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  1. Daytonite

    Define: Nurses Eating Their Young

    This is an older thread that still has significance in the nursing field today: I see this posted all the time. I always thought it was someone who deliberately embarrasses or has a tantrum for the express purpose of making the other person feel small and/or stupid in front of others. Am I wrong in this thinking? ...And here are some updated articles about this topic: Nurses Eating Their Young, A Different Perspective Why Do Nurses Eat Their Young? Nurses Eating Their Young Is Not Okay Watch A Video [video=youtube_share;r9aUx2yMy10]
  2. Excellence is not a skill. it is an attitude. judy garland said, "always be a first-rate version of yourself, instead of a second-rate version of somebody else." that's what you need to do. instead of trying to impress this instructor, why not just try to learn the material to the best of your ability to impress yourself. success comes in cans, not can'ts.
  3. the first thing i need to do when i am helping anyone with their care plans is to go through the nursing process (which is what you should have been doing also). it helps organize you. i can't do step #1, the assessment because the patient and his medical records aren't in front of me, so i need to depend on the information that you've listed. step #2 of the process is to make a list of all the abnormal data. these are the symptoms (nanda calls them defining characteristics) that the patient has. these are important because they form the entire foundation of your resulting care plan. they are the basis for any nursing diagnoses you choose, the goals you decide upon and the nursing interventions you will order. that's pretty much the entire nuts and bolts of the whole care plan, so these symptoms are pretty important and you need to give them their just due. here's what i gather are your patient's symptoms: low h&h (what were the actual numbers?) - h&h is low in anemia, blood loss, chronic disease, when there has been hemorrhage, fluid retention or splenomegaly low prealbumin, also called transthyretin (what was the actual number) - may be an indicator of hepatic damage, malnutrition, disease of the liver, tissue necrosis or an acute inflammatory response slightly elevated non-fasting glucose (if the patient is on iv fluids with dextrose in them this may account for this) crackles in right lower lobe of lung inspiratory wheezes in right and left upper lobe, and the left lower lobe of the lung o2 sats of 90-93% chronic pain (where is this pain? what other descriptors do you have about this pain?) other information that is important to know is the patient's medical diagnoses. you need to know the pathophysiology of these conditions because it is through knowing the pathophysiology of the underlying medical conditions that you determine much of the r/t parts of your nursing diagnoses which is primarily what you asked in your post. the medical conditions are: interstitial pneumonia anemia metastatic cancer to the bone, origin unknown protein malnutrition hyponatremia one of the things you should be doing before even approaching the writing of this care plan is looking up all the information you can find about these five conditions: their signs and symptoms, how the doctors diagnose them, and what the doctors generally order to treat the signs and symptoms of them as well as their underlying cause. that is going to answer some if not all of the questions you posed in your post. you can download and print out the critical thinking flow sheet for nursing students which is a form attached to the end of every one of my posts to help you organize this information for each medical diagnosis. this learning of information about medical diagnoses is crucial to your critical thinking and problem solving of patients problems. the next part of step #2 is to take the list of your patient's symptoms and shop for nursing diagnoses. a diagnosis is the resulting decision or opinion you make after going through the process of examination or investigation of the facts. you did your examination and investigation of the facts in step #1 (assessment). when a doctor diagnoses someone with a medical condition, they do exactly the same thing. they do a review of systems (medical history) and physical examination of the patient and consider all the abnormal data before putting a medical diagnosis on them. we nurses need to be as careful about doing this as well. we have the nanda taxonomy (a big word meaning a classification--an arrangement or ordering of the nursing diagnoses into some kind of logical grouping) to help us out. so, you really need some kind of nursing diagnosis book as a reference to help you out here. i, personally, use nanda-i nursing diagnoses: definitions & classification 2007-2008 which is a small pocket book size and contains all the current 188 nursing diagnoses, their definition, the defining characteristics (symptoms) for each diagnosis, and the related factors (r/t's) for each diagnosis. most fit on one or two pages. this is the same information that is included in most of the currently printed care plan or nursing diagnosis books on the market. the authors pay nanda a fee to use this information. these authors, however, add other goodies to their books, like nursing interventions and goals which is really what most people buy these books for. most people overlook the nanda information. however, as students and new learners of how to diagnose, you really need to pay attention to it. before you assign any nursing diagnosis and related factors to a patient you need to verify that it is meeting the nanda criteria for that particular diagnosis. if it isn't, then you've diagnosed it incorrectly