i answer questions about nursing care plans all the time on allnurses. there are several sticky threads to help you with writing care plans in the student forums, the best one is listed first:
first of all, i don't like students using care plan books to find nursing diagnoses until they understand how the nursing process works in the care planning process.
i am going to make a few important statements and you need to think about them for a few minutes and let them sink into your brain cells because they are extremely important to what you are trying to accomplish with this project (and many others to come).
care planning is all about solving patients nursing problems
in nursing we are taught to use the nursing process to help us identify what the patient's nursing problems are.
a nursing diagnosis is only a shorthand expression of a nursing problem. the true problem is described in the definition of the nursing diagnosis that is found in the nanda taxonomy.
the definition of a "diagnosis" is the resulting decision or opinion after the process of examination or investigation of the facts is completed; it is based on the abnormal data that was found.
the definition of a "nursing diagnosis" is a patient problem that is identified by the nurse after assessing the patient has been completed; it is based on abnormal data that was found.
the steps of the nursing process as it applies to care planning are as follows:
- assessment (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
- determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
- planning (write measurable goals/outcomes and nursing interventions)
- implementation (initiate the care plan)
- evaluation (determine if goals/outcomes have been met)
determining nursing diagnoses doesn't even happen until the patient has been thoroughly assessed, information about their disease or medical condition and its treatment found and a list of all the abnormal signs/symptoms and patient responses to what is happening to them has been compiled. only then can you make an intelligent decision about their problem(s). assessment includes:
- a physical assessment of the patient
- assessment of the patient's ability and any assistance they need to accomplish their adls (activities of daily living) with the disease
- data collected from the medical record (information in the doctor's history and physical, information in the doctor's progress notes, test result information, notes by ancillary healthcare providers such as physical therapists and dietitians
- knowing the pathophysiology, signs/symptoms, usual tests ordered, and medical treatment for the medical disease or condition that the patient has. this includes knowing about any medical procedures that have been performed on the patient, their expected consequences during the healing phase, and potential complications. if this information is not known, then you need to research and find it.
let me give you an analogy. . .it is much the same as a detective. he knows someone has been murdered. but he doesn't go out and just arrest anyone for the murder. he must investigate and collect evidence to prove his case.
you have to do the same. whatever nursing diagnoses you use, you have to prove your case for using them. every nursing diagnosis has a set of defining characteristics (signs/symptoms and patient responses).
you get this information from your assessment of the patient and then use nursing diagnosis references to help you choose the appropriate nursing diagnosis. you don't choose nursing diagnoses based on a patient's medical disease. it helps to have a book with nursing diagnosis reference information in it. there are a number of ways to acquire 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.
- the nanda taxonomy and a medical disease cross reference is in the appendix of both taber's cyclopedic medical dictionary and mosby's medical, nursing, & allied health dictionary
- there are also two websites that have information for about 75 of the most commonly used nursing diagnoses that you can access for free:
now, i get the impression that this is a group project so this is probably not a real patient? not a problem. this just means that you won't be able to do a real physical exam or read a real chart. you do, however, need to know the pathophysiology of cancer (particularly skin cancers), their signs/symptoms, usual tests the doctors will order to diagnose this group of diseases, the medical treatment for skin cancer, the common medical procedures performed for it, the expected consequences during the healing phases, and potential complications of treatment. if this was someone else's job in the group you need to get together with them and get their information because you need to know signs and symptoms and pathophysiology in order to determine the nursing diagnoses and put together the 3-part nursing diagnostic statements.
the best cancer information that is available is on the website of the national cancer institute (http://www.cancer.gov/
) where you can find very nice booklets on cancers of all types including the skin.
i have chosen impaired skin integrity as one.
is it possible to breakdown nursing diagnoses into primary, secondary, and tertiary stages?
to use this diagnosis you must understand that the real problem it describes is in the definition of this diagnosis: altered epidermis and/or dermis.
this is the destruction of the skin surface only. anything that goes deeper into the subcutaneous tissue has to be classified as impaired tissue integrity
. this is why your assessment and supporting evidence is important. if you don't have a nursing diagnosis reference you can read about the nanda defining characteristics (signs and symptoms) for this diagnosis on this website: [color=#3366ff]impaired skin integrity
no, there is no such thing unless your nursing instructors have given you some nursing diagnosis rules to follow that are very different from nanda guidelines. however, "primary, secondary and tertiary stages" sounds like the description of a type of cancer.
if you post the list of symptoms your fellow group members provided to you i can show you how to determine the nursing diagnoses.