MomBak2Skool

Actually, now I'm second guessing myself. "Electrolyte imbalance" isn't a REAL NANDA diagnosis...it's actually listed as "Risk for electrolyte imbalance". So I'm not sure if I should use electrolyte imbalance as a diagnosis. Maybe I can use it as part of my fluid volume excess diagnosis? I feel like I should mention it because it's an out-of-range potassium level which can have extreme consequences on the heart but I don't want to just "make up" a diagnosis that's not NANDA-approved. And this way, I can still include impaired skin integrity like I originally wanted to! Thoughts?

How about this for prioritizing?: 1. Ineffective breathing pattern... 2. Electrolyte imbalance... 3. Excess fluid volume... I really wanna put impaired skin integrity in there but I guess that would come in at a close #4? Please tell me if you think these should be rearranged in any way. Thanks again!! :)

Thank you so much for your responses! Esme12...do you mean I should include risk for ineffective renal perfusion? What other NANDA diagnoses could be used for renal failure (besides the excess fluid volume that I already used)? Or should I just add renal failure to my electrolyte imbalance diagnosis like hodgieRN suggested? For example, I could put: "Electrolyte imbalance r/t ascites, continuous peritoneal drain, and renal failure aeb hypokalemia and elevated BUN and creatinine levels." We have to list as many diagnoses as we could come up with for our patient and then pick the top 3 priorities to develop a care plan for. Thanks again for the help! I really appreciate it :)

My patient is an 80yo M with a history of HTN, DM, cirrhosis secondary to Hepatitis C, blindness, and dementia. He is hypokalemic (3.3) and thrombocytopenic (26,000). BUN is 84, creatinine is 3.5. Low eGFR, low INR, high PT. Vitals are normal except for high RR of 22 and high BP which he takes Norvasc for. Blood sugar was below 150 (so no coverage) both mornings I cared for him. He is Islamic and speaks no English. His son translates for him but is not always around. No history of tobacco, alcohol, or drug use. He is on bedrest; has a peritoneal drain and a condom catheter; is incontinent of stool; has skin tears on his forearms, tops of thighs, and buttocks. He is very skinny but eats all of his food (Kosher). He is DNR. Discharge planning included hospice care but the staff was fairly certain his family would not agree to that and would want to take him home so plans were made to send him home with the peritoneal drain and possibly the condom catheter as well. So far my nursing diagnoses are: 1. Risk for bleeding r/t thrombocytopenia (platelet count of 26,000) 2. Bowel incontinence r/t dementia aeb inability to recognize the urge to defecate. 3. Urinary incontinence r/t dementia aeb uninhibited urination at unpredictable times. 4. Impaired dentition r/t self-care deficit aeb excessive plaque and missing teeth. 5. Electrolyte imbalance r/t ascites and peritoneal drain aeb hypokalemia. 6. Ineffective breathing pattern r/t pressure of ascites fluid on diaphragm aeb tachypnea. 7. Fluid volume excess r/t cirrhosis of the liver aeb ascites and pitting edema +1 in the lower extremities. 8. Impaired skin integrity r/t physical immobility and bowel incontinence aeb skin tears on the forearms, tops of thighs, and buttocks. Am I missing any important diagnoses? I can't seem to narrow in on what my top 3 would be (I'm thinking it would be #s 6,7,8 although I think #1 is very important but not sure if I can include a "risk for" in my top 3). Do I need to elaborate on any of the diagnoses I have listed? I would really appreciate any and all advice I can get. This is my "big assignment" for my main Med-Surg course (3rd semester) and it's due on Tuesday. Thank you all in advance for your help!

Also, I have no diagnosis for my Genitourinary assessment. True, he is experiencing anuria as I saw him on Wednesday and he hadn't urinated since the Sunday before. But I looked at the impaired urinary elimination diagnosis and he didn't seem to quite fit that. He also doesn't have urinary retention because his kidneys simply aren't making any urine to be retained. The other diagnoses for elimination include incontinence (No), constipation (No...he had a BM the morning I saw him and says he usually has 2 a day), diarrhea (No), and motility problems (No...he had normal bowel sounds). I'd hate to leave that blank but I also don't want to make something up just for the sake of filling in that one area.

I'm still not happy with that diagnosis. I have others that I need to prioritize. Here are the ones I feel are most important, but I don't know which would be my #1, #2, and #3. Decreased cardiac output r/t altered stroke volume aeb dyspnea, anuria, crackles in the lungs, cough, and restlessness. Ineffective airway clearance r/t secretions in the bronchi aeb crackles in the lungs and excess sputum. Fluid volume excess r/t renal failure aeb dyspnea, crackles in the lungs, pulmonary congestion, decreased Hb/Hct, and restlessness. Risk for electrolyte imbalance r/t renal dysfunction and effects from cardiovascular medications. Any suggestions are greatly appreciated :)

Thanks for the link Streamline! It looks helpful. I came up with this diagnosis...not sure if it's good or not: Ineffective renal tissue perfusion r/t hypertension and renal disease aeb decreased RBCs, decreased Hb/Hct, elevated BUN/Crt, anuria, and fluid overload.

