erican3232

Nicely stated Gman. *Soul Search* Use what you have* You know what you desire and you have goals... State what they are with conviction and let your passion shine through. Go back to basics... alturism, fidelity, intregrity. Write from your heart. Wait a day or two then ,edit with your mind.

Our teacher is big on "Explorative Learning".... I am almost done with my first semester of nursing school... and I need the break. Although, I don't know what I'll do with out the constant worry of having assingnments due.

I don't know what happened with the formatting. Sorry.

i have this "mind map" due. it's based on assessment data i collected during 5 functional health patteren interviews. i copied and pasted the assingnments i completed after the interview's. now i have to squeeze all that plus interventions on one sheet of paper.... i have add, and she wants me to produce a picture of whats in my head! lol if any one has any suggestions.... i have the map started but i need to come up with two highest priority nursing diagnoses and five interventions for both diagnoses... i will try to copy and past the mind map i have so far... but i don't think i'll be able to. functional health pattern: health perception-health management pattern on november 14, 2009, i conducted an interview on jw in her home in xxx, mi. jw is a forty-five-year-old, eastern european female who lives in her home with her three children. jw is alert, cooperative and pleasant. she is a single parent who is very involved with her children's activities. she has three children: one child completing high school, one in middle school and her youngest is in elementary school. jw has a master's degree and teaches kindergarten. she is a member of a lutheran church in the town where she lives. her home is neat, clean and free of clutter. jw has no allergies and has not had any colds in the past year. she does not use illegal drugs, smoke or consume alcohol. she is responsible for her health care needs and is able to make all recommended appointments to her primary-care physician, endocrinologist, physical therapist and dentist. she is up-to-date on her immunizations and received the optional seasonal influenza and h1n1 vaccination november 24, 2009. jw has no problems obtaining prescribed medications, when i asked her about her ability to pay for her health care needs she stated, "i have excellent insurance." jw expressed her concern with her general health: "fair, because of my thyroid, i have low energy, fatigue, and weight gain." she goes on to say, "i feel stressed at times and i try to slow down and relax" jw has hypothyroidism, plantar fasciitis and passed four kidney stones last year; jw has no current kidney stones. she manages her planter fasciitis with physical therapy, shoe inserts and by doing stretching exercises before she gets out of bed, randomly throughout the day, and prior to bed. she takes all prescribed medications and recommended vitamins at the correct times each day. based on this interview, i formulated three functional health strengths, they are readiness for enhanced immunization status this diagnosis is appropriate because j.w is a kindergarten teacher who has children in three different schools. she has expressed her ability and desire to obtain the vaccinations recommended by the center for disease control. the other two functional health strengths are readiness for enhanced therapeutic regimen management and [color=#333333]health-seeking behaviors. theses pattern both fit because j.w. has expressed her desire to follow a stricter diet that was recommended by her endocrinologist. the latter was chosen because j.w is constantly seeking out medical advice from health care professionals. this was evident when she asked me for diet advice during our interview. based on this interview, i formulated two functional health deficits, one is risk for ineffective therapeutic regimen management and deficient knowledge related to the weight loss process. these are fitting nursing diagnoses because j.w stated several times that she does not know what her doctor wants her to eat. her doctor recommended a low carbohydrate, low protein, low "sugar" and low sodium diet. j.w. has gained 30 pounds over the last two years and she has expressed her desire to lose weight. functional health pattern: elimination pattern on november 14, 2009, i conducted an interview with j.w. in her home in xxxxx, michigan. j.w. is a forty-five-year-old, eastern european female who lives in her home with her three children. j.w. is alert, cooperative and pleasant. she is a single parent who is very involved with her children's activities. she has three children: one child completing high school, one in middle school and her youngest is in elementary school. j.w. has a master's degree and teaches kindergarten. she is a member of a lutheran church in the town where she lives. her home is neat, clean and free of clutter. j.w. does not consume alcohol, smoke or use any illegal drugs. j.w. has a medical diagnosis of hypothyroidism. according to j.w., her doctor recommended a low carbohydrate, low protein, low sugar and low sodium diet. j.w. takes all prescribed medications and vitamins for the treatment of hypothyroidism. each time j.w. consumes a prescribed medication or multivitamin, she consumes a full eight ounces of water. i asked j.w. about her urination habits. she stated, "i need to drink more water. other than that, i don't have any problems in that area." after asking some pertinent negatives, j.w. informed me that she passed four kidney stones last year (she has no current kidney stones); she urinates an average of six times a day, mostly in the mornings and; she was constipated regularly until recently. j.w. stated, "i was constipated because of all the medication and vitamins i have to take for my thyroid." j.w. believes she is no longer constipated because she consumes six to eight glasses of water each day and eats mostly fresh fruits and vegetables. j.w. has not used anything to aid her with bowel elimination for about three months now. she states that, since she has changed her diet to include more fresh fruit and vegetables, her stools have been soft and formed. she then went on to say, "my pee is always clear."