lwhatley

At risk for surgical site infection; At risk for ventilator associated event; Tissue perfusion impaired; fluid and electrolyte imbalance; at risk for urinary catheter associated infection; at risk for bleeding....

Searching for labs that are associated with an infection would only be helpful 48-72hrs post operatively. After ALL surgeries there will be a bump in WBC's related to the inflammation/coag cascade brought on by the trauma that is surgery... This question probably hints toward prioritizing labs that would indicate active bleeding and poor tissue perfusion...so CBC with coags, paying close attention to H&H, PLTs, ptt/inr.

Good luck. I'm an SDSU graduate and I will just say right now that the programs are incredibly impacted, and this is the norm for pretty much all BSN programs within 150 miles of the school... Get your pre-req's done at feeder schools, and don't expect much of a chance to get it if you don't have primarily A's. Ace the TEAS and get as many points as you can for the application process. Apply early. Get to know people.

The above explanations are indeed true, I just want to add that infusion rates and certain medications run the risk of literally causing trauma to the fragile beds. This rationale is also why wedging PA's is becoming outdated...the risk of blowing out the PA/capp beds is too high to continue to justify in a lot of cases.

Asking for a rectal tube is a last resort for me...it's for when I absolutely can't keep up with the amount of loose stool the patient is passing...there's a couple of reasons why this is the case for me personally... 1. In my mind, I've usually got tubes coming out of pretty much every body part in my patient, and I've got all of these sources of both discomfort, trauma, and possible infection....if I can limit even just one of those tubes going in, I'm going to do it; especially if we're talking the back door... 2. I always kind of resent the nurses that hop on the rectal tube train as soon as they see some loose stool. Loose stool happens in the ICU, especially given the scenarios a lot of these patients are coming from...post-op, tube-feeding, bowel program...get enough tube feeding and milk of mag in anyone and they're bound to be a poop fountain for a bit...you have to prepare to do a little doodoo control after the fact...warm up the barrier cream before hand, stack some chucks, run some warm soapy water and prepare for a few hours of twistin, turnin, scrubbin' and protecting....it's our job. The time that I believe a rectal tube is necessary is in the cases where break down is actively occurring...because I definitely understand contact dermatitis happens after a significant amount of time left warm and wet down there...I also believe in the use of a rectal tube when the output is putting central lines and/or wounds at risk. I wouldn't smear fecal matter in a cut anywhere on my body, so I'm gonna try to protect wounds and lines as best as I can...and in this case, it's likely the rectal tube is better safe than sorry... With that being said, like I said, I delay as long as I possibly can, and if I do put one in, I make sure I only keep it in for as short as possible...I attempt to find literally any other alternative measure I can....to be at the very least a little less emotionally traumatic for the patient.

New Grad ICU, Texas: $20/hr for orientation period, $24.95/hr after orientation with +$3.50/hr differential for nights, and +$4.00/hr differential for weekend.

No they delayed their January Internship, so they did interviews for their ICU internship positions this past week for a program that starts March 10th.

I really don't want to ruin your day, but the enforcement process takes at least 4 months it is one of the most painfully annoying processes ever. They don't communicate with you regularly, and they actually get really annoyed if you call them for updates. I'm so sorry. The $150 doesn't make a difference, they'll blame the time period on the amount of files they have in the office and the lack of employees to meet the amount...it's pretty much ********. You just keep yourself busy. You have to. There's literally nothing you can do about it. You HAVE to wait it out, just study, do your questions every day, and keep busy.

I just interviewed at Scott & White temple.

Baylor has posted their new grad positions this week, UT southwestern should be following shortly. Ben Taub Memorial posted theirs, and new grad positions for Parkland are popping up a couple times if you browse the career postings regularly...