and need to keep looking for another more appropriate nursing diagnosis. let me clear one question out of the way first. you asked: can i use infection as a nursing dx or only risk for infection? don't we know that this patient already has an infection: interstitial pneumonia? so, by default, you can't use risk for infection. next, there is no nursing diagnosis of infection. nanda considers that to be a medical diagnosis and we aren't going to step on doctor's toes here. the way nanda skirts around this issue of intruding into doctor's territory is to look at the patient's reaction to his medical condition. this is an important concept that is prevalent throughout nursing diagnosing. we don't diagnose medical conditions, but the patient's reaction to them. that means you are assessing their symptoms. so, what are the patient's reaction to, or symptoms of, the interstitial pneumonia? this is where your foray into some online resources and filling out a critical thinking flow sheet for nursing students comes in very handy. but, to help illustrate my point i'll help you out here. the symptoms of interstitial pneumonia are: high fever chills cough with purulent yellow or bloody sputum production dyspnea tachypnea crackles and decreased breath sounds pleuritic pain malaise there will also be: infiltrates on the chest x-rays normal or elevated wbcs blood cultures that reveal a bacterial as a causative organism varying arterial blood gas levels reduced oxygen sat levels now, assuming that you are probably new at assessment, i would compare that list i just posted with what you remember observing in your patient and think about if you might have noticed any of these things and just didn't write them down. if so, add them to your patient's list of symptoms now. you won't have a nursing diagnosis of infection, but you will use your patient's symptoms to diagnose them with other problems that are related to the symptoms of this infection. see? so, for the o2 sats of 90-93% you have impaired gas exchange. if you look at the related factors that nanda lists for this diagnosis (see this link: [color=#3366ff]impaired gas exchange) you will find only two possibilities listed: alveolar-capillary membrane changes and ventilation perfusion imbalance. you need to know what each of those terms mean. ventilation perfusion refers to gas exchange that occurs in the alveoli. in the case of pneumonia it doesn't occur efficiently (is imbalanced) because there is exudate and debris from the pneumonia interfering with the gas exchange. with interstitial pneumonia there may also have been some damage to the alveoli over time that has led to alveolar-capillary membrane changes. however, unless you have x-ray evidence or a statement by the doctor from the chart confirming this, i wouldn't use that. so, your nursing diagnostic statement should read: impaired gas exchange r/t ventilation perfusion imbalance aeb oxygen sats of 90-93%. http://www.thedoctorsdoctor.com/diseases/lung_interstitial_pneumonia.htm now, you have other respiratory symptoms: crackles in right lower lobe of lung, and inspiratory wheezes in right and left upper lobe, and the left lower lobe of the lung. these you have correctly assigned with ineffective airway clearance. if you read the definition of this diagnosis, it says the following: inability to clear secretions or obstructions from the respiratory tract to maintain a clear airway. this is the underlying problem the patient should have for using this diagnosis. you mention nothing about this patient having a cough. if this inability to clear secretions from the airway is not the patient's problem then you're in the wrong nursing diagnosis. however, the crackles and wheezing suggest your patient does have an obstructed airway. so, what would be the underlying etiology (cause) of an obstruction in the airway of someone with pneumonia? here is what nanda lists as the related factors are for this: airway spasm excessive mucus exudate in the alveoli foreign body in the airway presence of artificial airway retained secretions secretions in the bronchi you know this patient better than i do. what do you think is the underlying reason for these adventitious breath sounds? my educated guess based on what i know about pneumonia would be either/or both excessive mucus and/or exudate in the alveoli (based on whether or not the patient is coughing and what they are coughing up). so, your diagnostic statement is going to look something like ineffective airway clearance r/t excessive mucus [and you could add, and exudate in the alveoli] aeb crackles in right lower lobe of lung, and inspiratory wheezes in right and left upper lobe and the left lower lobe of the lung. you also have a patient in chronic pain. you didn't mention anything about where this pain is or what it is like. you really have to be more specific. what i know of cancer that has spread to the bones is that it is quite painful. there are also special precautions that have to be taken with people who have bone metastasis. these bones are subject to pathological fractures. these patients are also subject to impaired mobility. and, i am not so sure that chronic pain is an appropriate a diagnosis to use as would be acute pain in this case. acute pain is defined as . . .a duration of less than 6 months. chronic pain is defined as . . .a duration of greater than 6 months. you would only know this from a review of the patient's medical record and an interview with the patient. the related factor for his pain is his cancer and you can legitimately say that in your diagnostic statement: acute [or chronic] pain r/t metastatic cancer aeb [the specific signs and symptoms of the pain]. don't know where you're getting the imbalanced nutrition: less