C287

Hey DLC--I think I understand where you're trying to go with this. In our program we set up ND's in the following format (Dx, r/t_____AEB____). In our format, an elevated temp would be part of your "as evidenced by." I'm not sure what kind of infection your patient has, but for example: Urinary tract infection, related to (indwelling catheter, improper toileting, stasis..etc) as evidenced by fever/chills, burning on urination, foul-smelling urine, elevated WBC, hematuria...etc. Look on the chart and see if the doc has determined what kind of infection...UTI, wound, etc. and go from there; you'll then be able to do your assessment, actions/interventions, and expected outcomes. Don't get discouraged with learning to do care plans--some of my classmates HATE them--but you really learn a lot from constructing them. One thing our program chair didn't require we buy our first quarter of med-surg was a cp book...man, if I only knew...I have a couple now and they've been worth every penny. Here they are: Nursing Care Plans Diagnoses, Interventions, and Outcomes by Meg Gulanick and Judith L. Myers 7th ed. and Nursing Diagnosis Handbook, An Evidenced-Based guide to planning care by Betty J. Ackley and Gail B. Ladwig 9th ed. I found them the cheapest on amazon.com. Good luck and by the way, Esme is so right about reading past post by daytonite...I've read a ton of her post just for fun, I think she must be a professor, nurse educator, or her hospital's #1 preceptor or something...awesome.

I want to thank each and every one of you for your posts and I look forward to getting to know you guys better in the future (after OB/PEDS and Leadership...I'll be dancing alright--coming home cryin' to ya'll every night is more likely). Also, I am not ignoring the pm's sent...I can't sent a response because I need more posts or another level of membership or something. I see that it is quite a debate about helping students with assignments...I really did not intend for it to seem as though I am trying to get someone to do my work for me; and, I'd like to apologize to those who might have gotten that impression...and thank those who rose to my defense. The assignment is not that I turn in a question and answer interview, I am to write a 2-4 pg essay in narrative form from an interview that includes each of those nine questions. In retrospect, I should have clarified that from the get go and perhaps just asked your opinions on some of the questions or something...oh well, we all know where paved roads and good intentions occasionally lead lol. Surely, by the 2nd I'll will have been able to do the face-to-face interview as well and I really believe that those of you who did respond gave me some great info about several of the questions I should focus on in the interview and in the essay; again, I thank you from the bottom of my heart:hug:. As for hard feelings or any of that...no way...never seen much to gain in holding on to all that; besides, it takes too much time, thought, and effort. I'm the sensitive sort down deep and can end up worrying too much about stuff like that, so I just try to never start. Not to mention, in this profession you really do have to learn to let a lot roll...Earlier today, a drunk college student :barf02:on my arm while I was drawing his blood and then called me a *** **** f b after I rolled him back over and took the yonker out of his mouth. Little does he know one of us is coming back for more--lol--pd can't take anyone to the pokey until their etoh

I need to have an interview done for an assignment. The LPN I had asked is working, in school for her ADN, and raising a family--I think she just must be too busy right now to call and take me up on have lunch one friday to get this interview done. Granted, there's still a couple of weeks left but since I'm working two twelves, in school, raising a family, and have clinicals and two tests the week this essay's due I'm starting to freak out a little that I can't get it done a little early. Please help me. Here are the nine questions I have to spin this essay from: 1. How long were you or have you been an LPN? 2. Where did you attend school? 3. Where did you or do you currently practice and in what area of nursing? 4. What seems to be the biggest difference in your role as an LPN compared to the RN's in your practice setting? 5. Have you thought about returning to school to further your education? 6. Are you now or have you ever been affiliated with any LPN associations or organizations? 7. Would you encourage anyone else to pursue a career as an LPN? 8. Do you feel if you left your current practice (as an LPN) that there would be opportunities in other areas for practice? 9. Do you hold or have you held a leadership position in your practice setting? Thank you, thank you, thank you...for any input.

