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Daytonite BSN, RN

med/surg, telemetry, IV therapy, mgmt
Member Member Educator Expert Nurse Retired
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Daytonite has 40 years experience as a BSN, RN and specializes in med/surg, telemetry, IV therapy, mgmt.

BSN, RN - Specialty areas include: Medical-Surgical, Telemetry, IV therapy, Management, Student Assistance, Educator


BSN, RN - Specialty areas include: Medical-Surgical, Telemetry, IV therapy, Management, Student Assistance, Educator

Be helpful to each other. Haven't most of us experienced enough backbiting and negativity at work? And please don't use the phrase "eating our young". People that "eat their young" are just nasty people who are difficult to get along with. They are in every profession, every walk of life, and not just nursing. ~ Daytonite

Daytonite's Latest Activity

  1. Daytonite

    Help with Care Plans

    What kind of help are you looking for? You know the nursing diagnosis. What you do next is determine the goals and nursing interventions.
  2. Daytonite

    School admission essay

    Aerican nurses are problem solvers and leaders and not just compassionate care givers. We are expected to manage patient care at our jobs and that is what makes American RNs different from the RNs in other countries.
  3. Daytonite

    help with "risk for suicide" care plan

    Risk for suicide related to schizoaffective disorder of the bipolar type is an acceptable way to word the diagnosis. You can also add "and experiencing auditory hallucinations advising him to commit suicide" as well so that the diagnosis reads: Risk for suicide related to schizoaffective disorder of the bipolar type and hearing auditory hallucinations advising him to commit suicide. Remember that the "related to" part of the statement is why there is the risk.
  4. Daytonite

    Seizures

    Good job, vanlo001! :redpinkhe I couldn't have said it better myself.
  5. Daytonite

    Care Plan Help

    there is a thread on allnurses that will help you with construction of a care plan: https://allnurses.com/general-nursing-student/help-care-plans-286986.html - help with care plans when sitting down to write a care plan the best tool you can use is the nursing process. by following its 5 steps it will keep you focused on the task at hand. step #1 is assessment of the situation. since you are to focus on falling you want to look at all the data that contributes to falls. your nursing diagnosis handbook is going to help you with this. if you look at the diagnosis for risk for falls you will find a listing of the risk factors. read through them because you missed a few that were mentioned in the scenario that apply to this patient. step #2 of the nursing process is determining the nursing problem and then naming it--in this case that has been done for you--risk for falls. step #3 is to determine your goals and develop nursing interventions. now, a "risk for" diagnosis is a little different because it is a potential problem and not an actual problem. the nursing interventions for potential problems need to be: strategies to prevent the problem from happening in the first place monitoring for the specific signs and symptoms of this problem reporting any symptoms that do occur to the doctor or other concerned professional goals in relation to them are really what you expect will happen as a result of any interventions you perform being done [if we do this, then this is what will happen]. time frames for goals are always difficult, but you have to pick something that makes sense and fits along with the intervention that matches with it. you've got to give the interventions some time to work so the goal can be achieved. in some cases a goal can be achieved immediately; in others it may takes hours, days or weeks. your interventions for monitoring the patient's neuropathic condition can be included, e.g., doing periodic neuro checks to assess his ability to feel, assessing his balance. rationales are merely explaining why you are doing those interventions. if you can't find or think of why, a care plan book will have them. this is often one of the more tedious parts of a care plan because it requires some thinking as well as good writing on the part of the nurse. one last suggestion i have for you is to check the beginning of your nursing diagnosis handbook and see if it doesn't have some discussion about care planning or the nursing process. i have found that many of these books do and people neglect to read this important information. it sometimes takes several readings to comprehend the information. it also takes doing several care plans to get the hang of this nursing process business because it is a new way of thinking and processing information for many students. however, it is how we problem solve in nursing and must be learned.
  6. Daytonite

    CVA(Basal Ganglion Infarction)