than body requirements, deficient knowledge (specify), or activity intolerance from because you didn't list any symptoms to support any of them. i can't help determine related factors without the defining characteristics. lastly, you titled your post, diagnosis prioritization. prioritization is done by the patient's most important needs. keep in mind that the care plan is a problem solving process, so each nursing diagnosis is actually a patient problem. you list the problems in the order of which is most important of needing attention first. most instructors suggest prioritizing by maslow's hierarchy of needs. the hierarchy from most important to least important is as follows: physiological needs (in the following order) the need for oxygen and to breathe the need for food and water the need to eliminate and dispose of bodily wastes the need to control body temperature the need to move the need for rest the need for comfort [*]safety and security needs (in the following order) safety from physiological threat safety from psychological threat protection continuity stability lack of danger [*]love and belonging needs affiliation affection intimacy support reassurance [*]self-esteem needs sense of self-worth self-respect independence dignity privacy self-reliance [*]self-actualization recognition and realization of potential growth health autonomy by this hierarchy, the diagnostic statements that i did for you would be prioritized and listed this way: impaired gas exchange r/t ventilation perfusion imbalance aeb oxygen sats of 90-93%. ineffective airway clearance r/t excessive mucus [and you could add, and exudate in the alveoli] aeb crackles in right lower lobe of lung, and inspiratory wheezes in right and left upper lobe and the left lower lobe of the lung. acute [or chronic] pain r/t metastatic cancer aeb [the specific signs and symptoms of the pain].
  4. here is my listing of weblinks to information on medical disease and their treatment which is another important component of your nursing education. i often go to these websites for information when answering posts. now, you can go to these websites for information yourself. many of these sites have good patient teaching materials if you search the sites for them. use the search boxes, menu bars and the links on some of these sites to find more useful information on them. government sponsored sites medline plus (use the search box) http://www.medlineplus.gov/ better health healthier living online (australian) http://www.betterhealth.vic.gov.au/bhcv2/bhcsite.nsf/pages/bhc_sitemap?opendocument healthfinder http://www.healthfinder.gov/ health library - http://www.healthfinder.gov/library/ [*][color=#231f20]womens health.gov http://www.4women.gov http://www.4women.gov/topics.cfm - listing of topics [*]national library of medicine http://www.nlm.nih.gov/nlmhome.html [*]national institutes of health http://www.nih.gov/ the various institutes and links to them: http://www.nih.gov/icd/ http://www.cancer.gov/ - national cancer institute, everything you need to know about any kind of cancer is here http://www2.niddk.nih.gov/ - national institute of diabetes and digestive and kidney diseases, massive imformation about diabetes and kidney disease is here http://www.nhlbi.nih.gov/ - national heart lung and blood institute, all kinds of information about heart and lung diseases and testing as well as sleep disorders http://www3.niaid.nih.gov/ - national institute of allergy and infectious diseases, information about aids is here [*]a to z index of topics at the cdc - http://www.cdc.gov/az/a.html [*]national guidelines clearinghouse (for guidelines on procedures, etc.) http://www.guideline.gov/ [*]http://ncadi.samhsa.gov/about/sitemap.aspx - national clearinghouse for alcohol & drug information of the u.s. department of health and human services and samhsa [*][color=#231f20]new york online access to health (also in spanish) http://www.noah-health.org - huge site [*]who health topics (tropical disease information) http://www.who.int/topics/en/ physician sponsored sites family practice notebook (use search box and input a disease) http://www.fpnotebook.com/index.htm emedicine http://www.emedicine.com/ (you may have to register to view articles, but registration is free) medem http://www.medem.com/medlb/medlib_entry.cfm?sid=103af635-c640-11d4-8c0100508bf1c1f1&site_name=medem medicine net diseases & conditions a to z index http://www.medicinenet.com/diseases_and_conditions/article.htm emedicinehealth list of topics from a to z http://www.emedicinehealth.com/script/main/art.asp?articlekey=60185 web md index list of medical conditions http://www.webmd.com/a_to_z_guide/health_topics.htm http://www.thedoctorsdoctor.com/f_diseases.html - the doctor's doctor website [color=#231f20]family doctor.org medical conditions a-z http://familydoctor.org/online/famdocen/home/common.html [color=#231f20]http://www.familydoctor.org/men.xml - men's health [*]liverpool handbook of geriatric medicine http://www.liv.ac.uk/geriatricmedicine/textbookframe1.htm [*]the imaging of tropical diseases http://tmcr.usuhs.edu/toc.htm [*]zoonotic diseases tutorial http://www.vetmed.wisc.edu/pbs/zoonoses/ [*]surgical tutor.org (links are at left and top of page) http://www.surgical-tutor.org.uk/default-home.htm?core/trauma/shock.htm~right clinical tutorials http://www.surgical-tutor.org.uk/default-home.htm?core/trauma/shock.htm~right [*]surgical operations http://focosi.immunesig.org/surgicaloperations.html [*]color atlas of medical diseases http://www.ecureme.com/atlas/version2001/atlas.asp [*]medical images and illustrations http://www.mic.ki.se/medimages.html#a07 the merck manuals merck manual of diagnosis and therapy http://www.merck.com/mrkshared/mmanual/sections.jsp merck