sjmadailey

Thank you all for commenting! I will certainly look into each of the programs suggested. I was in need of some encouragement and this has given me that. :)

Hello! I am a new graduate RN (ADN) and a military spouse. My spouse received orders to move out of state 2 months after I received my RN license. Unfortunately, I have yet to find employment due to following reasons: 1- Childcare for a 2 year old has limited my ability to work no more than 8 hour shifts (I do not have a support system in this new area and my spouse's job requires to be on call so basically I am a single parent and I can not rely on other parent to care for children) 2- Currently 4 months pregnant and unsure of who would employ me (I realize that this is a form of discrimination) So my next option is to pursue my BSN. I have been looking into Online schools offering RN-BSN programs. Many of them require that you call or contact them. Before I do.. I was hoping to receive some advice from others of which colleges to look in to or to avoid. I am worried that I will not be eligible for any of these programs because I'm not currently employed. Are there programs that are 100% online and accredited? Is there a "clinical" component to these programs that will require that I complete at an acute care facility? Will preceptorship/mentoring be a critical part of the program. I am in need of direction and advice. Thank you in advance.

Thank you for the time you spent to answer my questions. It helped me to better understand the nursing diagnosis process. I have since graduated and passed NCLEX. :)

Can Hypertension be used as a related to factor for nursing diagnosis: Risk for decreased Cardiac tissue perfusion? Or must it be reworded to say High blood pressure because hypertension is a medical term and medical diagnosis?

I have 10th edition. I looked in Ackley and see it listed only as Risk. Ok, I will stay away from diagnosis that are not NANDA approved.

She was coughing, but infrequently and it wasn't very forceful. She was able to expel some mucus that she would spit into a tissue and wipe away. It was yellow/green and thick. I reminded her to use incentive spirometer and was able to have her demonstrate for me 3 times before the end of my clinical day. I heard some crackling in her lungs at the base of both when I listened posterior side. Her temp stayed around 99 during my shift. Her admission temp was 104. Respirations appeared normal 18-20 per minute. She was not breathing heavily. She would reach 1000 during inspiration on the incentive spirometer.

Infection is listed in the careplan book as a nursing diagnosis, but I see what you are saying. It's not NANDA dx.

I was having issues posting my comment and had changed the priority diagnosis of Impaired gas exchange to Ineffective air way clearance, but I see that it did not post my updated comment. I realized that the impaired gas exchange did not explain my patient's problems after reading the s/s for it.

I have the Nursing Diagnosis Handbook by Ackley and Ladwig. I recently bought Nursing Care Plans by Gulanick & Myers.

Thank you! Your explanation clarifies the purpose of a care plan for me. I thought that it was based on the patient's diagnosis. Abnormal findings that I assessed were some crackling in the lungs, patient coughing but not productive 100% of the time and complains shes unable to expel mucus, SpO2 in range of 95-98% on room air, temps ranging from 99 F to 104 F since admission, her legs appeared edematous and when I assessed for pitting (1+), she is wearing ted hose. No complaint of pain, but when assessing puncture site in groin for bleeding by palpating surrounding area after cardiac cath she had the evening prior, she winced. Bruising observed on arms from blood draws due to anticoagulant. She had a foley but it was discontinued. She was able to get out of bed and perform ADL's with close supervision. She was on diuretics causing her to go to the restroom frequently since the removal of the foley. I could see that she was becoming increasingly tired from getting in and out of bed 2-3 times an hour. She would refuse a bed pan when offered. What would be priority nursing diagnosis? Impaired gas exchange related to infection of lungs secondary to pneumonia as evidenced by o2 sat 95%, ineffective coughing, crackling in lungs, mucus Secondary diagnosis? Infection related to viral organisms secondary to pneumonia as evidenced by elevated white blood count, temps above 99 F, cough with some sputum production. What could some other diagnosis be? Decreased cardiac output related to MI? Risk for injury related to medications, fatigue? Risk for electrolyte imbalance related to diuretic?

I am really confused. My patient (73 y.o female) was brought to ER for unresponsiveness. Her labs show high cardiac enzyme levels (troponin & CK-MB) indicating she had a MI. On top of this she has been treating Bronchitis with a Z-pak for a week with no success. Now she has pneumonia. When writing up my care plan which medical diagnosis should I focus on? Which is priority? I want to say pneumonia because its causing respiratory problems from excess mucus and infection which would lead to more problems due to improper oxygenation, however, with a heart attack (She had stents placed) circulation is a problem which could lead to more problems also. I would greatly appreciate any input! Thank you!