[color=#231f20]j.w. reports for the past two to three weeks, she has had soft, formed stool at least every other day. she reports her stools as brown with no mucous or blood. j.w. has had hemorrhoids but denies having any problems with them in the past three months. [color=#231f20]j.w. tries to walk every day for at least thirty minutes and goes on bike rides with her children in the summer months. while walking or bike riding, j.w. sweats from her forehead and underarm areas, but the sweat does not drip off her. during routine activities of daily living, she does not sweat. based on this interview, i was able to formulate two nanda nursing problems that labeled j.w.'s health deficits. the first is functional incontinence and the second is perceived constipation. functional incontinence is an appropriate diagnosis for j.w. because she stated, "i dribbled a little bit a couple times this year because i had to go to the bathroom as soon as class started." j.w. consumes more than thirty-six ounces of water before her class begins at 0800. she often has to empty her bladder because she consumes a significant amount of water prior to starting work. however, j.w. is a kindergarten teacher and is unable to leave her classroom unless another teacher is present. when asked what she does when she begins to feel pressure, she stated, "i just hold it until i get a break." risk for constipation was formulated for j.w. because she stated she was not having difficulty defecating at the time this interview took place. however, she has suffered from constipation in the recent past and has hemorrhoids. she takes calcium, iron and multivitamin gel-coated capsules. based on this interview, i formulated a health strength of readiness for enhanced urinary elimination. this is fitting because j.w. has had urinary incontinence in the past due to her inability to get to a restroom. j.w. stated it was embarrassing and expressed her desire to not let that happen anymore. j.w. said, "i think i'm going to see if i can schedule a time where someone will come and watch my kids for five minutes. then, i can run to the bathroom about two hours after class begins." the aforementioned, nanda approved diagnoses best support the assessment data that i collected. functional health pattern: activity-exercise pattern on november 27, 2009, i conducted an interview with j.w. in her home in xx, michigan. j.w. is a forty-five-year-old, eastern european female who lives in a single-family home with her children. she is a single parent who is very involved with her children and their activities. she has 3 children: one child completing high school, one in middle school and her youngest is in elementary school. j.w. has a master's degree and teaches kindergarten. she is alert, cooperative and very pleasant. her home is neat, clean and free of clutter. she does not smoke, use any illegal drugs or consume alcohol. j.w. is five feet tall and weighs ninety kilograms. she has a body mass index of thirty-nine. j.w. has gained thirty pounds over the last two years. she has expressed her desire to lose weight during this interview. j.w. has the medical diagnoses: hypothyroidism and; planter fasciitis. she follows a strict diet and takes all prescribed medication and multivitamins to manage her hypothyroidism. she manages her planter fasciitis with physical therapy, shoe inserts and by doing stretching exercises before she gets out of bed, randomly throughout the day and prior to bed. she makes all recommended appointments with her podiatrist. j.w. has a treadmill, in the living room of her home, that she uses every evening for twenty minutes after supper. she states, "i like to walk because it helps my feet feel better. if i can't walk outside, i use my treadmill." she went on to say, "i bend and move with my kids all day," in reference to her work as a kindergarten teacher. j.w. proudly stated, "according to my podiatrist, i'm doing really good." despite having plantar fasciitis j.w.'s range of motion or balance is not impaired. she remains independent and fully mobile. she has smooth, coordinated muscle movement. j.w. stated she has no problems related to her cardiovascular system or with shortness of breath. j.w. manages her single-family home and the daily routines of her family. she is the sole financial provider for herself and her children. she does all the shopping and cooks most meals. j.w.'s children assist her with some chores. she is very active with her children's activities. her children range from age's nine to seventeen and their activity schedule's change frequently. currently, j.w. goes to their dance classes, play rehearsal, orchestra concerts, voice lessons, cub scouts and is a troop leader of girl scouts. she is also visiting colleges, throughout michigan and it's neighboring states, with her seventeen-year-old child. j.w. is an active member of a lutheran church in the town where she lives. she volunteers in the church's nursery on sundays and takes part in the planning and teaching of vacation bible school. during this interview, j.w. expressed, "i'm probably not going to volunteer on sunday's much longer. i am just to busy." after careful review, i was able to formulate the following functional health deficits: risk for activity intolerance related pain secondary to plantar fasciitisand; fatigue related to a busy lifestyle and lack of energy secondary to hypothyroidism. j.w. has hypothyroidism and symptoms related to it. she expressed having a lack of energy, wanting more energy and feeling's of guilt for not preforming up to her usual standards for routine activities. j.w. stated that over the past two years her tolerance for activity and exercise has decreased and many times she just wants to relax. j.w. went on to say, "i'm not able to keep up with the house and kids like i used to. sometimes, i wish i had someone to help." j.w. stated several times during our interview: "i wish i had more energy,"and "i am always tired". readiness for enhanced self-care, was formulated as a wellness diagnosis for j.w. because she has been able to obtain information about her medical diagnoses and how to treat them. j.w. is knowledgeable about her role as a parent and teacher. she works very hard to care for her health but does want to work on weight loss. during this interview, j.w. stated, "i think i'm going to have "child b" and "child c" stay over night at their aunt's house, once or twice a month. hopefully, i will be able to catch-up on things and rest." functional health pattern: sleep-rest on december 4, 2009, i conducted an interview with j.w. in her home in xx, michigan. j.w. is a forty-five-year-old, eastern european female who lives in a single-family home with her children. she is a single parent who is very involved with her children and their activities. j.w. has a master's degree and teaches kindergarten. she is an active member of a lutheran church in the town where she lives. she is alert, cooperative