ksurette

Here is my first attempt at the first one.. thoughts what have i missed? Nursing Diagnosis Acute pain related to fractures his left ankle and right femur Planning(goal) The client will experience diminished pain as evidenced by:1. verbalization of a reduction in pain 2. relaxed facial expression and body positioning 3. stable vital signs Intervention(Nursing) Conduct pain management interview. Document location, quality, onset, duration, intensity, aggravating and alleviating factors. Use self-report tool to understand intensity level. Access patient for pain routinely both when vitals are assessed, during activity and rest and with interventions or procedures likely to cause pain. Ask patient to discuss changes in pain to understand medication effectiveness. Implement measures to reduce pain: perform actions to reduce fear and anxiety about the pain experience (e.g. assure client that his/her need for pain relief is understood). perform actions to reduce fear and anxiety in order to promote relaxation and subsequently increase the client's threshold and tolerance for pain. perform actions to promote rest (e.g. minimize environmental activity and noise, limit the number of visitors and their length of stay) in order to reduce fatigue and subsequently increase the client's threshold and tolerance for pain Rationale- Pain is expected after fracture; pain is subjective and is best evaluated on a pain scale of 0 to 10 and through. description of characteristics and location, which are important for identifying cause of discomfort and for proposing interventions. Continuing pain may indicate development of neurovascular problems. Pain must be assessed periodically to gauge effectiveness of continuing analgesic therapy. Evaluation Client reports increased comfort, decreased pain. Client expresses comfort when leg is positioned and immobilized. Clients vitals are stabilized. Client expresses they are rested and relaxed and this is further demonstrated in clients face and body movement.

I know they are currently reviewing the laws here. I see what your saying many of the articles say similar things of nurses thinking the patient was old, etc. Its tough --happy to hear that one time you did move forward your employer stood with you.

I live in Canada and i'm studying to be a nurse- this is not homework so no specific question.. just curious about everyones thoughts and experienece. New around the industry always me me think about the world I am about to enter. Over the last few months there have a been alot of articles here that nursing -and that nurses are finding themselves in roles of working with patients that are violence regularly. Many are around patients with mental illness, kicked, being hit, etc. They are saying most never report it --and here in Canada virtually none are ever charged for the violence. One nurse was fired for bringing it up at a union meeting and she now has a case. Im curious, is it like this in the states? I know everyone one here is from every where- i'm just curious if this is a canadian problem with to relaxed laws...Do the hospitals you work for charge patients for their behaviour? Im not sure why any act of violence would treated less then if it was done to a police officier..

I am a first year student.. working on the below assignment. I would think in this scenarios i would first focus on pain and secondary on the fact this person will not have much movement with a fracture on both sides. What are your thoughts on this assignment..what would be the first two critical things you would address. You have been assigned to care for Mr. J, who fell from the first story of his home while shoveling snow off his porch roof to prevent collapse. He landed on his feet and fractured his left ankle and right femur. He is currently on bed rest. Vital signs are T- 37, P- 78, R-20, and B/P 112/74. He is ordered diet as tolerated. Medications ordered for Mr. J include, morphine sulfate for pain. His order reads morphine sulfate 10 mg IM q 6-7 hours for pain. Develop a nursing care plan for Mr. J. Critically think Include 2 nursing diagnosis relevant to Mr. J's situation For each nursing diagnosis develop at least 2 goals/interventions/ rationale Evaluate the nursing actions/State weather the goals/outcomes were met

Your neighbor Mr. Lewis, age 76, knocks on your door. He says, Look at my left foot. It is very swollen. I wore new shoes yesterday that felt tight. Now, I can hardly get any shoe on this foot. There is a tender area on the top of my foot. I think something is wrong. Can you help me?” You help him in and ask him to sit down. He limps to a chair and sits down, breathing heavily. You note that he seems sad. He says he has been feeling blue since the loss of his wife several months earlier and that he gets very lonely living alone. When you look at his foot, you note an open area on the top, with a small amount of yellow drainage. Even after 20 minutes in your home, he still seems to be breathing heavily. You identify the following problems. Prioritize them based on Maslow's hierarchy of needs. Left foot swollen with open lesion Lives alone Grieving loss of wife Difficulty breathing Difficulty walking my initial thoughts are breathing first and foremost #4 open sore #1 walking #5 alone #2 wife#3 Your thoughts?

are these two better written out nursing diagnosis? [TABLE] [TR] [TD]Displaying Nausea and vomiting (r/t) to effects of chemotherapy [/TD] [/TR] [TR] [TD]Notice yellowish drainage with foley catheter (r/t) prostate cancer [/TD] [/TR] [/TABLE]

thank you these are great suggestions!

