dietsprite

First of all, I would like to congratulate you for being a true professional. Placing medication in coffee or stating that God has told the nurse that the patient should take the medicine are clearly unethical actions because they violate the patient´s right to self determination (refusal of treatment), informed consent to treatment, and involve a breach in trust and honesty necessary to developing and maintating a therapeutic relationship. I suggest that you spend some time speaking to your patient and inquire whether she is a member of a particular faith communiy or adheres to a particular belief system (Christianity, Islam, Judaism, Budhism, etc). If this is the case, it may be beneficial to ask the patient whether she would be willing to speak to a person of authority in her faith commuity (priest, rabi, etc) for counsel as to what her religion says God´s wishes would be in a particular situation such as this. I would make sure that you make clear that the purpose is not to convince her to accept medication, but to assist her in spiritual counsel and whether or not her beliefs allow the use of medication in this particular case. Emphasize that she will be making the decision, not her religous leader. Also, provide the option of the faith leader for purposes of spiritual guidance/prayer/healing aside from discussion of medication. If your patient has a self-constructed belief system, perhaps spend some time asking to reflect on whether God would have allowed the discovery of this medicine to occur if it were contrary to His wishes that it could be used when necessary. Ask her to reflect/pray or guidance from her higher power in terms of what His wishes are for her during this hospitalization. As kmcnelly said, have her reflect on the pssibility that God is using you (nurses, doctors) as intermediaries in His desire to heal her by allowing her access to health care and medicine, etc. The hope is always that she will consent to treatment before her health is in enough risk to qualify for a court order, but we must alway respect the wishes of our patients and act according to the ethical principles that guide nursing care.

I first used a digital watch, but I found that my pulses were not as accurate. LOL Don't use the stop-watch on your cell phone either. I did that one day that I left my watch at home and it was a disaster. The best idea is to get one with a second hand! It makes life so much easier.

PS : If anyone else has an opinion, please share.

Thanks for your insight about being quick to rush into making a medical diagnosis. When we were given the case study in class, our teacher said she was what would be later would be diagnosed as someone suffering from Anorexia Nervosa, and I unfortunately forgot that while writing diagnoses at this stage (prior to making the referral) I cannot say secondary to: anorexia nervosa. I went back and changed it everywhere in the care plan. Kudos for reminding me that medical problems are for the doctors to diagnose. However, the case of your children is a little different. I doubt that your children would say when interviewed that they "believe they need to continue to lose weight because they are still fat" and that their recent weight loss is due to a diet that they plan to continue because they are still fat - yet claim to eat well despite being on a diet that has produced drastic weight loss. I also should have mentioned that the client showed visible signs of nutirient deficiency: skin and conjunctival sac pale, hair dull. So this case is a clear one for referral and I am still going to vote for denial since a person who is underweight with a BMI of 17 who claims they are fat and need to lose weight and continue dieting yet eats well seems to be in denial in my opinion. Your children on the other hand are like one of my best friends who eats like a horse and gets called anorexic by those who don't know that her metabolism and constitution are naturally just that way. However, she has never once told me I'm fat, I need to diet. Thanks for your help. If you have more suggestions, let me know.

Congratulations! I am waiting for the day that I too will be able to say that and jump for joy. :)

Based on the information you have given, I typically begin by developing some nursing diagnoses (actual, risk) and in this case collaborative problems first. Then, I take out my nursing care plan book and look up specific interventions. If you have taken pharmacology, you should use the knowledge learned to apply that to have some of your interventions be to look for potential adverse reactions, etc. In this particular case, you definately also need to have interventions related to intake and output, electrolyte monitoring, etc. Rationale: catheter + diuretic. She is on oxygen, monitoring of oxygenation levels, signs of proper tissue perfusion, checking for cyanosis in the oral mucosa, etc. Listening to her breathing, quality, rhythm, etc. But as Juli said, what have you thought of yourself?

How would I realistically intervene on a nutritional level as a school nurse without having any prior sort of a relationship with her? In other words, I could provide information to her about diet and help her set nutrient goals, but realistically if she is in denial that a problem exists would she accept the interventions? Any ideas on interventions that would work? I already included as an initial intervention, a family conference which would include referrals to professionals as part of the Ineffective Denial - due to the severity of the situation and her age (she is a minor). Should I just move those interventions instead to Imbalanced Nutrition along with the educational sessions, keeping a diary of intake, and weighing her on a weekly basis? Or do you think that if I contact the family and offer them professional referrals as part of Ineffective Denial, I can implement the teaching part of Imbalanced Nutrition later?

Hi, I'm sorry for reposting this from the assitance forum, but no one is replying over there. And it's really important. I am in desperate need of your opinions as to what your priority in this case would be. I have a hypothetical case study of an adolescent who comes into a school nurses office (I am the nurse) referred to by another teacher who is worried about her recent weight loss. She is in denial as to the fact that she has a problem which is clearly anorexia nervosa (BMI below 18, loss of menstrual cycle, has lost significant weight recently, self perception of being overweight, etc). However, the client claims she is eating well and does not have a problem. I have to create a comprehensive careplan with sever diagnoses (actual and risk). The two primary actual diagnoses I have chosen are Ineffective Denial and Imbalanced Nutrition: Less than Body Requirements. I am not including the entire diagnosis (3 part) for purposes of academic integrity - should you need more information, you may message me privately. My question is whether I should intervene first with the client's denial of the situation instead of her nutritional status since this is an outpatient setting and she is not in immediate risk of death or serious harm. I believe that any interventions related to nutrition will be ineffective until I at least tackle the fact that there is denial of an underlying problem. Then, I can slowly educate her on nutrition and show her how her own symptoms correspond to a poor nutritional intake. In conclusion, I have two questions: 1. Is it always necessary to address the goal of establishing nutritional balance before a goal lower on the hierarchy, or only if the status is severe? 2. In this particular case, would you address the client's denial prior to to addressing their nutrition? Or do you believe that it will not make a difference in terms of success?

I wish we didn't have to do care plans or at least not as many as are required by my school. I spend an outrageous amount of time on care plans. The theory behind care plans is okay in the beginning, but it gets to a point where it becomes ridiculous. I think you will learn the skills, theory, and rationale without having your hands ache from writing and/or typing.

Hello, This is my first post, and I am in desperate need of your opinions as to what your priority in this case would be. I have a hypothetical case study of an adolescent who comes into a school nurses office (I am the nurse) referred to by another teacher who is worried about her recent weight loss. She is in denial as to the fact that she has a problem which is clearly anorexia nervosa (BMI below 18, loss of menstrual cycle, has lost significant weight recently, self perception of being overweight, etc). However, the client claims she is eating well and does not have a problem. I have to create a comprehensive careplan with sever diagnoses (actual and risk). The two primary actual diagnoses I have chosen are Ineffective Denial and Imbalanced Nutrition: Less than Body Requirements. I am not including the entire diagnosis (3 part) for purposes of academic integrity - should you need more information, you may message me privately. My question is whether I should intervene first with the client's denial of the situation instead of her nutritional status since this is an outpatient setting and she is not in immediate risk of death or serious harm. I believe that any interventions related to nutrition will be ineffective until I at least tackle the fact that there is denial of an underlying problem. Then, I can slowly educate her on nutrition and show her how her own symptoms correspond to a poor nutritional intake. In conclusion, I have two questions: 1. Is it always necessary to address the goal of establishing nutritional balance before a goal lower on the hierarchy, or only if the status is severe? 2. In this particular case, would you address the client's denial prior to to addressing their nutrition? Or do you believe that it will not make a difference in terms of success? Thanks