ashleepules

thanks you guys! i meant 10/mg/ml, btw. But i managed to work through it and we went over it in lab today. Thank you so much for your time ! Have a good one....until next time! God bless.

K, i cant figure this one out, lol, any help would be fantastic diprovan is mixed in 100ml. How may mg are needed to equal 10/mg/m? Calculate the rate on the infusion pump of Diprovan using the range 5-50 mcg/kg/min. order: diprivan drip titrate 5-50mcg/kg/min for sedation pt weight: 90 kg say whaaaat! lol

Thanks for that advice epnurse, i did not know that...now that i think about it, that was not the most ethical decision, huh?

Well Bobby, I did complete the care plans, but they were just kinda thrown together enough for me to present to my clinical group. She was very pleased in a surprised kinda way, lol. I have until Friday to have them revised and my concept map complete. My priorities this morning were as follows....1. acute confusion r/t altered mental status aeb A&O x1 2. risk for falls r/t altered mental status 3. impaired gas exchange r/t alveolar-capillary membrane changes aeb need for continuous O2 therapy....ok, so we can all agree that the last one is a hot mess, and needs some work! We discussed however the priorities, she instructed me to change priority 3 to #1, leave 2, and #1 as 3. I see what shes saying, if we dont correct the problems with COPD then we won't be able to address the encephalopathy. I guess my thought process lead me to question the acuity of each problem first. Before we can start safely treating the COPD, we have to make her environment conducive to healing, and the only way we can safely treat her COPD is to address the confusion, get that under control with the antipsychotics, provide safety precautions and then focus on the COPD. And yes, i am 100% with ya on the fact that these things are tough...i'm having an extremely hard time giving her that perfect careplan...i almost loathe doing them . That worries me, b/c i've loved everything about this program until we started heavy on the careplans. My instructor is pretty tough on us, she expects a lot from her group. But any how, where i have the hardest time is my outcomes. we have to have at least 3, they have to have a time period (usually "during my shiftt...") and they have to be very specific and measurable....any advice/helpful hints would be fabuloso!

I would've chosen the Cdiff pt, i'm just a freshman, so i wouldnt call myself experienced however, i thought to myself, hmmmmm, which one would die quickest with no intervention....the uti is serious, especially in elderly pts, but b/c its not a resistant organism it should be easier to control. Cdiff is horrible, pts can deteriorate very very quickly, and the fact that she is immobile, malnourished, and bowel incontinent with diffuse diarrhea, is a recipe for skin breakdown, which opens her up for another infection, which equals disaster. I would put the 94 y/o at priority 2 b/c of the sepsis from the kidney infection, she would deteriorate pretty quickly too, but her DNR status put her priority just short of Cdiff lady. The COPDer, well this is probably not her first rodeo, and you usually can get COPD pts under control pretty easily, if they have no complications. Just my opinion, i do not know how accurate it is, but i always love to see others train of thought, it gives me different perspectives to work from. Good Luck!

Thanks Shaas!!! It took me four hours to just work out the etiology to understand the patho, but i did it! I was about to throw up my books and say eff it, lol, but then i saw she was on haloperidol and bisperidone which are dopamine antagonists, so i thought, ahah! the problem we are treating is excess dopamine....thats causing inflammation , what are some of the causes of excess dopamine. Google is my best friend. I typed in excess dopamine and found that it is caused by oxidative stress, which is a metabolic issue. Oxidative stress is one of the problems associated with COPD, which is one of her past dx. It was like angels dropped out of heaven with harps and french horns! AAAAAAAAAAAh praise Jesus, lol. :yeah:Thanks for the support Shaas, your advice about the toxins pointed me in the right path :redpinkhe. Merry Christmas everybody, one more clinical and i am D-O-N-E Done! with my first semester....

Hi, I'm a freshman SN and preparing for clinical #3 in med surg. I have clinical tomorrow morning at 0700, just got my assignment at 1630. I have to have 3 careplans ready for presentation in the AM and i am stuck on my pts dx. 94 y/o F Primary dx is metabolic encephalopathy, s/s of auditory and visual hallucinations, no hx of liver failure/disease (stumped). the physician is suspicious of a lesion and/or temporal epilepsy MRI scheduled for tomorrow, (could that be the etiology?) Hx of CHF, osteoporosis, paroxysmal AFib, HTN, and macular degeneration. Lab values by exception....WBC 3.5, rbc 3.5, hgb 10.9, hematocrit 33.3, PLT count 133 (is on an antiplatelet agent...dipyridamole.), BUN 38!, creatinine 1.2, GFR 44.5 Stage III normal to mildly decreased, Na 135 (lasix PO 40mg), ALT 27. Any help would be fabulous, not looking for a handout just stumped! I appreciate the help and your time! Thanks ! Ashlee:eek: