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If you search here for think like a nurse you will find some better ideas. Memorizing facts will not make you a nurse. And will not help for more than half of the questions. They want to know about how safe a nurse you'll be, that's judgement. Look for things that teach you priorities.

I think the references to climbing heights and the mountain metaphors remind us that when we first begin to learn things we're really excited. And due to the limited nature of our experience (the bounded nature of our mind) we aren't able to take the long view or see how far knowledge had to come to get us to that point. Then we see (now we are "more advanced") that there is so much more to learn! We climb! We are so pleased to climb those "towering Alps" and feel like we're walking on air, "tread(ing) the sky." Soon after that, though, just when we think we've learned it all, we are shocked to see ahead of us how much more there is to learn... "the growing labours of the lengthen'd way." It makes us tired just to look at it, more hills beyond hills, and Alps upon Alps ahead of us. So whoever thought lifelong education was supposed to be easy? Or any education, really? Isn't that the point, that whoever thinks school and learning isn't supposed to be work has a very immature view? Can't see the hills right ahead of him, as it were?

This appears to be a three-year-old thread. If the original poster is still here perhaps he or she could let us know what happened?

I think that this falls under the category of "no good deed goes unpunished," or at least un-complained about. I agree with the comments that this is both a ridiculous and sad question to feel you have to ask. Put it out if your mind, give your gifts, and then say a little something nice about every one of them for their personnel files with a little note. Raises, not roses, and all that. Bless you and Merry Christmas.

The The question is asking about "goal directed therapy." Your goal in treating shock is to provide adequate tissue oxygenation. Therefore, what two measurements tell you about tissue oxygenation? CVP tells you about volume, an important concept in delivery capability. SVO2 tells you how much oxygen there is left in the blood after the arterial side has done its best to deliver it. O2 sat tells you how much oxygen was out there for the taking (remember to look at hematocrit for the complete picture there-- a 99% sat with a crit of 15 delivers only one third the amount of oxygen that a 99% sat of a crit of 45 delivers). Therefore in my opinion, O2 sat and SVO2 are the parameters that tell you the most about your goal, oxygen delivery and tissue uptake.

Both: you would document the volume of D5W in the I&O, and the 1mg/hr of morphine on the medications. Describe the bag's contents and drug rate accurately: D5W 100cc with morphine 100mg, 1mg/cc, 1mg/hr It is also impermissible to substitute a different IV solution without a physician prescription. "Because we're out of it" is not acceptable unless it's a true emergency. It Is likely you misunderstood, but you are correct that it ought to be documented properly if different than prescribed. Good spot.

Why is shock bad? Because tissues are starved of oxygen and means to achieve homeostasis. Now reconsider your answer. If still unclear, ask me to expand on this. If you've really read the chapter twice, try it again with this in mind.