The priority, before ANYTHING ELSE for this patient is to correct the oxygenation issue she is ailing from...but to do this, we have to figure out the CAUSE of her respiratory issue... The pt scenario tells me that my pt is communicating her complaints, which means that her airway isn't probably compromised. She's telling me that she's short of breath and that she's anxious...these two symptoms are commonly paired, because when I can't breath, I'm anxious about suffocating, but actually, in THIS scenario, that anxiety clue is more significant.... What do we know about our pt's trauma? She broke what? She broke her femur. Only the sturdiest of human long bones. Oh no. What risks are associated with long bone fracture? Oh Boston! I see your post...you were leading, great, sorry, you're on the right track...Boston wrote a really good hint....a long bone fracture is prone to throwing fat into the blood stream. So without actually writing out the answer to where I'm leading you, let's just get you really close... If pt's long bone fracture has been possibly throwing fat into the blood stream since the night before, when she broke it, and is now coming into the hospital confused, disoriented, and having trouble breathing, terrible oxygenation sats, and a panicked circulatory system, and is anxious...how could those problems/symptoms be related? What could be going on that would trump surgical prep 100% of the time?

All posters are incorrect thus far [EDIT: just looked at BostonFNP's post, can't assume everyone is incorrect anymore, my bad]...but not for a lack of trying... Hypoxia and increased work of breathing can cause an elevation in body temperature, as can an active inflammation process, markedly so in the very old (your patient) and the very young...but that's not the most concerning about this scenario, so ignore this for now, lets dive in... While I don't think this case study is actually trying to just give away an "infection" answer, I do believe that the correct process of elimination approach would mean you'd have to rule that out first. So don't be so quick to assume infection, but don't rule it out until you've got the labs/cultures to prove it, but keep in mind you can't conclusively dx an infection until the culture has been sent for at least 48-72hrs... Your assignment is to, with the quick pt status information, 1. list off the possible causes of temperature elevation and heart rate increases, 2. Research and list diagnostic studies and lab you should expect pre-op...so let's do this. 1a. A few causes of temperature elevation/fever/pyrexia: immune response, failed thermoregulation, infectious process, inflammation process, thrombo-embolic process. 1b A few causes of increased heart rate: sympathetic response, anxiety, hypoxia, blood loss, fluid imbalance, electrolyte imbalance, increased metabolic demands, inflammatory response 1A&B as it r/t pt: Pt is 89 yo female disoriented, confused, short of breath, confirmed femoral (hint: long bone) fx from fall likely related to disorientation/confusion. Our pt is currently unstable r/t latest VS: BP 90/65 (concerning, but not my priority), Resp 24, sat 89% (emergency) temp 38.6 (still not my priority, but concerning), pulse of 140, definitely concerning, especially after combining that result with the others...pt is ACTIVELY COMPLAINING OF SHORTNESS OF BREATH AND ANXIETY. What's my priority? Before even going ON to list the pre-op check list basics... My patient is hyperventilating, and extremely hypoxic. Something is going terribly wrong....(posting this, continuing on another post)...

A rule of thumb for pharmacology in general as it pertains to nursing practice should be to memorize the ins and outs of the most frequently used meds (usually cardiac meds and pain meds), then focus on memorizing facts about certain meds that have the most serious risks/side effects. Safety is a nurses priority. Memorizing the meds that pose the most risk to safety is always beneficial to your future practice. But for now, in school, stick to the teaching style of your professor in order to meet their individual expectations from the course, you have your entire career to fine-tune your pharmacological knowledge/expertise.

Completely depends on the preferences of your instructor. The best advice I can give is to review the syllabus, specifically under the examination heading. Professors sometimes detail what to expect from the exams. Also, the way the content is being taught in lectures can give hints as to what type of questions will be asked. Does the lecture focus on brand name/generic name memorization? Highlight side effects? Are important interactions bolded/emphasized? How about pt education required for appropriate use of medications? Professors tend to bold/italicize/underline/emphasize the material they believe to be the most important, use those identifiers as trends, if there is a certain pattern to what is emphasized, chances are it will be the topic of at least one question on the exams.

