2007_RN

Hi! I took my boards in california on Monday June 18th and I just contacted my college to find out if my transcripts have been sent to the state yet. They haven't! I am freaked. Do you know of ANY way in california to find out results?

Thankyou!!!! I will write the carplan now and leave these puppies alone. Take care of you! Cher

Thanks!!! Do you think the prioritization is in order or would you choose to put them in a different order?

Alright I have come up with a few nursing diagnosis for my case study patient and I really would like some input on my prioritization of them. Backround: 44yr female with ventricular bleed went into a coma. Drain inserted and ventricles were no longer compressed. It seems the bleeding was contained in the ventricles only (phew!) She is now neurologically stable (No more bleeding) The after affects are why she is still in the hospital. She is in the ICU for weaning from the vent then onto a SNF for future care. For her case study I had to choose two systems that I would focus on. Since her medical hx contains hypertension I chose caridac and she also has aspiration pneumonia so I chose respiratory. I Only need three dx's per system so a total of six. Do you think the prioritization is in a good order or would you move them around? My list are as follows: 1. Ventilator weaning response, dysfunctional related to muscle weakness/fatigue, inability to control respiratory muscles and immobility as evidenced by inability to maintain respiration rate of 12-20 breaths/minutes when PEEP setting is lowered. 2. Impaired Gas exchange related to Ventilation-perfusion imbalance; alveolar-capillary membrane changes as evidenced by dyspnea; abnormal arterial blood gas levels; restlessness; tachycardia; abnormal rate, rhythm, depth of breathing; diaphoresis 3. Airway clearance, Ineffective related to obstructed airway as evidenced by retained secretions and presence of artificial airway (tracheostomy) 4. Decreased Cardiac output related to altered afterload as evidenced by variations in blood pressure readings and decreased renal perfusion/urine output. 5. Excess Fluid volume related to Compromised regulatory mechanism and excess fluid intake as evidenced by abnormal breath sounds (crackles); pulmonary congestion; pleural effusion; intake exceeds output; blood pressure changes; oliguria; altered electrolytes; edema. 6. Ineffective Tissue perfusion: renal related to decreased cardiac output as evidenced by decreased urine output What do you think? ANY HELP IS SOOOO APPRECIATED!!!

Wow! Valuable help! Thank you so much (Both of you!) What treaures you are to students! Cher

You are right about the increased BS not being a sign of activity intolerance. It really has not much to do with it at this moment. Grrr.... FYI..Respiratory is in there all day changing his settings. His lungs are just so full of crap. He is septic now so thirs spacing is becoming a major problem. Just adds to his lung issues. THe nurses say he is just circling the drain I have a love/hate thing with these care plans. I love how it makes things just stick and get you deep into critical thinking but I am SO TIRED of sitting in front of my computer. It is a beautiful day outside and I want to be doing anything other than sitting here! Alright I really appreciate you help and time looking into this.

HI thanks for your input. My idea of activity intolerance eas because his respiration rate goes up into the 30's above the vent settings of 14! HIs pulse rate goes into the 90's (not too alarming but he usually sits around the low 70's..due to his meds) He usually has hypotension 80's/50's and with "activity' these all change. It takes a bit and he is back at baseline. NOt a strong diagnosis I know but my instructor went over these with me and she changed this one to deal with endocrine as the three systems I am dealing with are respiratory, endocrine, and cardiac. It is really hard to find good dx's for endocrine acording to Nanda guidelines. Any suggestions in dealing with the change in his vital signs and would it still sit low on the priority list as it is only transient. (please excuse any spelling errors I am typing as fast as I can! I am still writing up the care plans for each of these puppies)

All right I have gone into total and complete brain fry! I have written this awesome case study on a patient and have all of the RN diagnoses but just can't seem to figure out the BEST order. Could ya help??? I know Maslows and I know ABC's...Just can't seem to figure this out because they are all physiological. History: This guy is 65 years old, End stage COPD, 152kg. Came into ER in respiratory failure and intubated. Found to be in SVT and electrocardioverted. He had pleural effusion and the CT scan showed a suspicious mass in his chest. Thoracotomy performed and 1 liter of adipose tissue was removed from his pleura. That was back in mid-July. He is still in the ICU with hyperthermia, still intubated and switched to a trach at the end of August Can you help me put these in the right order? 1.)Impaired gas exchange related to ventilation/perfusion mismatching or pulmonary shunting as evidenced by low PO2 & high CO2 in ABG and adventitious breath sounds on auscultation. (Respiratory) 2.)Risk for aspiration related to dysfunction of normal protective mechanism (cough reflex) due to high levels of sedation. (Respiratory) 3.)Ineffective breathing pattern related to musculoskeletal fatigue as evidenced by unsuccessful weaning of mechanical ventilation. (Respiratory) 4.)Decreased cardiac output related to alterations in preload as evidenced by impaired tissue perfusion (edema, decreased urinary output) (Cardiac) 5.)Excessive fluid volume related to renal dysfunction as evidenced by third spacing in the extremities and crackles auscultated in the lungs. (Cardiac) 6.)Decreased cardiac output related to changes in afterload as evidenced by labile blood pressures. (Cardiac) 7.)Activity intolerance related to imbalance between nutritional supple and illness demand as evidenced by increased blood sugars. (Endocrine) 8.)Imbalanced Nutrition: Less than body requirements related to increase in metabolic demands evidenced by low albumin. (Endocrine) 9.)Risk for infection due to circulatory changes and delayed healing of decubitus ulcers and post chest tube site. (Endocrine)

Timothy, When I first started reading posts on Allnurses I came across your stuff and even viwed more of your stuff on your homepage. You have such a gift in writing. I am encouraged by your insights and your faith. Please do not ever stop.

siri, i am so glad you were there for that mom. i think it is wonderful that you credit your faith with your career. i wish that the nurses that were with me the night they told me that my son was not going to live would have prayed with me. (thankfully he did but not without serious consequences) how much do you enjoy your job as a np? that is exactly where i want to end up! i am just starting an adn program but i figure it is never to late or harmful to set my goals high. :)

What a great feeling!!! I love it when we see answers to even our smallest prayers.

Hey thanks to both of you! I will buy that book and I will search for those threads. I was unaware of them so I thought I would start one ! :) God Bless Cher

Hi All! I am a nursing student and a practicing Christian. I credit my success this far to My Lord and Savior. I am excited about what he will bring in my future and what opportunities I will have to serve as a RN. I am wondering how many of you out there use prayer with your patients and what stories you have of how you have seen it help them or thier families. The stories I have heard thus far have brought tears to my Eyes and it reminds me of the book series called Stories for the_______ Soul. I would love to see one called "Stories for the Nurses soul." Maybe we can make our own stories here. I look forward to hearing any stories you may have. :)

Congrats on your baby! I do believe she has that book and had tried all those things. It really seems to me thathe needs to go to a speacialist because this seems to be beyond our scope of education. Thanks for the thoughtfulness of your reply!

Thanks! I will forward the information to her. She is using the tests and has not had any luck.