NUNS2016

How about, "Patient will not trip and fall over objects left in his path, or due to dim lighting, loose rugs, child gates, etc." Then for the intervention, I would have a home inspection done within 2 days of him returning home to educate him on safety in the home....? Something like that?

Hi all, I know I will remember all of this suddenly and feel silly, but for now, I am blanking. My patient's Dx (feel free to addendum!) so far is: Risk for falls R/T history of falls, age of 69 and impaired physical ability. I need 2 outcomes and 2 goals. My outcomes aren't "timed and measurable" as the goals are, right? I just feel silly saying, "patient will not fall". And I'm pretty sure there's a good reason for feeling silly, cause I don't think that's an adequate expected outcome. Also...whats NOC and NIC? National something-or-other? Sort of like NANDA dxs? Also, this is the first year with a rationale necessary. They seem pretty self explanatory though...why do I think this is important? Or why is this dx and goal and what not important to my patient's care? Thanks!!

Awesome awesome. Thank you. You hit the nail on the head with what was confusing me. And you explained it beautifully, and simply. I appreciate you taking the time to see where I was stuck, instead of just running the whole system down for me. I have a book to do that for me! Haha. I have the beginnings of the chart, I will definitely finish it now. Thank you immensely, NUNS2016

This is some sort of joke! The books says epinephrine act on Alpha 1, Alpha 2, Beta 1 and Beta 2. But, then on the other page, it says that Alpha 1 increases BP and Alpha 2 decreases BP! Uuuuuuuuuugh.

So like this… PNS activated—>block PNS receptor sites (anticholinergic)—>deactivates PNS—>activate SNS Or you can… PNS activated—>send adrenergic neurotransmitters to adrenergic sites—>deactivates PNS—>activate SNS

I'm not sure I know what you mean. I guess I feel like...there are drugs that are called adrenergic agonists, therefore they "activate" the sympathetic NS, yes? Then how are there drugs that also deactivate the parasympathetic NS, and are anticholinergics, but aren't adrenergic agonists? So, what I mean is, an adrenergic agonist and an anticholinergic do, or do not, in fact do the SAME thing?? If something activates the PNS, it therefore deactivates the SNS.......? Or no.? OR: is it that if the PNS is activated, and the SNS needs activating, it can either do it by blocking the receptors for the PNS (anticholinergics), so the binding to PNS stops, stopping the PNS effects- OR you can choose a drug that actually activates the SNS, by binding with an adrenergic receptor, therefore "deactivating" the PNS..?

OK, so despite what my brain wants me to believe, I think I understand it enough for now, as I study more, it will get better. However, what I'm having trouble with right now seems to be the fact that....some drugs are in one category, but do the same function as a drug in the opposite category? Or is that not true? So I feel like there are lots of drugs that increase the HR, but they're not all Beta 1 agonists, right? So, how are they different and the same?

And then, what the hell are catecholemines!?!?! My books says "catecholemines produce sympathomimetic responses" and that "noncatecholemines simulate adrenergic receptors"----WTH??!?! So now theres something else that does the same damn thing that I can't figure out already?!

