jbedwards

Any and all, honestly. I can recognize normal sinus, sinus brady, sinus tachy. A-fib and coorifice v-fib look the same to me, as do v-tac (I think), & Torsades. I am so lost when it comes to this, and honestly didn't do all that well when it came to the strip interpretation part of the cardiac test during nursing school.

I have my ACLS test tomorrow and was curious to see if anyone had any tips on interpreting the EKG strips, some 'easy' way to memorize the algorithms. I have been working on these for the past week, but it is NOT sinking in for me. Any and all help will be appreciated!

I just graduated on May 6, and took my NCLEX (& passed, YAY) on on Friday. I have my first interview tomorrow at 10. Does anyone have any suggestions for me? Any ideas what kind of questions that I should be preparing for, when do we discuss salary, etc.?

I decided on deep vein thrombosis and anticoagulant therapy, but now am having an issue finding studies to back me up. Everything I look up says I have to buy the articles??

Ok, so I need to do a powerpoint on an evidence based topic, and format it according to PICO standards...but I am coming up with nothing. I have a few ideas that I am toying with, such as elective inductions leading to higher rates of cesarean sections or early ambulation after surgery leading to decreased formation of DVT's, but nothing is really speaking to me. Is there anyone that can maybe give me a nudge and help me find a good topic for this?

When I saw the patient all of his vitals were normal, lab values were normal....everything was normal, except he still had infiltrates in his lung. Doctor states that this is due to the fact that the cocaine he is using is 'cut' with 'bad stuff'. I am so lost!

Ok, I am starting a new care map. I haven't seen the pt yet, but this is the info that I have: 51 y/o m presenting to ED with c/o weakness & being sick x 10d. He cannot keep his meds down, & has been attempting to crush them in order to take them, but has been throwing everything up. CT scan done d/t c/o 'left flank pain' showed right middle lung pneumonia, & a slightly distended gallbladder. His urine screen came back + for benzodiazepines, marijuana, & cocaine, but he denies drug use. His past medical hx is significant only for bipolar disorder & chronic back pain d/t a 4 wheeler accident. He did threaten the dr in the ED w/bodily harm, but the dr stated that he didn't feel threatened & felt the pt was more of a manipulative antisocial personality. At home meds consist of albuterol, tessalon pearls, dolobid, lithium, Seroquel XR, tramadol, trazodone, flexeril, & naproxen. My issue here is that my clinical instructor wants us to have the beginning of a care map ready when we come into clinicals. She expects us to (& has this entire semester) make our care maps based off of the patient's medical diagnosis. I understand that this is 100% incorrect, however I have to do it the way that she wants in order to pass this clinical. Ok, what I have come up with so far is ineffective self-health management r/t presence of adverse personal habits (illicit drug use), & risk for [spread] of infection r/t inadequate secondary defenses. Any ideas here? I have to come up with 2 more.

I appreciate you letting me know that! I actually was never told that!

I just have to say I LOVE that I called my instructor asking for help in this matter & she tells me that I can only have one r/t, & that I should use the r/t impaired gastric motility BECAUSE that is the reason that he came into the hospital. His MAIN issue the day that I had him was the r/t accumulation of fluid within joints & he was dx with osteoarthritis while I was there!!! Unfortunately, I have to do as she says in order to pass...but I hate the idea that some student might get her who has no idea what they are doing & will start basing their care maps solely off of the admitting diagnosis because that is what she teaches!!

I have a question. If I am using a nursing dx of acute pain for my patient in my care map, am I able to use more than one r/t? (Ex: acute pain r/t accumulation of fluid within joints, dysfunctional gastric mobility, & changes in myocardial contractility). If there was more than one issue that was causing the pain, do I address all of those in the r/t portion, or would I leave the dx as acute pain without a r/t & address all of those underneath in my supporting data?

All right, my 4 diagnosis that I chose were decreased cardiac output r/t changes in myocardial contractility; fluid volume, excess; activity intolerance r/t generalized weakness, & urinary retention r/t blockage (in order of importance). Opinions?

Do you have an ISBN # for this, or is online?

Oh, and as far as care plan books, I use the back of my Taber's medical dictionary to being formulating ideas for nursing diagnosis, then I use my Cox's clinical applications of nursing diagnosis. I bought the newest book (Nurse's Pocket Guide: Diagnoses, Prioritized Interventions and Rationales) but it's not very user friendly so I rarely use it.

*btw, thank you for the wording change!!! (acute to severe)...that looks much better!

Lasix was last given at 2200 (I went in at 0700). No, I am not sure that the last shift emptied his bag. They put in his EMR that he did, but this is a hospital that is noted for its poor quality of care around here, & I have noted many discrepancies myself in his chart, so I cannot say that they did. That's part of why I am having such a problem. He stated that they did, & I almost believed him until his doctor came in to speak to him & he told her that she was the one that emptied his bag before my shift! Lung sounds were clear & equal bilaterally. Pulse was equal & strong, excepting that they were slightly less palpable in his feet.

