Adelene

I know what you mean about no sleep. i cannot believe the NCLEX books tell you to relax the day before and get a good night's sleep! With the "good pop up," you passed! Congratulations, nurse! FYI: Board of Nursing and Nursys.com will give license info for free. Don't pay Pearson Vue the $7.95 for quick results. I actually got mine from the BON before it was available on Pearson Vue! Of course, your's might be different, but check it first and save a few bucks! I tested last Wednesday at 8:00 am. It was posted on BON at 4:00 am Friday. It was Friday evening before Pearson Vue posted that I could purchase quick results. I got my "Congratulations YOU PASSED" letter in the mail today (Monday) from BON.

FYI: Board of Nursing and Nursys.com will give license info for free. Don't pay Pearson Vue the $7.95 for quick results. I actually got mine from the BON before it was available on Pearson Vue!

I took Hurst Review on May 20 - 22. I studied the Hurst Review book, watched the videos, and done the 6 tests of 125 questions each. My scores were 86, 86, 94, 86, 94, and 91. I talked to some of my classmates who had already taken the NCLEX test. They did not think that Hurst helped them very much. Their advice for me was to study as many questions as I could, especially SATA and prioritization. I went back and retook ATI practice tests that I had taken during nursing school. And, I studied Saunders Comprehensive Review for the NCLEX - fifth edition. I downloaded the CD that came with it and studied 100s of questions from it. I took my test on June 26. After 75 questions, it shut off! I felt like crying and also relieved I didn't have to do the whole test. I felt like they were being kind by not torturing me any longer!! I did not feel like I got ANY of them right!! I continually done the Pearson Vue trick and got the "good" pop up each time. I kept going on the Board of Nursing website: put my last name and last 4 digits of SS #; About 4:00 am on Friday, there it was! My name, RN!! Wonderful news. Of course, I cried! The most blessedly relief at last! FYI: Board of Nursing and Nursys.com will give license info for free. Don't pay Pearson Vue the $7.95 for quick results. I actually got mine from the BON before it was available on Pearson Vue!

Thanks for your advice. You gave me a lot of wonderful information, and I really appreciate it! Keep it coming! It was hard to come up with diagnosis on a patient that I only saw for a couple of hours. I did my best to assess and snoop as quickly asI could. I had to rely on the patient's chart, but could only find a couple of abnormal labs. I conducted a 10 minute assessment (probably took me longer) on my patient. The only abnormal that I found was an elevated temperature of 100.4. When I checked it 2 hours later, it had gone down to 98.4. I gave my patient a bath because they were in pain or just afraid to move the left arm/shoulder. They were on a PCA pump and reported a pain level of 5 out of 1 -10 scale. I talked to my patient and conversationally tried to find out information without interrogating them. I looked at all of the prescribed meds (mostly diabetic and pain medications; an anti-infective IVPB), looked at all of the labs tests (bedside glucose from the day of surgery: 255 (90 - 110) and a hematocrit of 0.1 higher than normal - only two labs that were abnormal), looked at CT scan and CXR reports - nothing out of the ordinary, read the doctor's reports, and talked to the family. The patient had not had an asthma attack in 4 years. The patient was a thriving family member; others depended on them for transportation and emotional support. I really wanted to use pain as my #1 diagnosis because that is the one thing that my patient complained about. They were not a complainer really - just reported a 5 out of a 1 - 10 level. But, they vocalized about not being able to take care of things at home. I used that as my psychosocial diagnosis: interrupted family processes r/t hospitalization, invasive surgical procedure, inability to assume normal family functioning. The diagnosis part was hard with very few abnormals. Ithought that it's possible that their elevated glucose was from being NPO andstress from surgery. So I asked myself, looking at my patient, what is the worst thing that could happen to them right now? I was unable to look under the bandage, but I know there were incisions from the surgery. Even small incisionsin a diabetic patient can be hard to heal due to possibly poor glucose control and poor circulation. So I thought we can enhance healing if we can keep the sugar under control, give good wound care, and provide exercise for more oxygenation to help with circulation and increase nutrients and antibodies to the woundsite. Give proper nutrition - extra protein and vitamins for healing. This is something that needs to be done from the start - not wait until a problem presents itself. Therefore, I came up with: #1. Impaired skin integrity r/t incisions and tissue trauma from invasive surgical procedure. Now what else is wrong with my patient? I had to give them a bath because they can't/won't move their left arm/shoulder. It is in a sling, but they will need to start moving it. What can I do? They are on pain medication, so if I give them their pain meds and keep it at a comfortable level, they maybe able to do more - even exercise. But, they are being discharged home, so they may need to go to physical therapy where there is specific equipment and therapists to teach them exercise specific to their problem. At home, instead of doing ADLs for the patient, the family can allow the patient more time to complete the ADLs and even combine activities - just provide assistance if needed. Thus, #2 Impaired physical mobility of shoulder r/t invasive surgical procedure. I wondered if anyone agreed with me. You are right, I did not give a lot of assessment data on my patient, but I really did not have much to go on. Just a few hours to make snap decisions... I would appreciate more advice...

