Care Plan/Nursing Dx assistance please!!

  1. I am in some major need of assistance. I am a first semester LPN student and am having difficulties in prioritizing my nursing dx in order to get my care plan going. I don't have any trouble coming up with the nursing dx ( I can usually find more than enough). My problem is narrowing it down to the really important ones and then putting them in order of importance. To me they are ALL important. I have tried the "ABC" method ( airway,breathing etc.) Any advice from seasoned nurses or students would be greatly appreciated!! Thanks so much!
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  2. 13 Comments

  3. by   dacryocystitis
    I always thought of the ABC's first and Maslow's Hierarchy of Human Needs. Physiological needs always come first: breathing, food, water, sleep, excretion. Think of things needed for survival. Everything else comes after that....safety, love/belonging, esteem, self-actualization.

    As you learn more and become more experienced, prioritizing needs will become much easier.
  4. by   Antikigirl
    There is a ton of posts about this in the student nursing forums (stickies) from nurses that have volunteered to help with RN Dx. I have even gone there to give my tricks of the trade on them by request!

    Try looking there too .

    Priority to me is life threatening to non dependant on condition of the patient. For example..they may have a probelm with asthma and I put inaffective airway or altered gas exchange or what not as first since that is going to be the first probelm in this condition...but what about the other systems that effects? Well..then I have to prioritize according to actual risk vs potential risk (where actual comes in first). What if they are asthmatic but that isn't why they are there? Well..why are they there? Lets go with that first . They are falling alot and getting confused. Okay fall risk RN Dx first...and then I will go into the possible reasons for it like ineffective gas exchange, altered electrolytes, inaffective airway clearance, etc. dependant on the patients most urgent need for treatment!

    Takes some getting use to...but good luck!~
  5. by   cardiacRN2006
    Also, what my Clinical Instructors liked to see was a RNDx related to the specific reason for admission.

    But, as a general rule, ABCs and Maslows are your best friends.
  6. by   NaomieRN
    I am a new RN student and so far all my nurses diagnosis have been excellent. My first care plan, daynonite was really helpful in guiding to the right track.
    This is what I do: I check all the lab results, assess the patient, check the patient charts, check meds, medical history, medical diagnosis, from there, I cluster the data and come up with a diagnosis. For example, my last patient was diagnosis was impaired mobility r/t altered nutrition, my pt had not eaten for 2 days, was anorexia, lost 20lbs in 2 months, albunim was below the level, which tells me he was malnourished, he was fragile, he stated he was weak and needed assistance to walk. My plan was for my pt to eat at least 40% of the food on his tray with assistance, walk 20ft etc. He achieved the goals.
  7. by   adria37
    Girls here is your care plan generator


    http://www1.us.elsevierhealth.com/Ev...uctor/A-B.html


    :studyowl:
  8. by   MizDnurse2b
    That website is awesome! Thanks for all the info everyone! It is greatly appreciated !!
  9. by   Daytonite
    hi, mizdnurse2b!

    most nursing programs direct their students on how to prioritize their nursing diagnoses. maslow's hierachy of needs or gordon's 11 functional health patterns are two common systems of organizing nursing diagnoses by priority. nanda actually started out using gordon's functional health patterns years ago when it was grouping the diagnoses. they've tweaked it a bit, but in their publication, nursing diagnoses: definitions & classification 2005-2006 published by nanda international, you can definitely see the similarity to gordon's work. when i am responding to student questions on prioritizing nursing diagnoses, i go by maslow. maslow really lists the priorities for you so there isn't much thinking on your part. it also takes abcs into account. here is a website where you can read about the hierarchy. http://en.wikipedia.org/wiki/maslow's_hierarchy_of_needs if you happen to have a copy of nursing diagnosis handbook: a guide to planning care, 7th edition, by betty j. ackley and gail b. ladwig, the maslow pyramid is printed out on page 1325. the bottom of the tier of the pyramid is physiological needs and that is what takes precedence. within physiological needs the prioritization from most important to least important is as follows:
    1. oxygen (this takes into account your abcs, tissue perfusion, etc. - remember the brain must get it's oxygen first and foremost, then the heart, then the remaining tissues of the body)
    2. food (ultimately an organism can't live without food, water, and electrolytes)
    3. elimination (or, a way to get rid of waste products)
    4. temperature control
    5. sex
    6. movement (gross movement takes priority over finite movement)
    7. rest
    8. comfort (this is where things like pain and some of the adls rank)
    the ackley/ladwig book goes on in the next few pages to list the nursing diagnoses that fit under each tier of maslow's pyramid.

