mkcrturner

Thanks Daytonite!! I just reread my post above your last reply- can you see how i am getting myself tied up? LOL as simple as it was you gave me some more ways to say the same thing- and each section now has it worded slightly different. This is our last care plan, we have a NEW instructor, was given the wrong form to fill out...so I was freaking over turning in a bare bone plan. I spent today working on a P.O.C. page to staple to this crazy form. It is more specific to the needs of my patient- and omg I was able to add interventions about her PEG tube and include the fact that I dont want her to asphyxiate. hehehe So although I have no idea when she had first menarche..... I do know a few interventions :) Thanks again

Thanks for the reply Daytonite. I got all the info from the chart (scant as it was)that I could and we are not allowed to make calls to family members. This pt has been in LTC for about 2 years so the chart does not contain info like "date of last pap smear." This care plan format is written geared toward a patient in a hospital setting, not a LTC patient, so most of the questions we need answered are not geared toward the pt's residing in LTC. For a question like "pt's expectations for this hospitalization" or "ways you deal with stress" I was seeking something to fill in that simply/professionally states that they cannot tell me- without repeating over and over thru each section "expressive aphasia" since that would be written in about 80 out of 100 boxes :) Or if you were coming in behind me and reading this material is "expressive aphasia" appropriate?

Hi, I have one last care plan to do before graduation and have run into a NEW writers block. We did our rotation in LTC facility and I learned the term "poor historian" when filling in blanks for pt's with cognitive impairment. What I did not learn is how to fill in blanks for my stroke pt who has expressive aphasia, she cannot even blink/nod etc to express anything. Soo does anyone have any tips for how to fill in the blanks for questions like "age at menopause," "age at menarche," "pt's expectations for this hospitalization," seatbelt use," etc. I'm feeling a little redundant and uncreative. TIA~Kelly

That is exactly what i meant. I am used to having some actual 'abnormals' to evaluate to lead me to the nursing diagnosis. Thanks to this board i never made the common beginning error of thinking- this patient has copd, so they must be having some air exchange issues.... I knew to assess the patient and work off their abnormals to lead me to a diagnosis. I am not used to "pretend your patient has otitis (not specified) and come up with 3 diagnoses and some interventions" there are sooo many things that could need to be addressed there is no way to address them all. Thanks for the links, I am on my way now to look further into symptoms to create a patients condition then redo the diagnosis.

Yup, I got the careplan concept mastered.... Piece of cake....review patients problems- check, Work backwards- check. I was quite proud of myself.. Now comes the wrench. I need to do nursing diagnosis and interventions on an imaginary pediatric patient with otitis and one with tonsillitis. I need 3 for each disease. I froze up and went blank, this is HARD. I have no m/b or AEB cuz there is no patient. 20 months of doing this based on what I am seeing, now I need to fake it??!! I LOVE nursing school! LOL Anyway, I tried to be thoughtful, and I did not want to pull the 2 out of the book that I know most people in the class will use. We needed 3 FULL diagnoses with the r/t and m/b. Then we needed goals and interventions... I muddled through tonsillitis, and for otitis I came up with: 1- Acute Pain R/T infectious disease process M/B patient complaints of pain in both ears (this is a gimme) 2- Anxiety, mild r/t hospitalization m/b decreased pulse and sleep disturbance. 3- Disturbed Sensory Perception: Auditory, r/t chronic otitis, m/b head tilting, pt cups ears with hands, pt cannot walk straight and states his “head is spinning”, pt states his ear hurts. Be gentle, I know I do not have exact things like "pain is 8/10" but the instructor said to be real generic and include things that COULD be a symptom. This is what is throwing me for a loop. I cannot do a pretend person! LOL Will these suffice? And if you have advice for interventions for the disturbed sensory perception I would love to hear them.

Thanks Daytonite. Your fresh eyes helped alot. This Care Plan is hard to explain. But the middle pages have the areas broken up. And if there is one thing wrong/different/unusual/abnormal we need a NANDA dx for it. It gets confusing if your patient has a huge list of symptoms. ie- generalized weakness and pain (2 different areas) could both have a dx of "activity intolerance" This pt had stuff in every section and I was finding myself repeating or getting lost. LOL about the Lasix and renal insuffiency failure....if you only knew how many times I questioned that- to myself of course...to quote my instructor "do you take Lasix? then it is not a normal thing..." She wants EVERYTHING to be highlighted so she can spot it easily. she is grading me so I do it her way. Even if Lasix was the only thing in there and all else was OK, this instructor would want a diagnosis r/t the fact this patient takes Lasix. "I love nursing school, I love nursing school..... " hehehehe THANKS VERY VERY much for giving me a fresh view and the thought process that I needed to complete this LENGTHY Care Plan without repeating a million times.

