diagnosis, a brief discussion of it (disease process, S/S, causes, possible complications, etc.) - a definition of the current surgery (if applicable) and 5 activities of nursing care - prioritized acc. to Maslow's. Problem is, I'm a little unclear just what the diagnosis is, mostly because of how it is written. It's a new semester with a new clinical instructor, who isn't available for questions except during clinical hours. So, here's what's written: 2/9 abdominal pain (ileus) status post laprascopic cholecystectomy 2/4/10. I'm thinking the numbers are dates - the first one admission - the last one, date of surgery, since it says "post laproscopic cholecystectomy" (I'm thinking the patient went home & was later readmitted because of the pain)??? As far as admission diagnosis - abdominal pail (ileus) - could that mean pain r/t paralytic ileus, or possibly abdominal pain they think is ileus? And status - does that just mean the patient is post-op? Any help would be greatly appreciated. In the meanwhile, I'm going to start writing up a "brief discussion" of ileus & a description of a cholecystectomy & hope I'm focusing on the right things.

I just need to share this with someone (or several someones) who will understand. Earlier this semester, I decided to blow off a small, 5 point pharmacology assignment because I was feeling a bit crunched for time. I figured 5 points aren't going to make much of a difference in the long run. Well, I just saw my end of semester grade - 4 points from an A. Moral of the Story? There are no small assignments. Do your homework.

Daytonite (and all), Thanks again for your responses. Based on the requirements for the assignment, I felt that impaired urinary elimination was too broad a diagnosis. I did speculate on possible causes, but again, since we were limited to the data provided, I felt that "idopathic causes" was the best etiology to use. The idea of the 2nd diagnosis you mentioned had never crossed my mind, and while the assignment has already been submitted, I really appreciate the insight. Apparently there is more to the nursing diagnosis than what first meets the eye. I am really looking forward to the time when this "new language" isn't quite so foreign to me.

Thanks for the reply. I went with idopathic causes since there wasn't any information in the data provided to suggest any concrete reason/cause. My brain has been at th epint of Information Saturation for a while now - but there's 2 weeks left in the semester. Then we get an entire 2 1/2 weeks breaks before the fun begins again. I'm thinking a semi-deserted tropical island (someone else has to be around to bring me drinks and feed me grapes) sounds REAL good about now.

I could really use some help. I'm a first semester student & we're been assigned a case study (from the Evolve website - based on the Ackley Nursing Diagnosis Handbook). Outside of a mention of the nursing process during the 2nd weeks lecture in Fundamentals, this is the first (and apparently only, since the semester ends in 3 weeks) exposure to this we've had and the only instructions provided are those written on the assignment itself. We're supposed to write at least 2 nursing diagnosis, prioritize them according to Maslow, and prepare a care plan, providing rational when appropriate, etc. I've completed much of the assignment but I'm having some trouble figuring out the etiology/related to factors for one of my possible diagnosis. I'm pasting the scenario/assessment provided to us below and follow that with the diagnosis, related to and AEB that I've come up with. Ive underlined what I consider to be the significant symptoms: Case Scenario “Oh, this is awful,” Jenny muttered to herself. She was sitting on the toilet with a pair of very wet panties and slacks around her ankles. Jenny said that she never knew when it would hit, this need to urinate quickly. She would find herself running to the bathroom like a woman possessed and then usually not making it in time. “It also seems like I’m ‘peeing’ all the time,” she said. “This is getting old and is not fun at all.” Nursing Assessment Jenny Hill is an 82-year-old woman who lives in a home for elderly women. She has trouble controlling urination. She finds that when she has to urinate, she has to get to the bathroom quickly or she will wet her panties. She has started wearing incontinence pads, but she hates them because they are uncomfortable, and she’s afraid they show when she wears pants. Also they cost a lot of money. She finds herself getting up to urinate two to three times per night. Sometimes she finds she really smells of urine in the morning, and her sheets are wet with urine. She is limiting her usual social activities because of the possible embarrassment of smelling like urine. Mrs. Hill makes an appointment to talk her nice nurse practitioner to see if anything can be done about the situation. The instructions tell us to list the symptoms that indicate a health problem, group the symptoms that are similar and then select at least two possible nursing diagnosis. I selected: urge urinary incontinence r/t (???) aeb urinary frequency, urgency, nocturia & enuresis imparied social interaction r/t inability to control passage of urine aeb limiting normal social activities I'm not having any trouble prioritizing (elimination is primary/physiological need according to Maslow) or coming up with my NOC and NIC. I can not, however, for the life of me figure out the etiology for the urge incontinence (idiopathic causes???). especially since the instructions indicate we should use those provided in the book and none of them seem to "fit." I realize this has been long - so if you've read through to this point I am grateful. If you can point me in the right direction here - you will be my new best friend forever!

We were visiting a good friend of ours, a pastor, who came down with alll the S/S of a terrible head cold on Saturday night. He decided to "medicate" himself with a dose of Nyquil and preach his Sunday morning sermon anyway. AT the appropriate time, he stood up, looked out at the congregation and said. "Everyone please turn in your bibles to First Glasses while I reach in my pocket and pull out my peter." I about fell out of the pew laughing. The service was over before it really got started.