and very pleasant. j.w.'s home is neat, clean and free of clutter. she does not smoke, use any illegal drugs or consume alcohol. she has the medical diagnoses: hypothyroidism and; planter fasciitis. she follows a strict diet and takes all prescribed medication and multivitamins to manage her hypothyroidism. she manages her planter fasciitis with physical therapy, shoe inserts and by doing stretching exercises. j.w. doesn't have time to rest or relax during the day. she doesn't like to rest because then she will be tired and not want to do anything for the rest of the day. j.w. does have some quiet periods during the day however, they consist of driving, household chores, or completing work. j.w. admits, "i wish i had more energy," and "i am always tired." she goes on to say, " i think i sleep enough, i'm just tired because of my thyroid." j.w. sleeps about eight hours on the weekdays and eight to ten hours on the weekend. she said, "i never really feel rested, even if i get to take a nap." she mentioned her two youngest children are going to start staying over night at their aunt's house, once or twice a month. she stated she would use that time to catch-up on things and rest. j.w. mentioned that if she doesn't stay active throughout the day she gets sleepy. when asked about feelings of sleepiness in a car she said, "i could never fall asleep driving. i can't even sleep in a car when someone else is driving. i guess i only feel like dozing off when i'm at home... in between activities." j.w. scored an eleven (mild sleepiness) on the epworth daytime sleepiness scale. she said that once she falls asleep she stays asleep. j.w. prepares for bed at about 0800. then, she reads a chapter out of a book to her children prior to them going to sleep and prior to her walking. while she is walking, her children get ready for bed. j.w. stated, "i keep a pad of paper on my tread mill so, i can make a to-do list. once i make the list, i forget about it until the next morning." when she is done walking, she places her to-do list in her planner, and says goodnight to her children. j.w. goes to her room turns on her fan, and begins stretching. j.w. stated, "after i walk on my tread mill, i stretch and then go to bed. if i walk and stretch, just prior to going to bed i can fall asleep because my feet won't bother me. no matter how late it is i will walk and stretch before bed, otherwise i won't sleep. j.w. does not take sleep aids. her bedroom is conductive to sleep. she states her bed is, "very warm and comfortable." after clustering this interview data, i formulated the wellness diagnosis, readiness for enhanced sleep. this diagnosis is supported because j.w. has established a sleep routine that promotes sleep without the use of pharmaceuticals. her bedtime routine in-cooperates exercise, stretching and relaxation. it also allows for alone time and family time. she writes things down for the next day so she doesn't have to think about them while relaxing or falling asleep. she is making time to rest biweekly by having her two younger children spend time with a family member. j.w. has been working with her endocrinologist to learn how to manage her feelings of being tired. j.w. states the quality of her sleep is good. in her opinion, her feeling's of wanting more energy and being tired are attributed to her thyroid, not inadequate sleep. j.w. and health care providers are currently working on decreasing these symptoms. therefore, no functional deficits related to the sleep-rest pattern are applicable for j.w at this time. functional health pattern: cognitive-perceptual pattern on december 4, 2009, i conducted an interview with j.w. in her home in marshall, michigan. j.w. is a forty-five-year-old, eastern european female who lives in a single-family home with her three children. she is a single parent who is very involved with her children and their activities. she is alert and oriented to person, place, time and situation. she is cooperative and very pleasant. her home is neat, clean and free of clutter. she does not smoke, use any illegal drugs or consume alcohol. j.w. has the medical diagnoses: hypothyroidism and; planter fasciitis. she follows a strict diet and takes all prescribed medication and multivitamins to manage her hypothyroidism. she manages her planter fasciitis with physical therapy, shoe inserts and stretching exercises. j.w. believes, her hypothyroidism caused her to gain 30 pounds (within the last two years) and, the weight gain caused her planter fasciitis. she expressed her desire to lose weight to her health care professionals. she stated, "my endocrinologist told me to eat a diet low in carbohydrates, low in fat, low in sodium, low in sugar, and low in protein. i don't know what i can eat." j.w. has a master's degree and teaches kindergarten. english is her first language but she considers herself to be fluent in spanish, as well. j.w. states, " i learn best by hearing and reading. she enjoys reading but does not keep books or any other reading material in her room. j.w. does not have any hearing or vision problems. she is able to initiate, understand, maintain and appropriately respond to conversation. when comparing herself to those in her age group and educational level, j.w. feels she is of average intellect. she also feels her short-term and long-term memory are appropriate for her age. she had no concerns over her ability to recall information or events accurately. based on this interview, i formulated two functional health deficits, they are: deficient knowledge and; acute pain. deficient knowledge is appropriate because j.w. verbally expressed her lack of knowledge pertaining to the diet that was recommended for her. acute pain of the heel was formulated for j.w. because she has pain that is mild to moderate in intensity and been present less than six months. when asked about pain, j.w. stated, "my heel aches especially in the morning. the pain was a four or five when it first started three months ago. this morning it was two, right now it's a one. my plantar fasciitis has been getting better." after careful review, i formulated the wellness diagnosis readiness for enhanced comfort for j.w. this is appropriate for her because she experiences pain secondary to plantar fasciitis and has expressed her desire to improve her comfort. she stated "i keep doing my physical therapy because it helps relieve the pain." she purchased the recommended shoes and uses the shoe-inserts prescribed to her. she has also taken measures to ensure sufficient time to carry out recommended physical therapy. any suggestions!??? .....anyone?

