[kristiwhiz]

I'm a 1st semester nursing student and am needing help with coming up with 6 nursing interventions for my care plan on a 34 yo female with acute sickle cell crisis. For some reason my instructor has zeroed in on wanting interventions for peripheral tissue perfusion as related to risk for DVT. I could probably do acute pain in my sleep now but I guess she considers that too easy.
My nursing dx is: Risk for ineffective peripheral tissue perfusion R/T abnormal RBC morphology. I'm using the nursing care plan book by Gulanick/Myers which is usually to the point and dead on. In this case, there's no clear cut plan of action and I've been flipping thru all sorts of different dxs to try.
I talked to the nurses on the floor while at clinical and was told that the usual protocol is HOP - hydration, oxygenation and pain. They were mystified why I would have to come up with 6 interventions but didn't really give me anything to go on. I'd be beyond grateful if someone could help me out here!

By the way - she also admits to smoking 1/2 ppd - which I know is a big deal to someone with abn RBCs.

[earle58]

gosh, there are 50 nsg dx's for a pt w/sickle cell crisis.

the dx alone, carries many medical concerns, potentially affecting cardiac, pulmonary, neuro, circulatory, gi systems.

nurse needs to assess pain, mental status, activity/rest, mobility, circulation, elimination, nutrition, hygiene/self care, resps, safety, knowledge base...

as for your instructor's focus on circulation, you can assess for presence of palpitations, angina/chest pain, heart rhythyms, bp, cap refill, bruits, mucous membranes, diaphoresis, skin color...

this is a disease that affects multi systems.
you'll be monitoring the blood transfusions, the effectiveness of pain mgmt, o2 status, activity tolerance, and all systems involved.

this will be a great experience for you.
read up on it til you understand all dynamics involved.
it will fall into place.

best of everything.

leslie

[Daytonite]

Hi, kristiwhiz, and welcome to allnurses

When you are using a "Risk for" diagnosis, you have to have a defined "risk", problem, or complication in mind that you are trying to avoid the patient from getting. So, your instructor is wanting you to focus on DVT as the complication. What you need to do is look up information on DVT, what it is and what the signs and symptoms are for it. With "Risk for" nursing diagnoses you really don't have much choice for nursing interventions. The focus of using this nursing diagnosis is not to treat a DVT but to monitor for and prevent it from happening. In general, the nursing interventions will be to:

• Assess/monitor/evaluate/observe for the signs and symptoms (you will need to list out the signs and symptoms of a DVT. I would include the lab monitoring if your instructor has indicated that it is an important element.)
• Teach/educate/instruct the patient and/or other caregivers about the signs and symptoms to watch for
• Care/perform/provide certain specific nursing interventions that will prevent some of the signs and symptoms (this may not always be possible with some complications)
• Manage/contact/notify the doctor if signs and symptoms do occur

There is information on writing care plans on these threads:

• http://allnurses.com/forums/f50/help-care-plans-286986.html - Assistance - Help with Care Plans (in the General Nursing Discussion Forum)
  
• http://allnurses.com/forums/f205/desperately-need-help-careplans-170689.html - Desperately need help with careplans (in Nursing Student Assistance Forum)
• 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)