manual of medical information http://www.merck.com/mmhe/index.html merck manual of geriatrics http://www.merck.com/mrkshared/mmg/contents.jsp online medical textbooks http://www.mfi.ku.dk/ppaulev/content.htm - - textbook in medical physiology and pathophysiology essentials and clinical problems http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=cardio - cardiology explained http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=surg.toc - surgical treatment evidenced-based and problem-oriented http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=endocrin - endocrinology an integrated approach http://www.kidneyatlas.org/toc.htm - atlas of diseases of the kidney http://www.ncbi.nlm.nih.gov/books/bv.fcgi?call=bv.view..showtoc&rid=mmed.toc&depth=2 - medical microbiology http://www.ncbi.nlm.nih.gov/books/bv.fcgi?call=bv.view..showtoc&rid=cmed6.toc&depth=2 - cancer medicine 6 (use search box to access active links to chapters) http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=cm - clinical methods: the history, physical, and laboratory examinations consumer (patient) information encyclopedia of surgery http://www.surgeryencyclopedia.com/index.html finding answers to your questions about surgery http://surglinks.com/index.html narconon (drug addiction and rehab) http://www.addictionca.com/index.htm the mayo clinic http://www.mayoclinic.com/ [color=#231f20]stanford health library online video collection http://www.med.stanford.edu/healthlibrary/resources/videos.html - health-related lectures, classes, and other health-related presentations available online university of pittsburgh medical center health library - http://www.upmc.com/healthatoz/pages/home.aspx - see links at left (diseases and conditions. procedures, patient education materials, etc.) halifax health disease, condition & injury fact sheets - https://www.halifaxhealth.org/healthinformation/content.aspx evanston northwestern healthcare health encyclopedia (includes pictures) http://www.enh.org/healthresources/encyclopedia/ university of chicago medical center online health library http://www.uchospitals.edu/online-library/index.html university of michigan health system health topics a-z http://health.med.umich.edu/healthcontent.cfm?id=344 lancaster general hospital health library for adults and pediatrics - includes animated videos of some commonly performed procedures and a colored atlas of the human body http://www.lancastergeneral.org/content/healthinformation.htm mdadvice.com (includes pediatric and ob information) http://www.mdadvice.com/library/ http://www.healthopedia.com/ - your health encyclopedia health a to z - diseases and conditions page (use the search box) - http://www.healthatoz.com/healthatoz/atoz/common/standard/transform.jsp?requesturi=/healthatoz/atoz/dc/index.jsp aetna intelihealth (use the search box) http://www.intelihealth.com/ih/ihtih/wsihw000/408/408.html my electronic md http://www.myelectronicmd.com/step1.php answers.com http://www.answers.com/ about.com: a.d.a.m. healthcare center for consumers illustrated health encyclopedia (links to indexing include diseases & conditions, injuries, nutrition, poisons, special topics, surgeries, symptoms and tests) http://adam.about.com/encyclopedia/index.htm surgeries and procedures (includes some ob) http://adam.about.com/surgery/maindex.htm care guides for high blood pressure, allergy, type i and ii diabetes, low back pain, transfusion free surgery, exercise, high cholesterol, asthma, arthritis, and surgical weight loss http://adam.about.com/care/ lab/x-ray/other tests medicine net procedures & tests a to z index http://www.medicinenet.com/procedures_and_tests/article.htm web md index list of tests http://www.webmd.com/a_to_z_guide/medical_tests.htm lab tests online http://www.labtestsonline.org/ http://library.med.utah.edu/webpath/webpath.html - the internet pathology laboratory for medical education also see the "tests" link in the a.d.a.m. illustrated health encyclopedia http://adam.about.com/encyclopedia/index.htm patient information from ge on various types of radiological/nuclear scans http://www.amershamhealth-us.com/patient/ harvard health guide to diagnostic tests (organized by body system--includes ob procedures) http://www.health.harvard.edu/diagnostic-tests/ obstetrics http://www.brooksidepress.org/products/military_obgyn/home.htm http://wps.prenhall.com/chet_london_maternal_1 - online student companion website for maternal-newborn & child nursing by marcia l. london, patricia a. ladewig, jane w. ball, and ruth l. bindler. http://www.emedicine.com/obgyn/index.shtml - listing of emedicines topics on obstetrics and gynecology http://www.cayuga-cc.edu/people/facultypages/greer/biol204/heart4/heart4.html - fetal blood and circulation http://www.sweethaven.com/free-ed/healthcare/lessonmain.asp?cnum=3&icode=fra0000 - obstetics and the newborn http://www.aafp.org/afp/990501ap/2487.html - interpretation of the electronic fetal heart rate during labor http://www.who.int/reproductive-health/impac/images_c/normal2.gif and http://www.med.umich.edu/1libr/wha/labor.gif - good pictures of cervical effacements and dilatation during labor http://research.bidmc.harvard.edu/vptutorials/pregnancy/default.htm - tutorials from harvard medical school http://www.gfmer.ch/obstetrics_simplified/diabetes_mellitus_in_pregnancy.htm - white classification of diabetes during pregnancy and treatment http://www.manbit.com/oa/t81-1.htm - modified white's classification of diabetes during pregnancy http://www.medem.com/medlb/articleslb.cfm?sub_cat=2001 - links to medem consumer teaching articles on labor, delivery and postpartum care http://www.medem.com/medlb/articleslb.cfm?sub_cat=2005 - links to medem consumer teaching articles on pregnancy and fertility