    Cool your jets! This was not a breech of confidentiality. No names or places were exchanged. This could have been any of a thousand patients. Anyway, the original post is 3 years old! You're a little late noticing it.
  7. Daytonite

    help with my first careplan

    is this a real patient that you cared for or a scenario you were given? a scenario gives you specific information to work with. a care plan is a collection and determination of a patient's nursing problems. the nursing diagnoses are merely names that are given to the nursing problems. the remainder of the care plan is strategies to do something about the nursing problems that the patient has. in order to determine what the nursing problems are we use the nursing process. the first step is to do a thorough assessment of the patient. in doing so, abnormal data point the way to what the nursing problems are. dementia is a medical evaluation. what are her signs and symptoms of the dementia? look up the definition in a medical dictionary and see what symptoms she displayed. (see http://www.merck.com/mmpe/sec16/ch213/ch213c.html - dementia) some of them will be symptoms of a nursing problem that fits a nursing diagnosis. what is the result of her having contractures of her arms and legs? how does it affect her ability to move? can she walk? turn in bed? do you see that i am getting at how she responds to what has happened to her. those responses are important because they tell us exactly what her nursing problems are. step 2 of the nursing process is identifying the nursing problems and adding the nursing diagnostic names to them. if she is totally incontinent of bowel and bladder these are nursing problems: total urinary incontinence - definition: continuous and unpredictable loss of urine (page 403, nanda international nursing diagnoses: definitions and classifications 2009-2011) bowel incontinence - definition: change in normal bowel habits characterized by involuntary passage of stool (page 101, nanda international nursing diagnoses: definitions and classifications 2009-2011). a peg tube and oxygen are medical treatments that are ordered by physicians, but often left to nursing to carry out. what is the underlying problem for these treatments and any symptoms connected with the underlying medical problem? that is where to find the real nursing problem for them. maslow's hierarchy is used to sequence the nursing diagnoses once you have determined what they are.
  8. Daytonite

    Acute confusion care plan help?

    I'm an old lady I am stuck at home and sick I am as close as your computer I have a lot of time to think about how it could be easier for you guys. I wrote care plans for years and struggled with them in earlier days so I know what you're going through. All you have to do is ask your questions and I will answer them as best as I can if I am feeling up to posting. I am on chemotherapy again and I have days where I just don't feel like sitting at the computer. I have so many previous posts on allnurses, however, that there really aren't many new questions that are asked. I suspect some instructors may not know how to explain how the NANDA taxonomy works themselves. Truth be told, most nurses, including instructors, hate having to do care plans.
  9. Daytonite

    help on a care plan

    allnurses has a thread on care plan construction: https://allnurses.com/general-nursing-student/help-care-plans-286986.html - help with care plans that you should check out. it is important when care planning that you follow the steps of the nursing process when you actually sit down to write the care plan. it will help you organize everything much better and help you with the critical thinking. also, i need you to understand that a nursing diagnosis is merely a name that gets attached to a nursing problem so don't get too stressed over them. what is important is knowing what the definitions of these diagnoses are because they are a better description of what the nursing problem is. your diagnoses are difficult for me to evaluate because you have included very little of the assessment information that supports them. now, i worked in nursing homes and did many care plans for them so i know a great deal about ltc care plans. i also know the nanda diagnoses. the nanda taxonomy of diagnoses is listed in the appendix of recent copies of taber's cyclopedic medical dictionary if you don't have the money to buy an official copy of the taxonomy, nanda international nursing diagnoses: definitions and classifications 2009-2011,from nanda ($35). but i can tell you right off the bat that self-care deficit is not a correct diagnosis. it needs to be more specific. there are 4 self-care diagnoses: bathing/hygiene dressing/grooming feeding toileting does this patient actually have deficits in all 4 areas? i agree with impaired skin integrity for the wound on her arm, but that does not warrant a second diagnosis of risk for impaired skin integrity. that is overkill and the interventions for prevention of wounds would be included with the impaired skin integrity diagnosis. risk of falls should be risk for falls. are you sure her impaired memory isn't just chronic confusion? the difference lies in what her symptoms are. since you didn't really post much in the way of symptoms, it is hard to evaluate this. what is her medical condition? any alzheimer's or dementia mentioned in her history and physical by the physician. the patient's chart should always be gleaned for information and background. as for teaching, anyone can be taught a routine, even someone who is confused. we taught bladder and bowel control on a regular basis in ltc. the patient might need a lot of prompting by staff, but it is doable. do not be fooled into thinking that goals for ltc must be the restoration of wellness and independence. goals can ultimately have 3 objectives: improvement of the patient's condition/remedy stabilization of the patient's condition support for the deterioration of the patient's condition for ltc stabilizing or supporting their deterioration is about the best we can hope for sometimes. with dying patients we support their deterioration and eventual death. it may sound depressing and negative, but that is the nature of this profession sometimes. unfortunately, not everyone is going to get better, jump out of bed and go back to being a productive citizen again. it is perfectly fine to maintain their current level of functioning or support their deterioration of function and keep them comfortable.
  10. Daytonite

    Acute confusion care plan help?

