SeattleJess

There will be other more critical problems long before the bones are involved! Calcium blocks sodium channels and inhibits depolarization of nerve and muscle fibers; low calcium levels lower the threshold for depolarization. Remember the symptoms with "CATS go numb"- Convulsions, Arrhythmias, Tetany and numbness/parasthesias in hands, feet, around mouth and lips.

It all sounds very exhausting and challenging! I think the "mommy misses you" gifts are an amazing idea. Please give yourself credit instead of beating yourself up about "could have done better". We all could always do better. Prayers for a speedy and complete recovery!

Thank you so much! This really helps, especially knowing that delirium aka confusion is not a psych diagnosis. Valuable info on the benzos! My source for that WAS kind of old.

Thank you for this, Been there, done that! I don't think things have changed much.

I think the delirium is primarily the result of overmedication. She was given 50% more oxy than her max dose. She was given 4 times the recommended daily dose of Ativan for someone over age 65. Benzos are second or third-line treatments for delirium in the geriatric population; they can paradoxically increase s/s of dementia. Haldoperidol is the drug of choice. Age over 65 years increases the risk for post-op dementia. Additionally, the patient probably has had sleep disturbance related to the cholecystitis that necessitated her surgery. Surgery and the hospital environment has probably exacerbated this. However, this is not explicitly stated in the prompt so I'm thinking I shouldn't comment on facts not in evidence... including pain which I would expect to be a primary concern. (Maybe not so much given her drug dosages.) Similarly, I would be concerned about risk of impaired breathing pattern due to the high level of opiates and the potentiating effects of the benzo... but again, the prompt says nothing about respiration so I'm again thinking I shouldn't go there. On the other hand, that is a RISK diagnosis, so I don't need defining characteristics. The type of surgery and her meds would be risk factors for this. I'm thinking that using knowledge of drug actions and effects in an assignment like is not the same as making up assessment data that is not explicitly stated. I also like risk for trauma r/t impaired mobility secondary to upper GI surgery, effects of pain medication and sedatives, impaired sensorium and visual hallucinations, faulty judgment secondary to cognitive defects, and upper abdominal incision secured w/ steri-strips and gauze. Pulmonary complications are certainly a concern with upper GI surgery but the prompt doesn't indicate any preop risks or post op complications like pneumonia, pneumonitis, atelectasis, bronchitis, pulmonary emboli and/or acute respiratory failure. Along the same line, I'd expect acute pain, impaired physical mobility, and other issues... but again, no assessment data in the prompt. Risk for infection, another one I'd normally put high on the list because it was GI surgery and she's resisting assessment of the wound site. But is that enough? I have been told (I believe correctly) that I overthink things so I am really trying to focus on "just the facts, Ma'am!" Would I be okay with acute confusion, risk for trauma and risk for ineffective breathing pattern? These last two would not be my highest common sense priorities but trying to use only the prompts, they seem like the strongest. Thank you so much for your help. You would not believe all the time I've spent on this! It's embarrassing.

What do you think about Risk for Trauma for one of the medical nursing diagnoses?

No, you don't. I got the same pressure from instructors about how I need a study group. You need to find what works for you and what is the most efficient use of your time. Sounds as if you are doing well. Maybe keep trying to find people to review with; it does help to have others' input... but don't worry that you are doomed to fail if you can't find that. You are not.

Okay, maybe I posted in the wrong space so I'm trying here. Okay, I am really stuck on writing a paper. We need to use the nursing process to develop and create care plans for one "psychological" nursing diagnosis and two "medical" nursing diagnoses. Patient is a 74 year-old obese female admitted for an open cholecystectomy. Patient was alert, oriented x 4 and compliant with requests during day shift. She also received 30 mg of oxycodone PRN in the 8 hours before shift change; her max PRN dosage is 20 mg/8 hours (5-10 mg/4hrs). Patient tries to get out of bed 2 hours after shift change, hallucinating snakes under the bed. She has tremors in her hands when they are extended and is oriented to person only. You give her 2 mg of lorazepam for anxiety and 40 minutes later, she hits you in the face when you try to check her dressing. Her wound is held together with steri-strips and covered by gauze. I can think of many diagnoses but I'm not sure how to prioritize them. The best "psych" diagnosis would seem to be "Risk for Other- or Self-Directed Violence." Chronic confusion is given in our psych text, but there is nothing to indicate that this is chronic and not acute. Technically, "acute confusion" is a medical diagnosis as it comes from Carpenito... or is it psych because it obviously deals with mental state. There is nothing about pain... Davis Drugs says the max dose of lorazepam for geriatric patients is 0.5mg and that it potentiates the respiratory depression of opioid analgesics. Upper GI surgeries commonly cause shallow breathing. But there is nothing in the scenario about respirations or info on effects of lorazepam or oxy, for that matter. Is it making things up to be concerned about Risk for Impaired Breathing Pattern, given these facts? When I sort through everything, trying not to bring in anything not in the scenario, I think of Risk for Trauma, Risk for Falls, Risk for Infection are important. Too many risks, right? Self-Care deficit... but that's assuming facts not given explicitly. I don't know how to think about this. Our instructors have said they won't answer these sort of questions. (Citation I know. It's how to decide among the gazillions of NDs that I need to know... and that is not taught much in class.) So... I'm going to take a break and go for a brisk walk in the rain. Can anyone help me figure out how to think about this assignment? What knowledge can I bring into my assessment? How do I pick the priority diagnoses? I want to pick acute confusion because if THAT is successfully treated, the self-care deficits, risk for violence, etc. are probably solved. But is that a psych diagnosis if it's not listed in Townsend? Preventing violence doesn't solve the problems that would give rise to the other diagnoses. I'm really discouraged. My brain is just not working well on this, I'm getting anxious, and I'm getting WAY black-and-white in my thinking as in "I'll fail out of nursing school" and "I don't have what it takes to be a nurse. I hope someone can help me to focus and make reasoned judgments. I'm not being lazy, just stupid, I fear. (Have I hit a wall? I have had good grades so far and I am a tutor. But this just feels so overwhelming...) PS. I decided on Acute Confusion for my psych diagnosis. This leaves me with two risk diagnoses in the lead... which doesn't feel right.