http://www.medem.com/medlb/articleslb.cfm?sub_cat=2006 - links to medem consumer teaching articles on ob/gyn procedures (c-section, colposcopy, d&c, endometrial ablation) http://www.swmedicalcenter.com/body.cfm?xyzpdqabc=0&id=729&action=detail&aeproductidsrc=adam2004_14&aearticleid=000108 - your baby's first few weeks university of chicago medical center online health library http://www.uchospitals.edu/online-library/content=p01221 - pregnancy and childbirth topics http://www.med.umich.edu/obgyn/smartmoms/ - smart moms, healthy babies created especially for pregnant women and their journeys into parenthood http://classes.kumc.edu/son/nurs420/unit11/unit11.html - complex acute illness across the lifespan: high risk pregnancy and high risk neonate pediatrics http://home.coqui.net/titolugo/handbook.htm#iiib2 - online pediatric surgery handbook http://www.generalpediatrics.com/commonprobprof.html - common pediatric health problems for professionals (weblinks) http://www.uchospitals.edu/online-library/content=p01029 - university of chicago medical center online health library pediatric subjects including links to pages on well-care visits, growth and development by age, healthy child lifestyles, immunizations, common childhood illness and concerns and a glossary of terms commonly used in peds http://www.med.umich.edu/1libr/yourchild/ - your child: development and behavior resources guide to internet information on kids' development and behavior - click on "your child topics" on the menu bar for index of topics, especially for "developmental milestones" by age http://www.stmarkshospital.com/kidshealth.asp - kids health by st. mark's hospital, salt lake city, utah - extensive site with information for parents and kids (also in spanish) [color=#231f20]http://www.kidshealth.org - huge informational website by nemours foundation (also in spanish) http://www.lancastergeneral.org/content/pediatrichealthlibrary.htm - pediatric health library topic listing http://familydoctor.org/online/famdocen/home/children/parents.html http://www.mchlibrary.info/aztopics.htm - child health links at georgetown university http://www.kidsgrowth.com/ http://www.baptistonline.org/health/library/child.asp - list of subject links in library http://www.emedicine.com/ped/contents.htm - a list of links into subjects covered in pediatric medicine at the emedicine website http://home.coqui.net/titolugo/handbook.htm - online pediatric surgical handbook for resident doctors and medical students. links into common surgical problems in children with brief explanations of the treatment. http://classes.kumc.edu/son/nurs420/unit11/unit11.html - complex acute illness across the lifespan: high risk pregnancy and high risk neonate http://www.pediatrics.emory.edu/divi...re%20apnec.ppt - congenital heart defects (powerpoint slide show)
  5. Step 1 Assessment dark yellow, odorous urine pale dry skin poor skin turgor dry mucous membranes refusing liquids minimal appetite 140/98, hr=106 weight 102-usually 115 thin extremities minimal right leg movement unequal palmar grips-right weaker red 2 cm spot on right elbow oriented x2 occasionally confused and disoriented in the past few months incontinent of bowel and urine in the past few weeks confined to bed Step #2 Determination of the Patient's Problem(s)/Nursing Diagnosis Deficient fluid volume r/t loss of fluid AEB dark yellow, odorous urine, pale dry skin, poor skin turgor and dry mucous membranes Imbalanced nutrition: less than body requirements r/t inability to ingest food AEB weight of 102, thin extremities, minimal appetite (whatever that is, you need to be more specific about this) Total incontinence r/t dementia AEB unaware of incontinence of bowel and bladder Impaired physical mobility r/t ??? (need a cause here, probably her dementia) AEB minimal right leg movement, confinement to bed and unequal hand grips Impaired skin integrity r/t pressure and incontinence AEB stage ii ulcer on sacrum that is 2cm in diameter 1cm in depth and tender to touch and 2 cm red spot on the right elbow Acute confusion r/t ??? (probably dementia) AEB disorientation to ??? and confusion to ??? over the past few months step #3 Planning (write measurable goals/outcomes and nursing interventions) Remember that your goals are a reflection and anticipation of what will happen when your nursing interventions are performed. So, think about what nursing interventions you will be doing when putting your goals together. Your nursing interventions target each of the AEB items of your diagnostic statements. Just as a doctor treats signs and symptoms of a disease, we also treat the symptoms of a nursing problem. Nutritional imbalance of less than the body requires related to the refusal of fluids and minimal appetite as reported by the daughter, manifested by dark orderous urine, dry skin, and poor skin turgor This is not an official Nanda diagnosis the way you have written it. i know what you mean, however. This diagnosis has to do with intake of nutrients insufficient to meet metabolic needs (page 74, Nanda international nursing diagnoses: definitions and classifications 2009-2011). dark ordorous urine, dry skin and poor skin turgor do not have anything to do with the intake of nutrients and are inappropriate symptoms to pair with this diagnosis. You also need to be more specific about a minimal appetite. we are scientific. report a percentage of what she is eating. Management of ineffective family care related to the care of skin integrity manifested by stage II pressure ulcer called a blister by caretaker daughter I have no idea what this diagnosis is. it is not Nanda. The related factor has nothing to do with the management of care. The symptoms also have nothing to do with the management of care.
  6. Daytonite