Found this searching nursing care plan in the search bar. #10 very useful information I think. You are in school to learn to be a nursing diagnostician and treat people for what you diagnose. Yes, you are. You think it's all about learning how to do stuff like injections and IVs and tubes, but those are just tasks. You are learning how assess human responses and prescribe nursing measures. There is no magic list of medical diagnoses from which you can derive nursing diagnoses. There is no one from column A, one from column B list out there. Nursing diagnosis does NOT result from medical diagnosis, period. As physicians make medical diagnoses based on evidence, so do nurses make nursing diagnoses based on evidence. Facts first, diagnosis second, plan of care next. This works for medical assessment and diagnosis and plan of care, and for nursing assessment, diagnosis, and plan of care. Don't say, "This is the patient's medical diagnosis and I need a nursing diagnosis," it doesn't work like that. As an example: How does a physician make a medical diagnosis of anemia? The physician doesn't go to a list and say, "Gee, this guy looks pale, must be anemic, sounds pretty good to me," right? No- a diagnosis is made by obtaining a CBC. Then how does the physician know what caused it? Ah, then we collect more data-- renal failure (low erythropoietin), marrow malignancy (differential), occult GI beed (stool check), big bleeding with IV replacement (trauma record)... Then the physician can develop a medical plan of care to treat the causative (related-to) factors for the diagnosis made on data. Nursing diagnosis is the same thing. A nurse can't just pick a diagnosis out of a list. And you can't make a diagnosis without data, either. So... my first suggestion is banishing the words "pick/find/choose" from any discussion of the NANDA-I list of approved nursing diagnoses. I think if students got this concept in their first week of school, that they will learn how to make nursing diagnoses, they'd have a better hook to hang their hat on, so to speak. This is why you can't say, "My patient has diabetes. What are his nursing diagnoses?" Sure, when I admit somebody with diabetes I have some good ideas about possible nursing diagnoses based on my experience with caring for diabetics in many settings-- like, oh, knowledge deficit, fluid imbalance, impaired CV function, ineffective peripheral issue perfusion, pain, and many other things often seen in diabetics-- but I can't make one of them until I am sure the patient actually has defining characteristics. If I'm a smart person I will also keep my eyes and ears open for other nursing diagnoses for this patient -- maybe I see evidence of abuse, or sexual dysfunction, or death anxiety, or ineffective denial, or powerlessness, or risk for injury, or risk for self-directed violence, or contamination or .... You get the picture. This is why limiting your vision to "nursing diagnosis for diabetes" is so, well, limiting. You don't "pick" or "choose" a nursing diagnosis. You MAKE a nursing diagnosis the same way a physician makes a medical diagnosis, from evaluating evidence and observable/measurable data. This is one of the most difficult concepts for some nursing students to incorporate into their understanding of what nursing is, which is why I strive to think of multiple ways to say it. Yes, nursing is legally obligated to implement some aspects of the medical plan of care. (Other disciplines may implement other parts, like radiology, or therapy, or ...) That is not to say that everything nursing assesses, is, and does is part of the medical plan of care. It is not. That's where nursing dx comes in. A nursing diagnosis statement translated into regular English goes something like this: "I'm making the nursing diagnosis of/I think my patient has ____(diagnosis)_____________ . He has this because he has ___(related factor(s))__. I know this because I see/assessed/found in the chart (as evidenced by) __(defining characteristics)________________." "Related to" means "caused by," not something else. In many nursing diagnoses it is perfectly acceptable to use a medical diagnosis as a causative factor. For example, "acute pain" includes as related factors "Injury agents: e.g. (which means, "for example") biological, chemical, physical, psychological." You can thumb through your NANDA-I 2015-2017 and find lots and lots of medical diagnoses as related factors. They are not the origins of nursing diagnoses, however. To make a nursing diagnosis, you must be able to demonstrate at least one "defining characteristic" and a related/caustive factor. (Exception: see "risk for" diagnoses) (Think of the physician who has to have some lab work to diagnose anemia...same thing.)Defining characteristics for all approved nursing diagnoses are found in the NANDA-I 2015-2017 (current edition). $39 paperback, $23 for your Kindle at Amazon, free 2-day delivery for students. This edition also includes an EXCELLENT FAQs section aimed at students. NEVER make an error about this again---and, as a bonus, be able to defend appropriate use of medical diagnoses as related factors to your faculty. Won't they be surprised! If you do not have the NANDA-I 2015-2017, you are cheating yourself out of the best reference for this you could have. I don't care if your faculty forgot to put it on the reading list. Get it now. Free 2-day shipping for students from Amazon. When you get it out of the box, first put little sticky tabs on the sections: 1, health promotion (teaching, immunization....) 2, nutrition (ingestion, metabolism, hydration....) 3, elimination and exchange (this is where you'll find bowel, bladder, renal, pulmonary...) 4, activity and rest (sleep, activity/exercise, cardiovascular and pulmonary tolerance, self-care and neglect...) 5, perception and cognition (attention, orientation, cognition, communication...) 6, self-perception (hopelessness, loneliness, self-esteem, body image...) 7, role (family relationships, parenting, social interaction...) 8, sexuality (dysfunction, ineffective pattern, reproduction, childbearing process, maternal-fetal dyad...) 9, coping and stress (post-trauma responses, coping responses, anxiety, denial, grief, powerlessness, sorrow...) 10, life principles (hope, spiritual, decisional conflict, nonadherence...) 11, safety (this is where you'll find your wound stuff, shock, infection, tissue integrity, dry eye, positioning injury, SIDS, trauma, violence, self mutilization...) 12, comfort (physical, environmental, social...) 13, growth and development (disproportionate, delayed...) Now, if you are ever again tempted to make a nursing diagnosis first from a medical one and cram facts into it second, at least go to the section where you think your diagnosis may lie and look at the table of contents at the beginning of it. Something look tempting? Look it up and see if the defining characteristics match your assessment findings. If so... there's a match. CONGRATULATIONS! You made a nursing diagnosis! :anpom: If not... keep looking. Eventually you will find it easier to do it the other way round, but this is as good a way as any to start getting familiar with THE reference for the professional nurse. About Risk for” diagnoses: First: "Risk for" nursing diagnoses are very often properly placed first, as safety ranks above all of the physiological needs in Maslow's hierarchy. What are nurses for if not to protect a patient's safety? Second: It is a fallacy that "risk for..." nursing diagnosis is somehow lesser or not "real." If you look in your NANDA-I 2015-2017, there is a whole section on Safety, and almost all of the nursing diagnoses in that section are "risk for..." diagnoses. However, because NANDA-I has learned that nursing faculty is often responsible for this fallacy, the language on these has recently been revisited and was changed to include "Vulnerable to ..." in the defining characteristics the current edition. "Risk for.. " diagnoses do not have defining characteristics, they have risk factors. Third: Setting priorities. This sort of assignment is often made not only to see if somebody can recite rote information but to elicit your thought processes and see how well you can defend your reasoning. There is often no single priority; defend yours. Your faculty will be gratified to see you try and make your case. So, what is the reasoning you have applied to your ranking, as applied to a specific patient or to people in this situation. Two more books to you that will save your bacon all the way through nursing school, starting now. The first is NANDA, NOC, and NIC Linkages: Nursing Diagnoses, Outcomes, and Interventions. This is a wonderful synopsis of major nursing interventions, suggested interventions, and optional interventions related to nursing diagnoses. For example, on pages 113-115 you will find Confusion, Chronic. You will find a host of potential outcomes, the possibility of achieving of which you can determine based on your personal assessment of this patient. Major, suggested, and optional interventions are listed, too; you get to choose which you think you can realistically do, and how you will evaluate how they work if you do choose them.It is important to realize that you cannot just copy all of them down; you have to pick the ones that apply to your individual patient. Also available at Amazon. Check the publication date-- the 2006 edition does not include many current NANDA-I 2015-2017 nursing diagnoses and includes several that have been withdrawn for lack of evidence. The 2nd book is Nursing Interventions Classification (NIC) is in its 6th edition, 2013, edited by Bulechek, Butcher, Dochterman, and Wagner. Mine came from Amazon. It gives a really good explanation of why the interventions are based on evidence, and every intervention is clearly defined and includes references if you would like to know (or if you need to give) the basis for the nursing (as opposed to medical) interventions you may prescribe. Another beauty of a reference. Don't think you have to think it all up yourself-- stand on the shoulders of giants.

