ashleyv89

It was a typo. Just mixed up the 7 and the 9 from typing too fast. Obviously there would be more nursing implications if he had a temperature of less than 80 degrees! I've never even seen someone with a temperature that low. There'd be a lot more wrong with him at that point.

97.9 axillary temp isn't hypothermic, axillary temps can usually be about 1 degree lower than oral. he will be NPO until resolution of the hematoma which could potentially take weeks. He was scheduled to start TPN either that night or the following day. I did put in the care plan teaching for mom about hygeine, especially since the kid has eczema he really needs to be clean and moisturized.

Thank you very much for your lengthy reply. I am a third semester nursing student, so a lot of the information is stuff I've already learned but great to be refreshed on it! I usually don't put so much emphasis on trying to "come up with" a bunch of diagnoses and I focus my care on what the immediate problems are with my patients, but for this graded care plan we MUST have a minimum of 10 diagnoses to get full credit. I was able to brainstorm last night and came up with what I needed. I know how to do a care plan, I was just having a brain-dead moment staring at my NANDA diagnosis list and book and not being able to connect any dots. I will be visiting the links you sent. The trauma care plan looks like a great learning instrument. Thanks for the help!

Thanks, I did have caregiver role strain down as one of the diagnoses I came up with. I feel like I'm overlooking something - everyone keeps telling me how they can easily come up with 15-20 diagnoses for their clients! I had a list of things that I thought might fit, but I find that there are a lot of diagnoses that are pretty much the same thing so don't want to state the same problem twice.

I am working up a full care plan for a pediatric patient that I had. This is a 6yo male, who has a duodenal hematoma after falling from monkey bars. He has an ng tube with low continuous suction, and a picc line. His doctor was ordering TPN for him, but he hadn't started it yet (I had him 2 days after admit date). IV fluids D 1/4 NS KCL BP 111/58 HR 63 RR 14 T 79.9 axillary His mom was staying with him, but was sleeping all day because she stayed awake all night to make sure he didn't pull his ng tube out again. He does not report any pain. His abdomen was slightly distended, but going down a LOT according to the nurse. He was happily playing all day, and was okay to get out of bed and sit in a chair for a sponge bath. His lab abnormals were slightly low RBC (3.9) Hct (31.3) and Hgb (10.9) He was on Morphine, Pepcid, and Zofran. He says he doesn't like the ng tube and how it looks on his face. He has eczema and was scratching at it a few times. When I cleaned him up, he was really dirty! Dirt behind his ears, clumps of it between his toes, feet were black, dirt was everywhere really. His mom said she didn't know he had that much dirt everywhere, that it must have been from playing at the monkey bars and she didn't want know she could ask for bathing supplies or ask for him to be bathed. I have to come up with 10 diagnoses, and list in order of priority. The diagnoses I have come up with aren't in order yet, and are: 1. Risk for caregiver role strain r/t sudden trauma and unpredictability of illness course 2. Risk for infection r/t broken skin secondary to eczema 3. Risk for loneliness r/t social isolation caused by hospitalization and little interaction with sleeping mom 4. Risk for trauma r/t pulling out ng tube 5. Deficient knowledge r/t hospital policies aeb client expresses she did not know she was allowed to ask for child to be bathed 6. Disturbed body image r/t placement of ng tube aeb pt reports he doesn't like how the tube looks on his face. I don't know if these are any good, and can't think of more for him. Please help.

I thought there was no way in hell i would get accepted into the program, and i got lucky! my gpa was extremely low - 3.2 or 3.3 i don't really remember. it all depends on who has applied and what their gpa's are. what calley said about the college credits is right, and also about less people applying for spring. good luck!

Ah, yes, I am familiar with SpO2 :)

for the 3rd diagnosis i put Risk for ineffective peripheral tissue perfusion r/t decreased cardiac output i do not have any additional information other than what is given and we can not "assume" things about the patient, just use what what given to us. it's not a real pt where i can get more info. we haven't learned anything about PaO2, I don't even know what that is actually. Cap refill is definitely one that I missed. Thanks!

