suzers26

I agree with what you have listed. I just wanted to say the first thing that sticks out to me is "occlusion of the middle cerebral artery". This decreases oxygen perfusion and can continue to cause serious problems. As far as prioritizing, start with the ABCs, then Maslow's hierarchy of needs.

2. What procedures should the nurse anticipate the physician would do to minimize fetal and maternal injury immedietely before and during delivery? Describe. This makes me think of things like an episiotomy, comfort measures - pain control, assess positioning of both the mother and baby, control bleeding, possible forceps or vacuum use, hemodynamic change monitoring, etc 10. If you find something abnormal for the newborn during the apgar assessment, what are your nursing interventions? This I feel really depends on what the abnormality is. We would definitely suction, keep warm, O2, notify pediatrician, etc. But it may be a situation that requires CPR. Frequent monitoring is a big intervention. Apgar should be done in 5 minute intervals until the newborn's condition is stable. Perhaps think up a couple common examples to help answer this 11. What interventions must be taken to ensure the safety of the infant? I think of basics such as: don't leave unattended, alarm & name bands should be on, proper assessments, proper meds, if they are on a warmer safety measures apply, most facilities want infants in their bassinets when going through the halls instead of carried, feedings - don't lay flat, etc. 17. If You come across an obviously pregnant woman who is leaning over the hood of her car and yelling, "The baby's coming, please help me! I feel the baby's head coming out." No one is available except you! How will you help her? Well, definitely need an assessment: water broke? crowning?dilation? baby positioning?due date?contractions? other pain? medical problems? meds?. I would think getting her off the hood of the car would decrease risk of injury related to falls. Support, try to calm her. Note what materials are available if that baby is coming. hopefully a call can get into 911. if need be catch the baby, wrap the baby, clear airway, etc I'm still in school, but that's what came to mind when I read your post...good luck!

Glad that helped! Also, I wanted to mention the dementia as a secondary opposed to seizures is more than likely because the dementia there's really not much you can do about it. Many with dementia experience falls that often lead to fractures. And if they are confused it makes it harder to have them follow instructions to help the healing process. Chances are she's on phenobarbitol or something to control the seizures. Sounds like your two instructors didn't clarify that very well. We can write a dx for the Afib, hyperlipidemia, etc. but chances are they are more under control with her meds than the admitting dx. If she develops an infection from impaired skin integrity or a blood clot/ resp. infection from immobility the other hx dx may move to a more priority spot. But that's why such a focus on the mobility & skin integrity, because if that's not taken care of at the present moment consequences/complications will be what kills her. Just a suggestion, because instructors tend to expect different things, you may want to request a sit down with your instructors and explain your understanding to make sure it is correct with them. That will also help make sure they are on the same wave length also. And if they realize they confused one student, they might want to clarify to the rest of your class, because chances are others got confused also. Good Luck with your schooling!

In my class we are instructed to do nsg dx based on primary dx, or the one which brought them to the hospital. Though this can change if another health issue arises or becomes primary, we would have to adjust it. So if she was admitted r/t ORIF the nsg dx should be based on that. Not saying the cardiac OP & tissue perfusion isn't important. Impaired tissue integrity & impaired mobility, as well as acute pain are priority for the reason she is there. They can also contribute to fluid build up in the lungs, impaired cardiac OP & tissue perfusion, etc...which in turn would effect her VS as well. If you can keep her pain under control, it will improve her mobility which will improve perfusion, cardiac OP, prevent further build up of fluid in the lungs, etc. The albuterol is a basic bronchodialtor. I've found that sometimes there are Dx missing...no one's perfect. did you ask your patient if she had a history of resp. problems? You stated "lungs clear except lower lobes bilat, with fine crackles", in itself this can be a reason for a bronchodilator. It is used to control and prevent reversible airway obstruction as well as relief for acute/chronic bronchospasms. This can also all be related to immobility and pain, as if she is in pain she is not moving or doing coughing or deep breathing, allowing secretions to build up in lungs which can warrant the use of albuterol to prevent pneumonia, or other further complications. I'm only halfway through my schooling, but that's how I understand it through my instructors. So if I'm wrong I hope someone corrects me :)

