[goofygreyhound]

I am about to be a senior in the fall. This info would have been a life saver had I had it earlier! I used the oldfashioned, have no clue what the vague directions meant, discuss it with my fellow lost classmates, and guess, get a bad grade, and improve so much by the end of the semester that I pass. So glad I have found you now!

[studnurse345]

elow!! i am just new here and i am a second year nursing student... can you please help me how to make a good NCP?? it will be my first time to make one... please... tnx

[Daytonite]

Originally Posted by studnurse345

elow!! i am just new here and i am a second year nursing student... can you please help me how to make a good NCP?? it will be my first time to make one... please... tnx

Did you read Post #1 and #2 of this thread? After reading all that information, what else, specifically do you have a question about?

[WaGGy]

This thread is a big help…thanks. But honestly, I’m still a little confused and frustrated. I’m a 3rd year BSN student preparing for my first case presentation, the case is actually easy – PIH, but sad to say my team and I couldn’t get the facts/info that we need to support our case. Ideally, we can’t make an NCP based on assumptions…we need lab results, monitoring sheets and others, unfortunately we couldn’t get those from the hospital we were assigned to (they don’t even have complete lab tests, and other data essential to the patient’s case). We were assigned in a Charity Ward of a Provincial Hospital and in a 3rd world country like ours – it isn’t an ideal setting.
I just feel sad that we couldn’t do what we think is proper and ideal; we couldn’t apply what we learned in school because we have to follow ‘hospital tradition’ which includes habitual compromises on health procedures.

[Shwill]

We have to turn in a Teaching Plan along with our care plan..and I am confused. I thought the care plan was a teaching plan.

The Teaching Plan format is set up just like the care plan sheet we have to use only with different headings in columns.

Learning Objectives
Specific Content
Teaching Strategies
Type of Learning
Evaluation Methodology

My care plan CP

ND's:
1. Acute Pain r/t Low myocardial blood flow, increased cardiac workload/ Increased 02 consumption
2. Reduced Cardiac Output r/t inotropic changes
3. Anxiety r/t breathlessness secondary to COPD

Any suggestions would be greatly appreciated..our instructor is not very informative..we are basically teaching ourselves.

[Daytonite]

Originally Posted by Shwill

We have to turn in a Teaching Plan along with our care plan..and I am confused. I thought the care plan was a teaching plan.

The Teaching Plan format is set up just like the care plan sheet we have to use only with different headings in columns.

Learning Objectives
Specific Content
Teaching Strategies
Type of Learning
Evaluation Methodology

My care plan CP

ND's:
1. Acute Pain r/t Low myocardial blood flow, increased cardiac workload/ Increased 02 consumption
2. Reduced Cardiac Output r/t inotropic changes
3. Anxiety r/t breathlessness secondary to COPD

Any suggestions would be greatly appreciated..our instructor is not very informative..we are basically teaching ourselves.

A teaching plan expands on nursing interventions that are of a teaching nature and whose audience are the patient or caregivers who need specific information on how the supervising nurse wants some specific procedure to be done for the patient or some specific information to be imparted to them. The teaching format you were given is correct. I can expand on and define those terms for you.

• Learning Objectives - specific information that the learner will come away from the course knowing; goal(s) you have determined the learner will achieve.
• Specific Content - the specific content that you are going to teach and in the sequence it will happen (an outline). Your content should address and cover all the objectives. This part of the written lesson plan is often handed in to the instructor and handed out to your audience in an outline format
• Teaching Strategies - a strategy is a plan of action and is how all the above will be achieved. Lecture, demonstration, case study analysis, role playing, discussion, audio-visuals, handouts, experiments, stories, game playing and any number of other creative items. http://www.teach-nology.com/ideas/
• Type of Learning - (how people learn) visual (seeing), aural (hearing), read/write (touch), kinesthetic (movement)
• Evaluation Methodology - determining if you met the goals of the teaching plan. This can be done through a return demonstration, short posttest, short question and return answer session with the client to verify they understand the information correctly or a task the participant needs to perform.