Before I dive into the advice, let me start off by saying that I'm sorry you're feeling lost and overwhelmed, a lot of people on these boards can relate, you're definitely not alone. With that being said, here's some advice, step back and take a look at your history of learning, ANY learning. 1. Identify a Learning Pattern. Yaknow all those random facts of knowledge you have stored in your brain? The ones that you either feel odd for consistently remembering or repeatedly being reminded of over the years? My examples: I'll never forget the names of the great lakes because the mnemonic H.O.M.E.S, or I can recall the names of every state because I learned that song way back when in elementary school, I never missed a deadline date or appointment after I write it down in my planner...etc. After hitting nursing school and feeling the same frustration you felt by being suckerpunched with a massive fist of content/material, I was desperate to figure out the best way for me to retain the information in the least amount of time for the sake of using the spared time to retain the information from OTHER nursing topics/classes (exhausting, I know, hang in there). So, given our experience in at least 12 years of schooling prior to nursing school, I decided to call upon that experience and try to I.D the times that I felt like I mastered material, didn't matter what kind of material it was, and exactly HOW I did it...was it a memorable lecture? Did I go and ask the teacher to give me another explanation? Did I study the topic with a group of peers? Did I watch an interesting movie? Draw a diagram? Etc. The pattern I found for myself was that I learned best from being exposed to the lectured content. Professionals in the biz call this being an "Audible Learner". Remember those learning styles? Kinesthetic? Audible? Etc...the learning styles I didn't exactly believe could be condensed into such few styles? Yeah, they were on to something....anyway... Use this pattern identification to then outline your future learning & study habits. Keep in mind that you might have a different learning style for different types of courses, like how I learn the content of History Courses better by actually reading the textbook (its the ONLY subject that this remains true), and I physical science concepts, for me (and probably most), are learned best by actually conducting an experiment in a lab. There are exceptions to rules and different unique methods you'll find for yourself as you go along. By the end of nursing school, I figured out that I actually could cram (never responsible) for exams better if I color coded the material, and that I could sit down and focus for longer periods of time if I listened to dubstep with no words....it's the little things, but remain consistent! You'll notice results! 2. Establish a Study Zone Self explanatory. Establish an area that you use and associate primarily for studying. You'll find yourself more focused and productive later on. I could not EVER study for classes in my house because I was the type of person who would rather talk myself into prioritizing ANY household chore over remaining focused on studying stuff. My study zone was the library, and I literally spent DAYS at a time there (not recommending that practice, just admitting my experience). 3. Resourcefulness is the Key to Success Have a painfully boring professor that you can't stand to listen to for more than 10 minutes? Are concepts of certain courses being explained in a way seemingly more complicated than astrophysics? Time to move on to a different source of knowledge...but howww? You already noted some experience in this supplementation suggestion with how you use the NCLEX review textbooks to review concepts you've encountered in class, great! Here are some more that I used while I was in nursing school, I still joke that at least half of my degree should be attributed to what I learned on behalf of Apple, I probably should owe them tuition... Podcasts, Itunes university, youtube, and specialized forums like this one (allnurses) were invaluable to me over my nursing semesters. The more ya gotta dig for podcasts/videos/recordings on topics you want clarification on or an alternative teaching method on, the more well-rounded your understanding of the topic will become. My psych nursing lecturer taught in a format that may well have been in pig latin for how well I comprehended the content, sometimes I'd eve recognize a concept I actually REALLY wanted to know more about and the prof didn't deliver the way I would have liked, so what did I do? Dave's Psych Lectures podcast on itunes was AWESOME and taught me the majority of usable/testable content from the course in a style that I felt was tailored to ME, but this resource took some time to find, there are a ton of podcasts and itunes university pages on the subject of psychology, like I said before, ya gotta dig, but once you find that lecture that you felt was written and composed FOR you, you'll be glad you did the work to find it. Non-internet based resources to consider: 1.Attending medical conferences in your area. Most of the content will be above your head, but exposure to the material will help you in the long run, and it's an excellent opportunity network, and I don't care WHO tells you otherwise: nursing is, and always will be based on WHO you know first, and WHAT you know second. Took me a while to actually swallow that news and resent not networking more before graduation, but the concept as repeatedly been reinforced during my job hunts. 2. Keeping current on Journal Articles coming out. You don't have to understand the intricacies of the results being presented, but like attending those conferences, exposure to the material and the content being actively researched will help you cement topics you're currently trying to nail down in a variety of your classes. Making associations is one of the best ways to remember ANYTHING, it's how your memory works the most effectively. 3. Concept maps, drawings, comics: I drew things out, I marked diagrams, I made inappropriate comics about certain topics so that when I came upon them later on, I could laugh about making stupid comics about it, and then be reminded about all the data I tried to jam into a stupid comic, again, associations are awesome, get creative. Bonus: not sure what you're interested in, but assuming they're similar to my interests, here are some of my favorite podcasts that I still regularly listen to: Mark Crislips podcasts (persiflagers, puscast, quackcast), EMcrit, EMbasic, Frontline, ICU Grandrounds, ERcast, Tedtalks. Summary That's all I got for now, but mostly because in the time that I spent writing this out, I neglected the actual project that I need to finish sitting right in front of me. Remember how I said I can't be productive in my own home? Basically, exposing yourself to content in as many ways as you can will help ensure you remember it, but don't waste time exposing yourself to the content in a way you know doesn't jive with your learning style. I stuck with lectures because if people kept TELLING me about the topic, I could almost start reciting the material. I also figured out that if I wrote something down a couple times, I could remember it forever, so I started writing out ALL of my notes instead of typing them out like I used to in previous classes, my grades inflated! Find your pattern and expose yourself to methods that get along with the pattern you identified! Hope this helps.