Like DolceVita, we don't shadow the nurse. If we do run low on things to do I normally ask a nurse if they would mind me shadowing them. At the beginning of the shift whichever nurse has my patient(s) I ask if they are doing anything that might be helpful for me to observe please give me a heads up so I can try to be there. Normally they are thrilled you're asking to learn from them. You can also find out from your nurse what they have going on that you might be able to do in advance and perhaps set a time with yoru instructor from the beginning of the shift if it's something predictible. Also, in the hospital we go to, if we run into any down time the nurses normally really appreciate it if we just keep up with the call bells. 9 out of 10 times the call bells are on for something we can do independently (we may need to find out if there is any restirctions for ambulating, eating, fluids, etc first) and it gives the staff nurses a good break for that shift we are there, also giving us more basic communication practice. As far as being able to do skills and pass off on them. Our instructor suggested we keep a list of what we have, haven't, and would like to do again for comfort reasons, and let her know each week if there is something(s) in particular we would really like to work on, or need, either the day before or at pre conference. And as far as redoing assessments, it's nothing invasive so sometimes I'll even go room to room, introduce myself as a student and ask if they'd mind if I did another assessment on them. It helps a lot to get it down pat, especially if you can get the main diagnosis of why they are there and can practice focused assesments. Practice makes perfect, right? lol

All schools use it differently. My school has us take the first one at the end of 2nd semester of a 2 yr program. We just did this, I think maybe 3 people passed (% grade is also calculated into final score)....we are required an 850+ to pass. Those that didn't make the score have remediation to complete before they can start 3rd semester in the fall, but it doesn't keep them back. Our second round is the end of 3rd semester, which, again will be a required remediation if 850 is not achieved. And the 3rd taken at the end of 4rth semester, before we can graduate. We have the opportunity to take it 2 or 3 times before graduation. If we don't pass it then we can not graduate with the class. However, at our own expense, we can take it numerous times until we pass it and complete the class...then we can move onto the NCLEX, we just can't graduate with the class. My understanding is that my school opts for a higher pass grade than many other schools who require only a 750. As I said, only 3 people passed this round, so there will be a lot of remediation. Unfortunately, many of those who didn't get 850 isn't because they don't know the material, instead I think everyone made such a big deal about it that test anxiety was a major issue and took out even the highest grade students. The few of us that did pass were the ones that were joking around and laughing as we were logging to take the test and didn't stay up till 1am studying. So best advice....study...sleep...and sign up here: http://elsevierstudyparty.com/ ....for helpful study materials and tips for free!

Ineffective tissue perfusion is definately a good one but the low lab values would be more of an AEB. WHY doesn't she have effective tissue perfusion. If it's due to hypertension it may be r/t changes in blood pressure assoc with effects of prolonged/excessive elevation of blood pressure, possible decrease in cardiac output assoc. with increased workload as a result of elevated BP, excessive lowering of BP by antihypertensive meds. If it's due to DM it could be r/t vascular abnormalities that commonly develop with DM. There's a few examples for inadequeat tissue perfusion. The r/t factors should be more of signs & symptoms of the problem, then lab values and assessment data would be the AEB part of the diagnosis. How about her vitals? Does she show signs of worsening infection? Maybe Hyperthermia R/T infectious process AEB temperatures of. . . Altered Comfort..... Constipation r/t immobility.... Potential acute metabolic complications (DKA, hypoglycemia, hyperglycemic hyperosmolar nonketotic coma...r/t can be any of the s&s of these) Risk for constipation r/t immobility.... Risk for loneliness..... Risk for infection: superinfection r/t a. decreased resistance to infection assoc. with depletion of immune mechanisms resulting from current infection & treatment with antimicrobial agents. b. stasis of resp. secretions and/ or urinary stasis if mobility is decreased. Do you have a nursing careplan book? They help me a great deal! Also the website evolve.elsevier.com is very helpful also. Well I hope that helped, I need to get back to my work.