Ok...I've been spinning my brain in circles here...one minute I've got it, the next I'm so lost I could die. Let me see if I have this...at all...and if any or all of this is wrong, please feel free to correct or tweak anything!! So, within the Autonomic NS, there's the parasympathetic NS and sympathetic NS. The parasympathetic is the rest and digest. The sympathetic is fight-or-flight. Very simply, these two systems are in constant opposition of each other. When one is activated, the other is "off", and vice-versa. Within the body, there are different types of receptors. There are adrenergic receptors, for which there are adrenergic agonists (activating the receptor) and adrenergic antagonists (which block the receptor). There are also cholinergic receptors, for which there are cholinergic agonists (activating the receptor) and anticholinergic (blocking the receptor) The difference between adrenergic and cholinergic are the fibers by which the "travel"? The ways in which they...act on their receptors? The adrenergic uses the Alpha and Beta receptors. The cholinergic uses AcH. BUUUUTTTTT: Whats the reaaaalll difference?? They both work on both para and sympathetic nervous systems, yes? Is the difference just WHAT they mimic? Which neurotransmitters they mimic?? Even though they can potentially create the same effect...?? For instance...Epinephrine, an adrenergic agonist (?), increases HR, BP, etc., but technically, an anticholinergic does the same thing...but they are different somehow? HOW??! OR: is it: Cholinergic agonists increase the "resting and digesting", like lowering HR, lowering BP, increasing GI motility Cholinergic antagonists decrease the "resting and digesting" (activating SNS??), like raising HR and BP, and decreasing GI motility? Adrenergic agonists increase "fight-or-flight" and antagonists decrease it? So if something is a Beta blocker, it "stops" or decreases the SNS thereby decreasing the fight or flight response, lowering HR, BP, etc.? Ugh, this is all probably gibberish. HELLPPPPP. Everytime I have it, I spin myself back around. I know its more simple than I'm making it, but this is seriously stalling studying for my patho exam!!!! Thanks!

That was all incredibly helpful! Breaking out my comments like that really made it clear what you meant. And thanks for the tip about the name, I changed it right away. Thanks again!!

This was all incredibly helpful! Thank you again. And great advice about the name, I think I'll change it now

Speasa204, Thank you very much. This was simple, and laid out very plainly, step by step, I always like that. But the one I'm accustomed to for blood donation, or quick blood samples with the phlebotomist is a peripheral IV, yes? And when someone is having fluids in an emergency or short term fashion, that isn't a PICC, right? Its a periph IV as well? And PICC, CVA, Tunneled, Port, etc, those are all in a more long-term fashion for fluids, possibly, but also for other things, whereas the periph IV would be for quick/short term fluid, or IV push meds, although again short term or quick (emergency type situation)...but never a long term item like fluid maintenance, TPN, etc. Please correct if I am wrong in any way! I'm just trying to summarize what I think I've learned from you lovely folks, my prof and the book. Anyone else feel free to chime in to correct anything! Thank you all again, immensely, Sophie

IVRUS, thats incredibly helpful. The way the book and class powerpoint were written didn't make it seem that the tunneled and others were types of CVA. They seemed like they were options for either the PICC, Central or Port. Thanks!!

Thank you Studentofhealing!! That was really great information, and I sincerely appreciate the pep talk :) 2 more years and I'm sure I'll be just exactly where you are! Thanks again :) Sophie

Yeah, I think I feel even more silly than when I posted this....There are two types, peripheral IV access, like in the AC, where you could do a saline lock, or run a midline cath thru and for short term, and type two is CVAD/CVC. And ALL of those go into the SVC and are long term. Yes? So then, why did she say you can't draw blood from a periph? That's how we donate blood...and I feel like thats how blood samples are taken in the hosp and other places... Still would love any info on IVs. Maybe some indications of which to use, things to watch out for, contraindications for either, etc. Thanks again, Sophie

