tarheelsu

When I think about inneffective protection, I think about someone who is unable to protect themselves, as in unconscious in surgery or a coma, etc. Also, I thought risk for bleeding was a NANDA. I don't have my book handy but I think it is one.

Um, they are totally different, so it's really hard to compare. I don't think there is much available in terms of career advancement as a vet tech. I think of a vet tech being more comparable with a CNA rather than a RN. You should see if you can shadow someone in both jobs.

At my school if we are aware of cheating and we don't report it, we will be kicked out. You should go in person and speak to the director of your program.

Unfortunately there is no quick and simple answer. Look up TPN and fluid and electrolyte imbalances in your textbook. TPN is not going to fix all the electrolyte imbalances and it can cause significant side effects. I can't tell from your post if the patient is already on TPN. If not, I don't know if they would be put on it at only 3 days of not eating. I think you can go longer on fluids that that. The potassium is a big deal. The MD needs to be notified right away of that and will order KCL IV. The sodium is low (the low chlorine goes along with the sodium). I'd guess she would get NS fluids. You want to raise the sodium level relatively slowly. You probably want to put the patient on seizure precautions. The albumin does seem really low. You can give concentrate albumin IV I think. I'd also guess that their calcium is low if albumin is really low since so much of calcium is bound to albumin. I'd also look up patho and interventions for bowel obstructions. I think TPN needs its own dedicated central line. I've heard great things about the nursing made incredibly easy fluid and electrolyte book.

If the end result is the same, then I don't think there is a definite better route. I'd look at how fast you would have your BSN with both routes and what the financial cost would be. When you look at financial cost, make sure you include whether or not you will be working while you take pre-reqs for either program and whether you will be working while you are in either program. Another consideration is whether you want to start working as a RN after getting the ADN and before or while you would be working on the RN-BSN. I don't think you can say that a particular type of program is better than the other, there are great ADN programs and really bad BSN programs and vice versa. It's clear that the BSN degree offers more job security and opportunity for advancement but there isn't a clear better route to get there.

Then I would look mainly deficient fluid volume, imbalanced nutrition and acute pain. Look up info on the FLACS and FACES pain scale rating for acute pain data. Then for the others look at the defining characteristics for those nursing diagnoses and see how your assessment data compares.

So if you have to do respiratory you probably have ineffective airway clearance or impaired gas exchange. You need to have a care plan book. Look up the defining characteristics for these diagnoses and see what assessment data you have. Airway could relate to obstruction (tumor, mucus, etc), it could relate to a weak cough. If the patient has been on prolonged bedrest, they probably are weak, that could lead to a weak cough. If you have mental status problems then they probably can't make a controlled effort to cough and clear their airway. Prolonged fever could lead to fluid deficit which can make secretions thicker and more difficult to clear. Gas exchange can be related to the history of COPD - she probably gas less alveolar surface for gas exchange, immobility/ bedrest can lead to decreased lung expansion which would cause less air to come in the lungs for exchange, secretions pooling in the bases cause less surface for exchange. So I would look at these two, see what supporting assessment data you have and go from there.

We've had a number fail out, maybe 25% or so. I think maybe 3 for cheating. One or two for doing unauthorized procedures during clinical (removing catheters/ IV's, miscellaneous stuff without permission). One for HIPPA violation. We have a strict attendance policy (you can miss a certain number of lecture hours and only one day of clinical, which has to be made up). If you miss anymore that that you fail. No exceptions. They apply the exact same policy to everyone, that way it is fair. The instructors work with those who need to miss class/ clinical for a valid reason. One girl just had a baby and another is pregnant. They were able to do their clinicals early, etc so that they would meet the requirements.

When you had him as a patient what assessment data did you get? How was his fluid status? How was he eating? How about his output? Skin turgor? Thrush is basically a yeast infection of the mouth. It is very painful, and probably makes him not want to eat. If his tonsils were taken out/ tubes put in he, I would guess he has had repeated infections. How was his mood, interaction with his mother, was his development appropriate for his age. With repeated ear infections, how was his hearing. So from all that, if you have assessment data that indicate these: deficient fluid volume acute pain imbalanced nutrition less than body requirements caregiver role strain (if he has been sick on and off since August, that is stressful for a mother)

The first semester of nursing school is brutal. It just is. But complaining about the teachers, the tests, etc is useless. The people who do the most complaining are the ones who aren't going to make it. That's just the way it is. The instructors do not have a choice about how much reading they have to assign and how much material they need to cover. There is a lot of content in nursing school and there aren't enough lecture hours to cover it all. A huge part of nursing school is learning how to think and how to think critically and problem solve. Being told exactly what and how to study doesn't help that. And those people who do a ton of complaining, if they do make it through the program, aren't going to have good relationships with their instructors, which they will need for recommendations to get their first RN job. So that was a long way of saying, no you are not being insensitive. You are being practical. What I do is nod my head and say yes it is hard/stressful/frustrating but don't say a word about instructors being bad/tests being unfair etc.