Ineffective tissue perfusion definition is 'decrease in O2 resulting in failure to nourish the skin at capillary level'. In saying that, it would be more of a cause to skin damage. If the skin is deprived of oxygen it could become necrotic. Ineff. tissure perfusion would be r/t things such as low hgb & hct, rbc and interruptions in blood flow, etc....this is what carries the oxygen thru the system. If the proper O2 is not getting where it needs to go it would cause the BP to increase because it is trying to compensate for the lack of oxygen and solve the problem. You should rethink that one and look it up in your nursing care plan book and I'm sure you can come up with interventions once it's straightened out. Other Nsg Dx that pop in my mind are: Altered nutrition..... Risk for falls/ injury.... Impaired physical mobility... Pain.... Risk for constipation.... Fear/ Anxiety.... as well as many that would be listed under immobility & hypertension. Hope that helps some. Good luck

I never said they'd be honest...what I said is that's considered just as objective is doing a pain assessment. And that is what is expected for an answer on these tests. I'm sure many exaggerate pain too, but we have no other way to measure it.

I would think confusion would be r/t mediactions & restraints evidenced by pulling on the tubing, etc. Perhaps something on nutritional status? Anxiety..... impaired communication..... Impaired oral mucous membrane..... disturbed sensory perception..... impaired swallowing..... A few I think of anyway if it helps any!

Homeless & alcoholic...I agree, first thing that comes to mind is altered nutrition:less than body requirements. Ineffective health maintenance r/t..... Readiness for enhanced decision making r/t..... Dysfunctional family process:alcoholism..... Health seeking behaviors..... Impaired ability to perform or complete bathing/hygiene activities for oneself r/t environmental barriers..... there's many possibilities depending on your person. Then of course if you go into specific health problems that opens up even more. So there's few ideas that I think of. Just like your first reply...I'm still a student myself, but there's my 2 cents for what it's worth.

Future suggestion, davis drugs subscription is $30/ year and they do keep pretty up to date. There's very little drugs I needs to search all over for. And what I do is me and a few class mates join up together to cover the $30 then we all have access to it whenever we need it. There's never been a problem logging on from different locations at the same time or anything either. That way i can just copy & print the info onto blank index cards and it saves so much time! http://http://www.drugguide.com/ddo/ub For Lab tests we use Mosby's "Manual of Diagnostic and Laboratory Tests". It has been very helpful. I also like to go to http://http://www.abebooks.com/ to get books. Most you can get used for really cheap. Example, I paid $3 including shipping for my box of drug cards with CD included. Even text books, if you have the ISBN number you can search by that so you kow you're getting teh right book. Just some suggestions, good luck!

Whenever you need to gather specific information unknown to you it is always best to ask the patient/family, depending on what the case may be, because most have a pretty good idea on what is 'normal' baseline for theselves on basic things. Gathering information on them, from them is considered objective, just as if you were assessing pain using pain scales & descriptions from the patient. We don't just say they are not in pain because we can't scientifically measure it, we ask them about it in detail and consider it objective of what they feel. And, of course you will continue to weigh them daily because that will tell you if they are still losing fluid or if they are gaining it back evidenced by return to their normal stated weight. So to compare his current wt. to what he states he weighed prior to illness would be more accurate than turgor. Weight is always the best way to measure fluid imbalances no matter what the question states. We've had multiple questions similar to this on our exams and our instructor has drilled this point home with my class to the point that if anyone ever gets it wrong again there may be consequences....lol.

Alot of nsg programs are set up that half way through you can take a lpn course (normally a couple of weeks long) so you can work LPN while finishing Nsg school. Then depending on the state, I know PA does it, you may be able to get a temporary LPN license without taking the exam for 1 yr. to allow you to finish RN & work as a LPN without paying double testing fees. It really depends on the state and the school program. Ask your Nursing advisor what the options are at your school & state, it's the only way to get a difinitive answer.