I have a 36 yo patient in renal failure. He's on dialysis, producing no urine, has bronchitis, hypertension, congestive heart failure, is on 2L/min O2 via nasal cannula, and on remote cardiac monitoring. He presented with shortness of breath and headache but is being kept for observation due to his renal failure, bronchitis, and newly diagnosed congestive heart failure. His WBCs are high, RBCs are low, albumin is low, HGB and HCT are low; BUN and creatinine are WAAAY high and CO2 is high. For one of my nursing diagnoses, I want to put that he has ineffective renal perfusion but I have a few questions: 1. NANDA only has a "Risk for ineffective renal perfusion" diagnosis, not an actual ineffective renal perfusion diagnosis. Can I just take out the "risk for" part or would that not be acceptable? Clearly, I think this man is no longer just "at risk". 2. Would it be accurate to have my "r/t" part be hypertension and renal disease? 3. If I do take out the "risk for" part, what would my "aeb" part be? I was thinking about saying "aeb abnormal lab values and anuria; am I missing anything? So would this be okay?: Ineffective renal perfusion r/t hypertension and renal disease aeb abnormal lab values and anuria. Thanks so much in advance for any and all suggestions! (P.S. This is my first concept map/care plan due next week and it's a big part of our grade!)

I'm also in an ADN program, finishing up my first semester. We are expected to educate our client within the scope of our knowledge. Basically, anything we've learned so far in lectures and on-campus labs, we should be able to explain to a client. Of course, if they have questions regarding their specific care plan, disease, etc. we still refer them to their RN or doctor. But for a situation such as taking vital signs, as long as you know the normal ranges for BP, RR, temp, etc. (which was one of our first lectures) I don't think there would be anything wrong with saying they are within the normal ranges. If their numbers don't fall within the normal range (after re-checking) I would let the RN know and tell the family you would be more comfortable with the RN explaining any out-of-range measurements.

Thanks brillohead! That makes a lot of sense. Do you know anything about any differences in responsibilities between CNAs in an LTC facility vs in the hospital setting? Or are the responsibilities pretty much the same in both environments?

1 hour for 40 questions; 2.5 hours for our final exam which will be 100 questions

Hi everyone! I've been reading posts for quite awhile and really enjoy hearing all of your experiences! I am a first semester nursing student and have been informed that at the end of this semester (only a month away...yay!) I will be able to get my CNA license just by proving I've passed my Basic Health Assessment class and my Fundamentals of Nursing class with clinical rotations. I definitely want to go for it and get a part-time job while working so I can accumulate some experience. I've already started the job hunting process and it doesn't look like there's much available at the local hospitals (I'm in the DC metro area). The openings that are available want at least 6-12 months experience. I did find some openings at assisted living facilities. I just wanted to know what anyone's suggestions are for working as a CNA while in nursing school. I know that working in these kinds of places (nursing homes, LTC, etc.) can be very demanding, but just how different is it from working as a nurse tech in a hospital? When I become an RN, I definitely want to be in an acute care hospital setting, but I know I have to get my foot in the door somewhere. Will this kind of experience really help me in the long run? Should I wait for a hospital position to open up, or will any experience be helpful? Thanks for any advice you guys have!

HappyGurl, I'm in both your 110 and 105 classes! What time is your 121 class? I have it on Tuesdays too, from 2-4:50 with Bertiz.

Ok I just logged into my Yahoo account and I can't see anything about groups I belong to! How do I get there?

I agree! :)

Neither. But it's kind of hard to tell what her "tone" is when she speaks with such a heavy accent. Reading her face is a better interpretation of what she means. She seemed to be annoyed that we didn't really know what to do, but on the other hand she wouldn't jump in and help when she saw we were struggling...she would wait for us to ask for help. Then she wouldn't be mean about helping, she would actually be nice about it. It's just the initial reaction that caught me off guard because she seemed so sweet at first lol. She just seems to have high expectations and doesn't want to be disappointed, but is still willing to help IF she is asked. She's definitely not going to hold our hands or make things easy, but I'm trying to convince myself I'll come out more efficient at the end because of that. We shall see...lol. Do you guys start your hospital orientation next week or the week after? Looking at the syllabus, I see that some are supposed to start theirs next week. How will that be possible if the tunics haven't come in yet??

OMG that sucks that you guys drove all that way just for it to be cancelled! But it's cool that you were able to get to know some people at dinner. I didn't know that the lab wouldn't allow you to practice until you've had the orientation, but I guess that makes sense. I wonder what happened? It must have been something serious for her to miss something so important. Nikki, you are right. We should NOT have been expected to know those procedures but she's also the kind of instructor you don't really want to argue with because she'll just keep making you feel like it's your responsibility to come prepared regardless. We did have the syllabus before classes started and it did say something about the 3 other modules (remember I even asked on here if we should do those?) but since the hand-out that they gave us during registration only said to do the Infection Control module, that's all I did. I didn't want to get into an argument with her so I just let it be. Of course, she put Susie and I on the spot (maybe because we were sitting closest to her?) so all eyes were on us as we messed up almost every step of how to bathe a patient lol. I guess in the end it was a good learning experience; I just wish it hadn't been so much of a "learning-out-of-fear-of-being-humiliated" type of environment. We were told to gather our bathing supplies and wash our hands. Then she was like "Ok, bathe your patient". So we started...and she was like "Ummm...excuse me! Did you knock on your patient's door?? Did you introduce yourself? Did you ask for their name and check their ID bracelet? Did you engage in a little conversation? Did you tell them what you're going to do to them? Start over!!" Total and complete humiliation! LOL but everyone eventually felt the same sting cuz she went around and made other people do other things that she thought we should already know by reading the modules. You can bet I'll be prepared for next week though! No way I wanna go through that again...