You can see examples of teaching for consumers on consumer websites all over the Internet. I just found one this morning: Halifax Health Disease, Condition & Injury Fact Sheets - https://www.halifaxhealth.org/Health...n/Content.aspx

A care plan is not a teaching plan. A care plan is the written documentation of your thinking process in identifying the patient's nursing problems and your strategies to solve them. Your solutions (strategies, nursing interventions) to these problems take the form of 4 different types/actions:

• Assess/monitor/evaluate/observe (to evaluate the patient's condition)
• Care/perform/provide/assist (performing actual patient care)
• Teach/educate/instruct/supervise (educating patient or caregiver)
• Manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)

I want to address the nursing diagnoses you listed although you didn't ask about them because there are errors in their construction.

Acute Pain R/T Low myocardial blood flow, increased cardiac workload/ Increased 02 consumption

Acute Pain must be due to some sort of physiological injury. Low blood flow within the heart tissue itself, increased cardiac workload and increased oxygen consumption (of the heart tissue, I would presume, you mean) describe the nursing diagnosis of Decreased Cardiac Output whose definition is inadequate blood pumped by the heart to meet metabolic demands of the body. If one of the patient's symptoms is pain somewhere in their body, then it is appropriate to use Acute Pain, but low myocardial blood flow, increased cardiac workload and increased 02 consumption do not cause pain. Ischemia does and is an appropriate related factor to use if this patient is having angina. See the NANDA taxonomy information (related factors and defining characteristics) for this nursing diagnosis on these web pages: Acute Pain and http://www1.us.elsevierhealth.com/MERLIN/Gulanick/Constructor/index.cfm?plan=40

Reduced Cardiac Output R/T inotropic changes

(1) this is not an officially titled NANDA diagnosis (2) Decreased Cardiac Output is the correct name (3) inotropic changes, something that changes the force of the heart's contraction is one of the related factor of Decreased Cardiac Output, but I thought that was a strange way to word it. Why not just say Decreased Cardiac Output R/T altered contractility as suggested by the NANDA taxonomy? See the NANDA taxonomy information (related factors and defining characteristics) for this nursing diagnosis on these web pages: Decreased Cardiac output and http://www1.us.elsevierhealth.com/MERLIN/Gulanick/Constructor/index.cfm?plan=09

Anxiety R/T breathlessness secondary to COPD

Breathlessness may be one of the defining characteristics (symptoms) of anxiety because it is a patient response, but it is not one of its related factors (causes). The definition of this diagnosis clearly states that anxiety has to do with perceived threats. Breathlessness is not a threat, but threat of death is. See the NANDA taxonomy information (related factors and defining characteristics) for this nursing diagnosis on these web pages: Anxiety and http://www1.us.elsevierhealth.com/MERLIN/Gulanick/Constructor/index.cfm?plan=03

And. . .

This patient has COPD? I am surprised not to see the two traditional nursing diagnoses for COPD patients: Impaired Gas Exchange R/T alveolar-capillary membrane changes and Ineffective Airway Clearance R/T excessive mucus and COPD. NANDA allows the use of COPD as a related factor and does not consider it a medical diagnosis. It is a vague term that represents 4 respiratory conditions: emphysema, chronic obstructive bronchitis, chronic obstructive asthma and chronic bronchitis with emphysema. Patients with one of the COPDs often have cardiac disease involvement--often cor pulmonale. Your teaching can revolve around any of the treatments that the patient needs to be doing with relation to maintaining their pulmonary or cardiac health. For more ideas of possible nursing diagnoses to use for a COPD patient, see the nursing diagnosis cross reference in the appendix of either Taber's Cyclopedic Medical Dictionary or Mosby's Medical, Nursing, & Allied Health Dictionary. There is also a medical disease/nursing diagnosis cross reference in the front of Nursing Diagnosis Handbook: A Guide to Planning Care, by Betty J. Ackley and Gail B. Ladwig.

[Shwill]

Thanks so much..I will be redoing these all day.