ABC's are physiological needs, which is the first lvl to Maslow's hierarchy. Physiological needs are the literal requirements for human survival, including breathing, eating, homeostasis, ability to reproduce, etc. They would just come first in that category if there were multiple physiological needs not met.

Pediatrics is a very specialized unit. I am just in nursing school myself, but from what I've seen through school and with my own kids (which I have lost one after spending a week in a pediatric unit with him), it takes a lot to work in pediatrics. It takes a lot to work as a nurse in general, and no, it's not for everyone, but it takes a lot more for pediatrics. And most nurses in peds have specialized training and years of experience. It takes a special person to deal with critical peds & their families on a daily basis, and that takes practice. And it takes a very special person to admit they are not yet comfortable with being there and stepping back. But most ped nurses I've talked to say they have the 'what ifs' everyday, even after 20 or 30 years of experience, and the 'coulda, shoulda, wouldas' when a child is lost. The fact is nurses are not superheroes, they're only human. Looking back to when I lost my son, it was very hard for me to grasp that simple phenominon, but I get it now. The great thing about being a nurse (amongst many more) is that it's a big enough field that you have the choice to switch to a different unit if you find yourself in an uncomfortable situation. I would strongly recommend that if the charge nurse does not seem competent at what she's doing don't just let it go. If she doesn't know what she's doing that's putting lives at risk and she either needs retraining or a new unit. Maybe she's not really comfortable there either but doesn't want to admit it because if she does she may feel like she's quitting. I'm not saying go get her fired, but it should be brought to someone's attention that there's doubt and your not comfortable working with her because of it. Transferring to ER or going PRN is not quitting, it's simply putting yourself in a more knowledgeable & comfortable situation. And as a newer nurse you still have a lot of experience to receive, so maybe sometime down the road you would be better fit for peds. There's nothing wrong with taking time off for your own kids either, they need you too. Ultimately I want to get to peds also, but i don't forsee myself doing it comfortably till I've had more hands on experience in different units. I haven't even graduated RN school yet and already have the 'what ifs' about peds, but I'll get there, and when I get there if I realize it's not something I can handle after a fair shot I'll decide what to do then, but that's what my life dream is. Good luck in whatever you decide & have fun with your own kids!

Info on ARDS.... http://www.ards.org/learnaboutards/whatisards/brochure/ Basically it's injury at the alveolar level that impairs gas exchange. Which in turn would more than likely cause an ineffective breathing pattern & increased heart rate, etc....cuz the body is trying to compensate for the inadequate tissue perfusion. To be honest, I haven't seen the two diagnosis used together, but I'm only halfway through nursing. But I would think one would definitely lead to the other. i think priority would depend on which one is causing the other. If the pattern is ineffective b/c the body is having trouble meeting O2 demands b/c the gas isn't exchanging I would think working on the gas impairment first would be priority. on the other hand, if the impaired gas exchange is b/c the breathing patterns are ineffective enough that the O2 is not coming in to exchange the gas, or the CO2 is not being exhaled..... And on the other hand.....following ABC's.....the breathing patterns are the B's, and gas exchange the C's (because it directly affects the perfusion). Just some ideas off the top of my head. I don't think I'd use them together myself, I'd probably stick with the heart of the problem...breathing patterns or gas exchange? and go from there......good luck!