    Nursing DX for postpartum couplet

    for the mother: effective breastfeeding for the baby: effective breastfeeding ineffective thermoregulation r/t immature compensation for changes in environmental temperature risk for infection r/t break in skin integrity at umbilical cord site
  7. Daytonite

    Need for a psychological dx

    Problems with eyesight are Disturbed Sensory Perception, visual.
  8. Daytonite

    chemo care plan assistance

    ineffective protection r/t bone marrow suppression secondary to disease process and chemotherapy, decreased synthesis of immunoglobulin by plasma cells secondary to decrease in normal circulating antibodies, and immunosuppression secondary to chemotherapy side effects aeb decreased hgb, decreased hct, decreased platelet count, and recent removal from neutropenic isolation. too much information in the etiology. bone marrow suppression secondary to disease process and chemotherapy is good enough. recent removal from neutropenic isolation is not a symptom of a decrease in the ability to guard self from internal or external threats such as illness or injury (the definition of ineffective protection page 219, nanda international nursing diagnoses: definitions and classifications 2009-2011), but a treatment.
  9. Daytonite

    Care planning help

    They already told you in the admitting information. It is sepsis. You can tell from the vital signs.
  10. Daytonite

    chemo care plan assistance

    i get chemotherapy and one of my drugs causes the same problem with my feet as well as my hands. i do have to use a walker on the days that my feet as swollen and sore. your diagnosis impaired tissue integrity r/t chemical insult (?) secondary to chemotherapy side effects or r/t cell lysis secondary to chemotherapy aeb feets bilaterally hot and tender to touch, nonpitting edema tender to touch, protectiveness toward site, thrombocytopenia, and reported local and intermittent pain upon palpation of reddened areas is actually ok although i would clean up the wording a little bit: impaired tissue integrity r/t chemotherapy aeb bilateral feet hot and tender to touch as well as edematous, skin reddened, shiny and taunt over feet and joints, intermittent pain upon palpation of areas of feet and patient protectiveness of the feet. i would not use thrombocytopenia as a symptom of impaired tissue integrity. nutritional deficiency r/t malabsorption and decreased intake secondary to treatment side effects aeb reported loss of the sense of smell and reported loss of the sense of taste. i have runs where i don't feel like eating and then other days where i can eat like a horse. however, nutritional deficiency is not a nanda diagnosis. i would re-write this as imbalanced nutrition: less than body requirements r/t decreased intake secondary to chemotherapy aeb patient report of loss of sense of small and taste. impaired urinary elimination r/t kidney damage secondary to multiple myeloma and chemotherapy aeb reported daily use of diuretics and pt reporting need to rush to bathroom to avoid incontinent episodes. use of daily diuretics is a medical treatment and not a symptom of the nursing problem so you shouldn't be using it as an aeb item. the patient's frequency (rushing to the bathroom) is the symptom of the impaired urinary elimination. i would re-write this as impaired urinary elimination r/t kidney damage secondary to multiple myeloma and chemotherapy aeb patient reports of needing to rush to bathroom to avoid incontinence. social isolation r/t avoidance of crowds secondary to chemotherapy-induced immunosuppression aeb reported avoidance of crowds and h/o neutropenic isolation. well, you have this nursing diagnostic statement all messed up. first of all, avoidance of crowds is not a cause for social isolation. the definition of this diagnosis is aloneness experienced by the individual and perceived as imposed by others and as a negative or threatening state (page356, nanda international nursing diagnoses: definitions and classifications 2009-2011). your related factor (r/t), or cause, of the social isolation must explain to the reader why they prefer to experience aloneness and avoidance of crowds secondary to chemotherapy-induced immunosuppression doesn't do that. your one symptom of the isolation, the reported avoidance of crowds, is ok, but a h/o neutropenic isolation makes no sense. that sounds more like something someone would be fearful of. his illness alone and the way he might perceive what he looks like is enough aeb evidence for a social isolation diagnosis. you might try wording the diagnosis this way: social isolation r/t altered state of health aeb refusal to join in any group activities or go out into the public. - - - - - - - - - - - - - - - the construction of the 3-part diagnostic statement follows this format: p (problem) - e (etiology) - s (symptoms) problem - this is the nursing diagnosis. a nursing diagnosis is actually a label. to be clear as to what the diagnosis means, read its definition in a nursing diagnosis reference or a care plan book that contains this information. the appendix of taber's cyclopedic medical dictionary has this information. etiology - also called the related factor by nanda. this is what is causing the problem. it is the reason the problem exists and reasons can be many and varied. ask yourself "why did this happen?" or "how did this problem come about?" "what caused this to become a problem in the first place?" and dig deep. consider the medical diagnosis, the medical treatments that were ordered and the patient's ability to perform their adls. pathophysiologies need to be examined to find these etiologies if they are of a physiologic origin. it is considered unprofessional to list a medical diagnosis, so a medical condition must be stated in generic physiological terms. you can sneak a medical diagnosis in by listing a physiological cause and then stating "secondary to (the medical disease)" if your instructors will allow this. 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.
  11. Daytonite