This is my ROUGH Draft so far... Just wanted to let you know where my thinking was at (I do realize some of the symptoms and rationals are messed up, just excited to share) Nursing Care Plan: Fluid and Electrolyte Highest Priority NANDA Nursing Diagnosis: Deficient Fluid Volume. Deficient Fluid Volume related to insufficient fluid intake and lack of nutrition As evident by: Tachycardia; Potassium 2.7mmol/L; Serum osmolality of 440 mOmsm/kg; Dry mucous membranes; Poor skin turgor, Urine specific gravity of 1.100; Less than 30mL of urine volume in an hour; Generalized muscle weakness. High Priority NANDA Nursing Diagnosis: Acute Confusion related to electrolyte imbalance As manifested by: Disorientation to person, place, time and situation Sodium 155 mmol/L; Potassium 2.7mmol/L; Serum osmolality of 440 mOmsm/kg; Rational: Serum osmolality of 440 mOmsm/kg; is increased urine specific gravity of 1.100; Urine is concentrated Sodium 155 mmol/L; Sodium is elevated Potassium 2.7mmol/L; Potassium is low dry mucous membranes; Symptom of dehydration poor skin turgor, symptom of dehydration; Client is experiencing generalized muscle weakness; less than 30mL of urine volume in an hour; Urine output in low Mrs. T does have Alzheimer's however during admission she was disorientated to person, place, time, and situation. She was also suffering form "acute delirium" because this is not normal for Mrs. T attention should be called to it. Mrs. T is unable to care for her self in her present state at home. This nursing diagnosis would assist with ensuring her needs are met while she is hospitalized and call attention to reassessing her mental status before she is discharged to her home where she lives alone. Her potassium is low while her sodium level is elevated. This suggest her Electrolytes are not balanced. An average adult receives 1200 to 1500 mL of water from oral fluids 1000mL from food and 200mL as a by-product of food metabolism. Mrs. T has not been consuming a sufficient amount of food or water. Mrs.T Serum osmolality and sodium is elevated which is and indicator of fluid volume deficit. Mrs. T concentration of solutes in urine is high causing the specific gravity to rise.

