LostLoneStar

I am bipolar, I am stuck in limbo between SN and GN. I graduated in May but in Texas you have to have a letter from your psychiatrist/doc writing your meds sent to the BON. I have been seeing the same psychiatrist for the last 5 years. I asked him for said letter 10 weeks ago. I still have no letter. I can't even be considered a GN until everything is turned in. Can't get a job, can't take NCLEX, can't move on with my life!! Tomorrow I'm making an appointment with a new psychiatrist. The one I have is holding up my life. I can't work and my family keeps asking where the letter is.

i am struggling with my careplan for a pp sickle cell crisis pt. i have 5 dx but i am not confident that i have the most important. any input would be greatly appreciated. my aeb is in my subjective and objective data in a different column on the care plan. pt was re-admit 10 days pp repeat c/s. g4, p3, a1, l2. came to ed, dx w/ pih, uti, sickle crisis, abd pain, ha. the 5 i have: 1. impaired gas exchange r/t decreased oxygen carrying capacity of blood, reduced rbc life span, abnormal rbc structure, and increased blood viscosity. 2. ineffective tissue perfusion: peripheral r/t hemolysis, vaso-occlusive nature of sickling, inflammatory response, peripheral circulation damage of small infarcts and iron deposits. 3. acute pain r/t vaso-occlusive crisis hypoxia, which causes cells to become rigid and elongated, thus forming crescent shape aeb pt statement and non-verbal cues. 4. anxiety r/t perceived threat to neonate’s well-being secondary to complications of pregnancy; maternal illness. 5. compromised family coping r/t chronic nature of disease