Like a lot of other people are posting on this thread, fictitious pt scenarios make it really difficult to really get GOOD practice creating care plans, but they aren't impossible...my advice is to break it down. Again, a repeat of previous opinions, but nursing dx's come from a different world than medical dx, and it's important to keep that in mind, because the EASIEST mistake is to list a bunch of medical dx's in the wording of nursing dx. So in relation to your scenario, since you can't talk with this pt, focus on the possibilities, brain storm, brain dump, then prioritize: "55 yr old male, who was in a road traffic accident and sustained a neck injury, he was admitted with a neck brace and is diagnosed as being paralyzed from the neck down. His T 36 (((P120 R 24 Bp 170/100 sat 90%.))))" Alright, we've bolded areas that, as a nurse, we'll likely target throughout the course of our treatment of this patient...in our own words: We've got a middle aged man (demographic), hospitalized (stressor) that was just in a traumatic accident (stressor) that left him paralyzed (stressor), and the most recent vitals that we know have abnormalities that need to be addressed (go back to this basics, this is a stressor, but because they relate directly to ABC's, they'll be our priority) Just with that info we've got enough data to allow us to at least visualize a potential encounter with this patient as a nurse. Our nursing assessment will likely find psychological stressors, physiological stressors, and priorities of care related to both psychosocial and physiological needs, and that's without even trying to take the (incorrect) easy way out of JUST medical dx needs... For example, (remember, think like a nurse): A middle aged man is just now being told he no longer has the use of his extremities (we don't know how severe it is, but we know based on the given dx ((which was worded completely incorrectly btw, but I'm not here for that)), he's paralyzed neck down. What implications does this type of data have both to the patient, and the care that we'll give? - He's 55, he's probably still working in a career, supporting himself or possibly a family. Will being paralyzed effect his ability to do so in the future? (Anxiety? Depression? Isolation? Role Confusion?...) -He's gone 55 years NOT being paralyzed, think this major loss of abilities will impact his self identity? His ability to accomplish basic ADL's and self care? How will you address that? - He was in a traumatic car accident, think this issue has to be addressed? PTSD? Anxiety? - Any education/knowledge we might need to give to this patient related to these issues? There are nursing dx's about this... -He's hospitalized. Just that factor alone is a stressor based on numerous reasons: lack of privacy, sleep disturbance, etc. Address that. It's important. He's in a neck brace following an accident that injured him so severely that he's paralyzed. - Given this information, is this patient, with traumatic injuries, still at risk for injury? - Any education that he might need related to these issues? I'm leaving the physiological stressors that will be your priority up to you to break down the way I broke down these topics above...physiologic priorities such as abnormal vital signs are easy to find nursing dx's that relate to them, but be sure to cover all your bases. Hint: what does each finding mean for the whole body system? Be able to back up your diagnosis with facts of why it is so important that you define your plan of care with its prioritization....A patient isn't going to be doing much else if he's not breathing, or correctly using the O2 from breathing in his body... Also, be careful, keep this scenario FULL PICTURE when you're assessing it. A vital sign MAY be abnormal, but is this abnormality expected or unexpected? Should we prioritize correcting an abnormal finding that is expected? (This is where reading up on spinal cord injuries will help you greatly hint hint hint hint hiiiiinnnt) Hope this helps, and I'm sorry it's long winded, my initial intention was to actually make it quick...I'm really bad at making things quick...