***lightbulb*** thank you for you guidance! you are a very wise person... i'm sure my answer's sound aweful to you both :) this is my first semester of nursing and my first care plan. i owe you a huge thank you... i have seen you input on several posts and i admire you critical thinking abilities. thank you. this is why i want to be a nurse: to laugh often and much; to win the respect of intelligent people and the affection of children; to earn the appreciation of honest critics and endure the betrayal of false friends; to appreciate beauty; to find the best in others; to leave the world a bit better, whether by a healthy child, a garden patch or a redeemed social condition; to know even one life has breathed easier because you have lived. this is to have succeeded. ralph waldo emerson today you have made one life, live (sleep) easier. thank you erica

What is less important... deficient knowledge or Risk for

Okay... So I decided I'm not quite ready to decide on my second Dx I was thinking about what you said, now I think I back in the forest looking for a way out. I was thinking Decifient fluid volume r/t inadquite nutrition and inadquite fluid intake for a priority dx (it is also the unit we are on in the book) Is electrolyte imbalanc diferen than fluid deficientcy? I was looking in the book and noticed that it said dificient fluid volume is not related to sodium. What does that mean!? So now I think for dx number 2 I need something r/t electrolyte imblance because Deficient fluid doesn't cover that? Am I wrong? What dx goes with low K and high NA.... I thought about Cardiac or renal but we have not cover ed those chapters yet... Maybe Inneffective Tissue Perfusion?

Thank you, Thank you, Thank you!!! I will post my final paper on tuesday and my grade some time after that :) I can't beleive this is what I have to do for 10 points! Thank you so much for you direction and for the Gordan's sheet I think it will help me alot over the next 17 months.... I can't wait untill I get to do this for money.... I mean points are good too but.... lol Thank you so much for your input and guidance, it has helped alot! Erica

My highest priority nursing Dx will be defeicient fluid volume I need advice on my second... I was thinking Failure to thrive (???) Chronic Confusion or Acute confusion Deficient Knowledge (feeding?, Alzheimer disease process?) Ineffective Health Maintenance, Self Care Deficient, Feeding PLEEASSSSEE! this is me begging!

It does! I printed off a copy to try to committ to memory for assessments! Thank you so much! Do you have any suggestions for the nursing Dx? I am going to use Deficient Fluid Volume r/t Inadequate fluid intake and Electrolyte imbalances. However, I'm not sure which one is the next pirority and what makes it more important than the rest.

What do you think about these questions? Two Highest Priority Nursing Diagnoses? Identify two areas of functional health patterns that you would like to obtain on Mrs. T. Explain how you will obtain this information and from what source(s).

Oh yeah! Risk for Injury to Self (is that one?)