When you label the tubing, you mark either the date you put it up or the date it is due to be changed. From what I know, the guidelines are based on the risk of infection based on how many times the IV tubing system (from the IV site through the tubing to the IV bag) is opened. Every time it's opened there is an increased risk for contamination and therefore infection. So piggybacks where the tubing is connected and disconnected more frequently needs to be changed more frequently whereas primary bags changed less. If you are labeling the tubing with the medication being run then that could help make sure the all the piggybacks are compatible with each other and the primary fluid. I think of it as one more check to make sure medication errors aren't made.

You have got to do more background work before getting help with careplans/ nursing diagnoses. If its an actual chart, read the history and progress notes/ labs, etc to find out details of why they are in the hospital. If you don't have that, look up the past medical history in your med-surg book. Read the patho and potential complications. The book should list common nursing diagnoses for the disease process. Numbness and tingling are just too broad of a complaint to prioritize nursing diagnoses. Things I would ask: are they currently being treated for cancer (chemo/radiation), do they take meds for hypertension, do they follow their medication protocol for HIV, what medications do they take and what are the potential side effects of those medications? What does their CBC look like -- WBC, RBC, Hmg, hct, and especially CD4 count for HIV.

Perhaps it is a habit that is second nature. Did she actually touch the needle with her hand to bend it? If so, that is BAD. But if she pressed the needle against a hard surface, maybe a bit less bad. But either way is unsafe. Touching it risks needle sticks and touching it against something else can transfer body fluids/bacteria/diseases from the needle to whatever surface it touches. Better to go straight into the sharps and better yet if it has a safety lock on it.

We had a lab on IV starts. We had to pass a clinical skill test where we started the IV on a dummy arm. We couldn't practice on each other, we were told that it was because of insurance. We do IV starts in clinical, starting from whenever we have passed the lab skill, sometime in the first semester. But whether we really get to do it depends on if we are assigned a patient that needs a new IV. I've done it twice in 4 semesters. We had lecture on IV therapy, complications, peripheral/central lines. Hanging primary fluid/ piggybacks was part of our medication lab. We do that in every clinical as the clients need them. We also do IV push for all except emergency type meds. We have since the first semester. The hospital where we do clinicals does have an IV team, but we are encouraged to put on a tourniquet and at least look for good veins first. And if we/ our instructor thinks it is likely we will try one stick before calling the IV team. I'm in an ADN program at a CC.

Supra = too much Look up what INR measures. Look up some anticoagulants in your drug book. How do they work? What would they cause if you had too much of them? What are the adverse effects?

Look up DM in your med-surg book and see what ND are common for it. For neurosensory think about any problems with pain or sensation. Many diabetics have issues with perhipheral neuropathy where they can't feel their feet very well, so they get foot ulcers that don't heal because they don't know they're there. For cardiopulmonary, think of anything that has to do with circulation. Tissue perfusion, blood pressure, etc.

Airway -- think of the actual airway like a tube - what could cause it to be blocked? Trauma, mucus, etc. One nursing dx is ineffective airway clearance. Breathing -- anything having to do with the act of breathing -- respiration rate and depth (ineffective breathing pattern) or gas exchange in the lungs (ineffective gas exchange). Circulation -- anything to do with the vascular system. Think bleeding, cardiac output, dehydration, overhydration, etc. Decreased cardiac output, fluid volume deficit/excess, risk for bleeding. Then you go with Maslow's hierarcy for your prioritization. Pain before coping, food before love, etc. Also another to think of is anytime that fixing one nursing dx can fix multiple other dx.

I'm going to agree with the others, this is just the way nursing school is. All information covered in lecture or texts is fair game. And the questions are often not "fair". Often answers are wrong because of one word. So read all questions carefully, underline key ideas and think through them very carefully. You have to learn a different way of thinking, to take the facts that you learn and apply them. Try to be easier on yourself about your grades. Try not to compare your grades in NS to your grades prior. Also focus not on the exact grade itself but how you did in relation to the other students in your class. That can be a better indication of how you are doing.

I would word the physical assessment pretty much you would for an adult patient . . . results of your head to toe, etc. Then I would look up what developmental tasks they should have accomplished according to their age and document that. Ex -- developmental milestones appropriate for age. I don't think "development is impressive" is good, first of all its too vague. I think what you are looking for is if their height and weight are appropriate for age, their fine/gross motor, speech, social development etc.

Well do you have some guidelines in your textbook or notes for therapeutic communication? I think there should be some in your fundamentals book and definitely in a psych book. In this case think about coming across as being nonjudgemental and upsing open ended questions. For example, "You seem overwhelmed, would you like to talk more about your concerns?" You might want to ask about their support system, if they have respite care providers for the mother, etc.

I think it all depends on the particular school, not whether it is a 4 yr or 2 yr program. I'm in a 2 year program and tons of people have failed, probably about a third of our class (we're halfway through the program). For what its worth if I was in a program to get a BSN would not consider transfering to an ADN program.