I passed in 75 questions, you are potentially able to get 265 questions with the CAT they use. From my cohort, here are their numbers and pass/fail rates that I remember: 75-pass 75-pass 75-pass 111-pass 75-fail 265-pass 148-pass 185-pass 75-pass This was from a select group of my 120 person cohort, this was more or less the few people I studied with... you can pass in the 165-170 range and a lot of people have done so.

What did you notice you did wrong when you went through your exam? Did you neglect to notice key words in the question? Like "except" "but", "first", etc? That was my problem in nursing school when I took my exams early on... Next, don't be so hard on yourself. Bad test grades happen, especially in nursing school, but the hit hurts none-the-less. Though your average is 72%, keep in mind that averages are harder to dip than you think, ya gotta keep in mind that the probability of you performing in such a way to significantly dip your overall average is slim. Failing tests in nursing school is easier than general courses because they raise the passing curve, but again, keep in mind, overall averages are hard to knock off fast. You can do this. The worst thing you can do in this scenario is go into this with a negative attitude. You've got your motivation to keep on top of your studies, especially in this course. This course obviously takes priority in your study schedule unless you're also riding the pass line in other courses...grab a study buddy, and focus primarily on the testable content of this course. If you need help, I still remember quite a bit of testable content from OB, I had to study that course harder because my heart wasn't in the course, so the facts are still burned into my brain. Let me know.

No offense implied! I'm really sorry! I just meant I've noticed very prompt thorough responses to these types of questions from you in every thread I've opened. I think it's fantastic how quick and thorough you are in responding to these pleas for help! If anything, I'm in training! I only hope to offer different strategies in hopes of meeting their learning style by either my answer or yours! Again no offense! I'm sorry! I love your buck wild responses :)

Boom! Here was my design! http://i.imgur.com/C2GxQDl.jpg

I feel bad that everyone is leaving you hanging...so here goes, Short answer: yes, but not in the ways you're probably thinking. I'm going to be completely honest with you, you sound like a nightmare for a professor. Before you get defensive about that, let me first tell you that I can only say that statement with such confidence because there was a time in my nursing school career where I could arguably have been accused of the same stunts.... Even the way you explain your side of the crisis makes you sound like you're not even genuinely acknowledging your role in this issue, you are kinda trying to take the route of a victim, but I get it, you're probably scared... While I can't speak for certain because I do not know where you are going to school and institutional standards vary from place to place, I do know that prior to entering in the program, you in some way were prompted to "agree to the terms and conditions" of the program. Kinda like a student handbook you know? In other words, just by paying the tuition, probably, you were thereby agreeing to their terms and conditions, which include expectations of behavior. Realistically, the chances of them actually pursuing this potential "void of contract" in an effort to expel you is actually really slim. Just the legalities of such an event would be a mess, and with the way you have portrayed your "tenacity", you'd be just the person to probably make it a nightmare for them to proceed...but I'm getting side tracked. Every clinical and course you take in school will have a syllabus that outlines course objectives that have to be met in order to pass the class, and I'd be willing to bet that every course syllabus a nursing student has ever had has included an objective r/t "professionalism"...guess what? Your attitude toward the aforementioned "professional qualities" with descriptions like "..of sucking it up" indicate an alarmingly apparent failure to meet the objective...which could cost you your right to pass the course...failing courses leads to being terminated from the program. Deep breath, you've only received a warning...which means you're in the hot seat, but they're giving you a chance to shape up. USE THIS CHANCE THEY'VE GIVEN YOU TO ACTUALLY SHAPE UP AND CHANGE YOUR ATTITUDE. So here's a few suggestions: 1. You need to start SERIOUSLY choosing your battles, because not all battles are worth it, regardless of if you're actually the victim or not. You absolutely can NOT raise a fuss over every single scenario that MIGHT have questionable "fairness" qualities. Life isn't fair, and your nursing career won't be fair 100% of the time either. Deal with it. Raising hell over every issue of fairness (as determined by you) is seriously unprofessional. That's basically equivalent to adult-toddler tantrums, no boss wants to hire or deal with an adult-toddler. 2. Kind of related to the first suggestion, but start taking constructive criticism! It will help you! I promise! You kinda sound like you get defensive when you're evaluated and you really have to put a stop to that. Take evaluations for what they are, and opportunity to hear from an observing party about your strengths and weaknesses...don't fight their perception of your weaknesses...just listen, and develop a plan to either better yourself, or better represent that perceived "weakness" if you believe the observer was actually wrong (which will sometimes happen)...it simply just means you have to present the quality in a different way as to not be misinterpreted.