    Care Plan Help

    Good diagnoses, but before making any goals, consider what nursing interventions you will order. The reason I recommend this is because your goals are what you expect to happen as a result of the nursing interventions being performed.
  12. Impaired Verbal Communication.
  13. A "risk for" diagnosis almost never is sequenced first because it is not an actual problem. actual problems are always sequenced before potential problems. second, poor tissue perfusion is not an official nanda diagnosis and i have no idea what you mean by it. poor tissue perfusion of what tissues? the diagnosis of decreased cardiac output covers the poor tissue perfusion of the heart. the edema is evidence of that. third, if the patient is actively bleeding and hypovolemic then there is no risk for fluid volume deficit. there is already deficient fluid volume [decreased intravascular, interstitial, and/or intracellular fluid. this refers to dehydration, water loss alone without change in sodium. (page 84, nanda international nursing diagnoses: definitions and classifications 2009-2011)] if the symptoms are there. the evidence (assessment information) you have of the deficient fluid volume is the tachycardia, decreased urine output and hypotension. someone who has active gi bleeding would be pale and weak. when they try to get up they become diaphoretic and tachycardic and sometimes need help to get back to bed. they have low hemoglobin and hematocrit levels. if this patient had those symptoms then deficient fluid volume would be the diagnosis to use. this would be sequenced after decreased cardiac output. please look at this thread for information on the construction of a care plan using the nursing process and how to determine diagnoses: https://allnurses.com/general-nursing-student/help-care-plans-286986.html- help with care plans
  14. Daytonite

    effective breastfeeding care plan

    Do not mix interventions or goals for the mom with the neonate if the care plan is for the neonate.
  15. Daytonite

    Need chest tube basics

    Because continuous bubbling means there is a leak in the system and therefore the chest tube is not able to do its job. Yes, it is supposed to bubble, but only on expiration when the lung is releasing air from the pleural space.
  16. Daytonite

    effective breastfeeding care plan

    Your goals reflect what your interventions would be, so what are your interventions?
  17. Daytonite

    Confused about this??

    The problem is that the care plan is about the mother. You can't mix up mother and baby problems on one care plan.
  18. Daytonite

    Need some advice on this

    you posted this on the nursing student discussion forum and i just got finished replying to it. you need to go over there to read the answer. https://allnurses.com/general-nursing-student/confused-about-this-457358.html - confused about this??
  19. Daytonite

    Nursing Diagnosis Question

    no. you would know that from knowing the course of the disease. you would know that it created the nerve damage and that is why the patient is having pain. the definition of chronic pain is unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage (international association for the study of pain); sudden or slow onset of any intensity from mild to severe, constant or recurring without an anticipated or predictable end and a duration of more than 6 months. (page 355, nanda international nursing diagnoses: definitions and classifications 2009-2011). so placing the kind of damage as the related factor on the nursing diagnostic statement is perfectly acceptable.
  20. Daytonite

    Confused about this??

    an l&d care plan is no different from a med/surg care plan. you still go through the same process for determining the nursing problems. you are just dealing with a different set of data that involves the gynecological system and the birthing process. the first thing you need to do is assess that patient. you also need to know the birthing process and its pathophysiology just as you do for any other medical disease or condition. the only information you've provided in this post is all about the patient's medical conditions. we are nurses. we deal with how the patient responds and reacts to what is happening to them. so, when you assess the patient you think about what you know about the birthing process and what it does to the patient's body. think about what happens to the birth canal as a baby comes through it. does damage to the tissues occur? is that where some of the pain comes from? what happens when tissues are damaged? the inflammatory response sets in: redness, heat, swelling and pain. just because it is internal and you can't see it doesn't mean that it isn't happening. this is not different from a med/surg patient that comes in with some kind of physical trauma except we call it part of the normal birthing process. what else happens to the woman's body when that baby comes through the birth canal? how does it affect the bladder and the anus? is she breastfeeding? there are 3 nursing diagnoses that involve breastfeeding whether things or going well or not. if you want to address the patient's substance abuse problem you care plan for it just as you would for a med/surg patient, but is it affecting the labor and delivery process? i get that you "feel" it needs addressing, but care planning and the nursing process is scientific and you have to address the evidence in front of you. if there is no evidence of a problem now, then leave it alone. you cannot begin to write nursing interventions until you have gone through your assessment data and found the abnormal data that is going to be the evidence of the nursing diagnoses you end up with. you will do nursing interventions for the symptoms of each nursing diagnosis. - - - - - - - - - - - - - - - acute pain r/t pitocin induced labor process you cannot use a medical treatment as the cause of her pain here. her pain is due to the contractions she is having or the afterbirth pain. did she have an episiotomy. that can be a cause of pain as well. risk for maternal/fetal injury r/t obstetrical complications you need to be able to actually list what procedures she had that are putting her at risk for injury. also, i would not include fetal injury with the diagnosis because this care plan is about the mother and not the fetus. potential for post partum hemorrrhage r/t cervical or vaginal laceration or hypotonic uterus this is not an official nanda diagnosis. hemorrhage is a medical decision so you really can't use it in a nursing diagnosis. what you can use is risk for bleeding.
  21. Daytonite

    help with care plan

    see this thread for information on how to construct a care plan: https://allnurses.com/general-nursing-student/help-care-plans-286986.html - help with care plans. all care planning begins with listing out your assessment information, not trying to diagnose the nursing problems first. the nursing problems (what everyone wants to call nursing diagnoses) are based on the abnormal assessment data that we see and observe in the patient. that data is evidence and symptoms of each nursing diagnosis that gets chosen. why or how you came up with something like dysfunctional ventilatory weaning response is kind of impressive, but it usually is used when there are a lot of problems getting the patient weaned off a ventilator. while breathing problems are symptoms of this diagnosis, using accessory muscles when breathing is a symptom of another nursing diagnoses: ineffective breathing pattern. dysfunctional ventilatory weaning response is primarily about how the patient is handling oxygen and their responses to that. you need to look at other assessment information like the patient's lung sounds, if they are coughing and their abgs. there are other respiratory diagnoses that will probably be better to consider for this patient. your nursing interventions then target the symptoms of the nursing problems the patient has.
  22. Daytonite