Hi! I'm a "second career" first semester student in the Springfield area. I'm originally from Chicago, but have lived here in SWMo for close to 30 years - so this is definitely "home" to me now. Nice to meet you all! Marji

Yeah - the "Nursing School Diet and Exercise Program" is not the best way to loose weight - in fact, I put ON almost 10 pounds just doing my pre-req classes. Mi Vida offered some really great advice about packing lunch and healthy snacks. I'd also add that I can pretty much guarantee that you are not the only one struggling with this, and one of the most helpful things that I've done is to find a partner at school (actually there's a small group of us). We keep each other accountable and enthusiastic - do a "healthy pot luck lunch" share recipe ideas, etc - and walk together as a group during breaks, etc. This is only the 4th week of classes for us and I've already lost 4 of those pesky pounds. Friends are amazing things! :wink2:

Honestly, I can't think of anything that would be worth sacrificing my moral convictions. Really good programs will be still be there when the timing is better. Millions of others have found jobs and passed the NCLEX even without a "guarantee" - and 30 years from now, you don't want to be lying awake at night with tears streaming down your face asking yourself "how could I have done that?"

Math, especially clinical calculations, will be with you all the way through nursing school, the NCLEX and beyond. For those who are "math challenged" there's a great book available "Clinical Calculations Made Easy" that walks you through learning how to solve these problems using a technique called dimensional analysis. Since our school started using this 10 years ago, there has only been one student that failed their math test. Math was never a big struggle for me, but even I have found it extremely helpful. The older addition of the book is available on Amazon for less than $3.00 (vs, the $45 they want for the new edition) - and would work just fine as both a refresher and a way to help you with this through the remainder of school and your career. Here's a link to the Amazon page: http://www.amazon.com/gp/offer-listing/0781748380/ref=dp_olp_1

while i am still a student (first semester actually) i have worked for several years as a disability advocate & ltc ombudsman. i have several friends & clients who are either hoh, deaf or deaf, and have presented workshops and in services on the subject of caring for the deaf or hard-of-hearing patient, so i felt i was at least semi-qualified to answer your questions. i will say that i have noticed a certain level of mistrust of health care professionals among the deaf community, based in a large part on cultural myths (both founded and unfounded). to be fair, i have encountered a great deal of misconceptions about the deaf community in the health care world as well. in regard to the deaf community - simply put, the best way to truly combat stereotypes is to not fit into them - and the first step in that is to identify what they are. in regard to the hoh/deaf patients we encounter, with the aging population, this is going to become more and more common, so it's essential we educate ourselves on communication strategies now so we're not scrambling to figure out what to do then. so, let me applaud you for choosing this subject and seeking to educate yourself and others in an effort to improve care for this particular group of people:yeah: questionnaire for health care workers 1. how often do you work with deaf or hoh patients? on a weekly, if not daily, basis 2. do you dread having to work with the deaf/hoh community? not at all. i am conversant in asl (not an interpretor though) and have researched ways to effectively communicate with the hoh or deaf patient who does not know sign language, so i'm actually fairly comfortable. 3. how much harder/easier is your job relating to this community? i won't lie. communication can be time consuming with those who aren't conversant in asl and time is a precious commodity for anyone who works in health care. however, i'm enough of a bleeding heart/idealist to think that a big part of my job is to relate, regardless of the community or effort required. 4. is it required you obtain an interpreter for these patients? yes, if the patient uses asl as their primary language, according to the ada, it is. the interpreter must also be licensed, so it is illegal to use family members or friends - or your coworkers who know sign language - to serve in that capacity. 5. who pays the fee for an interpreter? the patient or the healthcare facility? again, the law requires that the health care provider/facility cover the fee. 6. what is your view of this community? well, there is only one part of the people being discussed that actually qualify as a "community" - the big d deaf - and even then, there are those who are easy to get along with and those that are more difficult, just as there are in any other group. 7. do you believe this community is flexible in accepting whatever communication interpreter you obtain? i know some that are way too flexible and wind up having no idea what is happening to them or why. i know others that are going to have it their way (i want this interpreter and no one else!!) or there'll be hell to pay. 8. if your facility has equipment for this community, where is it kept? i know that one of our local hospitals does have adaptive equipment - but i'm not sure where it is stored. 9. what is the procedure if a deaf patient is being treated? in theory, in an emergency situation, an interpreter is contacted immediately and communication is accomplished through other means only until the interpreter arrives. if an appointment has been made, the interpreter is contacted beforehand and present when the appointment begins. in practice - not so much. i've seen notes, gestures or worse - just doing the work without any communication because they had "other patients that needed taken care of too." 10. if you are unsure how to proceed in the care of a deaf/hoh patient, where can you go for assistance? in most hospitals, the charge nurse should know what the procedure is, as well as have a list of available interpreters. you can also be proactive and find out about policies beforehand, as well research for yourself to discover effective communication strategies so that when the time comes, you do know how to proceed.

I had my first skills return today: PO med administration, IM, ID, SubQ injections and IV insertions. I managed to pass the IV insertion skill, even though my clinical partner has the smallest, deepest veins I (or my clinical instructor for that matter) have ever seen. I even managed to remember all the correct steps for the procedures, needle gauges, lengths, injection sites, etc. What I forgot - was the fact the I REALLY need new glasses. The lighting in the room wasn't that great and I found it just about impossible to read the numbers on the syringe. So, I decided to go by the markings - which might have worked if I hadn't gotten it into my head that I was using a 5 mL syringe instead of the 3 mL that I actually had in my hand. Needless to say, I drew up substantially LESS "medication" than the 0.5 mL the instructor had indicated. I'll have to make an appointment to return and do my return again (they graciously allow you 3 attempts to pass). I think while I'm at it - I'll make an appointment for an eye exam as well. So - what was I thinking about this "second career" thing again?

Cheap (err - inexpensive) is good. There's a place near my house that sells used sets, the Springfield craigslist has a bunch for sale and there's 2 or 3 shops in town where you can get new ones, along with good ol' Wally World and Dollar General. You also have the option of buying them from the St. John's Co-workers Store. If I remember correctly, they even offer a payroll deduction method for payment - but you might want to double check that.