ChristineWV

Thanks for the reply. That's how it was at the hospital that I trained at, but I wanted to do that today at the patient's request at the new facility that I'm working at and an RN jumped all over me...said the doctor's orders were for 2 tablets q6h. I told her that the patient requested it as 1 tab q3h and she said that it would be exceeded the orders...tried to reason that I wouldn't go over the prescribed dosage but she asked "But what if he wants 2 tablets next time?". I indicated that I would not give him 2 tablets the next time after we had started to stagger...she said I would then be denying him what the doctor ordered. Couldn't quite figure it out after that. Just wondering if others have done this.

If a doctor has ordered 2 percocets q6h prn for pain, can it be given 1 percocet q3h instead (not to exceed 2 tablets in 6h?)

Thank you...why doesn't NANDA list Infection as a diagnosis?

NurseVandy thanks for the reply. I definately left it at #1 spot with Infection as my #2; but still had a tinge of doubt - I think it's from only having one more week left in this semester and being a bit brain-dead. I still get confused with the infection diagnosis...it seems to me that gangrene would definately kill the patient before Ineffective peripheral perfusion (cardiac or cerebral I can definately see as killing them first)...but I went with the perfusion since that is what we are taught. What is your opinion? It's kind of a "chicken or the egg" thing as well...the ineffective perfusion definately caused the gangrene, but the infection could lead to septicemia and organ failure....it's all so confusing! I can't wait to be done with all of this.

Thanks for the reply. I am assigning the Ineffective Peripheral Tissue Perfusion, a Maslow 1, as my first priority, and then the Infection/Risk for Infection, a Maslow 2, as my second. If it were just a Risk for INfection and not an active infection, I wouldn't be having the problem because an actual diagnosis always "trumps" a Risk for...but our instructor uses Infection as a NANDA diagnosis...so in my mind, I'm asking "Which will kill him first"...and keep coming up with "Infection"...but am afraid to put it first since it's a Maslow 2 and not a 1! Argh!!!

Hello, I am a 2nd yr. Nursing student and have not struggled with care plans or prioritizing diagnoses until this patient. I am stumped and hoping that somebody with experience can help to clarify. My patient presented to ER with gangrene of 2nd right toe and was admitted for surgical amputation of the toe. He also has cellulitis in his right lower extremity and the beginning of 2 more lesions on his left foot/toes. He is on 4 different IV Abx and is allergic to PCN. He does not have any lung/breathing problems; has Hx of htn and an MI but is on no cardiac meds or antihypertensives other than Lasix at home. He is a diabetic, obese, lives alone, is depressed, cannot ambulate with out assistance, and noncompliant with his diabetic regimen. Our instructor allows us to use Infection (not just risk for) as a diagnosis. I know my diagnoses can/will include the following: Perfusion, ineffective peripheral tissue; Infection; Impaired skin integrity; Ineffective Health Maintenance, Imbalanced Nutrition More than Body Requirements, Risk for Falls/Injury, Impaired Mobility and something to do with depression (am not sure where that goes). I am thinking that my Infection should be my first one....but am wondering if maybe the Ineffective Tissue Perfusion should be. Can anybody help me decide? Thanks in advance.