schantzy143

thanks so much for all the responses. It is so stressful trying to find a job right now. I don't graduate until May but so many of my classmates already have a job lined up. I started to apply online but everywhere I want to apply for requires at least a year of experience and the only experiences I have are clinicals and my preceptorship that I'm doing in the PACU. It's really stressful when people ask if I job yet and I say "no" and they give that look like "seriously?"

I'm about to graduate in May and I am really stressed about finding a job. I really like LTC and have been looking at nursing homes and assisted living places to apply, but I heard that pay a lot less than hospitals, and while I didn't become a nurse for the pay I do have a lot of loans to pay back from college. Anyone have any ideas abouta graduate nurse RN with BSN pay in LTCs and hospitals in PA??

Maybe I am just confused, would you actually have the r/t gallstone pancreatitis part in there because that's what we can't have...they don't want any medical diagnosis in our care plan, even though it makes much more sense and it is easier to read. "...related to obstruction and inflammation of the common bile duct, inflammation, edema, distention of the pancreas, and peritoneal irritation..." I only wrote all of that because I was trying to explain that all of that caused the pain from the pancreatitis and gallstones

acute pain r/t gallstone pancreatitis s/t obstruction and inflammation of the common bile duct. aeb: pain of 8 on a 1 to 10 scale thats how i would write it, but good for you listing all those other ones so you understand why you are using that diagnoses they always tell us not to use the medical diagnosis in here, even though it sounds better then the mess i have!

thanks everyone for the help, very helpful :)

We are not aloud to use PC in our care plans, they tell us we need to use what is actually happening with the patient. Any suggestions for short/long term goals for excess fluid volume? I don't lilke the ones my care plan book is giving me and I can't find ones that make sense. I'm thinking something about monitoring the edema or reducing it?? I'm not sure how to word it so it makes sense with "Client will..." I'm also considering using, Client will remain free of jugular vein distention, positive hepatojugular reflex, and gallop heart rhythm throughout shift.

i have a care plan due soon and since my instructor is not emailing me back and answering my questions, i could really use some help. my patient is 78 years old and diagnosed with gallstone pancreatitis. he is in a lot of pain, has inspiriatory and expiratory wheezes throughout his lungs, sob, his bun (42) and creatinine (4.25) levels are also really high which to me indicates acute renal failure. the patient is on 3lnc, xopenex aerosol treatments, dilaudid q4hrs, lasix, potassium chloride, zosyn, has elevated bilirubin, wbc, alt, ast, amylase, and lipase.he is on a clear liquid diet, is hr ranges from 99-110, occasional sinus tachy on telemetry, +1 edema lower extremities, productive cough with thick yellow sputum, firm &distended/obese abdomen, voided 400ml during 7 hours of clinical day, took in a little over 1000ml during that time, and had warm/dry skin. potassium, iron, albumin, sodium, calcium, hct, hgb, and rbc are all low. there is obviously a lot going on with this patient so i am having a hard time coming up with 5 diagnoses, 3 of which i have to work out. so far i have ineffective airway clearance related to increased mucous production as evidenced by sob, inspiratory and expiratory wheezes throughout lungs, pox 93% on 3lnc, productive cough with thick yellow sputum and xopenex aerosol treatments three times a day. acute pain related to obstruction and inflammation of the common bile duct, inflammation, edema, distention of the pancreas, and peritoneal irritation as evidenced by patient reporting a pain of 8 on a 1 to 10 scale, the need for dilaudid every 4 hours, pain and tenderness in ruq and back, and pain when coughing. excessive fluid volume related to renal insufficiency as evidenced by intake greater than output, shortness of breath, and +1 edema bilaterally in lower extremities. i'm not sure if the second one sounds right because i tried describing what causes the pain, and in this case it's the gallstones (obstructing the common bile duct) and the pancreatitis. i also wasn't sure if i should include the diagnsostic studies (ultrasound:small stones and sludge within the gallbladder. gallbladder wall approx. 4mm, and ct scan: gallstones, dilated cbd and peri-pancreatic inflammation) i was also thinking of using ineffective breathing pattern due to the pain and inflammation and maybe also due to the use of dilaudid which causes respiratory depression, and maybe the secretions could be a cause too??? and for the last one i was going to do imbalanced nutrition: less than body requirement related to reduced food intake (clear liquid diet), and increased metabolic needs... i would really appreciate any feedback, it's really nice to bounce my ideas off other people. :)

