tulip5

So if I understand your current question(s). (1) Why am I adamant his priority problem is dehydration? The answer is: fluid imbalance (current... not risk for) always ranks everything else except issues of oxygenation. End of story. Is your instr...

When do you know if something is "proven"? What threshold of proof do you require?

What is "NS"?

Your priority is dehydration. Why? Because after oxygenation (which appears OK based upon the data you give) the next most important basic human need is fluid and electrolyte balance. You did not tell us what his serum chemistries are, but chance...

Oh, actions... I think some of this takes adjustment of the analgesics. May need something with the opiate. NSAID (ketoralac if she's not bleeding) works GREAT. If she's on morphine, try equianalgesic dose of dilaudid. (different people do better...

Oh... likely nursing diagnosis: (depending upon exact assessment data) Impaired gas exchange RT respiratory depression (opiate/anesthetic) and splinting AEB (vital signs here), pt. not coughing deep breathing, c/o incisional pain, etc.

You've gotten some really good responses here, and I am just going to give you my simple-minded approach to the pretty-freshly-post-op patient. First of all, you must have a system for prioritizing your patient assessment and planning. Here is min...

Ya know what... there are people walking around who have AAA's and don't know it. There are others that know it and are just being monitored... to make sure it doesn't get any worse. And then there are those that are burst and you have WWIII on you...

I agree with LauRN. In addition, as you're learning about clinical reasoning... always remember that "RT" (related to) requires that you address causality. I have students who will write a dx like "Knowledge deficit RT coumadin AEB taking drug inc...

I'm an instructor. But my approach to sizing up students is much like my clinical style... I don't make judgements based upon one thing. If (1) the student looks way too casual during clinical, and (2) isn't answering call lights when not with thei...

Yes. I was an RN then. I did not know any RN's who refused to take care of Gays, even those with what we were recognizing as Gay-related diseases such as Kaposi's sarcoma and pneumocistis. But we realized early on that it was body fluid related. ...

Our state fought back the "non-licensed assistive personnel" push years ago by lobbying our legislature really hard. As a result, certification of CNA's was put into the Nurse Practice Act and is regulated by our State Board of Nursing. But here is...

Yes... almost ALL my students that work while going to school do so because they MUST. (Their job is where the health insurance is, or divorced spouse is not paying child support or whatever.) There is no good answer to whether "2nd semester" is eas...

I get that we need(ed) a standardized, agreed upon language for research and publishing and it's handy to have all of it (diagnoses, outcomes and actions) codified in EMR for the purposes of our own retrospective data collections. However, these (the...

Our school uses Ackley and Ladwig which... in its own way (this section for this... that section for that... flip here, turn there...) contains the 3 N's. And I know that Med-Surg I and II faculty (bless their hearts) do their best to show students ...

I tell my students that PROFESSIONAL nursing is what goes on between the ears. And I put a lot of emphasis on teaching students how to reason about patient care. Here are my questions for you... 1) How much of nursing school should be spent teachin...

Nursing school (doesn't matter ADN or BSN) is harder than you can possibly imagine. Not impossible. Just unbelievably demanding. My recommendation is that you clear the decks, make sure your car is in good working order and reliable, you have child...

Yep. Read an analysis today that said that some small % of people who have signed up for insurance post ACA were genuinely unable to get insurance previously. It made the case that by expanding Medicaid and subsidizing the heretofore uninsurable, w...

I have done 15 years of bench science (yep... whole deal, microscopes, tissue cultures, radioligand binding, measuring calcium transients with fluorescence, grant writing and publishing, blah-dee-blah) and I have a couple of advanced degrees. I gues...

Um... where are all those valiant defenders of ObamaCare that were here a year ago? Totally flaming anyone who dared to have any doubts about how Democrat promises square with reality. Debacle. Train wreck. Disaster. Total fail. Incomprehensible. Il...

Not so much, bankruptcy due to medical bills is the number one cause of bankruptcy in the US. If everyone's insurance was working that well then few if any of these bankruptcies should have occurred to people with health insurance. In reality, abou...

This is not a free market.

I think you are exactly the sort of family this program was supposed to help... and I'm gratified that it has helped you. According to CBS (as of several days ago) 2 million American families have been notified that they have lost their insurance, th...

The excuse de jour from the administration is that no one had to leave the health plans that they liked. But, you see... people are just being "transitioned" from "inferior" policies that did not quite meet ACA minimum standards. Oh, and if you are...

Now that the affordable care act is rolling out I wonder if we should revisit this notion. AND (maybe more particularly) if it is a right, is the federal government the best instrument to provide it.