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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. Hello would you mind sending me your medsurg organization sheet. I saw that you had one on another post. My email is schwartzsk2@gmail.com.Thank you so much! 

  2. Daytonite

    Help with Care Plans

    the writing of a care plan follows the steps of the nursing process. the first thing you need to do is to collect together (make a list) all your assessment data of the patient. nursing assessment includes: a health history (review of systems) performing a physical exam assessing their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming) reviewing the pathophysiology, signs and symptoms and complications of their medical condition reviewing the signs, symptoms and side effects of the medications/treatments that have been ordered and that the patient is taking the next thing you do is make a second list from that which includes everything that is abnormal. it is the abnormal data that is the evidence of the patient's nursing problems which you will probably know better as nursing diagnoses. once you know what the nursing problems are you can then develop nursing interventions to treat them. and, that is a care plan.
  3. Daytonite

    Help with Care Plans

    first of all, your related factor is inappropriate. a gunshot to the abdomen is not an appropriate etiology (cause) of someone having limitation in independent, purposeful physical movement of the body or of one or more extremities (page 124, nanda international nursing diagnoses: definitions and classifications 2009-2011). there was either impairment of the muscles that are responsible for the movement, their ability to feel what they are doing with their limbs or pain. also your aeb (as evidenced by) part of the diagnostic statement is supposed to be the proof, or symptoms, you have that are the evidence of the impaired physical mobility. a surgical incision to the abdomen is not evidence of limitation in independent, purposeful physical movement of the body or of one or more extremities. your evidence would be things like the inability to move an arm or leg without assistance, difficulty turning in the bed, jerky movements, slowed and cautious movement or can't walk. so, you need to rethink what this nursing problem is and make sure you have diagnosed correctly and rewrite your diagnostic statement. secondly, what help is it that you need with the care plan? you didn't say. did you read the early posts of this thread?
  4. Daytonite

    Help with Care Plans

    A nursing diagnosis reference is not the same as a nursing care plan book. It is a book that contains all the nursing diagnoses, their definitions, defining characteristics and related factors. Diagnosing requires that an assessment of a situation be done first to determine what is going on and what problems are going on. You cannot write a plan of care until you identify some kind of problem. Readiness for Enhanced Coping sounds like a possibility if that is what your data suggests is going on. But if you looked in a nursing diagnosis reference like I suggested you would also havd foundd these diagnoses: Readiness for Enhanced Parenting and Readiness for Enhanced Family Processes so you are either not understanding what a nursing diagnosis reference is or you didn't do what I asked you to do. Nursing care plan books are going to give you diagnoses for medical conditions as well as nursing interventions and rationales for them which is why your instructor doesn't want you using them. She wants you to use the nursing process yourself to crank out this care plan step-by-step, which by the way is how the writers of those care plan books develop those care plans that are in them so they've already done the critical thinking for you. Nursing Diagnosis Reference: NANDA International Nursing Diagnoses: Definitions and Classifications 2009-2011. This is not a book of care plans, but a listing of the 206 nursing diagnoses, their definitions, defining characteristics, related factors and what catagories they are classified into by NANDA.
  5. Daytonite

    Help with Care Plans

    do you have a nursing diagnosis reference? there are a number of nursing diagnoses that pertain to the family. and if you read some of the definitions of the nursing diagnoses, the family is mentioned as being part of the diagnosis and not just the individual. when wellness is involved (no actual problems) the "readiness for" diagnoses are used. they are used to enhance what the clients already know and provide more teaching to them. if you have a recent edition of taber's cyclopedic medical dictionary you will find the nanda taxonomy (all the definitions of the nursing diagnoses along with their defining characteristics (symptoms)) in the appendix.
  6. Daytonite

    Help with Care Plans

    No one help you without assessment data. A psychosocial diagnosis is no different from a physiological diagnosis. You still need to have assessment data in order to determine what the psychosocial problem is.
  7. Daytonite

    Help with Care Plans

    if you go back to the beginning of this thread and read the information about care planning you will find that diagnosing is based on the assessment information you have about a patient and you have provided none of that. i suggest that you read about the development milestones of a 10-year old as well as where she falls on erickson's stages and see how this patient compares to get some of your patient's assessment data. you can find some pediatric websites with developmental milestones listed on this sticky thread in a section of pediatric weblinks: https://allnurses.com/nursing-student-assistance/medical-disease-information-258109.html - medical disease information/treatment/procedures/test reference websites
  8. Daytonite