This sounds really, really stressful! So sorry you are getting off to this rough beginning. It does not sound like you don't want to be a nurse. It DOES sound like you don't want to be a nursing student and in that you are not alone! Hope your daughter has a speedy and complete healing and that you can compartmentalize. Nursing school is rough but you can do it. Don't get mad, get even. Jump through all the hoops and claim your reward at the end.

I will post to myself. I am going with acute delirium for my psych diagnosis even though it isn't listed in our required psych text book as a psych diagnosis. Dare to use common sense! Now on to the next diagnosis. Still would be great to have comments.

It might be useful to research the different legal standards for mens rea (guilty mind) in criminal law. (A crime is a guilty act + a guilty mind.) Then you could compare the results with different psych conditions based on how the defining characteristics compare to the legal standard. That's a tough assignment for a first year student.

Okay, I am really stuck on writing a paper. We need to use the nursing process to develop and create care plans for one "psychological" nursing diagnosis and two "medical" nursing diagnoses. Patient is a 74 year-old obese female admitted for an open cholecystectomy. Patient was alert, oriented x 4 and compliant with requests during day shift. She also received 30 mg of oxycodone PRN in the 8 hours before shift change; her max PRN dosage is 20 mg/8 hours (5-10 mg/4hrs). Patient tries to get out of bed 2 hours after shift change, hallucinating snakes under the bed. She has tremors in her hands when they are extended and is oriented to person only. You give her 2 mg of lorazepam for anxiety and 40 minutes later, she hits you in the face when you try to check her dressing. Her wound is held together with steri-strips and covered by gauze. I can think of many diagnoses but I'm not sure how to prioritize them. The best "psych" diagnosis would seem to be "Risk for Other- or Self-Directed Violence." Chronic confusion is given in our psych text, but there is nothing to indicate that this is chronic and not acute. Technically, "acute confusion" is a medical diagnosis as it comes from Carpenito... or is it psych because it obviously deals with mental state. There is nothing about pain... Davis Drugs says the max dose of lorazepam for geriatric patients is 0.5mg and that it potentiates the respiratory depression of opioid analgesics. Upper GI surgeries commonly cause shallow breathing. But there is nothing in the scenario about respirations or info on effects of lorazepam or oxy, for that matter. Is it making things up to be concerned about Risk for Impaired Breathing Pattern, given these facts? When I sort through everything, trying not to bring in anything not in the scenario, I think of Risk for Trauma, Risk for Falls, Risk for Infection are important. Too many risks, right? Self-Care deficit... but that's assuming facts not given explicitly. I don't know how to think about this. Our instructors have said they won't answer these sort of questions. (Citation I know. It's how to decide among the gazillions of NDs that I need to know... and that is not taught much in class.) So... I'm going to take a break and go for a brisk walk in the rain. Can anyone help me figure out how to think about this assignment? What knowledge can I bring into my assessment? How do I pick the priority diagnoses? I want to pick acute confusion because if THAT is successfully treated, the self-care deficits, risk for violence, etc. are probably solved. But is that a psych diagnosis if it's not listed in Townsend? Preventing violence doesn't solve the problems that would give rise to the other diagnoses. I'm really discouraged. My brain is just not working well on this, I'm getting anxious, and I'm getting WAY black-and-white in my thinking as in "I'll fail out of nursing school" and "I don't have what it takes to be a nurse. I hope someone can help me to focus and make reasoned judgments. I'm not being lazy, just stupid, I fear.

Still... if I were a family member and I observed a practice directed at another resident, I might have concerns for my family member. And I'm not so sure I want to live in a world where I would blow off a potential harm to someone who was not a family member. After all, the person didn't know what drug was being administered.

EXCELLENT! You identified the key issues on study and set out a clear path to solving them. Sadly, my nursing program will not allow recording lectures. Why, I have NO idea. It would help so much to be able to listen to the lecture again on the long drive home and while I am writing out my (visual) notes. Any suggestions?