OK, I am truly stuck. I am doing a huge care plan. pt is 38 y.o. f with aids, hep c, mrsa in a wound from an ind to a cyst that has gone from anterior hip to the iliac crest with osteomyelitis (fun dressing change..) she was admitted with lady partsl bleed and green frothy discharge. medical dx = trichomonas lady partslis. for the life of me I am stuck on a nanda diagnosis. our care plan is broken into each system, under elimination I have the following elimination intake for shift = 2254 output for shift = voids x5, bm x1 urine characteristics/problems voiding; foley (y or n)= amber, cloudy, sediment, strong odor hx of kidney or bladder disease = renal insuffiency bm/stool pattern/last bm= daily, 4/12 @ 11:30 hx of hemorrhoids or bleeding= admitted with lady partsl bleeding, green frothy discharge. diuretics= 40 mg lasix daily bun= 7 creatinine= 0.6 we are supposed to highlight anything that is abnormal, then if there is any abnormality we need to include a nursing diagnosis for that section. I am stuck on this area. please help...... tia~ kelly

THANKS VERY much!! The websites/links were helpful as was your time to help me!

oh and... after the undermining clears up- the perfect dressing that is permeable and promotes healing by sealing in fibrin, plasma etc is called? and two examples. I am looking all over the place. This is for sure not in our book, we only have one paragraph that gives the definitions of the 4 different stages, and that is all.... hmmm

I have a question I need some help with please. Our books are sorely lacking in pressure ulcer info. scenario= A pt with a stage 3 pressure ulcer....sacral coccyx area...7.5 cm x 5 cm and 5/8" deep with undermining (tunnels) at 2 o'clock and 9 o'clock. ?= To which layer of skin does this wound extend the deepest? All I can find is "Involves full thickness of dermis--into subcutaneous tissue; may see tunneling below skin surface" So if there is tunneling, I know it is 'below the skin surface' but not sure of the layer of skin the wound extends the deepest to. I WISH they would teach us in order..chapter 1-12. Not 3, 8,11, etc. LOLOLOLOL TIA for any help

I am F and prefer my M ob-gyn. As a matter of fact, I moved to FL and still schedule my annual exam during a trip back home to MI to see him. I had a F once and was uncomfortable with HER doing my breast exam, etc. Just my comfort level-When I am healthy and have the choice. However, if I am sick, I do not care who treats me as long as they are doing their job well. I discriminate against attitude, not gender. Although... my own gender is losing alot of points since I have yet, to date, run across a rude male nurse. I lost count of the number of female nurses that treated my family and myself like slabs of meat.

Thanks to all who replied. This board is (and has been) a gift to me. From trying to get into school, and now to survive school. I am off to work on my care plan and study for test on 2 systems tomorrow- lymph and digestive. I truly appreciate the experioence you shared to help me get out of my rut.

sorry I left that out- she had another problem and was in an infusion center for 54 days receiving antibiotics to treat a leg infection. While there she didn't get up much, became weak...... and so on. oh, and if i use the Urinary Retention dx, where can I fit in the elevated WBC ?? I actually really do know how to formulate the care plan..just for some reason this one is stumping me in having to change UTI to something not a medical DX. The book the school required lists medical dx for almost every r/t for nursing dx- ie; impaired gas exchange r/t COPD. We cannot use COPD. We cannot even say r/t femur fracture, r/t hysterectomy, etc.

please help me with some wording.... our instructors will nto allow us to use medical dx for our r/t. my pt has a uti, was retaining 1000ml of urine so they put in a foley. i cannot use: "impaired urinary elimination r/t uti aeb....... " i am drawing a complete blank with how to rephrase uti the pt was otherwise ok healthwise, she is weak and i plan to use a "risk for" dx as my second (w/instructor approval cuz there really was nothing else) this pt will be discharged soon. tia for any help!

I live in Bradenton and I enrolled in Manatee Technical Institute LPN program. I lived in MI and was taking pre-req's to become an RN, and the move here was a mess. Cost per credit hour at MCC was almost 300 due to me not being a resident yet (need to live here for one year first,) some of the classes I took in MI as pre-req's were not pre-req's here... etc, etc. etc..... Anyway for about $4800 (TOTAL for the entire class) I am enrolled in the LPN class that is in the evenings from 5:30-9:30 on Monday and Wednesday, then every other Saturday and Sunday from 7a-3:30p. This way I will not need to worry about daycare for my children. It will take me 2 years to complete- But it would have taken me almost 4 years to complete an RN program (due to time and money and wait lists.) I still plan to become an RN, I will just bridge down the road. ...... Hope this info helps some. I know different things work for different people, just wanted to share the path I chose. At least in 2 years my youngest will be in school full time so I can work during the day, class at night for RN, or vice versa.... but I will be earning a decent salary as an LPN while chasing the RN dream :)

tests NCLEX Practice Questions - Pass your NCLEX Test with free NCLEX Test Preparation Materials these are a couple of 'test' sites i have saved. your textbooks might have a website and you can do tests per chapter from there. check inside the front few pages for a website. Also google the topic. ie; "anatomy and physiology practice test." that should lead you to some sites with some tests for the topic you are seeking.. hth- Kelly