help!!! i have a care plan due soon and since my instructor is not emailing me back and answering my questions, i could really use some help. my patient is 78 years old and diagnosed with gallstone pancreatitis. he is in a lot of pain, has inspiriatory and expiratory wheezes throughout his lungs, sob, his bun (42) and creatinine (4.25) levels are also really high which to me indicates acute renal failure. the patient is on 3lnc, xopenex aerosol treatments, dilaudid q4hrs, lasix, potassium chloride, zosyn, has elevated bilirubin, wbc, alt, ast, amylase, and lipase.he is on a clear liquid diet, is hr ranges from 99-110, occasional sinus tachy on telemetry, +1 edema lower extremities, productive cough with thick yellow sputum, firm &distended/obese abdomen, voided 400ml during 7 hours of clinical day, took in a little over 1000ml during that time, and had warm/dry skin. potassium, iron, albumin, sodium, calcium, hct, hgb, and rbc are all low. there is obviously a lot going on with this patient so i am having a hard time coming up with 5 diagnoses, 3 of which i have to work out. so far i have ineffective airway clearance related to increased mucous production as evidenced by sob, inspiratory and expiratory wheezes throughout lungs, pox 93% on 3lnc, productive cough with thick yellow sputum and xopenex aerosol treatments three times a day. acute pain related to obstruction and inflammation of the common bile duct, inflammation, edema, distention of the pancreas, and peritoneal irritation as evidenced by patient reporting a pain of 8 on a 1 to 10 scale, the need for dilaudid every 4 hours, pain and tenderness in ruq and back, and pain when coughing. excessive fluid volume related to renal insufficiency as evidenced by intake greater than output, shortness of breath, and +1 edema bilaterally in lower extremities. i'm not sure if the second one sounds right because i tried describing what causes the pain, and in this case it's the gallstones (obstructing the common bile duct) and the pancreatitis. i also wasn't sure if i should include the diagnsostic studies (ultrasound:small stones and sludge within the gallbladder. gallbladder wall approx. 4mm, and ct scan: gallstones, dilated cbd and peri-pancreatic inflammation) i was also thinking of using ineffective breathing pattern due to the pain and inflammation and maybe also due to the use of dilaudid which causes respiratory depression, and maybe the secretions could be a cause too??? and for the last one i was going to do imbalanced nutrition: less than body requirement related to reduced food intake (clear liquid diet), and increased metabolic needs... i would really appreciate any feedback, it's really nice to bounce my ideas off other people. :)

i have a care plan due soon and since my instructor is not emailing me back and answering my questions, i could really use some help. my patient is 78 years old and diagnosed with gallstone pancreatitis. he is in a lot of pain, has inspiriatory and expiratory wheezes throughout his lungs, sob, his bun (42) and creatinine (4.25) levels are also really high which to me indicates acute renal failure. the patient is on 3lnc, xopenex aerosol treatments, dilaudid q4hrs, lasix, potassium chloride, zosyn, has elevated bilirubin, wbc, alt, ast, amylase, and lipase.he is on a clear liquid diet, is hr ranges from 99-110, occasional sinus tachy on telemetry, +1 edema lower extremities, productive cough with thick yellow sputum, firm &distended/obese abdomen, voided 450ml during 7 hours of clinical day, took in a little over 1000ml during that time, and had warm/dry skin. potassium, iron, albumin, sodium, calcium, hct, hgb, and rbc are all low. there is obviously a lot going on with this patient so i am having a hard time coming up with 5 diagnoses, 3 of which i have to work out. so far i have ineffective airway clearance related to increased mucous production as evidenced by sob, inspiratory and expiratory wheezes throughout lungs, pox 93% on 3lnc, productive cough with thick yellow sputum and xopenex aerosol treatments three times a day. acute pain related to obstruction and inflammation of the common bile duct, inflammation, edema, distention of the pancreas, and peritoneal irritation as evidenced by patient reporting a pain of 8 on a 1 to 10 scale, the need for dilaudid every 4 hours, pain and tenderness in ruq and back, and pain when coughing. i'm not sure if the second one sounds right because i tried describing what causes the pain, and in this case it's the gallstones (obstructing the common bile duct) and the pancreatitis. i also wasn't sure if i should include the diagnsostic studies (ultrasound:small stones and sludge within the gallbladder. gallbladder wall approx. 4mm, and ct scan: gallstones, dilated cbd and peri-pancreatic inflammation) i was also thinking of using ineffective breathing pattern due to the pain and inflammation and maybe also due to the use of dilaudid which causes respiratory depression, and maybe the secretions could be a cause too??? i think that the acute kidney failure also needs to be addressed so i was thinking excessive fluid volume related to renal insufficiency as evidenced by intake greater than output, shortness of breath, +1 edema bilaterally in lower extremities, need for lasix 120mg iv, and (i would like to put the labs here but i'm not sure which ones, i'm thinking the decrease sodium, hct, hgb, and rbc????) i'm really confused, i kept going back and forth between fluid excess and fluid deficit..am i right with excessive fluid volume?? the patient is on lasix which would make me think of deficient fluid volume...but that's the only past of the assessment that would make me think fluid deficet, unless i mixed the labs up. and for the last one i was going to do imbalanced nutrition: less than body requirement related to reduced food intake (clear liquid diet), and increased metabolic needs... i would really appreciate any feedback, it's really nice to bounce my ideas off other people.