[Daytonite]

Originally Posted by greenfaery

Hello all. I wanted to do a care plan with the diagnosis of self-care deficit for my quadriplegic patient who needs assistance for bathing, dressing, feeding, toileting, but I noticed they have a separate diagnosis for each area of deficit (hygiene, dressing, feeding, toileting) So my question is: am I allowed to combine them all into one diagnosis and one care plan?? Or do I have to do a separate diagnosis/plan for each one?

You can do it either way. If you combine them all into one, you will have a huge problem with a lot of nursing interventions that may or may not be all mixed up unless you clearly delineate and organize the way you present them.

In any case, since you are a student and your care plan is most likely going to be graded, I would check with your instructors before you make any decision about combining the self-care deficits. Your instructors may not let you do this.

[SCaregivr]

I could use some help- for some reason I'm having trouble with outcome criteria. My patient's medical dx was hypercalcemia d/t hyperparathyroidism. My nursing dx is Acute confusion rt electrolyte imbalance and dehydration aeb increased calcium level and hypovolemia.

These are my outcomes:
pt will demonstrate restoration of cognitive status to baseline
pt will obtain adequate amount of sleep
pt will maintain optimal hydration and nutrition

I don;t think this looks very good, and I can;t even come up with a short term goal to go along with it. I really didn;t do well on my last care plan due to this, so I'd like to at least make some progress. Can anyone give me some hints? Please?

[Daytonite]

Originally Posted by SCaregivr

I could use some help- for some reason I'm having trouble with outcome criteria. My patient's medical dx was hypercalcemia d/t hyperparathyroidism. My nursing dx is Acute confusion rt electrolyte imbalance and dehydration aeb increased calcium level and hypovolemia.

These are my outcomes:
pt will demonstrate restoration of cognitive status to baseline
pt will obtain adequate amount of sleep
pt will maintain optimal hydration and nutrition

I don;t think this looks very good, and I can;t even come up with a short term goal to go along with it. I really didn;t do well on my last care plan due to this, so I'd like to at least make some progress. Can anyone give me some hints? Please?

I recently wrote very specific information on what a goal (outcome) should be. It is on post #157 of this thread: http://allnurses.com/forums/f50/care...121128-16.html

In looking at the information you have posted, the primary reason that I see that you are having problems is that I cannot tell what you are basing your outcomes on. Outcomes, or goals, are the predicted results of our independent nursing actions (nursing interventions). Since you've listed none of your nursing interventions I can't tell whether these are good outcomes or not. Also, you cannot equate what you are doing as a nurse for a patient's problems with their medical diagnosis. That makes no sense. A doctor doesn't treat based on nursing problems and a nurse shouldn't treat based on medical problems either. We assess the patient for different things than the doctor does.

Please read the information on the post I listed above and I think that if you follow the information that is given there you will be able to write outcomes that you will be satisfied with. One thing that you must understand about care plans is that they are primarily based upon the assessment information that you gained. Everything you do in the planning stage of the care plan (formulating the outcomes and the nursing interventions) is based upon the symptoms, or abnormal assessment data, you obtained during assessment and has very little to do with the medical diagnosis except where some symptoms may be the same. Keep in mind that you are developing outcomes and nursing interventions for the patient's symptoms, so you need to be very clear about what the patient's symptoms are and you should have developed a list of them back when you were determining what nursing diagnoses to use.

And, by the way, your nursing diagnostic statement Acute confusion rt electrolyte imbalance and dehydration aeb increased calcium level and hypovolemia is not put together correctly. You've diagnosed this incorrectly. The definition of Acute Confusion is Abrupt onset of reversible disturbances of consciousness, attention, cognition, and perception that develop over a short period of time. (page 41, NANDA-I Nursing Diagnoses: Definitions & Classification 2007-2008). Your AEB items should be the symptoms that support this definition. Do increased calcium and hypovolemia make you think immediately that the patient is confused? I don't think so! What you have described in your diagnostic statement is dehydration and belongs with this diagnosis: Deficient Fluid Volume R/T active fluid volume loss AEB increased calcium level of ___ and confusion. Since you mention that this patient is dehydrated, I would also include other symptoms of the dehydration since there is bound to be more than just a low calcium level and confusion. Look at the defining characteristics (symptoms) that are listed with this diagnosis to see if you missed something in assessing this patient: Deficient Fluid volume (this is a link to a nursing diagnosis page from a nursing diagnosis book)

When you are determining nursing diagnoses, you need to use a nursing diagnosis reference of some sort either from a care plan book, a nursing diagnosis book, or the reference I listed above and check to make sure that the definition of the diagnosis, the related factors (etiology) and defining characteristics (symptoms) that are listed in the reference match with your patient. If they don't, then you can't diagnose the patient with it.

