dmw2489

Thank you both so much!! It feels good to hear that what im doing is ok and normal... I get so uptight especially with how are clinical instructors are, its like i have all of the information but within a second poof its gone. But thank you again for the encouraging words :)

Hello everyone, I am a senior nursing student taking Med Surg I. I just am in need of some advice on how to be more proficient in clinicals, I am a good student Ive never gotten below an 85 on a test (mental health was not a strong point for me lol) and it seems that I am on the right track at putting information together and linking it. I also seem to have a good grasp on care plans and relating them to my patient. My biggest problem seems to be that when I am on clinicals and encounter something its like everything that is in my brain flies out and i dont know what to do. For example one of my patients complained of abdominal pain. I asked her about her pain, like where it was, how bad it is, what it felt like ect. but then after the primary nurse came in to check more about the pain i realized i forgot to ask her if she has even been moving her bowels. (BTW the patient did not have any condition relating to abdominal.) But even worse than that i didnt even put it together until later in the day that the pain meds she had ordered for her back were probably the cause of her abdominal pain (she had not moved her bowels in two days which was abnormal for her)... I just am not sure on how to help these kinds of things, does it come with time? is there anything i can do to help or make this better? I know that I am always nervous on clinicals and i feel that makes it worse but I dont know how I can start to resolve this issue. Any suggestions would be so helpful!! thank you :)

GREAT POINT!! this is a priority also, even though in stage 1 there is NO broken skin as of YET, pressure ulcers do tend to accelerate quickly if there is no intervention, if you do nothing for it right now it will just get worse, RISK for impaired skin integrity is a good one, your interventions will be to prevent any breakdown of the skin (air matress, T&P, skin care... you know the drill lol) but this is a great point on a risk for dx!

remember ABC's as your priority!!! A=Airway... does he have a problem with airway? B=breathing... does he have a problem with breathing? C=circulation... does he have a problem with circulation? I would change the orders around slightly... but look at the ABC's first!! what do his abnormal values mean?? are there any other values that you did not list here that were abnormal like a WBC count or an H&H? BUT FIRST THINK PRIORITY!!

i know, but it will all fall into place... pretty soon they will just be coming to you when you look at some information lol!! I would also suggest a care plan book, they are really helpful! I can give you the names of the two that I have if you are not sure, and another thing is read posts on here about care plans and dx, they will really help increase your knowledge about how things are connected and looking at different aspects of the pt :)

here is something that i see, his H&H is low, what does that effect? to add to that what meds is he on? and what are some of the side effects of the meds? (I am thinking of some specific class that there is a possibility he is on) also in his hx he is a smoker.... There are also some huge red flags that come up in his history for me.... 1 being DM- what type and is it pharmacologically treated?? (adding to the pharm portion, what med is he on for the HTN?) 2 being the alcoholism hmmmm... there are alot of high priority dx in this pt. start with your ABC's, are there any deficits in airway? breathing? or circulation? these should be addressed first. always remember to that safety is huge in nursing! and the final thought would be think about what things are currently in his body that ARENT normally there... what is a big risk after surgery? You are thinking and that is good but go by priority! ABC's!!!!!

umm what about risk for impaired skin integrity, if it was an open fracture risk for infection, not sure what types of meds he is on specifically pain control but if so depending on which med - risk for constipation, risk for deficient fluid volume can be a great dx because there can be multiple risk factors from your pt for example... if he is vomiting from the med that can be a factor, possibly imbalanced nutrition- especially if diet is not adequate for wound healing, how about pain!?!?!? acute pain r/t trauma!!!! he must be in pain the poor little guy, knowledge deficit, risk for disuse syndrome may work for this case r/t the humerus fx. I dont know about you pt, there wasnt to much information... but look at EVERYTHING, i promise you can come up with so much more... how were his labs... look at anything that is related to liver, i havent studied GI yet in school so im not sure if they would do a billi level on him with this dx, but it would proably be good to see, also WBC and inflammation markers, how was his chem 7 and cbc anything abnormal? did they test stool for occult blood? did they do any LFT's?... what meds is he on? how do those meds metabolize? do any effect the liver? what are the side effects? did you assess him? -did he have pain? did he have equal, bilateral radial pulses, cap refill less than 3 seconds on both hands, did he have any numbness or tingling in the affected arm, how was the color in the affected arm? was the arm warm or cool? swelling/edema any where? look at all these and see what is abnormal and that can help you, you need the evidence to back up your nursing dx.... i gave just a few possible things but it will really be dependent on the info you have for him

the nursing dx is fine, but your related to cannot be a medical dx, which a pressure ulcer is... you could use skin breakdown, tissue damage... as long as it is not a medical diagnosis, but you can then add secondary to pressure ulcer AEB stating pain is 7/10 :)

Here is the thing, dextrose in the bag is hypertonic once infused into the body becomes the solutions osmolality, d5w, if you take out the dextrose and you just have the water what kind of solution is that? its hypotonic, (water doesnt have the same osmalality as the body therefore its hypotonic), d5 and 1/2 ns is hypotonic, but once again the dextrose makes it hypertonic in the bag but once infused becomes the solutions osmolality, what I find helpful is to cover up the Dextrose and look at just the solution and see what that is, b/c that is what it will be in the pt's body.

