Care Plan

  1. Hi all! I have a care plan due next Thursday on the Musculoskeletal System and it has to be done on one of my patients, but the problem is they've been ESRD patients. Anyone have suggestions on how to find out how ESRD affects this system?
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  2. 9 Comments

  3. by   StudentSandra
    did any of your patients have edema? if so, how about,

    mobility, impaired physical
    r/t restrictive therapies, e.g., lenthy dialysis procedure
    s/t inability to move within physical environment

    or r/t decreased strenght/endurance
    s/t decreased muscle mass/tone


    self care deficit
    r/t intolerance to activity
    s/t musculoskeletal impairment


    hope this helps.

    our care plans are assigned according to diagnostic divisions, such as: safety/security, nutrition, elimination, oxygenation, motor sensory etc.

    good luck.

  4. by   CaliLVN
    Now I get it!! I was trying to make it a monstrous project! Thanks again!

    Anita
  5. by   zacarias
    originally posted by studentsandra
    did any of your patients have edema? if so, how about,

    mobility, impaired physical
    r/t restrictive therapies, e.g., lenthy dialysis procedure
    s/t inability to move within physical environment

    or r/t decreased strenght/endurance
    s/t decreased muscle mass/tone


    sandra,

    even if they didn't have edema, i think impaired physical mobily could be used because if someone's not moving, there's bound to me, even if extremely minor, loss of mass and tone. is that right?
    i used to think i was pretty well at nursing dx but i'm taking this "critical thinking" class to help us with careplans and the teacher knocked off both nursing dx i had chosen for a patient with chf and sob. they were risk for impaired gas exchange and decreased cardiac output. he said i couldn't use either of those! i sorta understand where's coming from but it really upset me because i got those suggestions directly from taber's dictionary!! it was a really bad day at school...i almost left class. i had a whole thought process behind everything i did like the following:

    i couldn't say risk for impaired gas exchange r/t pulmonary edema as the latter is a medical diagnosis. obviously if he's sob, something is going on with his lungs plus he has crackles, so i put risk for impaired gas exchange (or was this the dec. cardiac output one? ack i forgot!) r/t pulmonary changes aeb etc.... and he said to everyone as i was standing in front of the class, "that's a little vague." man, i'm sure i overreacted but man did that day affect me.

    thanks for letting me vent.


    z
  6. by   StudentSandra
    Zach, are you doing a 2 part or 3 part ND? How about:

    Decreased Cardiac Output R/T alterations in rate & rhythm.........

    then ........ as evidenced by ...... inreased HR..or..Extra heart sounds... or...changes in BP........

    or Secondaring to CHF.... from what I understand in the 3 part that used S/T you can use the medical diagnosis for that. Good luck Z. What care plan books are you using?
  7. by   Furball
    renal failure results in decreased GI absorption of calcium resulting in bone demineralization. (high risk for fractures) Thats why renal pts need to take Ca supp's and vit D.
  8. by   zacarias
    Originally posted by StudentSandra
    Zach, are you doing a 2 part or 3 part ND? How about:

    Decreased Cardiac Output R/T alterations in rate & rhythm.........

    then ........ as evidenced by ...... inreased HR..or..Extra heart sounds... or...changes in BP........

    Sandra,

    We do 3 part Nursing Dx. The teacher wouldn't let me use decreased cardiac output at all. Him and I don't connect well at all LOL. I hope it gets better cuz I'm gonna have it a lot in 4th quarter.

    Z
  9. by   jobear
    Hey Sandra,

    LOL, I know what you are talking about with that connect thing. How about a Potential risk for cardiac dysrhythmias. Potential being the word! I know this is only a one part dx, but maybe you can slide it in at the bottom tehehehe. Interventions--montior electrolytes, ca++, K+, na+, respiratory rate, BP, urinary output: rational--renal imparement leads to POTENTIAL alterations in electrolytes imbalances thus cardiac dysrhythmias. Accurate monitoring leads to early prevention. Good luck, Stef
  10. by   zacarias
    Originally posted by jobear
    Hey Sandra,
    Interventions--montior electrolytes, ca++, K+, na+, respiratory rate, BP, urinary output: rational--renal imparement leads to POTENTIAL alterations i
    The problem is at my school and others? they want us to focus on specifically Nursing Dx only right now. Anything that requires you to monitor labs or whatever is actually collaborative and can't be a self-limiting Nursing Dx. In a similar vein, if you have Acute Pain r/t whatever, and one of your interventions is you will give PRN meds, it means you just went outside the confines of the Nursing Dx because of the collaborative facet of that intervention; doctor prescribes the meds.
    For this reason, I have a hard time understand the utility of actual, proper nursing dxs. I mean, it becomes so awkward that you start doing things like this:

    Altered Comfort r/t blah blah blah AEB blah blah blah

    Interventions: I will fluff pillows. I will straighten out that one wrinkle in the bed.

    Outcomes: Client will verbalize feeling comfortable due to the effects of the nurse's advanced training on how to change linen.

    I can do (or try to do) the Nursing Dxs, but let me tell you, it's a struggle because it seems almost silly. The general ideas contained in the nursing dxs are important (e.g. if needed, nurses we would change pillowcases to make a patient comfortable), but I guess the whole writing it out and over-analyzing it in school makes it seem so tedious and contrived.

    Anyone else share similar opinions? or differing ones? Maybe it gets more interesting doing PC diagnoses.


    Z
  11. by   Franca
    ...Moving this to the top of active threads...

    I'm not in school yet. I am studying diseases and their effects; however, this thread pinpoints the problem I'm having with self-study: I don't know how to assimilate what I learn in order to apply it to the critical thinking of nursing (which is one of the purposes of school of course, to teach me those steps in thinking, but I want to begin now. I have a long wait before school starts).

    I work with medical reports on my job, so I only see the doctor/residents' thinking; therefore, I am confused about the difference in thinking between the two health providers' (nurses and doctors), which surely is collaborative at times (great word, Z). I'm a recent postsurgical patient, so I saw the physical difference in care of the two, I just don't know how to conceptualize that well enough to put it into a plan. Again, I don't understand how to apply the "critical thinking" that flows out of seeing a patient with a specific diagnosis or diagnoses FROM A NURSES' POINT OF CARE.

    Have I explained my confusion clearly enough to be understood?

    A Web site link(s) that would help is a fine answer, just anything you think would help. Thank you.

    Georgia, USA, is "scheduled" for upper 50s to low 60s in temp. today. Lots of sunshine! Don thoust shades!
    Last edit by Franca on Feb 11, '02

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Care Plan