    Part of your responsibility as a student and learner is to look up the definition of medical terms being used in these scenarios as well as the side effects of drugs being used. One of the things that I stress in most of my posts when helping students doing care planning and diagnosing is that a nursing problem, which is what a nursing diagnosis gets attached to, is the patient's response to what is happening to them whether it is as a result of their medical disease, medical treatment or just the stress of what is happening in their life. In this case, the patient's response to the drug is what is the cause of the nursing problems and there are more than one nursing problems here than the confusion as I am sure your instructor will point out as you work through this scenario. Best wishes to you.
  11. Daytonite

    Case Studies

    Just do a search for nursing case studies and you should find a lot of websites with them.
  12. Daytonite

    Acute confusion care plan help?

    Are you saying that you have to stick strictly with the etiologies listed in the NANDA taxonomy? They are only suggestions. The woman is confused because of the drugs she has gotten. It is not drug abuse as the taxonomy would suggest, but her confusion is because of the delirium caused by the side effects off the Dilaudid. Acute Confusion R/T delirium secondary to Dilaudid ingestion AEB disoriented to time and place, inability to recall events, inappropriate responses to questions, difficulty concentrating and becoming irritable and frustrated with multiple commands.
  13. Daytonite

    Diabetes Mellitus

    as a working nurse this happened occasionally. i got the fingerstick immediately and noted that it was taken as the patient was eating breakfast. sometimes it turned out that the blood sugar hadn't elevated yet since it takes time for some of the sugars to get into the blood stream. and, yes, i would definitely give the patient their insulin. if i didn't, they would get hyperglycemic.
  14. Daytonite

    Labs for possible MI???

    I meant to look this up for you, but yesterday. A 49-year old man with indigestion is going to be evaluated for a heart problem first--ALWAYS. Indigestion can be mistaken as a GI p[roblem when it is really a heart problem. Once a heart problem is ruled out, then a GI cause is looked for. In looking through Nursing Care Plans: Guidelines for Individualizing Client Care Across the Life Span, 7th edition, by Marilynn E. Doenges, Mary Frances Moorhouse and Alice C. Murr and their care plan for Angina and CAD these are the diagnostic studies they have listed (page 64): ECG: Often normal when client at rest or when pain-free; depression of the ST segment or T wave inversion signifies ischemia. Dysrhythmias and heart block may also be preseent. Significant Q waves are consistent with a prior MI. 24-hour ECG monitoring (Holter): Done to see whether pain episodes correlate with or change during exercise or activity. ST depression without pain is highly indicative of ischemia. Exercise or pharmacologic stress electrocqrdiography: Provides more diagnostic information, such as duration and level of activity attained before onset of angina. A markedly positive test is indicative of severe CAD. Note: Studies have shown stress echo studies to be more accurate in some groups than exercise stress testing alone. Cardiac enzymes (troponin I and cardiac troponin T, CPK, CK and CK-MB; LDH and isoenzymes LDy LDz): Usually within normal limits (WNL); elevation indicates myocardial damage. Chest X-ray: Usually normal; however, infiltrates may be present, reflecting cardiac decompensation or pulmonary complications. PCO 2, potassium, and myocardial lactate: May be elevated during anginal attack (all play a role in myocardial ischemia and may perpetrate it). Serum lipids (total lipids, Lipoprotein electrophoresis, and isoenzymes cholesterols [HDL, LDL, VLDL]; triglycerides, phospholipids: May be elevated (CAD risk factor). Echocardiogram: Motion mode (M-mode) or two-dimensional (2-D or cross sectional) electrocardiography helps diagnose cardiomyopathy, HF, pericarditis, and abnormal valvular action that might be cause of chest pain. Nuclear imaging studies(rest or stress scan): Thallium-201: Ischemic regions appear as areas of decreased thallium uptake. MUGA: Evaluates specific and general ventricle performance, regional wall motion, and ejection fraction. Calcium scoring (also called coronary artery calcium scoring): Ultrafast CT scan that measures the amount of calcium in the coronary arteries. Elevated calcium scoring in client with other risk factors (e.g., family history, hypertension, diabetes, hypercholesterolemia) is an indication of some level of coronary artery disease (CAD). Cardiac catheterization with angiography: Definitive test for CAD in clients with known ischemic disease with angina or incapacitating chest pain, in clients with cholesterolemia and familial heart disease who are experiencing chest pain, and in clients with abnormal resting ECGs. Abnormal results are present in valvular disease, altered contractility, ventricular failure, and circulatory abnormalities. Note: Ten percent of clients with unstable angina have normal-appearing coronary arteries. Labs for GI, if there is something like a gallbladder problem, would be CBC, serum bilirubin, amylase, liver enzymes (AST,ALT, ALP, LDH), prothrombin levels, stool for occult blood, BUN, creatinine and electrolytes.
  15. Daytonite

    Which labs???