I only got to see my patient for 2 1/2 hours before they were discharged home. This patient had bone spurs removed/rotator cuff repaired. Other diagnosis: IDDM, HTN, asthma, and arthritis. The only labs that were abnormal: bedside glucose from the day of surgery: 255 (90 - 110) and a hematocrit of 0.1 higher than normal. Patient was on PCA pump morphine 1mg/ml. Also, three additional PRN pain meds. Was given a total bed bath due to inability to move that side of body. Able to ambulate nursing their arm in a sling. PRN ice packs on affected shoulder. V/S slightly higher than normal. Temp of 100.4 that went down to 98.4 within 2 hours. Given 1 hour to write down 10 NDs specific to my patient. Number them in order of priority. Pick out 2 physiological and one psychosocial ND - write care plans for each one; must include ND with R/T statements, clinical data supporting ND, interventions with rationales (at least 5 per ND care plan). Wanted to use pain as #1, but I was told that instructor said nobody has ever died from pain. Thought about risk for impaired glucose control, but realized that blood glucose of 255 is probably not that unusual for patient (probably NPO, stressed) on the day of surgery. Picked 2 safety and security NDs. Maybe not a good idea? #1. Impaired skin integrity r/t incisions and tissue trauma from invasive surgical procedure. Interventions included that diabetics sometimes have more problems with wound healing - may need wound care specialist. Included nutrition with extra protein for healing properties. Exercise for more oxygen capacity for healing. Of course, keep wound clean, dry, and bandaged as ordered. Monitor temp as an indicator of infection. #2 Impaired physical mobility of shoulder r/t invasive surgical procedure. Interventions were to give pain med 30 minutes before exercise; go to physical therapy for specific exercises and equipment; allow pt. plenty of time to complete ADLs. Combine activities when possible for less exertion; provide assistance as needed. Now anxiously awaiting my grade... Anyone have any ideas?

Well, I made an 80 on the test! I passed the care plans, but I made some mistakes. How long does it take to get comfortable doing the care plans? I am struggling just to figure out if my assessment data belongs with a certain diagnosis. So far we have had pretend patients to do our care plans on, and we are never provided with enough data – not enough for me anyway. HIPPA laws are brutal... understandably; we cannot use real patient’s information after leaving a facility. Spring Break after Friday!! yeah!!

In reality without all the fancy stuff, I would be taking the baby to the mother’s room and begging her to use skin-to-skin contact and breast feed her baby. I would stand by her side and help her if needed. If that did not work, I would beg her to let me try to feed the baby. I would put it in the incubator (trying to get the temperature regulated) and if I could not get it to feed from a bottle, I would use a dropper, a spoon or something… I am talking as a mother who has raised two children… I have a HUGE lecture test at 8:00 in the morning that I am cramming for (I know we aren’t supposed to do that), so I just wrote the best I could on the Nursing Diagnosis that I have to turn in at 7:55 in the morning. I would love to come back and get some advice on my next assignment. I do not want anyone to do my work for me, but it helps to get advice on how to do these diagnoses. Maybe something you say will help me learn it. Thank you for trying to help.

Thank you for your response. I need all the help I can get to understand these wonderful nursing diagnoses. I decided to use “risk for imbalanced Nutrition: less than body requirements r/t insufficient intake.” The mother is having problems feeding her baby. It has poor latch on, it is sleepy, and it is spitting up. Also, the Apgar score of 6, 7 (can indicate a stressful birth – used more brown fat and maybe depleted glucose stores) and the low temp of 96°F (cold stress will also need more glucose for body heat). Like you said, I have no “subjective data,” just the objective. LOL We were taught that skin is safety/security, but I agree with you. I think skin could be physiological. Of course, I am going to go with what my instructors teach me... make the grade, you know...