Is that 2.5 years all as an RN, or is your manager correct that you have only been employed AS AN RN accurate? if you want to resign, all you write is, "Dear Managername, I will be resigning my position on Floor as of DATE. My last shift will be DATE. I appreciate the opportunity to learn about SPECIALTY during my time here, and the assistance and support from STAFFMEMBER. Sincerely, Coolpeach RN."

He won't be doing any conceiving, since he presumably has no uterus (although in some of these cases they find that too). However, assuming he had normal testes, vas, and spermatogenesis, he could have reconstructive surgery or, failing that, semen retrieval for in vitro fertilization.

Short answer: it is routine for HR minions to consult the state database on employment for work comp claims on new applicants. Every employer of more than a certain size must pay work comp premium for its employees. This means ... Employment data. They also check credit data, which includes...employment data.

Reading that 27-year-old paper (which cites papers from the 80s) does not support the contention that AF causes deep venous thrombosis. The best it can do is say that they may be associated, but association is not causation. (It also says that there is no consensus for anticoagulation therapy in AF, citing papers from 1986 and 1988. I believe that ship has since sailed.) This demonstrates the risk of not understanding the entire article-- it doesn't say what you think, once you read it in its entirety. Last: Saying atrial emboli can travel anywhere bespeaks a misapprehension of circulatory anatomy. Tell me how an atrial clot from either right or left atrium travels and gets into deep veins. (I'll wait.) (Hint: capillary beds)

My fave like this was not me, but the hospital operator. One day she said over the overhead, "Paging Dr. .... , please call the operator, Dr. .... ." And then not realizing her mic was still live, she said, "... That *** ****." Brought down the house all over the whole hospital. Funny thing was, he really was one, and we all knew it. Even the operators.

Not quite perfection since DVT isn't caused by AF. But otherwise ...

"Secondary to" means "caused by." DVT is not caused by atrial fibrillation, so don't say that. For that matter, atrial fibrillation doesn't cause DVT, either. Atrial fib may allow clots to form in the atria, and so if one floats out of the atrium and into the ventricle and out the aorta, it could cause a stroke or later as of blood flow to any other artery. If it floats out of the right ventricle it will block blood flowing to part of a lung, a pulmonary embolus. Another reason to get a clot to the lung is when one forms in a deep vein and travels to the right heart and then to the lung, but that has nothing to do with atrial fibrillation. A patient with risk factors for DVT might be on anticoagulation prophylaxis, meaning, something to prevent inappropriate clot from forming in the deep veins. A patient with atrial fib might be on anticoagulation prophylaxis to prevent clot from forming in his atrium. Otherwise, the rest of it is fine. "No change in medical plan of care, no new prescription," or, "New prescription to increase/decrease dose to ..."