[cutegurl]

pls help me. i dont have any reference thats why i dont know how to make a care plan. pls help me. my deadline is tomorrow

[Daytonite]

Originally Posted by cutegurl

pls help me. i dont have any reference thats why i dont know how to make a care plan. pls help me. my deadline is tomorrow

I already gave you some of an answer on your post to this thread:

• http://allnurses.com/forums/f50/careplans-help-please-r-t-aeb-121128-7.html - CAREPLANS HELP PLEASE! (with the R\T and AEB) (in General Nursing Student Discussion Forum)

However, now I'm worried. If you don't have a care plan book and do not know the sequence of steps to writing a care plan, you may not be able to complete this by tomorrow. Here are some links to information about what a care plan is. The best thing you can do is to try to find a care plan book in your school library if you cannot afford to buy one. The first pages of most care plan books discuss how to write a care plan. This information is crucial to know.

• http://home.hiwaay.net/~theholt1/NURS1100/careplan.htm - this is a care plan guideline from the nursing department of Fairleigh Dickinson University with instructions on composing your diagnosis, goals, interventions and evaluations. Includes links on suggestions for conducting interviews with patients and Gordon's 11 Functional Patterns.
• http://home.cogeco.ca/~nursingprocess/index.htm - the nursing process is the basis of the nursing care plan. You must understand the nursing process to understand how a care plan is constructed
• http://nursing.about.com/od/nursesgeneralinfo/a/nursingprocess.htm - The Nursing Process. A short article explaining what the nursing process is.
• http://www.childbirths.com/euniversity/nursingprocess.htm - The Nursing Process and writing nursing care plans. From e-University
• http://www06.homepage.villanova.edu/elizabeth.bruderle/1103/nursingprocess.htm - The Nursing Process

These are two former threads on which I explained how to set up a care plan:

• http://allnurses.com/forums/f205/myocardial-infarction-nursing-care-plan-223788.html#post2200663
• http://allnurses.com/forums/f50/need-help-dreaded-care-plan-please-223744.html

Please keep in mind that every care plan is customized to the patient. Therefore, you are unlikely to find many samples for any particular type of condition on the Internet. If you do, your instructor is going to know in a minute that you copied it from somewhere!

[Angie123]

Can anyone help me with 2 nursing diagnosis relating to pneumonia? I choose activity intolerance and infection.

[Daytonite]

Originally Posted by Angie123

Can anyone help me with 2 nursing diagnosis relating to pneumonia? I choose activity intolerance and infection.

Please read some of the posts in this thread. The only way you can "choose" any nursing diagnoses is if your patient with pneumonia has the symptoms that match with those nursing diagnoses.

The symptoms (defining characteristics) of Activity Intolerance are:

• abnormal blood pressure response to activity
• a abnormal heart rate response to activity
• electrocardiographic changes reflecting arrhythmias
• electrocardiographic changes reflecting ischemia
• exertional discomfort
• exertional dyspnea
• verbal report by the patient of fatigue
• verbal report by the patient of weakness

The definition of this diagnosis is "insufficient physiological or psychological energy to endure required or desired daily activities". All of this above information comes directly from page 3 of NANDA-I Nursing Diagnoses: Definitions & Classification 2007-2008 published by NANDA International. Your patient should primarily be having shortness of breath upon physical activity and possibly arrhythmias and evidence of cardiac ischemia (chest pain, cyanosis, irregular heart rates). If this is not the case, then you shouldn't use this nursing diagnosis. If your patient has dyspnea on exertion, your nursing diagnostic statement would be written like this: Activity Intolerance (nursing diagnosis) related to exertional dyspnea (related factor) secondary to pneumonia as evidenced by shortness of breath upon ambulating 10 steps to the bathroom (patient symptom; abnormal assessment data item).

There is no official NANDA nursing diagnosis of Infection. Infection is a medical decision and medical diagnosis. You can, however, use nursing diagnoses for the manifested symptoms that the patient has of the infection, such as fever, leukocytosis (elevated white blood cell count), redness at a localized site of infection along with heat, pain, edema and sometimes loss of function due to the pain and swelling. (Review the inflammatory response in a reference book on pathophysiology.) These symptoms you can develop nursing diagnoses for and, subsequently, nursing interventions.

[danibanani]

I think those interventions are great! You are going to make one heck of a teaching guide for the new mommies!

I'm attaching some of my teaching careplans for when I went through OB. I hope you can get some ideas from them.

Dani.

[nikks]

Scenario: Female (36), fever, shortness of breath on occasion with frequent and productive cough. Wheezes in both LL.She has been sick for 3 weeks, cries easily and several bruises on both forearms

Diagnosis:
1.Elevated body temp r/t illness emb vital sign
2.Ineffective breathing r/t airway obstruction emb productive cough and lung sounds
3.Anxiety r/t illness emb pt's crying.

The question is what about bruises, I think it from previous treatment?
How do I state it?

[amak]

interesting on what you have said about Asthma. I am little curious to know what kind of the lab work would be done on Asthma? & what how this lab work would differ from normal lab works. Thanks.

Originally Posted by Daytonite

The first step in choosing a nursing diagnosis involves assessing the patient. Any nursing diagnosis is ALWAYS based upon the signs and symptoms the patient is having. These signs and symptoms are abnormal assessment items. Depending on how thorough your assessment of the patient is will determine how well your care plan is going to attend to the patient's problems.