    L/D Care Plan Help PLEASE

    The first care plans you do will seem difficult and go slow. It takes time to adjust and learn this nursing process and diagnosis business. There are 206 nursing diagnoses. Most nurses only know a handful of them off the top of their heads. I am still surprised that classes in nursing diagnosis aren't formally taught in all nursing schools. We all take some kind of classes in pathophysiology which is pretty much learning the medical diagnoses, but many nursing schools fail when it comes to teaching students the nursing diagnoses and the process of how to diagnose. The process (nursing process) isn't much different from what doctors do except the information that goes into our diagnosing includes not only some medical information, but other stuff that doctors aren't particularly interested in that is of more concern to us nurses. Remember back to when you first learned to ride a bike and even farther when you were learning to tie shoelaces. You didn't do either perfectly the first time. . .or the second time. . .or the third time. It takes practice and lots of it. Just keep at it. Part of why I post here is to help students get a better understanding of this seemingly complicated process. I am always looking for and thinking about ways to explain or make this whole care plan process easier for people just learning it. If you have any confusion about the process, please ask. I'll dig into my bag of tricks and see if there is something there that can help you. Chances are I have already posted it on a thread somewhere on this forum already anyway, but I will repeat this stuff when questions are asked.
  9. Daytonite

    L/D Care Plan Help PLEASE

    i spent a great deal of time going through your care plan. for the most part it is pretty well organized, but i did make a lot of suggestions for you. a care plan is a listing of the patient's nursing problems and strategies to do something for them. everything flows from your supporting data which come from your initial assessment of the patient. two things: (1) is she breastfeeding? there is a diagnosis for that whether the breastfeeding is going ok or if there are problems. (2) you made mention of an episiotomy. that is a wound that requires nursing attention. i gave you a diagnosis for it below and i think that should be included in the care plan. it is also a source of potential infection. #1 nursing diagnosis acute pain r/t uterine contractions and stretching of cervix and birth canal supporting data external monitoring of contractions, patient states "i am hurting," noticeable facial grimace, muscle tension, increased rr, client rates pain as 9/10, diaphoresis what about the episiotomy? goal: client will report that pain management regimen relieves pain to satisfactory level outcome: client will maintain your goals and outcomes need to be reversed. outcomes refer to the overall outcome of the diagnosis and usually go back to the related factors. goals have to do with how your nursing interventions impact on the symptoms (your supporting data). interventions: 1. assess pain level every hour and prn 2. administer stadol iv every 4 hrs and prn3. assist with epidural how is assisting with her epidural going to decrease her pain? 4. provide nonpharmacologic techniques like what? this is a very vague intervention. i'll list some for you below. 5. encourage client to try different positions 6. teach simple breathing and relaxation techniques 7. limit visitors as she desires limiting visitors doesn't belong here. 8. keep informed about the progress of labor and baby's condition how is this going to decrease her pain? this sounds more like it needs to be an intervention with your diagnosis of anxiety. 9. prevent pain when possible during procedures - pain during procedures is not among your supporting data (symptoms), so why would you have a nursing intervention for it? makes no sense. one of your interventions should at least be mentioning the pain scale of 0 to 10 that is being used to assess the pain since you mention it as an outcome and have included it as supporting data. what are you doing for the diaphoresis? #2 nursing diagnosis fatigue r/t childbirth supporting data ??????? help????? how can you even diagnose that the patient is fatigued without her having any symptoms of it? your supporting data would be the symptoms of the fatigue. look at the defining characteristics of fatigue in a nursing diagnosis reference (i've given you weblinks where you can find this information below). goal: patient will verbalize increased energy and improved well-being outcome: patient will verbalize environment is suitable for satisfactory rest during my shift your goals and outcome need to be reversed. interventions:. assess level of fatigue prn 2. allow client to express what best helps her relax 3. limit visitors as she requests 4. prepare the environment to promote rest 5. administer pain medication to relieve pain and promote rest this intervention belongs with acute pain. 6. limit the number of times she is interrupted try to administer medication, check vs, or or other actions in one room visit do room visits cause her fatigue or anxiety? hmm. if they cause anxiety this should be part of your supporting data for anxiety and belongs with that diagnosis. 7.teach methods to help relax #3 nursing diagnosis anxiety r/t fear of unknown and situational crisis supporting data: facial tension, increased perspiration, increased pulse ?????? this doesn't sound right????? yet they are. read up on anxiety. they are physiologic responses. all are listed as defining characteristics of anxiety in a nursing diagnosis reference. goal: patient will have vital signs that reflect baseline and will verbalize decreased anxiety outcome: patient will have a relaxed facial expression and body posture between contractions your outcome should reflect the related factor. goals should be predictions of what will happen when your interventions for the symptoms (facial tension, increased perspiration, increased pulse) are performed as you planned. interventions: 1. determine the couple's plans for birth and work with them as much as possible this makes no sense being here. you have no supporting data that their plans for birth have or are the cause of any anxiety. 