hellohihowareyou

i put this in the wrong place and cant delete the post:no:

I have to do a care plan on my post partum patient who is pretty much healthy and normal. I had to choose 4 diagnosis for my care plan the 4 i chose for my pt are 1. Risk for bleeding 2. Acute Pain 3. Impaired tissue integrity ( she had a c section) 4. ineffective Breast Feeding Now i am having a difficult time with prioritizing them in the correct order because some say all "actual" nursing diagnoses have priority over any "risk for" diagnosis. But then i keep thinking and I feel like the "risk for bleeding" has priority over acute pain because my initial response would be to assess for hemorrhage or impending hypovolemia as well as preventing hemorrhage before taking care of the acute pain. I cant figure out the best way to sequence these diagnoses, please help.

Im on the same boat. My final is on Thursday, I literally just read over all the powerpoints my professor has up and focused on the ones i had the most trouble with. But now I feel like ive studied so much over these past few days that everything just seems so scrambled ahhh, do you suggest any websites as far as those nclex style questions go?

I have one more question so should she be increasing fluid oral intake with liquids and food or will that worsen the edema? Or should she be on iv n/s , a diuretic (even though its not part of her medication in the scenario), AND just the Ondansetron (Zofran) for nausea to help increase food intake, and low fluid diet? Maybe giving IV n/s will create a more hypertonic state in the blood stream and the excess fluid will follow through osmosis into the blood stream. Am i making any sense at all here. I'm literally a newborn nursing student

Than you sooo soo much... That helped a whole lot!

This is my case study: Case Study for Concept Map Ms. M.D, 84 year old Caucasian female is admitted to the hospital with vomiting and dehydration. Patient states she was in her usual state of health at the nursing home until 5 days ago when she became nauseated and started vomiting about 5 times daily (non- bloody, non- bilious). She reported weakness and loss of appetite. “I can’t seem to keep anything down.” She denies fever, chills, abdominal pain, diarrhea or constipation. Last BM 3 days ago. PMH: Pancreatic cancer (advanced now palliative), Recurrent Cholangitis, GERD, Glaucoma, Hypertension, Diabetes Mellitus II, Breast cancer, Chronic venous stasis PSH: Right breast mastectomy, Gallbladder stenting (2 stents placed 2013) right hip replacement (2007) Admitting Medical Diagnosis: Small Bowel Obstruction and Ascites. [TABLE] [TR] [TD]Physical Examination[/TD] [TD]Diagnostic Test[/TD] [TD]Lab results[/TD] [TD]Medications[/TD] [/TR] [TR] [TD]Ht. 5’6” Wt. 98 lbs V/S: BP-110/60, P-112, R-18, T-97.2, Pulse ox-90% on room air A&Ox3 Abdomen distended with hypoactive bowel sound in all 4 quadrants. Positive fluid shift on palpation and flat on percussion. Lungs with course crackles at bases. B/l lower ext with + 2 pedal edema, cool to touch. Pulses diminished. Skin dry and flaky, lips dry. Stage 2 pressure ulcer noted on the sacral area.[/TD] [TD]Abdominal X-ray demonstrates multiple air fluid levels and dilated loops of bowel consistent with SBO. Chest X-ray: Positive Pulmonary Congestion.[/TD] [TD]Chemistry: K 3.2 Cl 94 Glucose 131 BUN 36 Creatinine 0.9 Calcium 7.8 Mg 2.0 CBC: Hbg. 31 Hct. 9.6 Plts. 150,000 Wbc. 6,000 ABG: pH 7.28, CO2 52, HCO3 24[/TD] [TD]Amlodipine (Norvasc) Docusate (Colace) Esomeprazole (nexium) gerd Heparin injection Insulin (lispro) Senna (senokot) Morphine Ondansetron (zofran) vomiting Simethicone(mylion) Gas IV Fluid N/S @100cc/hr[/TD] [/TR] [/TABLE] Now this is what i got so far, i had to come up with four nursing diagnosis and prioritize as well as give intervention and and rationales. so far i have: -Impaired Gas exchange R/T: Ventilation-perfusion imbalance Pressure on diaphragm from ascites E/B: Pulse Oxygen Saturation at 90% on Room Air Abnormal Blood Gas Results; pH: 7.28, PaCo2: 52 Decreased Hgb: 9.6 and Hct: 31 Pt reports feeling of weakness -Fluid Volume Excess R/T: Compromised regulatory mechanism E/B: Coorifice Crackles heard at bases of lungs. Chest X-ray: Positive Pulmonary Congestion Tachycardia HR 112 Abdomen: Positive fluid shift on palpation and flat on percussion Bilateral Peripheral Pitting Edema in Lower Extremities + 2 pedal edema Diminished Peripheral Pulses in Lower Extremities Skin in lower extremities cool to touch -#3: Imbalanced nutrition: less than body requirements R/T: Loss of nutrients associated with vomiting E/B: Pt more than 20% below ideal body weight Pt states, “ I can’t seem to keep anything down.” Pt reports a loss of appetite Serum electrolyte abnormality (Decreased K 3.2, Cl 94, Calcium 7.8) (Increased BUN 36) -4: Impaired Skin Integrity R/T: Age Change in fluid status E/B: Stage II ulcer noted on sacral area Skin dry and flaky, Dry lips The problem im having is that she is dehydrated and also in excess fluid volume so im confused in what action to even take. Theyre so contradicting! Idk which way to go with this scenario. Please help.