I have an I.D. Tag, but more importantly I developed the habit of keeping it with/on me. I feel soooo stingy and greedy which is not at all how I want to be, but ya know........ it costs a lot of money, and everyone should have their own anyway. My DH bought it for my birthday, and the 2nd day of my Core class, someone picked it up off the table and walked away to go take vitals of classmates. That taught me to keep it ON my body or in my pocket at all times. I figured if someone would grab it to use without asking, that someone could just as easily steal it How sad.

I just got my acceptance letter and they included a Holiday Gift Suggestion Letter. Here are things I didn't notice already mentioned.. but then again I am tired.. sorry if I am repeating.... for non monetary idea: promise cards for babysitting when you need to study for test, promise cards to cook/clean if you get behind, promise cards for support as you go along- shoulder to cry on, someone to complain to... low cost= lot of hair tie back items misc i didn't notice above: pocket saver/organizer, good ink pens- black

My hubby is planning a cruise with my first earned money- LOLOLOL I have been a SAHM (stay at home mom) for 6 years- so money has been really tight for us.

Oops, couldnt edit. to clarify- The reason i was upset with this is that I felt it was a waste of $1400 to take BIO, I felt ready to take the A&P without their pre-reg of BIO. If I had failed A&P due to lack of BIO knowledge...that would have been my fault. I realize the concept of pre-req's to build/prepare for other courses. But I was and am well versed in BIO :)

Believe you me.. I TRIED and it was a no-go. It was a huge mess, they wouldn't even allow me to transfer high school Biology since it had been over ten years ago. They said "we like to see the classes taken recently so they are fresh." Now Biology isn't even required, they want Micro. GRRRR I had too many things to test out of for their liking. Don't even get me started on their 2 hour 'computer literacy' class that is required for everyone no matter what. And never mind the fact that I took one class online, and used to work for 6 years at a computer help desk.... Just give me my nursing classes- I'll be happy. :)

What ever happened to good old apprenticeship?? You work side by side with a master of the occupation in order to learn, they you begin doing the work. Points from both sides are well noted. I agree that some classes are just a plain waste of time. Some of the classes to get the associates degree are ridiculous... English comp 1 & 2?? WHY? That is 2 semesters of something that should be able to test out of, or do a review type class to be sure I know how to write a paper. (despite my poor grammar while posting in the world wide web, i did take both and pass with a 4.0- really- LOL) I personally feel that my time would have been better spent in a hospital learing real NURSING skills and applications. The college received a lot of money for classes that just do not relate. As long as I am able to communicate in a functioning way, it should not matter that I am able to understand Othello or not. JMHO

ok, i'll 'fess up to this....... but my mistake may help you. Are you properly placing the earpieces in??? When they are backwards you CAN still hear, but flip them around to the correct listening side and WOW what a difference!!!! I feel silly now, but I still say that the wrong way looks like the correct way- LOLOLOL I also bought my own stethoscope instead of using the schools so I could practice at home, and it is in far better condition. Also. A tip to help- when listening you will hear background noises, then a loud beat will come in (systolic number) , then it goes away (dystolic number). A classmate said to think of it like an annoying neighbor playing their music too loud. You want to report it- so you note the time they turned it up (systolic), then the time they turned it off (dystolic) :) Hope that made sense, and that it helps somewhat. From one student to another...

LOLOLOL, I found this funny. Reading those words took me back in time. It is how I was treated when I worked in various fast food places in my younger years. I was earning $12 hourly plus commission on net sales- almost ten years ago- managing a sub shop (took me to about $13.75/hr.)....yet the customers basically treated me like some low end $2/hr 'thing' they could belittle. Did I mention the 'dirty' people that wanted free food, made HORRIBLE messes in the restrooms?? etc. etc... I think that no matter what job you have, if you are dealing with the public you are exposed to ALL types of personalities and issues. So you might as well do something that YOU want to be doing :) A job that gives you satisfaction and makes you feel good about what you do! Go for it!!!!!