I have a case study to do and I'm having a lot of trouble with it, even though it shouldn't be that difficult. Each question must be answered in 3-5 sentences. Here is the information: Mr. B is a 78yo patient admitted for chest pain. He reported not eating or drinking much on the day of admission. PMH past medical hisotry includes CAD and HTN. His IV fluid order is for D5 1/2NS. The RN assigned to the patient changes the IV bag at the end of his shift at 7am. He gives report to the oncoming nurse. The day nurse is behind in her assessments and does not see Mr. B until halfway through her shift. Mr. B tells her he is having difficulty breathing. A physical assessment reveals bilateral rales and marked edema. The day nurse finds that 0.9NS 9% normal saline is infusing . Questions: 1) Are there any other nursing assessments the RN should do? 2) What interventions would be appropriate for Mr. B? 3) How could infusing 0.9NS affect Mr. B's labs?(specifically Na and K+) 4) Why does Mr. B have bilateral rales? 5) Explain what types of fluids D51/2NS and 0.9NS are and list their indications. 6) List 3 nursing diagnoses with the R/T s. Answers: 1) Vitals (specifically looking for tachycardia and elevated bp), body weight changes, I & O, check for distended neck veins, assess Na and K+ levels 2) discontinue IV immediately, elevate head of bed, O2 therapy, diuretics 3) D5 ½ NS = 77 mEq sodium; 0.9% NS = 154 mEq sodium. Risk for elevated Na levels, therby creating low K+ levels due to the sodium-potassium inverse relationship. 4) I know this has to do with the edema, but not really sure what else or how to expand on that. 5) D5 ½ NS is a hypertonic solution. Shifts fluid back into circulation/vascular expansion/replaces electrolytes. 0.9 NS is isotonic. No fluid shift/vascular expansion/electrolyte replacement. 6) Ineffective Breathing pattern r/t pulmonary edema Fluid Volume Excess r/t ...? Can someone help me see the big picture so I can put it all together? I seem to be missing a lot, and don't really know what else to do.

Thanks. Our professor is already aware of the situation, we spoke to her about it yesterday before registration even opened because we had heard that this might be an issue. She said to email her if we didn't get in and she would do what she can. None of us realized that it would be THIS bad though! From what I have heard, students switched to Southshore because they did not want to have their NP2 instructor and will be switching back for NP3! Of course I'm not saying this is the case for every student, but c'mon! Apparently there were some NP2 students in lab today who were originally from Plant City and they admitted that they switched to Southshore just for the semester to avoid the NP2 instructor. These students do not realize the burden they are putting on others. There is talk about students having to QUIT the program because they live in Ruskin, and cannot afford to drive out to Plant City for class. I know for me it's going to be extremely difficult to manage. We will certainly be bringing this up to the dean if our professor can't get it resolved for us. There needs to be a change in the way this program's registration is ran.

to anyone who goes to plant city campus: why in the world did you all rush over to southshore? half of our class can't get back in to southshore for the fall, and we're all extremely close. we are so frustrated and know it was plant city students because that is the ONLY campus that has spots available for NP2. there are still SIXTEEN spots at plant city, while every other campus is full. the program should not be set up as a free for all. once you are accepted into a campus, i believe you should have priority registration to that campus. then if there are any leftover spots in the campus you want to switch to you can then try to switch. we're going to try to fight this, but i really don't think we're going to get anywhere with it. it's illogical that so many people would switch after getting accustomed to their campus.

oh okay, so your test #3 is just a week ahead of ours then! well, i'm sure you're doing great and you're gonna be the best nurse for your patient!

wow, i've only had two tests - exam one for regular class, and the clinical calculations test. i think exam two will be next week. i started clinicals last week, and i totally psyched myself out before hand so had a hard time actually getting in there. but it's really nothing to be so nervous about, you aren't expected to be perfect and your pt is going to be happy just to have you there. we were encouraged to ask questions to our nurse and to the clinical prof, we were even allowed to buddy up and take a friend into the pts room with us if we were uncomfortable. it really wasn't half as bad as i thought it would be. =)

Hope everyone had a good first week!

Does anyone know if southshore campus bookstore is open? I thought i read somewhere that they are closed until the 9th! Also, do you know if Brandon campus sells the books we need? I have a feeling I'm going to have to make a trip out to plant city or dale mabry and i REALLY don't want to!! =( *edit* nvm, southshore is open. =) good luck everyone, we're coming up on our last weekend before school starts!!!!