2. explain all activities, procedures and issues that involve the client 3. stay with client as much as possible during labor !!!!!!!!!!need more interventions!!!!!!!!!!!!!! the problem with your interventions is that they do not target the symptoms of the anxiety (your supporting data, or symptoms). just like doctors, we also treat the patient's symptoms. in this case, you are saying her symptoms of the anxiety are facial tension, increased perspiration, increased pulse. your interventions need to be what you are going to do about them. the definition of anxiety, the nursing diagnosis, is vague uneasy feeling of discomfort or dread accompanied by an autonomic response (the source often nonspecific or unknown to the individual); a feeling of apprehension caused by anticipation of danger. it is an alerting signal that warns of impending danger and enables the individual to take measures to deal with the threat (page 242, nanda international nursing diagnoses: definitions and classifications 2009-2011). what will you do to allay those feelings of fear and dread? better still. . .did they verbalize them at all? if so, they are supporting data (symptoms) that you need to include above. #4 nursing diagnosis risk for infection r/t multiple vaginal exams and tissue trauma supporting data!!!!!!!!!need supporting data!!!!!!!!!! there is no supporting data because this is not an actual problem that exists yet. it is a potential problem. there are only risks that it could happen. the risks are that she has had xx vaginal exams and tissue trauma from xx. list it out. include that episiotomy. goal: patient will remain free from infection outcome: patient will free from signs of infection as evidenced by normal vs during my shift your goal and outcome need to be reversed. interventions: assess and report signs of infection such as swelling, discharge, increased body temp and warmth 2. follow standard precautions what are standard precautions and why are they important to the prevention of infection? 3. use sterile technique when inserting foley 4. use appropriate hand hygiene what is "appropriate" hand hygiene? you need to be more scientific. spell it out exactly. 5. teach patient proper perineum care 6. teach patient the symptoms of infection and when to report to physician 7. teach patient proper episiotomy care this patient has an episiotomy? that's another nursing problem and diagnosis impaired tissue integrity. 8. monitor vs again, outcome should be that the patient will be free of infection. goals will reflect predictions of what will happen when your interventions for the potential symptoms do not occur or your interventions are performed as you planned. with "risk for" diagnoses nursing interventions are restricted to the following: 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 - - - - - - - - - - - - - - - interventions for pain: assess and document patient's level and intensity of pain using the 0 to 10 rating scale with 0 being no pain and 10 being the worst possible pain assess and document where the pain is located and what, if anything, makes it worse or better observe and document any of the following physical responses: frequent changing of body position, moaning, sighing, grimacing, crying, restlessness, dyspnea, tachycardia, diaphoresis, pallor give pain medication as ordered provide emotional support by spending time talking to the patient and reassuring them that measures are being taken to relieve their pain reposition the patient give a back massage use short, simple relaxation exercises to distract the patient's attention dim the lights in the room and keep noise down play soft, soothing music have the patient perform slow deep breathing and concentrate on feeling weightless with each breath reassess and evaluate the patient's response to each method employed. ask the patient which techniques work better for them. monitor for side effects of narcotic therapy: respiratory depression, constipation, nausea/vomiting teach the patient about prescriptions they will be going home with including the dosage, how they should be taken and any side effects - - - - - - - - - - - - - - - symptoms - also called defining characteristics by nanda, these are the abnormal data items that are discovered during the patient assessment. they can also be the same signs and symptoms of the medical disease the patient has, the patient's responses to their disease, and problems accomplishing their adls. they are evidence that prove the existence of the nursing problem. if you are unsure that a symptom belongs with a nursing problem, refer to a nursing diagnosis reference. these symptoms will be the focus of your nursing interventions and goals. - - - - - - - - - - - - - - these are nursing diagnosis pages that refer to the nursing diagnoses you are using for this patient. on them you will find the defining characteristics (symptoms) of each of these nursing problems. acute pain acute pain http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=40 - acute pain [*]fatigue fatigue http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=19 - fatigue [*]anxiety anxiety http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=03 - anxiety [*]risk for infection risk for infection http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=32 - risk for infection
  10. 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.
  11. 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.
  12. 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.
  13. Daytonite

    Seizures

    Good job, vanlo001! :redpinkhe I couldn't have said it better myself.
  14. 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.
  15. 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.
  16. 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.
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