tnstudent21

I'm still in nursing school, but a few months ago I noticed something very peculiar. The only places spreading around the phrase "there's a shortage of nursing, job security, high pay...etc" are nursing schools. I'm from the southeast U.S., so I can't speak for the rest of country, but that's what I've noticed here. Out of curiosity I looked up job openings for various hospitals and clinics in my area. All but two had "no new grads" stamped at the bottom of the requirements. I've yet to see if the same is true for nursing homes in my area, but the outlook isn't looking so good for us new grads in TN.

Compression fracture is recent. The patient is in pain sporadically, but subsides with medication. Doing a diagnosis on pain is fairly simple, and because it is "controlled" I was directed to go with another diagnosis. Risk for ineffective renal perfusion seems to be my best bet so far, possibly dehydration. Thank you guys so much. I believe I have learned more about critical nurse thinking in this thread than I have in the past 8 months in school.

Well, I must confess that I'm not too familiar by what you mean by "dry" lung sounds. I listened to the lungs for over a minute, did not hear any wheezing, rales, rhonci or any other adventitious lung sounds.

Thank you! Seems I made a mistake, the output for the last 20 hours was 500 mL, intake for the 8 hours I was there was approximately 500. Lungs sounds were not dry, mucous membranes and skin turgor are good. No stool was passed during my time there.

Hopefully she can! By the way, thank you guys for all the help you have given me. I really, really appreciate it.

I was thinking of that also, however, skin turgor and mucour membranes are both excellent. Nothing to indicate dehydration. This is a tough call, I need more info than what I have. I think I'll just knock something out on paper and turn it in, we aren't graded on these. I hate to do that, but the feedback I'll get ( in red ink pen) should be helpful.

The instructor just pointed me toward the renal system as the primary concern-she did no specify if she wanted an actual or an at risk for diagnosis. I would prefer an actual diagnosis though, but with the absence of an urinary analysis and kidney scan, thats kinda hard. BUN was 37 and creatinine was 1.8

No edema is present. Vital signs: BP 132/74. RR-12, HR-65, Temp-96.5, O2 saturation 94% on room air. I do not know if the confusion is r/t to the increase in BUN, this was a one day rotation for me. Thank you for the advice, it seems I am on the right path because that's how I've been doing my care plans. I put all my abnormal data into columns based on what body system they affect, relate them to their medical diagnosis (if applicable) then go from there. It's just that in this case, I'm stumped. I can use the acute pain, but my instructor said that the renal issue was more pressing (because it interferes with homeostasis). I just can't think of a renal-related nursing diagnosis that aligns with the info I have

Yes I have three nursing diagnosis books. I thought about the ineffective tissue perfusion but I have no data to support that other than elevated BUN and creatinine levels, do you think that would be enough? The intake is pretty much equal to the output, so I can't use excess fluid volume unless I used it as an at risk for.

I'm in a bit of a dilemma trying to write up a care plan. Two things are holding me back. 1.) actual problem vs risk for. This age old debate has been brought up several times here and I've read through them, but still a bit uncertain. 2.) I can't come up with a nursing diagnosis for this situation: 90 yrs old male, admitted for back pain ( compression fracture ). Pain is under control. Alerted to person but not time/place. History of hypertension and dementia. Urine appears slightly concentrated w/ 500 mL output in last 20 hours (intake roughly the same). BUN elevated to double normal level, creatinine elevated slightly. Hemoglobin and Hemtocrit decreased also. Electrolytes all in balance except calcium, which is low. Pt. is not dehydrated, no signs of edema. Because of the dark urine, elevated BUN and creatinine I'm sure the renal system is compromised in some way. But what can I use as a diagnosis? A urinary analysis and kidney scan results are not available. I have an actual diagnosis- pain r/t the compression fracture. But the renal system is of more importance because of it's role in homeostasis, so would an at risk for trump an actual diagnosis here? The renal failure has not been officially diagnosed medically yet, it's a new occurrence.

Thank you for your help.

I am in my first semester. My program wants us to use the PES system, just like you described above. That is very helpful. However, my main concerns are whether or not my related factors have to be related to each other, and if I must include the "secondary to dementia"?

First semester. I am in fundamentals. We are required to use the PES format. The problem related to etiology, as evidenced by signs/symptoms.

I have to do a diagnosis for self-care deficit. I have a few questions on the format. I know that I am allowed to have multiple R/T factors. Do these factors have to be related? May I say Self-care deficit r/t cognitive impairment, physical immobility and fatigue. Also, my patient has a history of dementia. Must I include "cognitive impairment secondary to dementia", or is that optional?