Choose 2 nursing diagnosis and develop a care plan utilizing the steps of the nursing process. Remember to set 2 realistic goals for the client and develop nursing interventions that could help meet these goals, as well as the rationale for the interventions. Case study. Mr. B has been assigned to your care for the day shift. Mr. B is a 78year old male client in the hospital who is medically discharged. He is waiting for homecare to be initiated. He has a below the knee amputation of the Rt. leg and has prostate cancer. As a result of the prostate cancer Mr. B is unable to void on his own and has a Foley catheter. He has been nauseated and vomiting as a result of the chemotherapy that he is receiving. He has been NPO for the past two days and has an IV of R/L infusing at 100 mls/ hr. Mr. B usually is able to perform his own care and is ambulatory with prosthesis, but because of his vomiting and resulting weakness he requires partial assistance with his bath. During his morning bath you notice yellowish drainage around the Foley catheter. No other findings were noted. By midafternoon the client has been free of vomiting for 6 hours and is beginning to feel hungry. You consult with his Dr. and the doctor orders the IV to be discontinued and to start the client on clear fluids. Mr. B's vital signs for 1000 hours are B/P 110/70, Pulse 68, RR-18, and Temp. 37°C, oxygen saturation on room air is 98%. Mr. B's vital signs for 1400 hours are B/P 118/74, Pulse 70, RR-18, and Temp. 36.8°C, oxygen saturation on room air is 96%. The Dr. requested that the client be weighed. You did so and the client's weight is 70 Kg. Mr. B's intake for dinner : 250 mls apple juice, 250 mls 7-up, 500 mls water, 500mls clear soup broth and a bowl of jello. MY ANSWERS SO FAR: Nursing Care Plan: Nursing Diagnosis: (4marks) Nausea related to effects of chemotherapy as evidence by patient reporting nausea and chemotherapy treatment for cancer. Unable to void on his own and has a Foley catheter having yellowish discharge Nursing Goal(s): (4 marks- 2 goals) Nausea will be reduced. Catheter will be clear of discharge and with nausea cleared can be removed Nursing Interventions and Rationale (8 marks) Clients feel more comfortable Balanced fluid status Adequate nutrient intake Give / teaching methods of distraction from the sensation of nausea eg using music, etc.. Motivate clients to eat / drink a little but often. Keep the catheter environment clean and washing with soap and water at least twice a day Evaluation: (4 marks)

I like that.. (not homework- just thinking) do you think someone can be to nice? strange question .. but alot of my interactions so far my teachers feedback is that i hope or see a patient doing more then they are capable -- my values would be to try (especially in long term care) and give them as much as I can...Im being told i'm not being realistic. I think i'm going to have a hard time with being realistic.. to me that is kinda of a value of being me...do you think once i am nursing i will figure out balancing this out

This really makes me wonder about conflict for the last question --and how often a nurse may find themselves between various opinions of what is right... that has to be hard to deal with. Have you been in this situation? I love the insight on the ulcer not healing and having them before.. the nurse seemed very quick to decide it was healing fine.

I am just wrapping up my 2nd term of nursing. I am reflecting about all i have learned and what I am going to be exposed to in medicine. As a nurse how do you see your personal values influence your approach to care?

See where I am heading on my answers for this case study.. and I'm on the right track? The nurse visits a 75-year-old African-American woman to evaluate healing of a pressure ulcer on her left hip. The patient is upbeat but feels that the ulcer is taking too long to heal in comparison to others she has had in this same area. The woman's children are also present at the visit and inform the nurse that they have been encouraging their mother to sit out in direct sunlight in her backyard, where she can expose the ulcer area to light. The children read on the Internet that this is the quickest way to heal an ulcer and feel that other treatments are not needed at this time. The patient listens to her children but voices her disinterest in their treatment choice, stating that she prefers traditional treatments. Identify the clinical problem(s) in the case study. Provide the rationale for your answer. (2 marks) My answer: Patient has an ulcer she feels are not healing fast enough. (should I be including something about the family treatments) The nurse assesses the ulcer by examining the skin color and determines that healing is progressing well. The patient has dark skin, with some areas around the ulcer that appear blue in color; no redness is seen. Based on these statements, is the nurse making an accurate assessment? Why or why not? Provide the rationale for your answer. (3 marks) Skin color can reflect a patient's overall health and is an important part of assessing skin breakdown and wound healing. , dark skin takes on a dark bluish-purple tint at the site of early pressure-ulcer development. So when caring for a dark-skinned patient at risk for pressure ulcers, keep in mind that assessing by touch is as important as visual inspection. I don't believe the rationale is correct. How should the nurse address the conflict between the patient and family? Provide the rationale for your answer. (5 marks) The case study didn't make it seem like a large conflict just a difference of opinion on treatment. After the conflict is identified, it must be managed specifically and immediately. Breaking down issues and dealing with each one from the easiest to handle to the most difficult will get the best result.