I can totally relate, I felt like I had it completely figured out in my head, but when I went to write it down in a fluent, calculated way, it just came out a jumbled mess. Talk it through, and write it all down in your own words before you try to tinker with the lingo into a more professional tone...it helped me immensely. Really, I just replayed how I felt care should have been directed throughout the day based on what I was told at report when I was assigned to the patient...I noted the things that I particularly prioritized and rationalized why I did what I did or delayed what I did...at that point the care plan wrote itself. I was able to see what areas of the pt's care I was really focusing on, and I got to recall just why I thought the way I did. Glad I could help!

In addition, I happened to have written a very long term paper in my OB clinical regarding the care of a postpartum patient fairly similar (mainly in that she had a critical H&H)...just to give you some strategy ideas, I'll show you the list of nursing dx's I listed off that applied to my pt...I used this list to pick one specific dx to then complete an extended care plan...have at it yo' see if it inspires you to develop applicable ones for your own pt... - Activity intolerance r/t fatigue secondary to anemia A.E.B pt report of light headedness, headache, dizziness upon standing. - Fatigue r/t labor A.E.B physical assessment and patient observation of activity intolerance. - Sleep Pattern disturbed r/t hospitalization A.E.B observed spurratic sleep pattern and lack of ability to attain adequate sleep. - Transfer ability, impaired r/t incision secondary to C-section A.E.B facial grimace and refusal to move without pain meds. - Risk for bleeding r/t birth A.E.B lochia characteristics and clot extraction. - Cardiac output, decreased r/t anemia A.E.B altered vitals - Moderate anxiety r/t transfusion indications A.E.B frequent questions of risk. - Fear of transfusion r/t associated risks A.E.B patient's report. - Risk for constipation r/t pharmacological therapy A.E.B lack of BM, iron supplement indications, pain medication orders. - Breastfeeding effective r/t proper training A.E.B successful feeds. - Anxiety r/t breastfeeding A.E.B lack-of-confidence in ability. - Risk for electrolyte imbalance r/t anemia and blood loss, A.E.B altered labs. - Risk for deficient fluid volume r/t breastfeeding A.E.B lack of supplemental intake. - Comfort impaired r/t hospitalization A.E.B irritability - Acute Pain r/t birth secondary to c-section A.E.B reports of pain - Gas exchange impaired r/t anemia secondary to blood loss as evidenced by altered perfusion. - Risk for imbalanced body temperature r/t loss of blood secondary to birth A.E.B vital sign changes. - Risk for contamination r/t blood transfusion secondary to critical H&B - Risk for falls r/t dizziness, fatigue, headache secondary to anemia. - Risk for infection r/t surgical incision secondary to C-section. - Risk for infection r/t blood transfusion secondary to critical H&H. - Risk for injury r/t blood transfusion - Impaired skin integrity r/t surgical incision secondary to C-section. - Impaired tissue integrity r/t surgical incision secondary to C-section. - Knowledge, procedure and risks of blood transfusion, deficient r/t anemia and critical H&H.