    any diagnoses that are anticipatory, such as those that begin with the words "risk for" always are listed at the very end of your diagnostic lists because they are not actual problems, but problems you are trying to prevent. within them, you also prioritize by the same logic you used for the actual problems that are listed before them.

    there are three "sticky" threads on the student nursing forums where a lot of care planning and nursing process information from past postings has been accumulated. some of it is well-worth looking at. i recently posted websites where you can view sample case studies that have been done by students.

    just yesterday we had a thread going on the difference between a goal and an outcome. you can read it here: http://allnurses.com/forums/f50/help...me-187170.html

    i invite you to at least peruse the threads on these two student forums on a regular basis for information and help with care plans. while i understand that you posted in this forum because you are thinking of the experience factor of licensed nurses, i fashion my answers for students to conform with what they are being required to provide on care plans by their instructors, not for what goes on in actual practice. care plans being done for school have the much broader purpose of helping you to learn to think critically as well as to learn about diseases, their treatment and the nursing interventions that are possible.

    i check these two forums almost daily for student questions about care planning and nursing diagnosis.

    the link that was given to you above by adria37 is from the ackley/ladwig care plan constructor. i often link students into some of the nursing diagnosis pages from the site. let me advise you, however, that the site does not help you with prioritizing your diagnoses. the nursing diagnoses do not have the complete listings of nursing interventions that are printed in the book. the website also does not contain a complete listing of the 172 nanda nursing diagnoses. there have been numerous times that i have gone to their index to search for a specific nursing diagnosis only to find that it has not been included in the website. to have a complete list you really should invest the money in their book (i've listed it above).

    if you are having problems getting your care plan going, either post a thread to one of the above forums or pm me. and, by the way, in the nursing process, your nursing diagnoses should always be chosen based on the assessment data that you have collected about the patient. that is what drives any care plan. ask and i will help you.
  10. by   squishy11
    Hi all! I have to write my first nursing care plan and I am having a hard time.
    My patient is in a LTC with MS. She is 51 and I am having a real hard time with the care plan.. usnure of the priority diagnoses... Then I have evaluation which includes effectiveness of intervention and then attainment of expected outcomes.. I am at Suffolk Community College, so if anyone has had any experience with these things any help or ideas would be appreciated (Even if you arent in Suffolk.. the help would be great! )

    thanks!!


    A struggling and tired nursing student
  11. by   Daytonite
    Quote from jjaye11
    hi all! i have to write my first nursing care plan and i am having a hard time.
    my patient is in a ltc with ms. she is 51 and i am having a real hard time with the care plan.. usnure of the priority diagnoses... then i have evaluation which includes effectiveness of intervention and then attainment of expected outcomes.. i am at suffolk community college, so if anyone has had any experience with these things any help or ideas would be appreciated (even if you arent in suffolk.. the help would be great! )

    thanks!!


    a struggling and tired nursing student
    there are all kinds of posts on care planning and the construction of a care plan on this thread in the general nursing student discussion forum:
    students post questions about care plans and nursing diagnosis on the nursing student assistance forum all the time. a care plan is about determining the patient's nursing problems and developing strategies to do something about them. ms is their medical disease. as nurses we are interested in how the patient is responding to the ms and our job is to assist them in their response, but since we are not doctors, we, per se, do not treat their ms except as collaborators with the doctors in carrying out their medical plan of care (also our job). we nurses are doing our own nursing thing. and that is what you are in school to learn to identify and treat--nursing problems. i talk about this all the time when i answer care planning questions. read some of the posts i have responded to on the thread i listed above or search for some of hundreds of care plan threads i have answered for students.


    you can see an example of a care plan for an ms patient that is still posted on the internet (this is rare), but do not assume it applies to your patient in any way since your patient may have other life and adl problems.
    prioritization of nursing diagnoses is usually done according to maslow's hierarchy of needs (http://en.wikipedia.org/wiki/maslow's_hierarchy_of_needs) and this, too, is asked a lot about care plans on the nursing student assistance forum. outcome and evaluation have to do with having an understanding of how the nursing process works. a care plan, which is (as i said above) a determination of the patient's nursing problems, if rationalized and constructed using the logic of the nursing process, which is the problem solving method that is drummed into us from our first to last day of nursing school, should reflect the sequential steps of the nursing process:

    1. assessment
    2. nursing diagnosis
    3. planning (outcome and intervention)
    4. implementation
    5. evaluation
    however, for the process to be truly successful, each step must build upon the information coming from the step before it.

    the care plan for your patient will start by you doing a thorough nursing assessment that includes:


    • taking a health history (review of systems)
    • performing a physical exam
    • assessing their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming)
    • reviewing the pathophysiology, signs and symptoms and complications of their medical condition (the ms)
    • reviewing the signs, symptoms and side effects of the medications/treatments that have been ordered and that the patient is taking
  12. by   squishy11
    Thank you so much. I think the reason I am having such a problem is because we only had 4 nights with these patients, and we are supposed to be doing gerontology, but the patient I ended up with is only 50 years old. She is only able to move her head and her left arm, so it seems as tho my diagnoses should be pretty simple, but the interventions are what is giving me trouble. She hasn't spoken much about the MS only to say that the doc wants her to goto physical therapy but she sees no point since she has a disease that will bot get any better... I guess its my interventions that I am having trouble with...

    Your info has definatley helped, and I thank you for your time!
  13. by   Daytonite
    Quote from jjaye11
    Thank you so much. I think the reason I am having such a problem is because we only had 4 nights with these patients, and we are supposed to be doing gerontology, but the patient I ended up with is only 50 years old. She is only able to move her head and her left arm, so it seems as tho my diagnoses should be pretty simple, but the interventions are what is giving me trouble. She hasn't spoken much about the MS only to say that the doc wants her to goto physical therapy but she sees no point since she has a disease that will bot get any better... I guess its my interventions that I am having trouble with...

    Your info has definatley helped, and I thank you for your time!
    I worked in LTC (long term care) too and well as the acute hospital. One of the things you must begin to re-think is what nursing is. You mostly know what the medical profession does. Up to this point your knowledge of healthcare has pretty much been defined by what doctors do so it is only natural that you think in terms of "the patient has MS" and "I'm supposed to be doing gerontology". As nurses we look at the person and how they are reacting and responding to what is happening to them. The other thing we do is carry out doctor's order (involves performing our technical skills). We still need to know about diseases like MS, what happens when someone gets MS and how docs treat it because we are going to assist in some of those treatments. But, after all of that, we also help the patient deal with the muscle spasms and simple problems like holding a fork, turning the page of a book, how to deal with the fact that they can no longer go to the movies, deal with the depression over the many losses and changes that the disease has brought into their life. And as a nurse that is what you will do for her.

    I currently have a home health nurse who sees me once a week to change the dressing on my PICC line she was doing my initial evaluation and taking my history she kept saying "you're too young to have so many problems". You shouldn't say things like that to a patient as it can make them feel more depressed than they already may be, but I understood her concern. I knew a long time ago I was young and had a lot of medical problems, but what could I do but get the best medical care I could? Remember Ericksons Developmental Stages. Be sensitive to what people are experiencing. It may be you on the other side of those side rails one day and the last thing you will want is for someone to do is call you "the geriatric patient in room ___" or "the MS patient in room ___".

    Now, your first care plans will take you a painfully long time to complete and get correct. Stay with it because with each one you are learning about that very important nursing process. It gets easier as you do more and more of them. Care planning is a mental skill. It involves thinking and requires putting together and processing a lot of different information. That information will be different and customized for each patient which is why care plans really can't be copied. The nursing process is what you will be expected to know by the time you graduate from nursing school. It is what makes a licensed nurse a professional. Knowing the nursing process is what will enable you to write care plans, plan and carry out nursing care, solve all kinds of problems even problems in your daily life and pass the NCLEX.
  14. by   squishy11
    I thank you again for your insight into the nursing process. I didn't mean to sound insensitive to my patient. I am veyr sorry to leave, because I almost feel as if I could really do a lot for her. More than she is getting in the LTC.(Of course, when I was there she was my only patient) I think what is making it difficult, is becuase she has had MS for over 20 years, and it seems to me that along with the nursing diagnoisis that could fit with MS, it seems as though she is ready for some wellness dx's and I don't think we are able to use those yet, and am not sure how I would go about measuring a goal for those. I guess what my problem is, is that to say she has a self care deficit with eating, seems like it is a dx that would be ok for someone who has just become diagnosed, or even a self image or depression type of dx. She has expressed that she knows she is not going to get better, and that she is having a hard time being in the LTC (she was just admitted becuase her parents could no longer care for her) because of the age differences as well as the other patients having dementia or the like. But, I also suppose that in a fundamentals course, we are trying to get the gist of writing the plans, so using very simple dx's are what I should make my goal in order to get through the care plan. My pt only has use of her left hand and head, so an immobility diganosis just seems like a given I guess is what I am trying to say.

    Again, since this is fundamentals, I suppose that is how I should be looking at this.. (That's what I figuered out last night and actually was able to write a list and prioritze it...)

    Thanx again! Every word you write enlightens me

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