[Daytonite]

Originally Posted by chevyv

. . .our instructor has informed us that for the next 2 [care plans] she wants collaborative care plans done. HUH!! With no etiology and more medical, I'm lost. She gave us the example of a pt not able to get out of bed our diagnosis would be P.C. (potential complication): pulmonary embolism.
I'm so used to using r/t and not focusing on the medical problem per se but what nursing can do for this pt. None of my care plan books have collaborative dx and I have to say I'm in a pickle. Is there anyone out there that can pass on pearls of wisdom? Thanks to all.

Are you sure you got the instructions right? Perhaps you need to see this instructor during her office hours to get a better explanation about this assignment from her.

There is no such thing as a "collaborative diagnosis" as far as I know. There are actual and potential diagnoses.

However, there are two kinds of nursing interventions: independent and collaborative nursing interventions.

• Independent nursing interventions are those specific actions that a nurse can prescribe, or order, for a patient that do not require a physician order. These are things such as assisting patients with performing their ADLs, seeing to their safety and comfort and teaching.
• Collaborative nursing interventions are those things nurses can only do for patients with an order of a physician or another healthcare provider—things like administer medications or provide certain treatments, etc. Or, they are actions that require you to work with another professional of the health team who has to initiate the intervention(s). This includes such professionals as the doctor, dietician, physical therapist, respiratory therapist, pharmacist, speech therapist, lab tech, etc.

I would imagine that in your care plan, your nursing interventions will include what my instructors used to call management type nursing interventions where you make sure that contact and referral to the appropriate licensed healthcare professionals is made and that their plans of care are brought in and merged/followed with the nursing care plan. This is the case management function of the RN.

By extrapolation, a collaborative problem would be one that requires the skills of a team of healthcare professionals rather than only the independent skill of the registered nurse. The treatment of most medical diagnoses or complications of medical care will involve a host of healthcare disciplines. Some examples of collaborative problems would be:

• infected wounds
• seizures
• gastric ulcers
• stroke
• emphysema

[rwright15]

Okay, I don't really know where to post this so I will try here first... I am in L&D rotation right now. I have to do a careplan on a post op cesarean pt. I did one last week on acute pain, and risk for infection... So I would like to do something else for this one. She is a 25yowf, antepartum labs are HGB 4.25, HCT 33.3, PLTS 209... blood loss during surgery was >500mL. I was thinking risk for anemia/iron deficiency something along the lines of this. She has symptoms of PICA, requesting large amts of ice, and stating that she "eats it all the time"... There is nothing in her chart substanciating this, just a hunch. So, with the HCT being the only abnormal lab, can I do risk for anemia, or risk for hypovolemia? I have the 8th edition Nsg Dx handbook, but can find nothing along the lines of this in there. What would the correct NANDA dx be for this? I will probably do acute pain in addition to this, so which one would be highest priority? Any help would be much appreciated.... Thanks

[chevyv]

I was having problems coming up with the collaborative problem. Our instructor provided us with a list of collaborative problems, but nothing was fitting my data. What I ended up doing was using the collaborative DX only for what they applied to and using the risk for...as evidenced by for others. I'll get it back Monday and have to go from there. It just didn't seem possible to have all collaborative DX, but I am new to the collaborative care planning, so I'll let you know. Thanks for taking an interest in my ques.

[chevyv]

I'm getting a much better pic of the collaborative process. What I've figured out is that I've been calling it an collaborative DX, but it's just a colloborative problem that is put into the nursing DX column of the care plan. I'll find out for sure if I'm on the right track tomorrow. I'll let you know.

[Daytonite]

Originally Posted by rwright15

Okay, I don't really know where to post this so I will try here first... I am in L&D rotation right now. I have to do a careplan on a post op cesarean pt. I did one last week on acute pain, and risk for infection... So I would like to do something else for this one. She is a 25yowf, antepartum labs are HGB 4.25, HCT 33.3, PLTS 209... blood loss during surgery was >500mL. I was thinking risk for anemia/iron deficiency something along the lines of this. She has symptoms of PICA, requesting large amts of ice, and stating that she "eats it all the time"... There is nothing in her chart substanciating this, just a hunch. So, with the HCT being the only abnormal lab, can I do risk for anemia, or risk for hypovolemia? I have the 8th edition Nsg Dx handbook, but can find nothing along the lines of this in there. What would the correct NANDA dx be for this? I will probably do acute pain in addition to this, so which one would be highest priority? Any help would be much appreciated.... Thanks

Please read post #1 and post #2 of this thread. You need to go through, assemble and analyze this patient's assessment data.

By PICA, I assume you are meaning the eating disorder where a person will ingest anything that is not fit to be classified as human food such as grass, crayons, and I had a patient once who ate plaster. Water is a necessary biological need for our bodies. Ice is frozen water and eating it does not qualify as a symptom of pica. Additionally, being nurses we cannot medically diagnose! Pica is a medical diagnosis. All we can do is note the patient's behavior: "consumes large amounts of ice" which, to me, might be consuming large amounts of fluid depending on how much she is actually consuming and is this really a problem? Monitoring I&O would tell us right away.

