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Esme12 ASN, BSN, RN

Critical Care, ED, Cath lab, CTPAC,Trauma
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Esme12 is a ASN, BSN, RN and specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

35 years experience, my specialty is critical care/ED/Trauma Flight and being Mom to 2 teenage children and one spoiled weimaraner

Esme12's Latest Activity

  1. We are happy to help with care plans and homework but we won't do it for you. We will lead you to the right information and then you can finish the rest. To write a care plan there needs to be a patient, a diagnosis, an assessment of the patient which includes tests, labs, vital signs, patient complaint and symptoms. What else do you know about this patient? Does he have any other comorbidities? The biggest thing about a care plan is the assessment, of the patient. The second is knowledge about the disease process. The medical diagnosis is the disease itself. It is what the patient has not necessarily what the patient needs. The nursing diagnosis is what are you going to do about it, what are you going to look for, and what do you need to do/look for first. Care plans when you are in school are teaching you what you need to do to actually look for, what you need to do to intervene and improve for the patient to be well and return to their previous level of life or to make them the best you you can be. It is trying to teach you how to think like a nurse. Think of them as a recipe to caring for your patient. Your plan of care. Care plans must be chosen from the "approved" script....NANDA. I think the biggest mistake students make is finding their diagnosis and trying to fit the patient into it. You need to let what the patient says, does and feels (the assessment) dictate what you do next. You need a care plan book. I prefer Nursing Care Plans: Diagnoses, Interventions, and Outcomes. Every single nursing diagnosis has its own set of symptoms, or defining characteristics. They are listed in the NANDA taxonomy and in many of the current nursing care plan books that are currently on the market that include nursing diagnosis information. You need to have access to these books when you are working on care plans. There are currently 188 nursing diagnoses that NANDA has defined and given related factors and defining characteristics for. What you need to do is get this information to help you in writing care plans so you diagnose your patients correctly. Don't focus your efforts on the nursing diagnoses when you should be focusing on the assessment and the patients abnormal data that you collected. These will become their symptoms, or what NANDA calls defining characteristics. Here are the steps of the nursing process and what you should be doing in each step when you are doing a written care plan: Assessment - Collect data from medical record, do a physical assessment of the patient, assess ADLs, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology Determination of the patient's problem(s)/nursing diagnosis - Make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use Planning - Write measurable goals/outcomes and nursing interventions Implementation - Initiate the care plan Evaluation - Determine if goals/outcomes have been met A dear friend to allnurses, daytonite (RIP) always had the best advice.......check out this link. What Is A Care Plan? A care plan is nothing more than the written documentation of the nursing process you use to solve one or more of a patient's nursing problems. The nursing process itself is a problem solving method that was extrapolated from the scientific method used by the various science disciplines in proving or disproving theories. One of the main goals every nursing school wants its RNs to learn by graduation is how to use the nursing process to solve patient problems. Care Plan Reality: The foundation of any care plan is the signs, symptoms or responses that patient is having to what is happening to them. What is happening to them could be a medical disease, a physical condition, a failure to be able to perform ADLs (activities of daily living), or a failure to be able to interact appropriately or successfully within their environment. Therefore, one of your primary aims as a problem solver is to collect as much data as you can get your hands on. The more the better. You have to be a detective and always be on the alert and lookout for clues. At all times. and that is within the spirit of step #1 of this whole nursing process. Assessment is an important skill. It will take you a long time to become proficient in assessing patients. Assessment not only includes doing the traditional head-to-toe exam, but also listening to what patients have to say and questioning them. History can reveal import clues. It takes time and experience to know what questions to ask to elicit good answers. Part of this assessment process is knowing the pathophysiology of the medical disease or condition that the patient has. But, there will be times that this won't be known. Just keep in mind that you have to be like a nurse detective always snooping around and looking for those clues. A nursing diagnosis standing by itself means nothing. The meat of this care plan of yours will lie in the abnormal data (symptoms) that you collected during your assessment of this patient. In order for you to pick any nursing diagnoses for a patient you need to know what the patient's symptoms are. Care plan reality: Is actually a shorthand label for the patient problem. The patient problem is more accurately described in the definition of this nursing diagnosis (every Nanda nursing diagnosis has a definition). Take a look at the information you collected on the patient during your physical assessment and review of their medical record. Start making a list of abnormal data which will now become a list of their symptoms. Don't forget to include an assessment of their ability to perform ADLs (because that's what we nurses shine at). What I would suggest you do is to work the nursing process from step #1. The ADLs are bathing, dressing, transferring from bed or chair, walking, eating, toilet use, and grooming. And, one more thing you should do is to look up information about symptoms that stand out to you. What is the physiology and what are the signs and symptoms (manifestations) you are likely to see in the patient. Did you miss any of the signs and symptoms in the patient? If so, now is the time to add them to your list. This is all part of preparing to move onto step #2 of the process which is determining your patient's problem and choosing nursing diagnoses. But, you have to have those signs, symptoms and patient responses to back it all up. You need to know what alzheimer's is....what the symptoms are, what treatments are available...if any. Does this patient have any other comorbidities? He is unable to verbally communicate and is combative at times. He is also a retired colonel and at one time was very active in his church. So your patient, from what you tell me has....... Impaired Verbal Communication NANDA-I definition: decreased, delayed, or absent ability to receive, process, transmit, and use a system of symbols Chronic Confusion NANDA-I definition: an irreversible, long-standing, and/or progressive deterioration of intellect and personality characterized by decreased ability to interpret environmental stimuli, decreased capacity for intellectual thought processes, and manifested by disturbances of memory, orientation, and behavior Impaired Memory NANDA-I definition: inability to remember or recall bits of information or behavioral skills Risk for Falls NANDA-I definition: increased susceptibility to falling that may cause physical harm Psychosocial Interventions - Learn more about psychosocial interventions by reading Psychosocial Interventions for Mental and Substance Use Disorders or read about it at ncbi.nlm.nih.gov/books/NBK321284/. Resources Nursing care plan | Nursing Crib Nursing Resources - Care Plans http://www.delmarlearning.com/compan.../apps/appa.pdf
  2. Esme12