It seems like my program is a bit different from some others, but we have 4 16 week semesters and one 10 week summer session. We started clinical halfway through the 1st 16 week semester and we do clinicals one day a week from then through the entire program. So far we've switched units every 8 weeks and we will be doing peds and OB during the summer.

I would look at impaired skin integrity and acute pain. You can't do risk for infection b/c a risk diagnosis can only been used when risk factors are present, but not when the condition is actually present. Risk for further infection is not a NANDA. You could look into knowledge deficit (wound care) but I don't think that would be his priority dx.

I would think you could use the +1 edema as part of your AEB. Was he on tele? If so do you have his rhythm from that. Did he have any abnormal heart sounds? What was his rate and rhythm? What were his other VS?

I could really use some help prioritizing nursing diagnoses for my clinical patient from this week. This is my first time putting a post up like this, so please let me know if I leave anything out. 72 year old female history admitting diagnosis of hypernatremia, hypotension, and fever. Other current dx: protein calorie malnutrition (BMI Other history: seizure disorder, HTN, dyslipidemia, PRES syndrome, probably meningioma, GERD, lower back pain. Hysterectomy. She was brought to the hospital when her home health nurse couldn't get a BP on her. Then they ran labs on her and found her sodium level to be very high (161). I saw her when she had been in the hospital 3 days. Assessement: VS: Temp 99 Ax, Pulse 112, RR 19, BP 116/69 O2 sat 95% general: Emaciated, frail, disoriented, elderly female laying in bed in fetal position. In no apparent distress when resting. Neuro: Blind in left eye. Disoriented x 3. Arouses to touch, pain and sound. Obeys commands at times (takes sip from straw, opens mouth for spoon) but at other times does not. Confused. Does not acknowledge son or grandson. Speech understandable at times, but inappropriate. At other times speech slurred and incomprehensible. Grunts frequently. Grips equal and strong. HEENT: normal except dry mucus membranes Pulmonary: WNL. On room air. O2 sat 95%. Cardio: normal except tachycardic. Pedal pulses thready (+1). GI: WNL except incontinent of stool. BS hypoactive. Last BM the day before, brown and hard. Renal: WNL except has indwelling cath, inserted on admission. Urine clear yellow, etc. Musc: normal except very weak and stiff ROM Skin: normal except skin very rough, flaky and dry. Stage II (just barely) decubitus ulcers on right and left sacrum. She screams in pain whenever she is moved. She can't use the pain scale. She is completely immobile, can't turn herself in bed, etc. Orders: BG Q6H VS Q8, neuro checks Q2 strict I&O puree diet with thin liquids. 1:1 feed. Bed rest Titrate O2 to keep above 92% 1/2 NS at 125 mL/hr Foley. Seizure and aspiration precautions. Labs: WBC: 12.H RBC: 3.07L Hcb: 8.8L Hct: 26.9L Glucose: ranges from 206-170 Bun and creatine were high on admissin, but normal now Sodium: 148H Potassium: 3.1L Chloride: 117H TSH: 0.326L CK/CPK: 220, 344, 342 - run 8 hours, then 6 hours apart Clean catch urine showed infection with gram neg rods Urine positive for ketones, high protein, WBCs Head CT showed no acute pathology. CXR: showed right lower airspace disease, likely pneumonia. Meds: cefriaxone 1 gm IVPB Q24, heparin 5000 units SQ Q8H, insulin lispro sliding scale Q8H, Flagyl 500 mg IVPB Q8H, Potassium PO 40 mEq Q24H x 2 doses, oxycodone 2.5 mg PRN Q8H for pain. So with all of that background, I've come up with tons of diagnoses, I'm just having a hard time prioritizing them. She doesn't have any airway issues. Breathing, she seems fine, even though she likely has pneumonia. Circulation: Decreased cardiac output r/t decreased plasma volume and poor cardiac contractility Deficient fluid volume r/t inadequate fluid intake Then outside of that: Imbalanced nutrition: less than body requirements r/t to inability to ingest or digest food Impaired mucous membrane r/t ind inadequate oral secretions Chronic confusion r/t neurologic changes secondary to dementia Hyperthermia r/t an increased metabolic state secondary to infection Impaired skin integrity r/t malnutrition and immobility secondary to decubitus ulcers Impaired verbal communication r/t aphasia Total urinary and bowel incontinence r/t cognitive and self care deficits Total self-care deficit r/t cognitive deficit impaired physical mobility r/t neuromuscular impairment acute pain r/t ??? risk for injury r/t potential for seizures secondary to hypernatremia and history of seizures Her fluid balance seemed to be pretty much in control while I was there, she took in 1000 mL by IV, approx 500 oral water and juice, urine output: 900 mL total over shift. The main issue I dealt with was trying to get her to eat. I was able to get her to eat about 1/3 of her breakfast and no lunch and then 2 little cups of applesauce in the afternoon. Since she is completely bedridden, I had to turn her frequently and she screamed with pain when I did this and almost seemed to contract up into a ball when moved. Thanks so much for the help!