Fundamentals Reviews & Rationals -Mary Ann Hogan http://www.amazon.com/Prentice-Hall-Reviews-Rationales-Fundamentals/dp/0132240785/ref=sr_1_2?s=books&ie=UTF8&qid=1316877036&sr=1-2 this is the amazon link, the success books are also great, Fundamentals Success: http://www.amazon.com/Fundamentals-Success-Applying-Critical-Thinking/dp/0803627793/ref=sr_1_1?s=books&ie=UTF8&qid=1316877113&sr=1-1 Test Success: http://www.amazon.com/Test-Success-Test-Taking-Techniques-Beginning/dp/0803618948/ref=sr_1_2?s=books&ie=UTF8&qid=1316877113&sr=1-2 All of the books are in a series so they can help you all the way to graduation, I have every one LOL Good Luck! :)

alot of nursing dx have changed since 2007- i would get an updated book, i use nursing care plans by gulanick/myers, and the sparks and taylor book that was mentioned above. but dont forget that it has to be tailored to YOUR pt. a book will not give you all the answers, they are just general interventions. for example if your pt has pneumonia and your intervention is encourage cough & deep breathing that is a great intervention as long as they are A&O, and they can follow commands. If they cannot follow commands you cant teach and encourage coughing and deep breathing... so just remember to keep your patient in mind when looking at the interventions, does this apply to my patient?, how will this help my patient?, will my patient benefit from this intervention?, and most importantly - IS THIS SAFE FOR MY PATIENT?!?!? Also dont be afraid to come up with your own interventions, you can always put in any intervention that is your own or one that you had found and changed. :) good luck!!

a big one that i would cover would be positioning... b/c obviously if she has had aspiration pneumonia 12 times teaching wasnt effective the first 12 times eeekkkk..... i would also teach the basics of caring for the peg, and feedings (are they getting bolus, continuous...) with the care giver... and also going over semi fowlers position/high fowlers position to prevent future episodes to me would be a must... but also what is your pts level of learning? are they alert and oriented, can they follow commands. This is where a care giver comes in and teaching family is a must if they will be taking care of the pt.

i would also add in funamentals reviews and rationals, it gives you an outline of important information as well as having questions. I have used all 3 of these books (fundamentals success, test success, and the reviews and rationals) they really do help with critical thinking and are great with questions - the bonus with the reviews and rationals is they have a outline of info also. highly suggest :)

questions are different and no take time to get used to what they are REALLY asking for, is it assessment or implementation, remember safety is always a priority, books i would suggest would be: Fundamentals - reviews and rationals by mary ann hogan fundamentals success - i dont have the author but they also make a book named Test success by Nugent i had gotten both and they helped tremendously, i passed my fundamentals with a 96% If you need the isbn numbers i can give them to you i just dont have them right in front of me, but i would say get all 3 if you can the fundamentals reviews and rationals, fundamentals success, & test success- you can buy them used through amazon also if they are to expensive. but search for these and if you come up with no luck just post back and i can give you the isbns :) good luck!

Hello, our school isnt picky on how you get the assessment done as long as you get all the information, i seem to do this a different way then head to toe, for example i am on a respiratory unit in clinicals for this rotation so, the first thing i do is do a visual scan of everything in the room, bed position, O2, IV, do they have glassess or dentures on their side table? then as i am doing the visual scan i introduce myself, take vitals and check orientation i ask them to tell me their name, if they know where they are, what time/date/or month it is, and if they know why they are here. then being on respiratory i check their lung sounds at the front, from there since my stethoscope is already on their chest i then check apical and heart sounds. right after i then check bowel sounds and THEN palpate abdomen. from there i move to feet to check pedal pulses & cap refill, while doing that ask them questions, (are you having any trouble breathing? do you have any pain? how did you sleep last night? do you have any dizziness/lightheadedness?) then i check holmans sign and if negative ask them if they can lift their right leg and then left. Then move to upper extremeties and do the same thing as with lower. here i will also ask them to move their shoulders to their ears and squeeze my hands. Then from there I check their mucous membranes, perrla, conjuctiva, palpate lymph nodes around ears and down neck. Then just do another visual scan to see if there was anything i missed or i needed to fix. Your assessment may end up changing depending on your patient or patients problem or deficit. That is the one thing I have learned is you may have to adjust your assessment to pts needs so never rely on being able to go head to toe or even being able to do a full assessment all at once (i had a pt that needed frequent rests, so my assessment had to be broken down into 3 different parts) I hope this helped and i hope i did not miss anything either lol good luck :)