    I meant to look this up for you, but yesterday. A 49-year old man with indigestion is going to be evaluated for a heart problem first--ALWAYS. Indigestion can be mistaken as a GI p[roblem when it is really a heart problem. Once a heart problem is ruled out, then a GI cause is looked for. In looking through Nursing Care Plans: Guidelines for Individualizing Client Care Across the Life Span, 7th edition, by Marilynn E. Doenges, Mary Frances Moorhouse and Alice C. Murr and their care plan for Angina and CAD these are the diagnostic studies they have listed (page 64): ECG: Often normal when client at rest or when pain-free; depression of the ST segment or T wave inversion signifies ischemia. Dysrhythmias and heart block may also be preseent. Significant Q waves are consistent with a prior MI. 24-hour ECG monitoring (Holter): Done to see whether pain episodes correlate with or change during exercise or activity. ST depression without pain is highly indicative of ischemia. Exercise or pharmacologic stress electrocqrdiography: Provides more diagnostic information, such as duration and level of activity attained before onset of angina. A markedly positive test is indicative of severe CAD. Note: Studies have shown stress echo studies to be more accurate in some groups than exercise stress testing alone. Cardiac enzymes (troponin I and cardiac troponin T, CPK, CK and CK-MB; LDH and isoenzymes LDy LDz): Usually within normal limits (WNL); elevation indicates myocardial damage. Chest X-ray: Usually normal; however, infiltrates may be present, reflecting cardiac decompensation or pulmonary complications. PCO 2, potassium, and myocardial lactate: May be elevated during anginal attack (all play a role in myocardial ischemia and may perpetrate it). Serum lipids (total lipids, Lipoprotein electrophoresis, and isoenzymes cholesterols [HDL, LDL, VLDL]; triglycerides, phospholipids: May be elevated (CAD risk factor). Echocardiogram: Motion mode (M-mode) or two-dimensional (2-D or cross sectional) electrocardiography helps diagnose cardiomyopathy, HF, pericarditis, and abnormal valvular action that might be cause of chest pain. Nuclear imaging studies(rest or stress scan): Thallium-201: Ischemic regions appear as areas of decreased thallium uptake. MUGA: Evaluates specific and general ventricle performance, regional wall motion, and ejection fraction. Calcium scoring (also called coronary artery calcium scoring): Ultrafast CT scan that measures the amount of calcium in the coronary arteries. Elevated calcium scoring in client with other risk factors (e.g., family history, hypertension, diabetes, hypercholesterolemia) is an indication of some level of coronary artery disease (CAD). Cardiac catheterization with angiography: Definitive test for CAD in clients with known ischemic disease with angina or incapacitating chest pain, in clients with cholesterolemia and familial heart disease who are experiencing chest pain, and in clients with abnormal resting ECGs. Abnormal results are present in valvular disease, altered contractility, ventricular failure, and circulatory abnormalities. Note: Ten percent of clients with unstable angina have normal-appearing coronary arteries. Labs for GI, if there is something like a gallbladder problem, would be CBC, serum bilirubin, amylase, liver enzymes (AST,ALT, ALP, LDH), prothrombin levels, stool for occult blood, BUN, creatinine and electrolytes.
  16. Daytonite

    Postpartum/newborn nursing diagnoses

    I've answered probably 50 of this same question on this or the Nursing Student Discussion Forum. With the exception of the 3 Breastfeeding diagnoses that are specific for the postpartum mom, the nursing diagnoses are universally used for all patients and are dependent on the signs and symptoms of the nursing problem the patient is having. If you are looking for diagnoses first before going over your assessment data of the mom and newborn you are not following the nursing process and how to diagnose like you should. A nursing diagnosis is merely a name that is attached to a nursing problem. A nursing problem is abnormal responses by the patient to what has happened to them. (EX: fatigue after hours of labor, vaginal soreness or afterpains after giving birth vaginally, an incisional wound after a C-section, hemorrhoidal pain after hard pushing during childbirth). Why do they keep those newborns wrapped in blankets? Is that umbilical cord a wound needing any kind of wound care? Is breastfeeding going on? I provided you with a number of hints. Review your assessment data on these patients and search for some of my older threads on this to get your answers.
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