If you still want to use a nursing diagnosis of Acute Confusion for this patient you will have to restructure your nursing diagnostic statement. NANDA lists the related factors for this diagnosis as being the following (page 41, NANDA-I Nursing Diagnoses: Definitions & Classification 2007-2008) and your patient must have one of these etiologies:

• alcohol abuse
• delirium
• dementia
• drug abuse
• fluctuation in sleep-wake cycle
• over 60 years of age

Dehydration and electrolyte imbalance is not an etiology that they include for confusion. Therefore, your patient's confusion is more likely a symptom of his dehydration and belongs with Fluid Volume Deficit unless he has one of these other etiologies for the confusion. Then, you need to have symptoms that prove the confusion. NANDA lists the symptoms as (page 41, NANDA-I Nursing Diagnoses: Definitions & Classification 2007-2008):

• fluctuation in cognition
• fluctuation in level of consciousness
• fluctuation in psychomotor activity
• hallucinations
• increased agitation
• increased restlessness
• lack of motivation to follow through with goal-directed behavior
• lack of motivation to follow through with purposeful behavior
• lack of motivation to initiate goal-directed behavior
• lack of motivation to initiate purposeful behavior
• misperceptions

Notice that you don't see the symptoms of increased calcium levels or hypovolemia listed there.

[elizabetta]

Hello everyone,

I am working on a caremap for a young women who just had a vaginal birth. I need to include diagnoses that include the families strengths? I was thinking of using effective breast feeding r/t infants weight gain
Would my goal/outcomes be : mother able to pick up on infants cues when hungry, decreased nipple soreness could be a sign of proper attachment to nipple. Mom states "it is going well" with a confident smile. I wouldn't have any interventions or evaluations right? I feel like I'm missing something. I'm not use to having patients that are doing this well. If someone could shed some light on this for me I'd appreciate it!

Also if you could think of any "positive: ND I'd appreciate it. Thank you!

Elizabeth

[Daytonite]

Originally Posted by elizabetta

Hello everyone,

I am working on a caremap for a young women who just had a vaginal birth. I need to include diagnoses that include the families strengths? I was thinking of using effective breast feeding r/t infants weight gain
Would my goal/outcomes be : mother able to pick up on infants cues when hungry, decreased nipple soreness could be a sign of proper attachment to nipple. Mom states "it is going well" with a confident smile. I wouldn't have any interventions or evaluations right? I feel like I'm missing something. I'm not use to having patients that are doing this well. If someone could shed some light on this for me I'd appreciate it!

Also if you could think of any "positive: ND I'd appreciate it. Thank you!

Elizabeth

You are barking up the wrong tree here. Effective Breast Feeding is a diagnosis has to do with the physiological need of nutrition and not with the family's strength.

Nursing diagnoses that might specifically apply to the family strength are:

• Readiness for Enhanced Family processes (NANDA definition: A pattern of family functioning that is sufficeint to support the well-being of family members and can be strengthened)
• Readiness of Enhanced Parenting (NANDA definition: pattern of providing an environment for children or other dependent person/s that is sufficient to nurture growth and development and can be strengthened.)
• Readiness for Enhanced Knowledge (specify) (NANDA definition: The presence of acquisition of cognitive information related to a specific topic is sufficient for meeting health-related goals and can be strengthened.)

In order to use any of them you need to look at a nursing diagnosis reference book that has these particular nursing diagnoses in it, look the definitions (I've already given them to you), defining characteristics and related factors of each to see if and how you can use them to fit in with your patient situation.

[Daytonite]

NANDA defines psychosocial as promoting optimal mental and emotional health and social functioning.

There are some other definitions with regard to the diagnoses listed below (page 259, NANDA-I Nursing Diagnoses: Definitions & Classification 2007-2008):

"The subject of the diagnosis is defined as the person(s) for whom a nursing diagnosis is determined. . .

• Individual: A single human being distinct from others, a person.
• Family: Two or more people having continuous or sustained relationships, perceiving reciprocal obligations, sensing common meaning, and sharing certain obligations toward others; related by blood and/or choice
• Group: A number of people with shared characteristics
• Community: A group of people living in the same locale under the same governance. Examples include neighborhoods and cities.

When the subject of the diagnosis is not explicitly stated, it becomes the individual by default."

Here are the psychosocial nursing diagnoses organized by class in the NANDA II taxonomy:

• Class: Behavior
  • Ineffective Health Maintenance
  • Health-seeking Behaviors
  • Noncompliance
  • Effective Therapeutic Regimen Management
  • Ineffective Therapeutic Regimen Management
  • Ineffective Community Therapeutic Regimen Management
  • Ineffective Family Therapeutic Regimen Management
  • Readiness for Enhanced Therapeutic Regimen Management
• Class: Communication
  • Impaired Verbal Communication
  • Readiness for Enhanced Communication
• Class: Coping
  • Risk-prone Health Behavior
  • Decisional Conflict
  • Ineffective Coping
  • Ineffective Community Coping
  • Readiness for Enhanced Community Coping
  • Defensive Coping
  • Compromised Family Coping
  • Disabled Family Coping
  • Readiness for Enhanced Family Coping
  • Ineffective Denial
  • Grieving
  • Complicated Grieving
  • Risk for Complicated Grieving
  • Post-Trauma Syndrome
  • Risk for Post-Trauma Syndrome
  • Rape-Trauma Syndrome
  • Rape-Trauma Syndrome: Compound Reaction
  • Rape-Trauma Syndrome: Silent Reaction
  • Relocation Stress Syndrome
  • Risk for Relocation Stress Syndrome
  • Self-Mutilation
  • Risk for Self-Mutilation
  • Risk for Suicide
  • Risk for Self-Directed Violence
  • Readiness for Enhanced Coping
  • Stress Overload
  • Readiness for Enhanced Decision Making
• Class: Emotional
  • Anxiety
  • Death Anxiety
  • Fear
  • Hopelessness
  • Chronic Sorrow
  • Readiness for Enhanced Hope
• Class: Knowledge
  • Deficient Knowledge (specify)
  • Readiness for Enhanced Knowledge (specify)
• Class: Roles/Relationships
  • Risk for Impaired Parent/Child Attachment
  • Caregiver Role Strain
  • Risk for Caregiver Role Strain
  • Parental Role Conflict
  • Dysfunctional Family Processes: Alcoholism
  • Interrupted Family Processes
  • Impaired Parenting
  • Risk for Impaired Parenting
  • Ineffective Role Performance
  • Impaired Social Interaction
  • Social Isolation
  • Risk for Other-Directed Violence
  • Readiness for Enhanced Family Processes
  • Readiness for Enhanced Parenting
• Class: Self-Perception
  • Disturbed Body Image
  • Disturbed Personal Identity
  • Risk for Loneliness
  • Powerlessness
  • Risk for Powerlessness
  • Chronic Low Self-Esteem
  • Situational Low Self-Esteem
  • Risk for Situational Low Self-Esteem
  • Readiness for Enhanced Self-Concept
  • Readiness for Enhanced Power
  • Risk for Compromised Human Dignity

(The above listing is from pages 289 - 293 of NANDA-I Nursing Diagnoses: Definitions & Classification 2007-2008.)

As always, to use any of these diagnoses you should also consult the most currently published nursing diagnosis reference book that you can find that contains all the current NANDA diagnoses in order to make sure that you are matching patients signs and symptoms (defining characteristics) with the correct diagnosis. A good many of the above diagnoses will not appear in care plan books that only address common medical/surgical conditions.

[HM3 S. Collins, SPN]

DX prioritization....Desperately need help with careplans
permalink

HELP!
I have a pt admitted for interstitial pneumonia, and has anemia- low H&H and metastatic cancer of unknown origin, he has low prealbumin, protein malnutrition, hyponatremia, crackles in RLL, inspiratory wheezes in RUL, LUL, and LLL. He is on 12L O2 NC and has a O2 sat of 90-93%.

I have some nursing dx's thought of but not sure about the r/t part and which ones to use and in which order I need 3.
impaired gas exchange - What is the r/t part that I should include ?
Ineffective airway clearance- What is the r/t?
imbalanced nutrition less than body requirements- What is the r/t part? the man has a normal bmi but has protein malnutrition!
deficient knowledge r/t ? aeb pt asking why he is on steroids,
activity intolerance r/t ?
Chronic pain is r/t chronic disease process okay? he has met Ca in his bones- high WBC, low RBC, low H&Hbarely low Na+, and slightly high glucose- non fasting.

Can I use infection as a nursing dx or only risk for infection?
Any help would be greatly appreciated!

[Daytonite]

Originally Posted by HM3 S. Collins, SPN

DX prioritization....Desperately need help with careplans
permalink

HELP!
I have a pt admitted for interstitial pneumonia, and has anemia- low H&H and metastatic cancer of unknown origin, he has low prealbumin, protein malnutrition, hyponatremia, crackles in RLL, inspiratory wheezes in RUL, LUL, and LLL. He is on 12L O2 NC and has a O2 sat of 90-93%.

I have some nursing dx's thought of but not sure about the r/t part and which ones to use and in which order I need 3.
impaired gas exchange - What is the r/t part that I should include ?
Ineffective airway clearance- What is the r/t?
imbalanced nutrition less than body requirements- What is the r/t part? the man has a normal bmi but has protein malnutrition!
deficient knowledge r/t ? aeb pt asking why he is on steroids,
activity intolerance r/t ?
Chronic pain is r/t chronic disease process okay? he has met Ca in his bones- high WBC, low RBC, low H&Hbarely low Na+, and slightly high glucose- non fasting.

Can I use infection as a nursing dx or only risk for infection?
Any help would be greatly appreciated!

I gave you an extensive answer to your questions and put it into it's own thread. You can view the answer here: http://allnurses.com/forums/f205/nur...ne-276459.html

[mybabyjhay]

please someone help me

[motan_shmecker]

hi
i am a working mom who is going to school to become lpn, i need some case study for neuro, gu, endocrine....i am busy and i don't have time to reserch, if some one has and wants to share i will appreciate, thank you ds