[leesespieces]

Just wondering if anyone is willing to proofread my ICU careplan. I just need to know if I'm missing and important interventions or rationales pretty much. I'm about 60 pages into it and still have a little to go. But when it gets this long I feel like I'm all over the place and forgetting to add things. I wouldn't blame a soul who didn't want to look over 60 pages of this stuff...just thought I'd throw it out there. Although it would possibly help you out if you ever need to do one of these in the future.......

It would mean the world to me.....this is worth about 30% of my final grade!!!! Thanks!!!!!!!!

[cardiacRN2006]

Can I offer a suggestion instead?

All ICU pts are at risk for falls, so make sure you have a Risk for Injury R/T falls diagnosis.

Also, pain, comfort, anxiety, fear, and communication are all big issues for pts in the ICU. As well as risk for infection R/T invasive lines and procedures being performed at the bedside.

[leesespieces]

Thanks for the suggestion... I'm going to have to add that one....these are the ones I have so far:
Nursing Dx:
Impaired Gas Exchange/Ineffective Breathing Pattern/Ineffective Airway Clearance


Related To:
Inflammation of the terminal airways and alveoli secondary to bacterial presence in the lungs


Nursing Dx:
Decreased Cardiac Output


Related To:
Decreased circulating blood volume, decreases renal perfusion, diastolic dysfunction, backflow of blood into the right and left atrium, increases peripheral vascular resistance, altered electrical conduction, decreases myocardial oxygenation


Nursing Dx:
Fluid Volume Deficit / Ineffective Renal Tissue Perfusion


Related To:
Fluid volume depletion secondary to increased metabolic demands on the body caused by infectious process in the lung parenchyma.


Nursing Dx:
Altered Protection


Related To:
loculated fluid in left lateral and upper chest walls, pleural effusion


Nursing Dx:
Activity Intolerance


Related To:
imbalance between oxygen supply and demand secondary to Inflammation of the terminal airways and alveoli secondary to bacterial presence in the lungs


Nursing Dx:
Acute Pain


Related To:



Nursing Dx:
Altered Nutrition; Less Than Body Requirements

Related To:
Increased metabolic demands on the body, decreased appetite, and NPO status.

Nursing Dx:
Anxiety


Related To:
Change/decline in health status, fear of the unknown, respiratory distress


Nursing Dx:
Impaired Skin Integrity


Related To:
Multiple invasive access lines and procedures

[Daytonite]

Are you supposed to use NANDA language? Because if so, you've got some problems here with the language you are using. Also, you have some very major problems with the construction of a good deal of these diagnoses.

First of all, you've combined three nursing diagnoses into one. Each of them have different meanings. I can't say that I agree with what you have listed as the etiology ("Related To") part as being the cause of any of the diagnoses.

Second, on your nursing diagnosis for Decreased Cardiac Output all of the etiologies ("Related To" factors) you've listed are all actually defining characteristics.

Third, again you have combined two nursing diagnoses (Fluid Volume Deficit / Ineffective Renal Tissue Perfusion) that have very different definitions and do not belong together. The etiology of deficient fluid volume can be fluid volume depletion, however where is this "secondary to increased metabolic demands on the body caused by infectious process in the lung parenchyma" coming from? Is this "secondary to" statement something that you are supposed to include in your nursing diagnostic statements? If not, don't include it.

Next, altered protection. The correct NANDA language is Ineffective Protection. The etiology is totally wrong. The etiology you have for this diagnosis more appropriately belongs to the nursing diagnosis of Ineffective Airway Clearance or should be used as the defining characteristics to support the etiology of that nursing diagnosis.

Activity Intolerance is OK.

What is main reason the patient has pain. That will be your etiology.

Seventh, Imbalanced Nutrition: Less than body requirements has decreased appetite and NPO status listed as etiologies when they are actually defining characteristics.

Eight, all your etiologies for the nursing diagnosis of Anxiety are actually defining characteristics.

Nine, you can simplify your etiology to "multiple invasive procedures".

And, finally, much of the sequencing is wrong. If this were sequenced according to Maslow's Hierarachy of Needs it would be much different.

I'm sending you a PM.

[leesespieces]

Actually I went through some of this with my instructor already and i was told to combine all 3 resp Dx's because they have similar causes and will have similar interventions.

We are told to form our related to statements from the pathophysiology of the etiological cause

I was told by instructor to combine tissue perfusion and fl vol deficit for the same reason I combined the resp Dx's

For whatever reason our instructors like "altered" protection

We are instructed to prioritize our Dx's by ABC's first (airway, breathing, circulation; which covers my first 3) then by what is affecting the patient the most...

NPO status and decreaseds appetite are why his nutritional status is imbalanced

[Daytonite]

OK. I now have no idea what your instructors are asking you to do. It all sounds jumbled and disorganized to me. Please ignore my PM. I don't think I can help you here. Your instructors obviously have a much different idea about writing care plans that I just don't understand. I would have to read up on all their rules and I don't have time to do that. I'm sorry.

[charlies]

I am in my final semester, and after 7 different clinical instructors, my experience has been that what one accepts as good nursing diagnosis, the next does not. They all want something different. I got used to it, it is important to find out exactly what the specific instructor wants at the beginning of clinicals, and in the world of academia, that is ALL that matters as far as clinical paperwork goes.

My last careplan was 121 pages long. What a buncha B.S. It currently resides in the county landfill, lol.

[cardiacRN2006]

Originally Posted by charlies

My last careplan was 121 pages long. What a buncha B.S. It currently resides in the county landfill, lol.

.


Oh, I turned all of mine into greenhouse gasses.

[nurse4theplanet]

Originally Posted by charlies

I am in my final semester, and after 7 different clinical instructors, my experience has been that what one accepts as good nursing diagnosis, the next does not. They all want something different.e

I completely agree with this!

[GIRN]

I'm with you guys! Time was so valuable and we spent so much of it working on the Care Plans instead of being out on the floor, learning from the patients and experienced nurses. Once we got into the real world...I've not written one care plan! I've made a lot of check marks on the pre-written ones,... Our school was into mapping...that was a pain but sounds a lot better than 100 pages of care plans. I wonder how many ulcers nursing students get from the resentment that builds up from having to jump through hoops.....