With asthma, the patient is, in general, going to have these symptoms in order as an asthma attack worsens:

• hacking, non-productive cough (due to bronchial edema)
• restlessness
• diaphoresis
• only able to speak in short, broken phrases
• eventually the cough become productive of frothy, clear sputum
• breathlessness
• chest tightness
• dyspnea (shortness of breath)
• use of accessory respiratory muscles
• hyperresonance
• tachycardia
• some mild systolic hypertension
• inspiratory and expiratory wheezes
• crackles (as spasm and obstruction worsen)
• prolonged expiratory phase of respiration (due to bronchospasm)
• mucusal edema
• mucus plugging with mucus trapped behind airways that are narrowed or occluded
• diminished breath sounds
• cyanosis, lethargy, confusion and hypoxemia (as the patient proceeds to status asthmaticus or respiratory failure)

Based upon one or more of these above symptoms being present, nursing diagnoses that would be appropriate to use, in priority order, would be:

• Gas Exchange (abnormal skin color, confusion, cyanosis, diaphoresis, shortness of breath, hypoxemia, tachycardia, abnormal blood gases) - this diagnosis is generally used when there is hypoxia, hypoxemia or the patient is getting close to it
• Ineffective Breathing Pattern (alterations in the depth of breathing, shortness of breath, orthopnea, prolonged expiratory phase of expiration, use of accessory respiratory muscles to breathe) - the act of breathing is not providing enough air
• Ineffective Airway Clearance (any kind of cough, ineffective cough, any kind of adventitious breath sounds, any kind of changes in the rate or rhythm of the respirations, difficulty speaking due to breathing Impaired, excessive sputum production) - this diagnosis is when the person is having difficulty clearing secretions from the respiratory passages in order to maintain a clear airway
• Fear (fear of suffocation or death) - threats to the self that the patient recognizes as dangerous
• Anxiety (obsessive tinkering with oxygen equipment, over attention to medication, treatment, physical symptoms) - warnings of impending danger causing patient to take measures to deal with threats

Examples of a nursing diagnostic statements using the above nursing diagnoses for an asthmatic patient might be:

• Impaired Gas Exchange related to alveolar-capillary membrane changes as evidenced by cyanosis, lethargy, confusion and hypoxemia
• Ineffective Breathing Pattern related to fatigue as evidenced by prolonged expiratory phase of respiration, shortness of breath and the use of accessory respiratory muscles to breathe.
• Ineffective Airway Clearance related to airway spasm as evidenced by diminished breath sounds with inspiratory and expiratory wheezes and shortness of breath.
• Fear related to threat of suffocation as evidenced by increased excitement and statements of "I'm not getting enough air!"
• Anxiety related to fear of suffocation as evidence by patient constantly checking to make sure oxygen tubing is correctly positioned and asking what the setting of the oxygen flow is.

It would be very useful to have a book of nursing diagnoses or care plans that include the NANDA definitions, defining characteristics and related factors since NANDA is very specific about how each of the nursing diagnoses should be used.

[Daytonite]

Originally Posted by amak

interesting on what you have said about Asthma. I am little curious to know what kind of the lab work would be done on Asthma? & what how this lab work would differ from normal lab works. Thanks.

This web page shows you what lab tests will be ordered by a physician for a patient with asthma. You will need to refer to a lab reference book to determine what the normal values of these tests are:

• http://www.fpnotebook.com/LUN16.htm

[Daytonite]

Originally Posted by nikks

Scenario: Female (36), fever, shortness of breath on occasion with frequent and productive cough. Wheezes in both LL.She has been sick for 3 weeks, cries easily and several bruises on both forearms

Diagnosis:
1.Elevated body temp r/t illness emb vital sign
2.Ineffective breathing r/t airway obstruction emb productive cough and lung sounds
3.Anxiety r/t illness emb pt's crying.

The question is what about bruises, I think it from previous treatment?
How do I state it?

Risk for Infection R/T traumatized tissue on both forearms

[gemini_star]

Originally Posted by Daytonite

Critical thinking is very simply making judgments based on facts rather than making random guesses based on nothing. Some of the steps in the nursing process provide you with the facts you need to continue onward to make judgments in the later steps. Critical thinking is nothing more than reasoned, logical thinking where each step of the process has rationale supporting it.

As you work through the steps of the nursing process for just one nursing diagnosis ask yourself these questions: What did I find in the patient's chart about him that wasn't normal? What did I find during my assessment that wasn't normal? What are those abnormal things telling me? If I put all those abnormal things together, do some of them look like they might belong together or be related in some way? What's causing them? When I look at this particular nursing diagnosis I see some of my patient's symptoms listed with it? Is this one of my patient's nursing diagnoses? I see that one of the related factors (cause) for this nursing diagnosis is something my patient has as well. That makes sense that this is the cause of these abnormal symptoms that the patient has. This sounds like it might be the correct nursing diagnosis because my patient has some of the symptoms that are listed with this diagnosis. Now, what about goals? Well, I want to see his symptoms get better, right? So, my goals are going to focus on how his symptoms are going to get better or go away. To do that, I'll need to choose nursing interventions to help that happen. Let's see, the first symptoms is ____. What, as a nurse, can I do for that? If I do this intervention, is that going to make the problem better or worse?

That is critical thinking. Taking facts you have and making some judgment and decision in working with them. That is how you use critical thinking skills to use the nursing process. Now, I know I may have exaggerated a bit, but I was trying to demonstrate to you the kind of thinking process that should be going on in your mind. When you've been a nurse for a while this critical thinking process of the nursing process happens so fast, that you'll miss it if you don't think about it. It will go painfully slow for you at first because doing this is all new to you. What you do is just follow the steps and keep asking yourself those questions as you go through each and every symptom every one of your patients has. Over your career you will do this thousands of times. The care plan is nothing more than the written documentation and evidence of your critical thinking.

Does that help you out?

Wow! I finally understood critical thinking. If not for your questions and exaggeration, I will still be clueless. I really appreciate your help here. Hope you stay around.