You delegate tasks as a CNA also. Example, if your resident/patient asks you for a sandwich between meals you ask the kitchen to prepare it. If someone leaves and the room is empty, you let housekeeping know so it can be cleaned. It shouldn't be thought of as 'giving orders'...it's teamwork and they are part of that team. However, aside from just being polite and using your 'please & thank you's' you need to consider their workload also. It's hard work to be a CNA, and if they have 10 people to get out of bed in 2 hours and the other one only has 4 left to do, they may get a little upset with you. And, as a rule of thumb you should always keep in mind that you shouldn't ask others to do what you WON'T do yourself. If they see you helping them keep up with someone that has diarrhea all day, they'll be more likely to accept a delegated task without a problem. But if they see that you do your meds, assessments & charting and nothing more, even when you see they have their handsfull, they won't be too happy about you asking them to take VS. Just because your the nurse & they are the CNA doesn't mean your exempt from cleaning up their person whose had diarrhea all day. That misses the point of team work. I've been the CNA that's worked with those nurses that won't lift a finger to help a CNA and pile more on top of the load, it sucks, and more than likely the other CNA's don't like them much either. Make sure you respect and appreciate them as much as you would expect them to do for you, and let them know it! Keep all that in mind with what everyone else has said and you'll do fine.

I wouldn't say they are the same, but active bleeding can lead to hypovolemic shock if too much volume is lost. If your NSg DX is ineffective tissue perfusion think what the signs are that those tissues are being deprived of oxygen, and remaining free of those individual symptoms can all be goals. Good Luck

Safety ia always a priority, however, when prioritizing nursing diagnosis maslow's hierarchy of needs should be a basic guideline. For Maslow's hierarchy, physiological needs should be met first, then safety needs, love & belonging needs, self-esteem needs and finally self-actualization needs. With multiple physiological needs the ABC's should come in to help prioritize, meaning Airway, breathing & circulation would take priority. This is where tissue perfusion would come in. Risk for falls is definately a priority, however, if the tissue perfusion is inadequate & urinary elimination is a problem (which can both contribute to fall risk), not to mention activity intolerance due to inability to keep up with O2 demand (also a contributor to falls), and these are current problems that could actually be life threatening to your patient they would need to be addressed first. Not to say you wouldn't address the fall risk, but addressing the fall risk is useless if they can't breath and are going to die from failing to address the actual problem anyway. And as you can conclude from Maslow's hierarchy physiological takes priority over safety. So, what I'm trying to say is safety always is A priority, but is not always THE priority. My logic to this is I think what would make sense to address first, and...as I said a bove, if they are going to die from a physiological problem going unaddressed or possible receive an injury (not even definite) from falling...what would you want someone to address first if it were you or your family?

Personally this is the order i would use for these particular dx. Following Maslow's Hierarchy & ABC's, Tissue perfusion would be first because it deals with circulation. And keep in mind it's always a priority to deal with what's already happening opposed to what the risks are so I would put the risk last. 1.)ineffective tissue perfusion(physiological) 2.)impaired urinary elimination (physiological)3.)Activity intolerance R/T imbalance btwn o2 supply and demand 4.) Risk for falls So that's my opinion for what it's worth, I'm in 2nd semester nursing so I'm no pro yet...but I'm working on it!

HI, I just completed clinical rotations in both Or & PACU and have to submit 3 nsg dx for each, doing a complete careplan for only the priority dx. What's catching me up is doing it generalized rather than patient specific, I find it much easier doing it patient specific. So here's what I came up with, any feedback, both positive and negative would be greatly appreciated! OR: 1. (Priority)Risk for aspiration r/t depressed cough & gag reflex, and decreased level of conciousness associated with depressant effects of anesthesia & narcotic analgesics. 2. Risk for imbalanced body temperature (hypothermia) r/t reduction of heat generation associated with lack of body movement. 3. Risk for injury r/t surgical environment & extraneous objects & equipment. PACU: 1. (Priority)Impaired physical mobility r/t sedative effects of anesthesia/narcotics AEB altered state of conciousness & possiblity of dizziness upon sitting upright/ standing. 2. Risk for ineffective airway clearance r/t depressed coughing/ gag reflex, impaired swallowing & possible regirgitation/ vomitting. 3. Risk for infection r/t alteration in primary defenses & possibilities of cross contamination. I know they get weaker as i go, but I am trying not to repeat dx between the two. As I said, and criticism would be appreciated. Thanks!