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I have a feeling you are correct. Since it's a personal medical history, and taking confidentiality into account, it's not something that can be referenced. I do know about the APA citations for a "interview", but I think that's a different situation. Thank you.

Anyone got a favorite website or know of one that does a nice concise summary of each of the nursing theorists? I know that many of the theorists are very "out there". So if you have a website that explains them in easy to understand terms, I'd appreciate it :)

I have a Case Management paper due for a BSN course. The client I chose is a 64 yo woman with Stage IV Breast Cancer with mets to the lungs. I have completed 3/4 of the paper. But this one criteria is where I could use a little help. If anyone can share their fresh perspective, I'd really appreciate it. I have been working on this paper all week, and I am now to the point where my head is going to burst! Could really use a fresh pair of eyes! here is the criteria: Present an analysis of the factors or issues that need to be addressed to effectively manage the care of the patient (you may select one aspect of the illness for this portion of the paper; i.e. CABG during treatment of CAD). Another part of the assignment asked us to make a summary of health problems/diseases that the patient has experienced, using a table or outline form. So if I am to select just ONE aspect of the illness, do I use one from the health problem list? The example given was CABG during CAD. Well my patient has Stage 4 Cancer and Chemo side effects. Would I focus the analysis on that? But really, what can you say about Chemo? It sucks. It wreaks havoc on the body. But it is a necessary evil. And what does it have to do with effectively managing the care of the patient? There aren't really any other options. It's either the chemo or nothing at all. So I just don't get what I am supposed to be analyzing here. I don't know why this isn't making sense to me. Like I said, I have been working on this paper for a week and a half and my brain just won't cooperate anymore. Here is my health problem list as it is so far. Maybe someone reading this will see something that I am not seeing. If anyone has any ideas, please share! It looks better on my word processor, so please don't mind the set up. : The following list summarizes the client's health problems and history. I. Breast Cancer A. MRM of left breast in 2004. 1. Body Image Disturbance 2. Grief B. Adjuvant Chemotherapy 2004-2005 1. Side-effects a. Nausea and Vomiting b. Mouth Sores c. Neutrapenia d. Alopecia 1. Body Image Disturbance 2. Grief e. Fatigue/Weakness C. Breast Cancer Recurrence in 2007 1. Metastasis to Lungs 2. Second-line Chemotherapy 2007 - present a. Neutrapenia / Immunocompromised 1. Risk for Infection b. Thrombocytopenia 1. Risk for Injury/Bleeding c. Neuropathy 1. Pain d. Nausea and Vomiting 1. Anorexia and Cachexia e. Periodontitis 1. Tooth Loss 2. Stomatitis and Oral Mucositis f. Fatigue and Weakness II. Cardiovascular Disease A. Hypertension B. Hyperlipidemia C. Family history of Stroke, Hypertension, etc. III. Pulmonary Disease A. Smoker of one pack/day X 35 years B. Emphysema C. Pulmonary nodules from metastatic cancer 1. Ineffective Breathing Pattern IV. Mental/Mood Disorders A. Major Depressive episodes X 5 1. Ineffective Coping B. Dysthymia C. Generalized Anxiety Disorder D. Social Phobia E. Alcohol Abuse / Quit in 2005 1. Family History of Alcoholism and Depression V. Gastrointestinal Disorders A. Cholecystectomy in 2010 B. Gastroesophageal Reflux Disease (GERD)

I have a paper for a Case Management assignment. The first 3-5 pages of my paper are 99% patient report (health history, family history, social history, etc.). Do I need to use citations? And if so, what is the proper way to do that in this situation. It's not like the info came from a medical chart, or a doctor. fyi: the patient is my mother. we were allowed to choose a friend or family member if we wanted to.

I always prefer if people wait to ask questions until the end or near the end. Because chances are they will answer your question before they finish giving report. If someone keeps interrupting, then it just takes that much longer. Plus it's kind of annoying, when they stop to ask you if the patient has an IV but you were just going to get to that part in your report.

