Nursing school involves constant mental emersion into the facts and physiology of the human body. As a student, you begin thinking of everything in medical terms: nearsightedness is myopia, vomit is emesis, urination is voiding, and pregnancy becomes gravidity.
You write “hypertension” (high blood pressure) so much that you just start abbreviating it “HT.” You feel the need to educate people and begin thinking things like, “Sir, please step away from the doughnut or your glucose level is going to skyrocket.”
One aspect of nursing care is to state a diagnosis that follows a specific format. For instance, if a patient is a raging alcoholic, the proper diagnosis would go something like this: Ineffective health maintenance related to cognitive impairment as evidenced by voiding into neighbor’s potted plant at 03 00 hours. Well, something like that.
A few of us students like to have a little fun with these diagnoses. A bad driver has a knowledge deficit related to inferior genetic heredity as evidenced by failure to yield in the face of oncoming traffic. If we get a low test grade, we have suffered from an altered self-image related to ineffective studying as evidenced by a failure to pass exam.
Sometimes, I think the nursing student is armed with just enough information to be a danger to ourselves, because, as we travel through each body system, we begin to think differently about those old, familiar aches and pains that have been experienced throughout our lives.
Everything is now under a cloud of suspicion: a pain in the chest becomes a pulmonary embolism, a blemish turns into a potential staph infection, and an ache to the right side of our upper abdomen accompanied by intense sweating has developed into symptomatic cholelithiasis (gallstones), which will undoubtedly result in a cholecystectomy (surgical removal of the gallbladder). It doesn’t help that I know 2 people in class, close to my own age, who have had this surgery.
A couple weeks ago, I received a concerned phone call from a female who I’ll call “Jane” to protect her identity. She exhibited a blue coloring on her right arm that spanned from her inner wrist up to her biceps. I told her she should head to my house so I could look at it and run her to the hospital if needed.
When she arrived, I grasped her hand to observe the cyanotic coloring of her wrist. I was shocked that it was ice cold, but when I expressed this, Jane said, “I just had the air-conditioning in my car on high and it blows right on my hands.” Relieved, I felt her pulse which was normal and inspected the affected areas of her arm.
We immediately ruled out a ruptured vein, which could pool blood into the surrounding tissue, because her veins felt and appeared fine, not to mention that the color was all wrong.
After scratching our heads for a while, I noticed a spot on her shirt. I said, “Jane, what is that on your shirt?” She looked down and turned a deep shade of “embarrassment red” before erupting into laughter.
“I had my blue folder under my arm when I ran out into the rain to get to my car! This blue is from my folder!”
Relieved and giggling, we both decided that this story should never be told in case a potential employer should question our nursing capabilities. I waited a week before begging her to let me write about it. She agreed on one condition: don’t use her name.
Nursing diagnosis: Impaired thought process related to medical information overload as evidenced by failure to recognize the most obvious conclusion.
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