So I am first year, 2nd term nursing student - I have an assignment and I'm on the last two questions and I'm stuck. I think I over think things. When its not exact I get lost. This is about Maslow Theory --and its a subject that I think you can have numerous answers to --and the more I look at the more it seems like they are all right. The case study is below --and my teachers last question is 1.Compare Patients current needs to each level of the pyramid. And explain whether or not they are being met. 2. How would you help her meet her needs on each level of the pyramid as a nurse? I've jotted below the case study my work in progress of the list I'm working on --can you tell me -am I heading in the right direction? Am I over complicating this? She is looking for a min. of 16 needs. Is there a need I may be missing given she is a stroke patient? Help if you can... Case Study Mrs. Rose Henderson, 76 was admitted to your long term care facility as she was no longer able to care for herself at home. Mrs. Henderson is a retired school teacher having taught grades 8 and 9 for 35 years. She married her husband, George, in 1956. The couple had no children of their own, but enjoyed spending time with their 2 nieces and 3 nephews. George passed away last year. Rose stayed in the home with her 2 cats but found caring for the property too much for her. She sold her home and moved to a senior's apartment 6 months ago. She liked her apartment but really missed her gardens. Rose's only sister, Violet age 80, lives 2 hours away and tries to visit with Rose every month. Her nieces and nephews are now middle age and have busy lives. Three of them have moved to other provinces and visit their aunt on holidays. Two months ago, Rose suffered a stroke and now has right sided weakness. She was admitted directly from the hospital and never returned to her apartment. Her cats were sent to new homes. She is wheelchair bound as she can no longer walk independently. Rose can bear weight for a short period of time. She has expressive dysphasia but understands what is said to her. Her stroke has left her with difficulty in swallowing her food and drinks. Her right eye and the right side of her mouth droop from the stroke. Her vision is impaired on the right side. She is right handed but now has very little control of her right arm. Initially, Rose seemed to settle into her new environment quite well. She enjoys socializing and seemed excited when local school children visited the home. Rose likes to read but finds the print too small and it strains her eyes. She attends church every Sunday, even though the service is an all denomination service and Rose is a devoted Catholic, she enjoys it anyway. As time passes, the children and other residents spend less time with Rose. They have trouble understanding her due to her speech problems. Rose started to spend more time in her room reading (as best as she could), and now has lost interest in her books and sits by the window in her room most of the time staring out. Rose's attendance to church is now sporadic, and she returns to her room immediately after meals, if she comes for her meals at all. She makes odd comments such as "look at that" when she looks into the mirror. She has lost 10 pounds since her admission to the facility. Rose used to participate in her personal care but now you find that you are doing all of it. --------------------------------------------------- My work in progress (answer): Physiological 1. Oxygen Yes being met -vitals 2. Food / Nutrition No – see if you can get her eating, ensure proper nutrition, feeding tube 3. Shelter Yes 4. Water ? doesn't say 5. Sleep ? doesn't say 6. Health (I have a chart saying this is safety but with a stroke patient would this not be Physiological- basic need given her symptoms) 7. Activity and Exercise (does this or should this go here?) Personal care? Safety – 8. Vision - No 9. Speech - No 10. Mobility - Yes with a wheelchair? 11. Predictability, stability, and familiarity – probably not 12. feeling safe and comfortable and trusting other people - probably not Love and Belonging Needs – When the needs for safety and for physiological well-being are satisfied, the next class of needs for love, affection and belongingness can emerge. Maslow states that people seek to overcome feelings of loneliness and alienation. This involves both giving and receiving love, affection and the sense of belonging. 13. Friendship – No 14. Family – No arrange visits 15. Religion -No encourage attendance or find a way for her to watch church service at facility 16. Acceptance and understanding -No 17. Loving and affection – the need both to get and give love -No 18. Intimacy – the need to share inner thoughts with others in close, caring ways. -No Self-esteem Needs -When the first three classes of needs are satisfied, the needs for esteem can become dominant. These involve needs for both self-esteem and for the esteem a person gets from others. Humans have a need for a stable, firmly based, high level of self-respect, and respect from others. When these needs are satisfied, the person feels self-confident and valuable as a person in the world. When these needs are frustrated, the person feels inferior, weak, helpless and worthless 19. Self –esteem . -No 20. Confidence . -No 21. Achievement . -No 22. Respect of others . -No 23. Respect by others . -No Self-fulfilled (Self-actualized) -When all of the foregoing needs are satisfied, then and only then are the needs for self-actualization activated. Maslow describes self-actualization as a person's need to be and do that which the person was "born to do." "A musician must make music, an artist must paint, and a poet must write." These needs make themselves felt in signs of restlessness. The person feels on edge, tense, lacking something, in short, restless. If a person is hungry, unsafe, not loved or accepted, or lacking self-esteem, it is very easy to know what the person is restless about. It is not always clear what a person wants when there is a need for self-actualization 24. Morality? -No 25. Creativity and Spontaneity-No 26. Problem solving-No 27. Lack of prejudice or acceptance of facts-No caregivers help them understand these changes are due to the stroke and emphasize that a more upbeat or typical personality should return