Hi Kay, This is a great example. This is actually the point I was trying to make but sometimes I tend to go off on tangents without getting my point across. Ok so your example said Morphine 1-2 mg. Now at one time I know alot of orders were written in a range like this. But a couple years ago, I am pretty sure that JACHO or some administrative body, (I can't remember who, but it was probably JACHO) said that medication orders can not be written in a range. They said it needs to be written specifically, either Morphine 1 mg, or Morphine 2 mg, but not 1-2 mg. Know what I mean? So if I remember this correctly, when you see an order like this, technically you are supposed to call and get it clarified. Now this may have changed as this was 2-3 years ago... maybe other nurses recall this new rule? Now also in your question: using the example of Morphine 1-2 mg q 2 hours. As far as I know, No you can not give it q 1 hour. If you give the smaller dose of 1 mg, it still must be q 2 hours, and not q 1 hour. You can not change the frequency of the dosing. The only part you can change is the dose. You either give 1 mg, or 2 mg, every 2 hours. But again, as I stated initially, if you see a order written this way, you should call to clarify it because of new JACHO rules.

What is the patient's PMH? maybe there's something you missed. Has the patient ever had shingles?

In my county, there is the hospital I work at now. Another hospital a few blocks away, which is now part of the same system since merger. So same hospital, just 2 different locations. And a 3rd hospital close to my house, but has a bad reputation... I doubt things would be any better there. I have worked at a hospital that was Magnet, and it was great, had stressful days too, but in hindsight... things were so much more organized and professional. Nurses were respected. But it is 1.5 hours drive each way. I was living in that city, but then had to move when my mom got sick. Tried the commute for several months, but my depression w/ driving, got the best of me. The only other places in this county are LTC facilities... correctional facilities... and Home health care. Tried home health for a couple months and I don't think I'd ever want to do it again.

You wrote a book? That is amazing! I guess you aren't allowed to tell me which book are you?

Since this is an OR rotation, you'd probably want to stick more with things that apply to a pre-op patient, rather an a post-op. But could use post-op if you plan to see the patient in recovery, and on the med-surg floor. Some that come to mind: Risk for bleeding as you already mentioned Risk for infection Pain Anxiety Knowledge defecit Impaired Mobility Not necessarily in that order though :)) The two goals that you mentioned seem fine to me.

There are PRN medications for lots of overthings. There are those for pain, as mentioned already, GI upset, as mentioned already... there is also Skin treatments, and Cardiac meds, Anti-anxiety, Sedatives, etc. You always want to check what the parameters are with a PRN med. You need to follow those stricktly. The parameters should be specific. For example, old ways of writing pain meds used to be every 4-6 hours. Now JCAHO says it has be to more specific, either every 4 hours, or every 6 hours, but not a range. This is how orders should be written: PRN Tylenol 650 mg every 4 hours as needed for fever, headache, or pain. PRN Ambien 5 mg at Bedtime as needed for Sleep. PRN Ativan 10 mg every 8 hours as needed for anxiety. So lets say you gave Ativan at 12 noon. That means the patient can not have it again until 8 pm. Now lets say the patient still has anxiety, and they are asking for more medication. You need to call the doctor to ask for an increase in dose or increase in frequency of dosing. Or a new med all together.

Hello, I personally enjoyed my Psyche rotation very much. And if you prefer to do something along the lines of Critical Care, you can do Acute Overdose? Psyche patients will never go to a psyche unit until they are medically stable. So you will definitely see your psyche patients on med-surg and critical care floors. Your project could be about the Nursing care or Nursing interventions of the patient with psyche disorders.

Well it would depend on the type of disorder, and how advanced the disease is. For example Myasthenia Gravis can affect the swallowing ability, so choking could be a hazard in the advanced stages. People with MS can have altered speech, altered swallowing, etc. Or some people you may not even know they have MS unless they tell you, because they appear symptom free. Generally speaking, if your patient has a difficulty swallowing, you'd want to make sure they have a consult with a Speech Therapist, and make sure the physician knowns as well, so that some meds can get changed to IV or other routes.

Conquerer, you are exactly right. In my state we also have an Abandonment rule. You could risk medical negligence/malpractice and risk losing your license or worse! The purpose of taping report is so that during your "overlap" period when the new shift comes on, you only need to give quick updates. They can listen to the detailed report on tape. We only get 15 minutes of overlap, which is more like 5-10 minutes, because oncoming shifts always like to piddle around.