My only suggestion to you for now is that you have to look at your assessment, step back, and look at the big picture. For a second, forget about the fact that you have to find an official diagnosis and just run through what you think this patient needs addressed... This pt is postpartum with her second child...this means multiple things that could be helpful in developing a plan...the most obvious being the pain/stress r/t child birth, the fact that she is now a mother of two children..what's her support system like? Have you asked her about it? Have you asked her about her plans after discharge? Is there any significant psychosocial factor that needs to be addressed in order to ensure the healthiest patient you can produce? You just said she complained about fatigue, and abd pain...so those are things that your patient is actively having a problem with... Now lets dig deeper...this patient just went through child birth...with even a basic understanding of the physiological process in play, we realize that her body was just under a significant amount of stress, and that is AFTER undergoing 9 months of the biologically stressful development of another life INTERNALLY....you listed off labs, well, one lab, hemoglobin, and pigeon holed yourself in your thinking by automatically associating it with anemia...not so fast! H&H levels are only one piece in a nursing diagnostic puzzle. Keep in mind what you said in earlier and later posts..."complaining of fatigue"..."looked pale"...alright, you're starting to build a good defense for a later nursing diagnosis... But first, ask your self if this lab result is expected or unexpected? Keeping in mind her recent events...(hint: expected decrease in H&H r/t child birth...) Don't narrow your vision of the patient based on one FRAGMENT of her overall assessment. Remember, a nursing diagnosis is going to drive the direction in which you base her entire care! If you still wanna run with it, you've gotta build a better case than just pointing to a lab value and making it your mission to correct it....(hint: your reports of skin color and fatigue are useful here) Without even realizing it, you've built a case for a prioritizing a nursing dx regarding inadequate perfusion, and you've got that assessment data to back it up...maybe take that into consideration? But as I said in the beginning, make sure you don't neglect the bigger picture, if your assessment data points to a psychosocial issue r/t this new addition to the family, or the foreseeable implications her healing process will have on her future post discharge, it might be worth while to focus on those in your plan of care as well... As for your attempt to prioritize targeting risk of infection r/t an episiotomy, think of it this way: Pt had an episiotomy, were there any complications in this procedure? Do lab results indicate any evidence of a possible infection? Does the site look worrisome? If not, remember that this is a pretty standard/common procedure in the OB world, so unless there is a red flag present from the procedure, this isn't all that relevant to target as a care priority, it's important to see to good wound care, but leave that to the priority of your teaching before discharge...

I'll take a shot at this one: Pt has C-diff (excessive diarrhea), and labs reveal an already low K+, which is something that you'd already be identifying as a potential side effect to this patho anyway. I'm not sure how long this patient has been c-diff symptomatic, but if it's still relatively early, labs revealing already low K+ lvls essentially mean this pt left the starting line of c-diff at a disadvantage... K+ supp is a given, given that you've not only already ID'ed the expected side effect of c-diff causing low K, but you've additionally run labs either confirming c-diff induced decrease in K has occurred, or were present prior to cdif arrival...so what now? Again, if we're still only in early C-diff presentation, we gotta correct K+, and we gotta correct it fast or we know our pt's about to tip that K+ scale upside down and get critical. So how to we ensure optimal ability for our pt to correct K+? Mag. K+ won't play ball until Mag's already on base; and again, let's say we're pessimists and we're assuming this pt might have had a problem with K+ before he started losing it out of his butt from C-diff...then we have to try and work backwards and target a likely cause just to cover our bases, which would be that pesky Mag love K+ has. People above have also made an excellent point that throwing Mag at a sick colon sounds silly because absorption is already going to be compromised, but think of this method of Mag supp more like "Throwing spaghetti at a wall and seeing what sticks", sure he'll probably leak more mag than he'll absorb, but at least some might slip through the cracks. There are very real safety risks that are involved with this drug, but this doctor should be weighing his risk/benefits...and pt's meds (BB) already kinda hint that his heart might not be able to handle a critically low potassium lvl in the future, and he's already cross checked to make sure that the kidneys would be able to handle the mag doses...so I would personally back the doc up on this one.