Hi again! Back at it for the third year, this one is the beginning of the true test, I believe. We go to medsurg 1 clinicals next week. Very excited! Anyway, I'm here today to ask about IVs. We're just learning about them in a medsurg fashion...and I think I may be over thinking some things. So these questions are pretty basic, but feel free to elaborate as much info as you want. I'm looking for info anywhere I can get it! So, the chapter we're in has a section about CVADs, which I understand to be access points to the central vascular system via a log tube inserted from a point on either your periphery or neck site, which extends either halfway (midline) up your central line, or all the way to the SVC. Although, my teacher informs that she has rarely seen a midline (other than someone who didn't bring enough tubing, and only made it half way, when it was supposed to be to the SVC). So, I feel okay about that...but what about just the little IVs that we get or give in the hand or AC (antecubital)? Are those just not in the umbrella of CVAD? Are they technically called something else? When I figure this out, I know I'm going to feel silly, but I can't help but ask. She stated that you don't take blood from a peripherally inserted catheter, and I know that when I donate blood, there isn't a tube going from my AC to my SVC...so I guess the CVAD includes only IVs that go into or halfway to the SVC? When someone is admitted or treated in the hospital, they usually get an IV, but its not a CVAD, right?? It's just a little guy in the hand or AC (or somewhere else)...yes? So, is this portion ONLY about the ones that go into your SVC? I'm sorry, this probably became crazy about 1/3 of the way thru...but I'm really trying to figure this out on my own. My problem is, this chapter only talks about CVAD, and there doesn't seem to be another chapter with IV info...so....are these all of them? Ugh, sorry Thank you all!! If this doesn't make any sense, just give me your overview on IVs and maybe it'll be answered in there. Thanks, Sophie

Yeah, I understand. The teacher grading this particular map stated, verbatim, "I always want to see assess as the first intervention." Done and done, I say. I gave her what she wants.

And thank you all immensely for taking time to help! The story part is indeed hard, the mannequins script thru a teacher who is also aiding another few groups of students makes it hard to get a full anything. Thanks again!

This is what I went with. Turned it in yesterday, I'll let you know how ravaged it is when I get it back Delayed surgical recovery R/T extensive or prolonged surgical procedure AEB ileostomy to divert stool away from wound bed secondary to dehiscence hemicolectomy wound site and stool present in wound bed.

Thank you immensely!! My "patient" isn't taking any food at all right now...well she wasn't when I was there, a week ago...lol. Sim lab, what can I say? So I feel like right now, the best plan is to get her to be eating anything. But the ideas of making stool less noxious is something I never would have thought of, and now wont forget! I will probably try to throw it into a convo with my profs, see if I can get a raised eyebrow or two :) Thank you so much for helping, some days nursing school just fries us, I'm sure you know!!! Have a good night, and a great day with the wee ones tomorrow! Sophie

While we're at it....these are the interventions I intend to use...if no one cares to comment, I understand, but if there's something seriously wrong with them, I'd love to know. I'd also love to sleep. But nursing school comes first! :) Assess nutritional status and current intake with MNA every 2 days-increase kcal intake daily as tolerated until goal of 1700kcal/day; Record I&O daily Inspect incision and stoma q8h and describe any changes Include stoma therapist to provide self-care teaching and aid in altered body image risks Educate pt on ileostomy and stoma self-care. Pt will verbalize understanding and exhibit correct self-care techniques within 2 days

Okay okay, I see (hear) it. ha, thank you. I have been doing this all day, plus helping classmates with theirs and editing my group's presentation...blablabla, excuses, whatever, but dang, my brain is fried! I just posted this to FB: Ineffective self-health management R/T excessive demands made AEB ineffective choices in daily living for meeting health goals, secondary to NURSING SCHOOL. Which, I realize is not an exactly accurate dx, but I think its falsities speak for itself. :)

Sorry...is that not the way I have it? My brain is mushy. I have first the hemi and dehiscence, and an ileostomy secondary to that...yes? Delayed surgical recovery R/T extensive or prolonged surgical procedure AEB dehiscence hemicolectomy wound site secondary to ileostomy to divert stool away from wound bed.

Right. yes, I do have a book. That's why I know there isn't one that fits...I just worry that my teacher will have something to say about it. Ok, so then how about this. Delayed surgical recovery R/T extensive or prolonged surgical procedure AEB dehiscence hemicolectomy wound site secondary to ileostomy to divert stool away from wound bed.

Oh crap. I forgot to mention that the hemicolectomy site had dehisced, THEN there was stool in it...does that change anything? I suppose my worry is that our focus right now is bowel elimination...and although delayed surgical recovery makes sense...it doesn't technically have anything to do with bowel elim...