the vitals were: t 97.7f, p72, r18, bp114/69, and o2 sats 96% (room air). MRSA was in the nares, he was on the mupirocin x 5d, then retest (I saw him within the time frame). I have no idea what the blockage was from. he was actually npo when I had him because he was waiting to go down for a cystoscopy, but there was also a possible bladder biopsy, bilateral retrograde, poss transurethreal resec of prostate &/or bilateral tumor. Again, these were all possibilities. He had just come in the night before. the 'cardiomyopathy with pacemaker induced with chronic systolic heart failure was copied directly from his chart. When I asked my instructor about it, she just brushed me off. I am so lost! Meds: Coreg (hx of htn), Lovenox (he had a prosthetic aortic valve replacement), zetia (hx of hyperlipidemia), furosemide IV, Zestril (htn), multivitamin, bactroban (in nares for mrsa), & demadex (oral mon, wed, fri). he had a hep lock in his left hand with a 22g needle (no fluids running). When I did my assessment, I noted edema (2-3+) as noted above, but I forgot to mention that he also had a cough that was kind of a dry, non-productive cough (s/e of lisinopril?), & cool dry skin. I also emptied 1475 mL of red-pink urine from his Foley bag at 0845. Beyond that, it was basically normal

as far as assessment data: vitals were within normal range. he did have cool skin and some edema (+2-3) in his lower extremities, but other than that there was really nothing that I could say was 'off'...he is on constant tele monitoring but was in a normal paced rhythm. he had a foley cath that had 1475mL of pink/red sedimentary urine in it that I emptied at 0845. it was supposedly emptied before shift change, but with that amount of urine in it I am not sure, considering that shift change was at 0700. there were no c/o pain...or any c/o anything for that matter...

It's not that I WANT to look at the medical diagnosis to write up my care plan, it's that my instructor is all but FORCING us to. I am aware that the patient is what needs to lead the care plan, but she does not agree with that. (I wasn't kidding when I stated that she was a nightmare). That is why I am somehow trying to fit this together...

I'm working on my caremap for my patient last week. He is an 81 y/o black male admitted for acute systolic heart failure and urinary obstruction after being seen in the office for acute swelling in his legs, ankles, & member. (He has no known allergies, is MRSA positive. On contact precautions. Past medical history: cardiomyopathy with pacemaker induced with systolic heart failure, HTN, & hyperlipidemia. Ascending aortic aneurysm, 2:1 AV block with pacemaker implanted. Aortic aneurysm repaired with ascending aortic graft. Aortic valve replacement (prosthetic).) Ok, my gut is telling me (& I could be wrong, I am only a third semester nursing student) that the #1 nursing diagnosis would be decreased cardiac output. Would that apply, however, considering that he is 100% paced? I am stressing over this BAD because I have the most awful clinical instructor on the face of the earth. *sigh*...#just another hurdle to get over. If I can get over the hurdle of this primary nursing diagnosis for him, I know that I will be fine from there. Thank you!!

I don't think I'm so much looking for medical advice, just someone that might have been through this also...I think that's mainly what I need at this point.

Ok, so I'm not looking for help as far as patients or care plans go on this one, but I have a huge problem and hope that someone can offer me some advice. I have a beautiful 13 month old baby girl (last of 6). She was diagnosed at 6 months of age with congenital motor nystagmus. Around 9 months of age, I was able to find help in the form of BabyNet (SC) who referred her on to SC School of the Deaf and Blind. (Not that she is blind by any means, it is just that they are better able to attribute her motor delays to her vision issues). Since then she has been receiving OT, PT, speech therapy, and early intervention services. We have been trying to teach her how to compensate and live normally with her condition. The OT has done WONDERS with her in the short amount of time time that she has been with them. They are AMAZING. Today she had her second opthamology appointment. I left crying. First off, the doctor said that the previous doctor was wrong. She DOES have congenital nystagmus, but its not congenital 'motor' nystagmus. Apparently, that type does not get better and hers has. The only time you see the 'dancing eyes' is when she is incredibly tired, has just woken up, or is breastfeeding (yes, she is still ebf at 13 months old). She also added on a diagnosis of ocular torticollis and told me that she had to have surgery for it. According to her, there are no non-invasive things that we can do to work with her. This is my one and only option. Now, from what I understand, she IS the best doctor around here and really good in surgery. (My mother in law has worked in the OR with her many times). The idea of putting my baby under anesthesia scares the beejesus out of me, though! To make things worse, they are talking about messing with her eye?!?! That's such a delicate part of the body! She can see perfectly fine right now, but one slip of the knife..... If I don't do something about the way that she compensates for her condition (she has a left head tilt/right twist) then the torticollis that has developed on the left side of her body could worsen, lead to scoliosis, then she would be in constant pain & possibly disabled (?). We HAVE been working on this in OT, but apparently the muscles in her eye need to be snipped or loosened in order for us to truly make progress. So, I guess what I'm asking...does anyone have any experience with this? Either with a child that has ocular torticollis and/or nystagmus, or one that has had the surgery. Maybe give me some noninvasive ideas to work with her? I think what makes things worse is me being a nursing student who has already taken pharmacology and I know the side effects/adverse reactions...I'm flipping out today!

I have to agree. Best advice ever. This one I will remember forever. Thank you.

However, you can encourage them to stay connected via other modes. We'd always encourage them to call relatives, Skype, message on Facebook, write letters, write emails, blog--whatever helped them feel more connected to people they cared about. I didn't even THINK of using social media as an intervention!! Thank you!!

you have to be 13-21 to shoot a gun (mag [lol, a gun]): levels are 1.3-2.1

Ok, I had a patient on my very first Peds clinical who was a 19 y/o male that was admitted with neutropenia, fever, and sore throat following a transfusion of RBC & platelets the day before. This has been a FUN care plan so far, but what I have come up with is: risk for infection r/t chronic disease, risk for deficient fluid volume (pt is receiving chemo, transfusion, & IV fluid), acute pain r/t disease process, and social isolation r/t altered state of health. Do these sound ok? I have been able to come up with interventions, rationale, and response to the first three diagnosis, but am drawing a blank on the social isolation! We have to come up with a general goal, then a specific goal. I don't know if I am just having an off day or what, but I cannot come up with anything! Please help! Thanks so much in advance!!