OMG...looooong day!!! My brain feels like it's completely fried and my eyes are struggling to stay open. This morning, we got acquainted with the MLC and registered for ProCalc. We then were allowed to work on ATI modules for the remainder of the 2 hours. Apparently, 4 modules were technically due today but they only really worried about 1: Infection Control (the only one I thought was assigned). The other 3 will be due next week along with the ones that were already due for next week. After the MLC, we went to the Safety and Infection Control lecture with Professor Davis who is HIL-AR-I-OUS!!! I absolutely LOVE her!! I wish now I had done my clinicals at Doctor's because she is really amazing. After that was lunch. Then we got with our individual clinical groups and met our clinical instructor, Mirna Ostchega. Our (mine and my friend Susie's) first impression of her when we met her was that she was very nice. She had a thick accent, but seemed very smiley and sweet. Well, that was kind of short-lived...she is nice, but she also seems to be very strict and serious. She is also one of those "put you on the spot" kind of teachers, which I am trying to tell myself will only keep me better prepared, on my toes and very aware of what I'm doing at all times. Today, she expected us to know how to bathe a mannequin and change the bedding while the mannequin was still in it. Nobody really knew how to do it (except for a guy who is already a PCT at Howard County General), so she seemed annoyed that nobody was prepared. Apparently, the lesson was in one of the other ATI modules that was supposed to be due today. We also practiced washing our hands, toured the lab, got our kits, and role played different communication roles. She does seem very knowledgeable about nursing practices and actually called me "honey" at one point so I can see she does have a soft side somewhere. I had hoped my first clinical instructor would be a little less demanding and a little more nurturing, but I am convinced everything happens for a reason...we'll see what that is as the semester progresses!

Nikki, Kristian: how was your first day of clinical? I have to be there at 7:30am tomorrow for mine. Definitely will be making a starbucks run...make it a Venti!! LOL I had 121 today with Bertiz and it was pretty fun. We talked for awhile about the course, watched a video on how to do a physical assessment, toured the lab we were in, and started talking about taking a patient history. There are only 8 people in the class so it's very intimate, and we sit at a round table which makes for great discussion! Just finished organizing my binders/notebooks, etc. so now I'm going to pack some munchies for tomorrow and hit the sack. Maybe I'll see you guys around tomorrow :)

Getting ready to leave for 121 girls! I have to go early to get my ID (the office was closed yesterday due to technical problems). I'm bringing my lab coat, steth, and penlight just in case. I made a copy of my chain of custody form, but you can't even see most of what is written on there because it's so light to begin with on the original copy. Oh well... My mentor called me last night while I was still in class! Lol, she left a message and seems really nice. Her name is Amanda. I'll call her back today on my way to class just to let her know I got her message, but I'll have to jot down the questions I have. It'd be nice to meet up with her in person, but with everyone's differing schedules e-mail convos might be best. I hope today goes well for everyone! :)

I'm hitting the sack girls. I can barely even keep my eyes open anymore. Maybe I'll run into you tomorrow. Otherwise, have a great clinical orientation! :)

Ostchega has a very thick accent, which I am a little worried about. But she seems nice enough, so maybe it won't be too much of a problem. Do you have 110 from 12-3:50 Nikki? You probably have at least large lecture with my friend Susie. I think I introduced you guys at orientation. She's a short blonde that kind of looks like Kate Bosworth from Blue Crush lol (I always tell her that!). I have 121 tomorrow from 2-4:50. Kristian had it today and all I remember her saying about it was that it was long lol.

LOL I definitely could too Kristian! I'm so mad I forgot to record Professor Mansir's lecture on Communication!! So, it looks like our first exam will be on about 8 chapters from Potter and Perry and 1 chapter from Wilson. That is ALOT of reading/studying!!! Not to mention about the course guide readings...

I'm glad we have 2 weeks before we have to do today's schedule again! Lol I think my clinical instructor, Ostchega, is going to be extremely high maintenance. We have that packet she e-mailed us from MGH about their Mandatory Education, including a post-test. And then today, she was introduced in 110 by Professor Robinson, and she handed out packets to people in her clinical that have all these things we're going to have to do after every clinical day. Oh, AND my clinical day is not from 7-5; it's apparently rom 6:30am-4:30pm!!! 7am was bad enough!!! I'm really gonna have to get to bed by 9 at the latest on Tuesday nights from now on...

Nikki, what time do you start and end on Mondays? When do you have 121?