Okay. I'm new to this here's what I think... one nursing Dx is Deficient Fluid Volume (Sparks and Taylor 123) R/T Inadequate fluid intake and Electrolyte imbalances AEB; Sodium 154 mmol/L Potassium 2.7 mmol/L Urine Specific Gravity 1.100, Urine output of less than 30mL for the "first hours" after retention cather was inserted, muscle weakness, dry sticky mucous membranes, poor skin turgor, Changes in mental status. We didn't do outcomes this time but I thought it might help me to come up with idea's for interventiions.... They're are not complete just for a guide. (I pulled the info out of chapter 52 Koizer & Erb Fundamentals of Nursing) Outcome: client experiences adequate fluid volume AEB urine output greater than 30ml/hr, 24-hour intake and output balance, urine specific gravity, normotensive BP, HR of 100 beats/min, consistency of weight, moist mucous membranes and normal skin turgor..... Outcome: Client will maintain electrolyte balance AEB serum Sodium of 135 to 145 mmol/L, serum Potassium 3.5 to 5.0 mmol/L, Urine Specific Gravity 1.005 to 1.010...... I'm completely lost for the second highest priority nursing Dx here is what I was thinking... Ineffective Health Maintenance, Self Care Deficient, Feeding Chronic Confusion, Knowledge Deficient (feeding?, Alzheimer disease process?) Memory, Impaired (Risk for) Decreased Cardiac Output Deficient Fluid Volume, (Risk for Excessive) Fluid Volume, Imbalanced Nutrition: Less than body requirements, Impaired Home Maintenance. What do you think? BTW thanks for the advice about adding my own thoughts... Hope this helps... I didn't identify two areas of functional health patterns that I would "like to obtain on Mrs. T. Explain how you will obtain this information and from what source(s)." Because I am completely lost on what that question means... I was thinking it is refering to Gordans Functional Health Patterens? Maybe Nutritional-Metabolic Pattern, Activity-Excercise Patteren or Cognitive-Perceptual Patteren. My rational for that answer is; I found the most probable Nursing Diagnosis under those sections. Unfortuntally I will not be able to use that for a rational :) I guess I would ask the client, ask her regular health care provider, and her daughter any questions but I don't know what I would ask... For the drinks do you think she just means juices? like V8, banana-orange Juicy Juice or sports drinks? I was thinking there was a special drink that I missed in the reading....

Case Study Situation: Mrs. T, age 56 years, is in the hospital for treatment of dehydration. Her only previous medical history includes Alzheimer's disease. The emergency room physician documented that the dehydration and electrolyte imbalances are the result of a lack of nutrition and fluids. Background: Mrs. lives alone, but an adult daughter lives nearby. Her daughter visited her this morning and realized the food she left for her Mother three days ago was left untouched. Her daughter believes her increased confusion is due to her aggressive Alzheimer's disease. Mrs. T's mental status will be evaluated after the acute delirium from multielectrolyte imbalances has been corrected. You are assigned to Mrs. T on her 2nd hospital day. You continue your client assessment, encourage the client to drink clear liquids, maintain strict I&O; and continue to review the daily serum chemistry reports. The RN provides IV fluids, administers prescribed medications, and begins discharge plans with Mrs. T's daughter. You are working closely with the RN to prevent self harm due to forgetfulness, infections, and skin breakdown. Assessment: Mrs. T's admission assessment findings include disorientation to person, place, time, and situation; generalized muscle weakness; dry sticky mucous membranes and lips; tachycardia; poor skin turgor; and a urine output of less than 30 mL for the first hours after a retention catheter was inserted. The physician has begun intravenous fluid replacement therapy with multielectrolytes. Mrs. T has a sitter with her around-the-clock to help the nursing staff provide for her safety. Diagnostic laboratory tests results include a sodium 154 mmol/L; potassium 2.7 mmol/L; serum osmolality 440 mOsm/kg, and a urine specific gravity of 1.100. What types of fluids would you recommend that Mrs. T's daughter stock in her Mother's home for rapid electrolyte replacement in the future? Two Highest Priority Nursing Diagnoses? Identify two areas of functional health patterns that you would like to obtain on Mrs. T. Explain how you will obtain this information and from what source(s).