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Esme12 ASN, BSN, RN

Critical Care, ED, Cath lab, CTPAC,Trauma
Member Member Expert Nurse Retired
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Esme12 has 40 years experience as 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. Esme12

    Witchcraft resurgence

    It is a regional and family thing to use Mama and Daddy. I was raised in the midwest and we use Daddy as well
  2. Esme12

    Strike nursing

    We are veering off topic a bit and I know the feeling of wanting more of the "guts" so to speak of medicine and so does my daughter who (mom pride moment) graduated last year RN BSN Magna cum laude. Back to unions..... A forty year career in nursing taught me, in general, nurses look for representation of any kind when they feel they are being marginalized, poorly treated, and the big reason.....When they feel the they "ARE NOT BEING HEARD". Could you imagine if nurses, like fire/first responders and police, spoke with one voice. I think we could be heard and ensure a safe productive workforce for all. The terms scab for crossing picket lines are pretty historical and I found more common in different parts of the country. When I was a little girl my Cousins, Uncles....family and friends manned the picket lines with shotguns. Unions have fallen from popularity now my cousins have to work harder for less money and a cut in Black Lung protection and pensions. It makes one think.
  3. Esme12

    Strike nursing

    I am guessing that the US Armed Services are helping in the cost of your education. I agree that other fields don't offer shift scheduling and good pay which does make nursing a flexible asset when going to school. The state you live in helps you make "out like a bandit" as the cost of living determines how far your dollar stretches. I am curious however that if you are "making out like a bandit" why are you leaving such a lucrative position? I was unable to definitively find the presence of any unions in your state. I admit I was, at one time, opposed to nursing unions. As time passed by I saw salaries begin to decline. I saw benefits being blatantly taken away. I saw staffing begin to return to the days when I graduated (yes there were hospitals in prehistoric times) and there was one RN, one LPN (if you were lucky a second LPN for half a shift) three aids and one orderly on a thirty five bed surgical unit when ALL patients were open (no scopes) with a terrifying array of tubes and drains on EVERY patient. We fought so hard for primary care nursing but we were punished for our efforts by losing the LPN's. Now we have patient ratios in non union facilities (generally....there is always an outlier) 6 to 7 patients on days to every RN and there is usually never enough CNA's on the floor. In the Midwest the union hospital RN's were not represented by nursing bargaining and I did not approve of unions. When I moved to the Northeast I watched the state nursing organization become the collective bargaining union and I found with the increasing disparaging treatment of nurses that unions are the future. The average salary working in Boston with days and no weekends is greater than or equal to $100,000.00. I do agree with you.....those of us in the nursing profession are TRULY BLESSED.
  4. I have to do a care plan based on a psychosocial nursing diagnosis for a 75 year-old man with Alzheimer's. I have no idea where to start. 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. As I said I am lost! Our instructors have not really gone into how to do care plans so we are learning as we go. Any help would be appreciated. (from Nursing Diagnosis - Psychosocial) 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. 5 Step Nursing Process STEP 1: 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 STEP 2: 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 STEP 3: Planning Write measurable goals/outcomes and nursing interventions STEP 4: Implementation Initiate the care plan STEP 5: Evaluation Determine if goals/outcomes have been met A dear friend to allnurses, daytonite (RIP) always had the best advice.......check out this link. https://allnurses.com/nursing-diagnosis-t206632/ 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
  5. 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.
  6. Esme12

    Compartment syndrome

    Hi! We are happy to help but we ask that all students post what they think first.
  7. 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!
  8. Welcome! Thread moved for best response
  9. Esme12

    Fundamentals HESI final

    thread moved for best response
  10. Esme12

    OB HESI Help!!

    thread moved for best response
  11. Esme12

    H&H trending down...why??

    It is a good question. Has anyone addressed the lab in the progress notes? Typically ortho surgeries are very bloody...do you know what the surgical EBL (estimated blood loss)documented. It is in the anesthesia note or the OR note. I would follow the blood loss. Do you have his pre-op H/H? The MD culd guiac a stool specimen to R/O a GI source.
  12. Esme12

    Does this nursing diagnosis makes any sense?

    You are one month away from discharge and have not completed a care plan...that is not the norm. A care plan is like a recipe card on how to care for your patient so that anyone after you will know what to do and look out for on that patient. Your nursing "diagnosis" is all about the patient assessment and patient needs. You "choose" the patient needs by priority by what will make them the sickest the fastest. DKA that is the medical diagnosis. The patient assessment is the diagnosis. The biggest thing about a care plan is the assessment, of the patient. the second is knowledge about the disease process. first 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. The medical diagnosis is the disease itself. it is what the patient has not necessarily what the patient needs. the medical diagnosis is what the patient has and 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. 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: ADPIE 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 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). [thanks daytonite] 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.
  13. Esme12

    Can my Professor be wrong?

    thread moved for best response
  14. Esme12

    Can't hear Systolic :(, Help??

    It is tough to take blood pressures on children. One BIG problem is that the the bell piece is too big. Try a correct size bell. That may be the issue.
  15. Hi! Welcome to AN! The largest online community! I know that starting nursing you are full of anxiety. Just reading your post made me tired...lol You are just beginning your journey. Every question you have will be answered in its own time....that is what nursing school is for, teaching what, when, and where of patient ca are. First step....breathe. Second step...BREATHE. Third give yourself time to learn how to be a good nurse. We are here to help you...hugs.
  16. Esme12

    Fountain Pens for Charting

    I am going to advise no. Those inks are not waterproof. If something is spilled there go the legal documents. Your home agency isn't computerized?
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