    Nursing Diagnosis Question

    I assume the patient had shingles at one time. Isn't the neuralgia because of nerve damage? Did you read up on the pathophysiology of this? That would make the diagnosis Chronic pain R/T nerve damage AEB [evidence of patient's pain]. All you have is subjective evidence of the patient's pain. Don't you have more objective symptoms?
  23. Daytonite

    Desperately needs help with my first care plan

    i see that you are a new poster on allnurses and that you already posted about this on the nursing student discussion forum. there is a thread that explains how to write care plans that you should be reviewing where the care planning process is gone over and there are many examples of how its done: https://allnurses.com/general-nursing-student/help-care-plans-286986.html - help with care plans. the care planning process is done by the nursing process. why? because care planning is problem solving and the nursing process is the tool for problem solving that we use. if you follow the steps in sequence you will get to your final destination--solving the patient's problem(s). first of all i want you to realize that diagnosing is done in many different disciplines. doctors, car mechanics, plumbers. diagnosis is just a fancy word for saying you are determining what the problem is. but all jobs that engage in fixing problems do pretty much the same process to get to finding the problem and solving it. the difference is that each one has a unique set of information that they have to deal with. we have to know about medical diseases and nursing care. step 1 assessment - assessment consists of: a health history (review of systems) - 80 year old female with atrial fibrillation and chronic pulmonary embolism. she has a history of falling a month ago because of being weak and dizzy and sustaining a concussion. performing a physical exam - the only physical exam information provided is that she is weak, dizzy and confused. no heart sounds, lung sounds provided. assessing their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming) - no information provided reviewing the pathophysiology, signs and symptoms and complications of their medical condition - each medical condition should be looked up and textbook symptoms compared with the patient's symptoms to see if you missed seeing any them. also the pathophysiology of the conditions is needed to help you determine the etiology ("related to") parts of your nursing diagnostic statements http://www.merck.com/mmpe/sec07/ch075/ch075e.html - atrial fibrillation http://www.merck.com/mmpe/sec05/ch050/ch050a.html - pulmonary embolism [*]reviewing the signs, symptoms and side effects of the medications/treatments that have been ordered and that the patient is taking - none provided. these can give you clues as to other conditions that the patient has as well as to potential problems that side effects of the medications might be causing. step #2 determination of the patient's problem(s)/nursing diagnosis - this is where you need to sort through the assessment data and separate out what is normal and abnormal. abnormal data is the evidence of problems. the only real evidence that you have provided is that the patient is weak, dizzy and confused and i am sorry to tell you that these are not symptoms (according to nanda) of decreased cardiac output. symptoms of atrial fib are dyspnea, dizziness, palpitations. someone with pulmonary embolism will generally have tachycardia along with weak and rapid pulses and hypotension (this is evidence of decreased cardiac output), low grade fevers, and possible a productive cough that may be blood tinged (ineffective airway clearance). however, your assessment information doesn't report any of that. weakness is evidence of something like fatigue, confusion is evidence of acute or chronic confusion and dizziness would be concern for risk for injury which are all nursing diagnoses. this patient also warrants a diagnosis of risk for falls because of her prior history of falling and her age. step #3 planning (write measurable goals/outcomes and nursing interventions) - this part of the care plan is based on the abnormal assessment data that you obtained. just as a doctor treats the symptoms of a disease we nurses also treat the symptoms of a nursing problem. if a patient has acute confusion and the symptoms are they hallucinate or do not know place or time, your nursing interventions are to do something about those. your goals are what you anticipate will occur as a result of your nursing interventions being performed. you need to review your assessment data because it is not complete. - - - - - - - - - - - - - - decreased cardiac output r/t a-fib amb dizziness, weakness and confusion. the related factor of a nursing diagnostic statement cannot be a medical diagnosis. it must be the cause of the decreased cardiac output in more generic terminology. this is why you must know the pathophysiology of atrial fib and what actually causes it. the related factor is what is causing the nursing problem. a nursing diagnosis reference will give you suggestions for related factors for this diagnosis, but they are very broad based. as i said above weakness and confusion are not manifestations (symptoms) of decreased cardiac output. dizziness may be if you get the correct related factor for this diagnosis.
  24. 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.
  25. Nursing intervention for "Risk for" diagnoses are restricted to: 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 and goals are always going to be what you predict will happen as a result of those interventions being performed.