A post op cesarean patient is basically a surgical patient subject to the complications of a patient who undergoes general or epidural anesthetic. I'm still talking about knowing the signs/symptoms/complications of

• the surgical procedure that was performed (the C-section)
  • http://www.surgeryencyclopedia.com/C...n-Section.html
  • http://www.childbirths.com/euniversity/mainpage.htm - all kinds of info on OB
  • http://www.emedicine.com/med/topic3283.htm
  • Complications of cesarean section
    • fever
    • redness, swelling or pain in one or both breasts
    • persistent abdominal tenderness
    • feeling of pelvic fullness or pressure
    • persistent perineal pain
    • frequency, urgency or burning on urination
    • increased amount, resumed bright red color, clots, or foul odor to lochia
    • tenderness, redness and warmth to a localized area of the legs
    • swelling, redness, drainage, or dehiscence of the surgical incision
• the type of anesthetic used
  • Complications of epidural anesthesia are:
    • hypotension
    • rash around the epidural injection site
    • nausea and vomiting from the opiates administered
    • pruritis of the face and neck caused by some epidural narcotics
    • respiratory depression up to 24 hours after the epidural
    • cerebrospinal fluid leakage and spinal headache from accidental
    • dural puncture
    • sensory problems in the lower extremities
  • Complications of general anesthesia are:
    • breathing problems (atelectasis, hypoxia, pneumonia,
      
    • pulmonary embolism)
      
    • hypotension (shock, hemorrhage)
      
    • thrombophlebitis in the lower extremity
      
    • elevated or depressed temperature
      
    • any number of problems with the incision/wound (dehiscence,
      
    • evisceration, infection)
      
    • fluid and electrolyte imbalances
      
    • urinary retention
      
    • constipation
      
    • surgical pain
      
    • nausea/vomiting (paralytic ileus)
      
• how this affected their ability to perform their ADLs (activities of daily living)
  
  • movement and walking - yes, they have pain, but how is it affecting their endurance, the amount of time they can be up and moving around at any one time period - this is activity tolerance and there is a nursing diagnosis relating to it
    
  • is the mother breast feeding? Whether she does or doesn't have problems with breastfeeding, there are three nursing diagnoses that address breastfeeding.
    
• the patient has an incision. What's being done for it? How will she know what to do in caring for it when she is discharged? Who's going to teach her?
  
• problems bonding with the infant?
  

After considering all these things, THEN you make a list of the actual symptoms she does have. That list is what you use to look for nursing diagnoses that having matching symptoms (NANDA calls them defining characteristics). Use a nursing diagnosis reference so you can see all the diagnoses that are available (there are currently 188 of them). There are a number of ways to get this information.

• Your instructors might have given it to you.
• You can purchase it directly from NANDA. NANDA-I Nursing Diagnoses: Definitions & Classification 2007-2008 published by NANDA International. Cost is $24.95 http://www.nanda.org/html/nursing_diagnosis.html
• Many authors of care plan and nursing diagnosis books include the NANDA nursing diagnosis information. This information will usually be found immediately below the title of a nursing diagnosis.
• There are also two websites that have information for about 75 of the most commonly used nursing diagnoses that you can access for free:
  • http://www1.us.elsevierhealth.com/Evolve/Ackley/NDH7e/Constructor/
  • http://www1.us.elsevierhealth.com/ME...ctor/index.cfm

[rwright15]

Thank you for all of this useful info. I am confused on the pica definition though. Not to argue, by no means can I possibly know more than an actual practicing nurse, but I thought that pica was a craving for anything that was of little nutritional value, food or non-food items. In fact, here is a little snippet from www.americanpregnancy.org
[What are typical pica cravings during pregnancy?

The most common substances craved during pregnancy are dirt, clay, and laundry starch. Other pica cravings include: burnt matches, stones, charcoal, mothballs, ice, cornstarch, toothpaste, soap, sand, plaster, coffee grounds, baking soda, and cigarette ashes.]

They state that a craving for items such as this might indicate an iron deficiency. So, what I am wondering, would it be a medical diagnosis still if we said risk for low blood volume r/t pregnancy ?? The only post surgical problem this pt had was pain. I may use self care deficit, but my instructor is always asking "what will kill your patient first".... In this case, all I can think of is the blood loss, and infection..... Thanks

[Daytonite]

Originally Posted by rwright15

I am wondering, would it be a medical diagnosis still if we said risk for low blood volume r/t pregnancy ?? The only post surgical problem this pt had was pain. I may use self care deficit, but my instructor is always asking "what will kill your patient first".... In this case, all I can think of is the blood loss, and infection..... Thanks

My advice is not to address pica. The actual problems this patient are going to have for sure are related to her incision and mobility. Then, she has potential problems related to possible complications (fluid loss due to blood loss, infection due to incision infection, thrombophlebitis if she is spending more time in bed than she should, UTI)

[rwright15]

Thank you so much, that sounds great!! I think I will go with mobility.... Thank you again for the wisdom. You are truly an asset to this website...

[Tota73]

Originally Posted by Daytonite

Other threads that talk about the nursing process and explain how care plans are put together. I put a lot of effort into writing the replies to these students and some of the information is copied and repeated because it is important:

• http://allnurses.com/forums/f205/help-nursing-care-plans-277791.html
• http://allnurses.com/forums/f8/desparately-need-help-care-plan-279187.html
  http://allnurses.com/forums/f205/need-help-w-1st-care-plan-please-help-286723.html
• http://allnurses.com/forums/f205/care-plan-help-280901.html

hello

[chevyv]

Thank you all for helping me sort out the Potential Complication part of my last 2 care plans. My instructor wrote that I had really good data and did a good overall job. I will continue to work on wording..... Others had to redo theirs, so I'm grateful that I found this site or I'd be burning the midnight oil so to speak instead of relaxing and spending time cruising this site .
Thanks again!