I'm not sure where you guys got that one of the little face peeking over the couch--but, that one's great. Hide. No, seriously...where I work we have a lot of cultural diversity because of the university and once I gave up trying to interpret what a doc was saying to me and I picked up the phone and dialed the language line ...after he got over the initial shock that I did that to him and was able to fix his problem, he was fine...we laugh about it now.

Unexposed non-tobacco user : Nicotine Less than 2 ng/mL Cotinine Less than 5 ng/mL 3-OH-Cotinine Less than 50 ng/mL Nornicotine Less than 2 ng/mL Anabasine Less than 3 ng/mL Passive exposure: Same as above Less than 20 ng/mL Less than 20 ng/mL Less than 50 ng/mL Less than 2 ng/mL Less than 3 ng/mL Abstinent user for greater than 2 weeks: Nicotine Less than 30 ng/mL Cotinine Less than 50 ng/mL 3-OH-Cotinine Less than 120 ng/mL Nornicotine Less than 2 ng/mL Anabasine Less than 3 ng/mL Active tobacco product use : Same as above 1000 - 5000 ng/mL 1000 - 8000 ng/mL 3000 - 25000 ng/mL 30 - 900 ng/mL 3 - 500 ng/mL* Hope this helps; ranges are from the send out reference laboratory our hospital uses. How they determine nicotine exposure is a little more complicated than just a neg/pos cotinine level; they can assess both nicotine and cotinine metabolites. There is a significant difference in serum/saliva/urine specimens. Urine is ten times higher than serum or saliva; which is why they choose to use urine. Keep in mind that even nicotine patches and gum also constitute nicotine intake as well. It is true that the amount you once smoked (tar, mg of nicotine per cig etc play a role) is the biggest factor in how quickly you will clear. Chin up, keep up with the H20, and best wishes you'll be all clear by time for the test.

Sorry for double responses; I thought I would be able to send Rabid Response a copy to her box in case she doesn't read this blog again.

I'm sorry my original post did not express my feelings about patient care; I should not have assumed that people would just know that I do feel that protecting the safety and privacy of my patients is my first concern. Although I am new to AN, I am not new to the medical profession. I have worked in two ancillary departments in one of our local hospitals for seventeen years, as a teenager I was a candystriper there, and now I'm in nursing school. It's is not that I do not feel their punishment was not warranted. I know that it was--in fact, where I work (I don't know about the clinical site's policy) all HIPAA violations are investigated and then reported to our state's department of health and human services. I just couldn't believe they all just let this happen without a care or a thought about all of the people's lives this would affect. That is what I was so upset about when I wrote the first post; and, absolutely, the patient on the table was foremost. This is just awful from every angle I've looked at it. If I had been there I would have said what the bleep are ya'll doing--that's disgusting, disrespectful, and illegal (I sometimes don't filter myself too well); it might have come out rather brazen but I would have had the patient's and their best interest at heart. Please forgive my failure to slow down and clarify that.

The worst thing happened to our nursing class today and I just really need to talk to someone other than my fellow students and my family. A couple of students were in the OR observing during clinicals this week and asked a nurse to snap a photo of them holding some recently removed body tissues--in the background of the photo you could see the patient's stomach a little. She posted the photo to her facebook page under all the rest of her nursing school pictures. Someone emailed the photo to our program director. The student who posted it to her facebook has been kicked out, the other one in the photo reprimanded, and the nurse who took the photo has been fired from the hospital. I'm not sure what to be most upset about...the thought that perhaps another student who was a FB friend of this student's emailed this photo with the intent of getting that student kicked out of the program (we are not allowed to have our cell phones) or the fact that the nurse who took the photo was fired (when I worked with her I believe she has been a nurse for 20 some odd years) or the fact that the rest of us have to go back there on monday morning and deal with the consequences and worry about having to lose the nursing school's contract with the hospital--if not for us, for future students! man this all a mess:crying2: sorry about the sloppy writing--I'm distressed.