mizlaura

Thank you so much! That really help clear my confusion.

Hi! My instructor have assigned me to demonstrate a quick cathether and mini catheter insertions, and I really need some input to clarify my confusion here. What is a quick catheter and mini catheter? Is there another name used for these two? Are the two similar to a Foley catheter insertion? I've looked it up online to no availability and my resources (test books) does not refer anything about quick cath and mini cath. I am in my second year of the nursing program, and by far have only demonstrated a Foley catheter insertion skill. Thanks in advance. Much appreciated!

Great examples! Thanks GrnTea!

What does "systematic observation" in nursing mean? Is that like observing the patient while caring for them, and noting any changes in them??? Thank you in advance!

Thanks. That really helps. I am still trying to navigate myself in using this site, and so your guidance is always welcomed. Much appreciated.

Thanks Mrsboot87. Looks like I am doing my med cards all wrong! Since you have mentioned that med cards are for 'highlighting the drug' ... Would it be ok to write my Drug Interaction like this: (For heparin) Drug Interaction: Increase bleeding affecting platelet function, hypoprothrombinemia, and thrombolytics.

Thank you Esme 12. You are so helpful! So, to begin with we were not taught how to do med cards. (Yikes!) So with that being said, my instructor indicated that we do med cards for the drugs given.. such as Heparin, but what confuses me is how to identify 'special concerns'... which it could be that I have no knowledge how to go about making med cards. My Drug Guide book indicates the following for heparin: Contraindication/Precaution: Contraindicated in: Hypersensitivity; Uncontrolled bleeding; Severe thrombocytopenia; Open wounds( full dose); Avoid use of products containing benzyl alcohol in premature infants. Use Cautiously in: Severe liver or kidney disease; Retinopathy (hypersensitive or diabetic); untreated hypertension; Ulcer disease; Spinal cord or brain injury; History of congenital or acquired bleeding disorder; Maglignancy; OB: may be used during pregnancy, but use with caution during last trimester and in postpartum period; Geri: Women >60 yr have increased risk for bleeding. Excerise Extreme Caution in: Severe uncontrolled hypertension; Bacterial endocarditis, bleeding disorders; GI bleeding/ulceration/pathology; Hemorrhagic stroke; Recent CNS or ophthalmologic surgery; Active GI bleeding/ulceration; History of thrombocytopenia related to heparin. So for instance, 'contraindication' was also to be listed on my med card; therefore, I pretty much just wrote the followings after 'Contraindicated in:...' (correct me if I am wrong). My other question is how do I go about making this med card to fit everything. For example, 'Drug interaction' is to be listed on the med card as well, and the book has so much information. Is there a way how to write out the 'drug interaction' so that I don't have to write out the whole entire thing? Or is there a way to look/write specific wordings? Any tips to write med card will help! Hope this makes sense. Thanks again!

Awesome! I will check the other book out. Thanks.

This may be a stupid question, but I am to define the "special concerns" when using the drug heparin. Would that be consider PRECAUTIONS when looking it up in the Drug Guide? Thanks.

Thanks!

Yes, Julie Reyes. Esme12 did a great job explaining it. I greatly appreciate you all for helping me.

Thank you, Esme12. I am in my first semester of the nursing, and I am using the Nursing Diagnosis Handbook by Ackley & Ladwig. Thank you for the explanation. It makes better sense now that you explained that way. Much appreciated!

Thank you.

Oh my! I can not even edit the post to remove the name...

Sounds good. This is a fake patient, but will go remove it. Thanks!

I guess what I am trying to say is ... can I seek other interventions/rationales from other nursing diagnosis as long as it relates to what I am working with? I am having a hard time trying to find more long term goals along with finding the right interventions and rationales to back it up. And do I need to write evaluation for each goals as well??

Thanks Julie Reyes for responding. Here is a brief history of my patient that I am working with: **** *****, who is hospitalized now, is a 55-year-old woman who is having a Jejunostomy tube removed and living with chronic pain related to stage IV pancreatic cancer. She was a pack a day smoker but did quit 5 months ago. She has been treated with chemotherapy with gemcitabine through an implanted port in her left upper chest following a Whipple surgery. The physician did order a nasogastric tube and she has been receiving parenteral nutrition at night due to the jejunostomy tube not functioning correctly. Upon admission she had severe abdominal pain and stated “the pain is mostly in my stomach but I hurt all over.” She is receiving Fentanyl 25mcg for her pain that she rates a 5 out of 5 and Zofran 4mg prn for nausea. Upon admission she did have a fever as well of 101.4 and oxygen saturation of 83% on room air with decreased breath sounds bilaterally noted. Her abdomen is slightly distended with no bowel sounds heard. She has a history of low neutrophil counts. Reverse isolation precautions have been instituted and lab reports are pending. She is confused, knowing where she is but unsure as to why. However, she has indicated she is aware she is dying and would like to die at home. Family has been arguing regarding if it is feasible for her to remain at home and a hospice referral has been made. My three nursing diagnosis that I was able to come up with are: 1)Impaired gas exchange r/t ventilation perfusion imbalance and alveolar-capillary membrane changes AEB decreased bilateral breath sounds, respirations at 22 breaths per min, O2 sats of 83%, and a weak/dry cough. 2)Risk for acute confusion r/t electrolyte imbalance, malnutrition, pain. 3)Impaired comfort r/t generalized pain and illness AEB respiratory rate or 22 breaths per minute, increased temperature of 101.4o F, decreased blood pressure of 92/58, rates pain 5/5.

I have looked at a lot of the previous posting about working on care plans for class. Like many others, I am overwhelmed and confused!! I feel like my instructor isn't given us good explanation to go about creating one. But I have taken some considerations from these previous posting. However, I am stuck with some long term goals/interventions/rationale/evaluation. So here is what I have for Nursing Diagnosis: Impaired Comfort r/t lack of ease, relief, and transcedence in physical, psycho-spiritual, environmental, and sociocultural dimensions. The followings are short term goals and long terms goals that I have so far: Short term goals: Patient will state her pain level at 1 to 2 within 20 minutes of analgesic. Long term goals: Patient will maintain stated level of comfort during hospitalization which will be measured by: 1. Assessing client’s level of comfort on an hourly basis. Sources of assessment data to determine level of comfort can be subjective, objective, primary, or secondary. 2. Patient will be repositioned every hour. Ambulation will begin daily with a goal of 10 feet. Once goal is obtained, an additional 5 feet will be added per goal met. A review comparing the study by Chair et al found its results to be consistent with other studies that have found that backrest elevation, side lying, and early ambulation all improved comfort. 3. Patient will be educated to the use of relaxation techniques that may reduce her pain and fatigue, and enhance her personal well-being daily. In a systematic review of randomized controlled studies, it was found that relaxation training was effective for decreasing pain intensity, depression, and fatigue in clients with chronic musculoskeletal pain. So, I was told by instructor that we need 5 long term goals and this is where I am stuck with. My Nursing Diagnosis Handbook only has a handful for this Nursing Diagnosis (Impaired Comfort). I may be wrong but correct me... I cannot use other Nursing Interventions from other Nursing Diagnosis other than the one I have, right? If anyone can also give me example on interventions/ evaluation, I would greatly appreciate it as well. My apology in advance that this is so long, and perhaps does not even make sense, but I am over my head with trying to figure out more long term goals, interventions, and evaluation! Thanks in advance!