    Help with ABG

    Welcome to AN! The largest online nursing community! THis may help you figure it out. ROME: Respiratory= Opposite: - pH is high, PCO2 is down (Alkalosis). - pH is low, PCO2 is up (Acidosis). Metabolic= Equal: - pH is high, HCO3 is high (Alkalosis). - pH is low, HCO3 is low (Acidosis) and......ABG tic tac toe...... I can't seem to paste the link. Here is the thread: https://allnurses.com/nursing-student-assistance/abg-help-821378.html
  3. Esme12

    Failing clinical

    I think this is excellent advice. Turn in assignments on time...especially care plans. Care plans are the recipe on how you are going to care for your patient. Explain whatever the difficulties were and how you're going to improve. I you happen to fail don't give up on nursing. Sit down and get a plan together to improve. ((HUGS))
  4. Esme12

    Asap!! Sim lab questions

    Hi! Welcome to AN! The largest online nursing community! We as all students to tell us what they think first so we can best help you find the answers. It's usually best to remember what is going to hurt the patient the fastest.
  5. Esme12

    Tachycardia and Hypotension in Asthma

    Welcome to AN! The largest online nursing community! Double helix was very kind to be so helpful...we ask that nursing students tell us what they think first so we can help you fully understand to find the solution yourself.
  6. Esme12

    RN nursing careplan

    Hi! Welcome to AN! THe largest internet nursing community! I would choose the one I could learn the most from. The CHF.
  7. Esme12

    Patient Diagnosis help

    It is...I Think there is a percentage that want the care plan written for them. Here at AN we don't give answers...we help the student who actively participates. The goal of AN is to help students become the best nurse they can be. We don't give answers.
  8. Amen! I have never felt anything as painful...I was shocked! I apologize to any patient that I thought was exaggerating!
  9. Esme12

    Patient Diagnosis help

    Welcome to AN! The largest online nursing community! To help you the best I like to ask students what semester they are and is this a real patient? We also ask all students to tell us what they think first so we know how to best answer. We don't give answers. AN is interested in helping students be the best nurse they can be. Care plans are all about the patient assessment. A care plan is the "recipe card" on the care of the patient so that everyone will know how to care for the patient. It is also used by schools to teach nursing students to think like a nurse. So what was your assessment of this patient? What did their lungs sound like? What was the O2 sat? When did the symptoms begin? What made the symptoms better/worse? What meds was the patient on? Was this patient on the heart monitor? What was the patients medical history? What about the vitals signs is significant on this patient? Resting HEART RATE: 30 (THIRTY) beats per min. Was this the palpated pulse? Did you listen to the Apical pulse? B/P: 125/82. Was this an auscultated B/P. Was an automatic B/P cuff used? Did you take orthostatic vital signs? Tell me about your patient.
  10. Esme12

    Accidental Pregnancy

    Oh honey...you are not alone. You have your significant other. YOu need to do what your heart tells you. Talk to friends, clergy (if that is significant for you) but the bottom line is what your heart says. Life has unexpected changes to your path and you just need to adapt. Even though your parents are religious you might find them more supportive that you think...hugs
  11. Esme12

    Struggling nursing student

    Welcome to AN! The largest online nursing community! ((HUGS)) Don't sell yourself short. There is no rule that a B student can't take the NCLEX. YOu got this....give yourself a break.
  12. Esme12

    Older Student, Unprofessional Nurse During Clinical

    I think in every profession there are chronic complainers. I also believe that there are people who chronically put others down to make themselves feel worthy. In all my years of being a nurse I found these people everywhere and in every department. As a young nurse I would just leave conversations that were participating in this kind of behavior. As teacher I made sure that the incoming nurses knew this kind of behaviour is NOT okay and encourage them to practice nursing their way. As a supervisor and manager I did not tolerate this type of unprofessionalism in the nurses. However...to say that the nurses you heard are not good nurses just isn't true. It is difficult to explain to students that as they gain more experience they too may have days that seeking the comeradare of a co-worker is, at times, therapeutic. Nurses develop coping mechanisms to shield us from the cruel realities of the medical world and the seedier side of humanity. Sometime making something seem less "human" helps in dealing with the stark realities. Try not to judge these nurses too harshly. While it might not be the best side of nursing it doesn't mean they are bad nurses. I encourage ALL questions/thoughts/criticisms of student nurses I feel that these should go to your professor/instructor and not to the management of the facility. It is increasingly more difficult to find clinical facilities and schools/programs/instructors/students are guests. I am glad you went to school. Comments from complete strangers really shouldn't define your career journey. All the best.
  13. Welcome to AN! The largest online nursing community! We are happy to help but we ask ALL of our students t post what they think first. This gives us a direction on how to best help you. What semester are you? Have you completed care plans before? Care plans is the recipe on how to care for a patient and are based on the assessment of the patient. Tell us about your patient.
  14. Esme12

    Osteoporosis question?

    Hi! We are happy to help but we ask all of our students to tell us what they think first.....we will them jump in to help. If this is a quiz for a grade, many schools would consider asking for help academic dishonesty.
  15. Esme12

    Compartment syndrome

    Hi! We are happy to help but we ask that all students post what they think first.
  16. Esme12

    HELP! Medication Error Question

    Welcome to AN! The largest internet nursing community! We ask ALL students to post what you think first so that we can best help you. We do not just give answers...our goal is to help you become the best nurse you can be.....tell us what you think!