Amber, these questions are designed to get you to critically think. They seem like they are "trick" questions, but really it's not difficult once you get the hang of it. You want to work at seeing the Signs & Symptoms. This is going to come from your Assessments. Then you want to work at knowing what is normal and what is abnormal. Once you know what a normal assessment is, then knowing what is abnormal is easy. Now you also what to look at what is going on with this patient. The question said this was a 2 day Post-op patient. So right there are already thinking one of the major Nursing Diagnoses... "Risk For Infection". You also know this is an acute change right? Meaning... the patient was not febrile before the surgery was he? Probably not, since surgeries would be postponed if the patient was sick. Now you also have swelling around the surgical site. Some swelling might be normal if this was a fresh post-op that just came to your floor about 2 hours ago. But after 2 or 3 days? You would expect swelling to be decreasing not increasing, right? So there ya have it... it's all in looking at What is going on with the patient? What are the potential dangers? Using Nursing Diagnoses as your guide for interventions... and looking at the 3 answers... all answers seem right... but there's always one BEST answer or one that is MORE important in priorities. Know what I mean? Post another question from your book, and I'll see if I can help you figure one out.

awww well hello there Cheyfire... that is where I would eventually like to go but everything in education requires a Master's. I am not even finished my BSN yet. But thank you so much for your kind words.

NurseFrustrated, You don't work at my hospital do you? LOL. The things you say and how you describe it sounds scarily similar to my hospital.

One last thing... a few Hyaline casts are normal... Now if you get a UA back that is showing moderate to many bacteria, the patient has a fever, and a elevated WBC, and mental changes... You got a UTI going on, so you need to call ASAP. Does that make sense? With labs it helps to know what will be affected and what are the potential dangers it can cause? Know what I mean? Here's another example... Is the patient on aspirin or plavix and has a very low platelet count? That's a side effect of being on blood thinners, so it's something you may be calling about to get the meds changed.

Well one thing to keep in mind is how are these abnormal labs affecting the patient? If the patient is asymptomatic then sometimes you can just fax. If the patient is symptomatic then that will affect your decision on calling. The big things are the electrolytes. Hypo/hypernatremia, Hypo/Hyperkalemia are major things to call about. Hypo/hypermagnesemia and hypo/hypercalcemia are sometimes important too. Another major concern is RBC's, H&H, Platelets, WBC's... If those are elevated or decreased... How is the patient doing? SOB? Febrile? Weak? If so then you are definately going to call. But keeping in mind how have the patients labs been running? Is this an acute change? Or has this change been going on for sometime and the patient tolerates it? And how much out of the normal range are they? What meds are they on that may cause the change? What in their PMH may be causing these abnormal labs? For instance, Na levels of 129 is much worse than Na level of 134. Patient is on lasix and has a K of 3.1 for example. I work in a hospital setting where MD's make their rounds atleast once a day or some times more often, so things may be a little different than in LTC.

Klone, I just looked back... the OP is another poster. I don't recall responding to any of your messages. My input was in regards to the OP and in agreement with a post made by Tittytat. It seems like you were a little offended, but I was only responding to the OP not you dear. Sorry.

I never said you said that. I was referring to Tittytat's post regarding the people who come in early to start complaining about their assignment and trying to get moved. I was not referring to the OP. I was referring in general to those people who do that.

Ok, wondering what kind of floor is this that you only have 4 patients? Is it an ICU step down? or similar kind? And what is going on that you don't report until 7:50? Why doesn't the night shift tape record? And what time is report "supposed" to take place? For example: our shifts begin at 7:00 and the night shift ends at 7:15. That 15 minutes of overlap is designed to be able to give a quick verbal report, or updates if you had taped. What is your "overlap" period?

I understand that some may want that extra time to get their "brain" written down. But I tend to agree with Tittytat on this one. If they are going to stand around, asking questions, and trying to get their preferred assignment then they are being royal PITA's. Lets say their's a particular rude or annoying patient, or several for that matter, on a particular section... If you go out of your way to come in early, so you can make sure you don't get assigned there then what does that say about you? Lazy? Not a good nurse? tittytat said it right on the money... don't come in asking questions at the end of our shift when we are trying to tie up loose ends and getting prepared to give you an excellent report.

oh man... CPSI? if there's anyway you can talk them out of that then you should... that program is lousy! It's very difficult to navigate, slow, crashes all the time... There are much better programs on the market.

Also want to add, that if your Surgeon would be downright ****** at you if you did not notify him of temp greater than 101, increased pain, and increased swelling.