Thank you so much for your reply. I forgot to mention - instructor specified that she wanted everyone to do Knowledge deficit about infant car seats - probably to teach ourselves. Very informative research - I could not believe that infant car seats have an expiration date! It makes sense; I just did not know about it. Think about all those old car seats at yard sales… I would love to do the breast feeding, but we were told not to do it. Probably because our textbook has an entire care plan laid out for ineffective breastfeeding r/t deficient knowledge of mother as evidenced by ongoing incorrect latch-on technique. Thank you for pointing out that less than 37 weeks is considered premature. I need to change my r/t statement. We also learned that normal vitals for a 2 day old newborn are: Respiratory rate ranges from 30 to 60 breaths/min Heart rate should be 100 to 160/min Blood pressure should be 60 to 90 mm Hg systolic and 40 to 50 mm Hg diastolic. Temperature should be 36.5° to 37.2° C (97.7 to 98.9° F) axillary. Given the above VS as norms, my NB has a low temp, but the rest is normal. We are just learning to do these care plans; I cannot wait for the light bulb to go off, and care plans become second nature to write!!

I am a new poster to this website, but I have been reading it for awhile. I posted this on another topic, then I saw this one for Nursing Student Assistance (where I should have posted it). I am going to do better next time. The only information I have is: newborn 03/01/12; 6#10oz, Apgar 6 and 7; breast-fed with poor latch on; sleepy; spitting up; voided/stooled twice; Temp: 96; HR 120; RR 42; Ballard scale gestation: 38 weeks; Normal NB I am struggling with these. I have a big lecture test Monday, but I cannot study for it from worrying about these. I have to turn them in before the test. I have to do a care plan on each one consisting of: Assessment Data, Nursing Diagnosis, Goal/Expected Outcome (with A.E.B), and then Plan of Care with rationales. I have to do 3 physiological, 1 safety/security, and 1 knowledge deficit. Then, I have to make a list of 10 possible ND for this newborn and put them in priority order. I have the following: (3) PhysiologicalRisk for ineffective airway clearance r/t inability to clear mucus by cough and expectoration (immature lungs?) Risk for fluid volume deficit r/t immature age and neonatal transition (?) ? - I need another one - Do you have any suggestions? (1) Safety/Security(Would this be Safety/Security because of skin or Phys. cause of circulation? ineffective thermoregulation r/t immature compensation to the environmental temperature (1) Knowledge DeficitDeficient knowledge of car seats r/t lack of experience and lack of exposure to infant car seats (?) I have written out my care plans for the four above (probably not very well). If someone could please help me come up with one more diagnosis with a r/t statement, I would appreciate it. I do not want someone to do my work for me, just need a little boost. I either need a safety and security or a physiological; I am not sure which one this is: ineffective thermoregulation r/t immature compensation to the environmental temperature. We were taught according to Maslow's that circulation is physiological, but skin is safety/security. Does anyone know? Thank you so much

The only information I have is: newborn 03/01/12; 6#10oz, Apgar 6 and 7; breast-fed with poor latch on; sleepy; spitting up; voided/stooled twice; Temp: 96; HR 120; RR 42; Ballard scale gestation: 38 weeks; Normal NB I am struggling with these. I have a big lecture test Monday, but I cannot study for it from worrying about these. I have to turn them in before the test. I have to do a care plan on each one consisting of: Assessment Data, Nursing Diagnosis, Goal/Expected Outcome (with A.E.B), and then Plan of Care with rationales. I have to do 3 physiological, 1 safety/security, and 1 knowledge deficit. Then, I have to make a list of 10 possible ND for this newborn and put them in priority order. I have the following: 3 physiological Risk for ineffective airway clearance r/t inability to clear mucus by cough and expectoration (immature lungs?) Risk for fluid volume deficit r/t immature age and neonatal transition (?) ? - I need another one - Do you have any suggestions? (1) safety/security (Would this be Safety/Security because of skin or Phys. cause of circulation? ineffective thermoregulation r/t immature compensation to the environmental temperature (1) Knowledge Deficit deficient knowledge of car seats r/t lack of experience and lack of exposure to infant car seats (?) I have written out my care plans for the the four above (probably not very well). If someone could please help me come up with one more diagnosis with a r/t statement, I would appreciate it. I do not want someone to do it for me, just need a little boost. I either need a safety and security or a physiological; I am not sure which one this is: ineffective thermoregulation r/t immature compensation to the environmental temperature. We were taught according to Maslow's that circulation is physiological, but skin is safety/security. Does anyone know? Thank you so much