Question 1 What events and changes occurred in Patient's life? How have the patient needs changed? My teacher says there are 18-20 changes. My thoughts: However I'm questioning if I'm repeating some or if they are more of a guess of a symptom then a change? What are your thoughts? 1. Patient is accustom to independent in life-fear of being a burden 2. A leader –teaching –change in work 3. Used to feeling busy and surrounded by kids in school 4. Retirement – doesn't say if it was something patient was looking forward to –large change and many feel like they have lost purpose 5. Loss /Grief–and possibly even more heightened with no children. Spouse and Patient together a long time 6. Stress to remaining individual decline in income 7. Age of patient and no mention of friends – many may have passed or relocated –social support 8. Self-Worth 9. Speech problems- feeling understood 10. Social connection 11. Weakness –one side on body. Mobility need assistance 12. Trouble swallowing 13. Feeling sad, blue, or down in the dumps. 14. Loss of interest in things that the person used to enjoy. 15. Aging with no children –support system 16. Losing pet 17. No access to gardening –changes in leisure 18. A stroke 19. Alone 20. Changes in body image with a stroke 21. Feeling worthless or guilty. 22. Decrease in appetite or weight. 23. Nutrition 24. Vision loss- Reading 25. Personal Care

Patient, 74 was admitted to long term as was no longer able stay at home. Patient was a retired school teacher having taught grades 5 and 9 for 30+ years. Married in 1954. The couple had no children of their own Patient did have nieces and nephews in their life when young. Spouse passed away last year. Patient stayed in the home with her cat/dog but found caring for them hard. She sold her home and moved to a senior's complex 8 months ago. Patient misses backyard and gardening. Patient has brother age 83, lives 3 1/2 hours away and tries to visit monthly. nieces and nephews are middle age and have busy lives. Most moved to other provinces and visit only at holidays. Three months ago, Patient suffered a stroke and now has right sided weakness. admitted directly from the hospital and never returned home. Animals were sent off to new owners. Can no longer walk independently, in a wheelchair -can bear weight for a short period of time. Patient has expressive dysphasia but understands what is said. difficulty in swallowing food and drinks. vision is impaired on the right side. Patient initially seemed to settle into her new environment quite well. Enjoyed socializing and seemed excited when school children visited . Patient likes to read but finds the print too small . attends church every Sunday. As time passes, the children and other residents spend less time with Patient. They have trouble understanding patient due to speech problems. Patient started to spend more time in room reading (as best as they could), and now has lost interest in books and sits by the window in the room most of the time staring out. Patient's attendance to church is now sporadic, and they returns to the room immediately after meals, if they comes for meals at all. Patient makes odd comments such as "look at that" when looking into the mirror. Patient has lost 12 pounds since admission to the facility. Patient used to participate in her personal care but now you find that you are doing all of it. Please answer the following questions: What events and changes occurred in Patient's life? How have the patient needs changed? Compare Patients current needs to each level of the pyramid. And explain whether or not they are being met. How would you help her meet her needs on each level of the pyramid as a nurse? Please choose interventions that would be appropriate and realistic.