[NurseNatalieRNBSN08]

Search Care plans on google. try evolve elsvier website.( I cannot remember the EXACT addie)They have a "create a care plan". This, as well as, other sites really helped me. With the help of the site I have become an amazing care plan writer, and my instructors have asked to use my care plans as examples. MY ADVICE: remember for interventions...ask yourself "what would or did I do for this patient". Although using the sites and care plan writing books are definately helpful, ALWAYS be thinking about "real life" care!!! It will really help you! Good luck

PS. I started off HATING care plans... now my friend and I are seeking out jobs where our soul job would be to write care plans for hospitals. : )

[Biol20fan]

So far I haven't had much trouble w/ care plans and I've always done relatively well on them. This one, though, I'm having a bit of trouble coming up w/ a dx for a pt.

We have just started our OB clinicals. My pt yesterday is (was) a 39-y.o.; also a gravida 14, para 7. She has a hx of DVT and it was apparent, as she was on Lovenox (sp?), which she discontinued a few days before the delivery. She also had the red mottling on her legs. I discussed this w/ my instructor, and she told me that she believes the DVT nrsg dx is the best one to go with (even though there were other issues, this one is the most emergent).

My question is the nrsng dx for the baby (and I've never done a care plan on anyone other than an adult, so I'm feeling a bit lost). Gorgeous little baby, healthy as can be, and was able to breast feed just great. Birth weight was in healthy range, zero jaundice...really, overall, her assessment was just about as perfect as can be. So what exactly can I put as a nrsng dx for her? Her parents seemed attentive and caring. The only things I can think of are somewhere along the lines of:
**Risk for Caregiver Role Strain (d/t the mom already having six other children and her socioeconomic status is, shall we say, not optimal; plus, mom's health isn't good)
**Risk for Impaired Parenting (with the same reasons listed above).

Knowing that I am required to do a NANDA-approved dx (can you do a care plan any other way?) seems like it's hemming me in. Plus, can I really apply the above dxs for the baby? Normally, wouldn't they be for the parent?

Any help that anyone can give me would be greatly appreciated!

Thank you, everyone!

[Daytonite]

Originally Posted by Biol20fan

So far I haven't had much trouble w/ care plans and I've always done relatively well on them. This one, though, I'm having a bit of trouble coming up w/ a dx for a pt.

We have just started our OB clinicals. My pt yesterday is (was) a 39-y.o.; also a gravida 14, para 7. She has a hx of DVT and it was apparent, as she was on Lovenox (sp?), which she discontinued a few days before the delivery. She also had the red mottling on her legs. I discussed this w/ my instructor, and she told me that she believes the DVT nrsg dx is the best one to go with (even though there were other issues, this one is the most emergent).

My question is the nrsng dx for the baby (and I've never done a care plan on anyone other than an adult, so I'm feeling a bit lost). Gorgeous little baby, healthy as can be, and was able to breast feed just great. Birth weight was in healthy range, zero jaundice...really, overall, her assessment was just about as perfect as can be. So what exactly can I put as a nrsng dx for her? Her parents seemed attentive and caring. The only things I can think of are somewhere along the lines of:
**Risk for Caregiver Role Strain (d/t the mom already having six other children and her socioeconomic status is, shall we say, not optimal; plus, mom's health isn't good)
**Risk for Impaired Parenting (with the same reasons listed above).

Knowing that I am required to do a NANDA-approved dx (can you do a care plan any other way?) seems like it's hemming me in. Plus, can I really apply the above dxs for the baby? Normally, wouldn't they be for the parent?

Any help that anyone can give me would be greatly appreciated!

Thank you, everyone!

Think about what you know about the assessment findings of a normal newborn compared to an adult. What's different? For one thing newborns can't regulate their body temperature which is why we don't leave them exposed to the room atmosphere for very long with just a diaper covering them. That's Ineffective Thermoregulation R/T immature compensation for changes in environmental temperature. Some newborns just have a few difficulties with excessive secretions in the respiratory track (the big hint here is that the nurses will keep a bulb syringe nearby the baby) so Ineffective Airway Clearance can be used. If the baby has been circumcised that is another reason for a risk of infection. This baby is breastfeeding so use Effective Breastfeeding. They also have a stump from the umbilical cord hanging off their future belly button. Do you? Are they treating this cord stump? If it's inflamed or there are umbilical cord problems there is risk for infection, so you can use Risk for Infection R/T break in skin integrity at umbilical cord site (Risk for Infection).

The underlined blue type are a weblinks to nursing diagnosis pages with NANDA information and some goals and nursing interventions.