Care plans + finding Nsg articles: 2 really good websites everyone should know about!

Nursing Students General Students

Published

http://www1.us.elsevierhealth.com/MERLIN/Gulanick/Constructor/#New

This website is highly recommended by all my friends if you have problems writing care plans. It is actually a care plan generator, all you do is pick what applies to your patient and out pops a complete care plan. I would like to stress DONT RELY to heavily on this website because in my own personal exp. you may have to write a care plan whenever and wherever you instructor see's fit. Make sure you know how to become a generator yourself before using this. :)

http://www.nursingcenter.com/library/index.asp#journals

If you need a nursing journal article, heres your place. It cost money for most of the articles but some are free. In my exp using it I was always able to find a free article for just about any topic I needed. Make sure if it says it cost money for a article to click on it and scroll down, because sometimes it only cost money if you print the article. Great for Nursing research papers. :)

Specializes in med/surg, telemetry, IV therapy, mgmt.
Can you please tell me how I can find the sites because I can't seem to locate them on your post. Thank You.

What sites are you referring to? Did you go through all the pages of this thread? There are currently something like 10 pages, or 100 posts to this thread.

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hey,

thankx for the web..the website is really helpful for care plan but i will surely wont rely on it ...thnk onc e again

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Specializes in Public Health/Underserved Populations.

thanks for the info

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Thanks for this, another tip, sometimes you can get the paid articles by using institutional log in and looking for your uni. I've found that my uni pays for membership to alot of the big sites.

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Specializes in aged & med/surg.

I am just starting with care plans and would love some advise on nursing diagnosis for someone with hypertension in the community. Here is the discription:

As an occupational health nurse employed by a mining company 700kms north of Adelaide, one of your primary responsibilities is to provide information to all employees about healthy lifestyles. While waiting in the kiosk line at lunchtime one of the machine operators, Stanley Harris, asks if he may talk to you sometime about some things he doesn't understand. Stanley, a 46 year old Indigenous Australian, tells you his doctor told him he has hypertension and that he must take medication everyday. He tells you that he doesn't take his medication as he feels fine. Stanley also shows you a script he has for Verapamil 120mg daily. 'This is what the doctor gave me, but I feel fine. I don't think I'll get it filled right now.' Nursing assessment reveals: temperature 36.4 C, pulse 94, respiratory rate 20/min, blood pressure 186/100 and weight 119kgs, height 1.70m

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Hi!

start with this: Deficient knowledge r/t need for frequent BP checks and adherence to antihypertensive therapy and potential for change.

Desired outcome: within 24 hours following teaching, pt verbalizes accurate knowledge about the importance of frequent BP checks and adherance to antihypertensive therapy.

*Taken from: All-in-ONE Care Planning Resource, Med-Surg, Pediatric, Maternity, and Psychiatric nursing care plans, Author is Swearingen, publisher is Mosby.

:monkeydance:

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Specializes in aged & med/surg.

Thanks for that, not being in a hospital setting makes it alot harder, especially when this is the first time I had even looked at care plans in this way

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Specializes in med/surg, telemetry, IV therapy, mgmt.
i am just starting with care plans and would love some advise on nursing diagnosis for someone with hypertension in the community. here is the description:

as an occupational health nurse employed by a mining company 700kms north of adelaide, one of your primary responsibilities is to provide information to all employees about healthy lifestyles. while waiting in the kiosk line at lunchtime one of the machine operators, stanley harris, asks if he
may talk to you sometime about some things he doesn't understand
. stanley, a 46 year old indigenous australian, tells you his
doctor told him he has hypertension
and that
he must take medication everyday
. he tells you that
he doesn't take his medication as he feels fine
. stanley also
shows you a script he has for verapamil 120mg daily.
"this is what the doctor gave me, but i feel fine. i
don't
think i'll get it filled right now." nursing assessment reveals: temperature 36.4 c, pulse 94, respiratory rate 20/min,
blood pressure 186/100
and weight 119kgs, height 1.70m

you asked for advice on a nursing diagnoses for someone with hypertension. first, you must understand that nursing diagnoses are not based upon patient's medical diagnoses. hypertension is a medical diagnosis and not a decision that a nurse can make. nursing diagnoses are based upon a nurse's assessment of the patient. if you, the nurse, find that the patient's blood pressure was elevated during your assessment, then you will list this as elevated blood pressure of 186/100 (as in this particular case).

here is the assessment information you were given in this scenario and upon which you must determine your nursing diagnosis:

  • the patient left his doctor's office not understanding everything he was told
  • the doctor told him he had hypertension
  • the doctor gave him a prescription for medication, but he hasn't taken it because he feels fine
  • he has a prescription for verapamil 120mg which he has not gotten filled and doesn't plan to get filled
  • elevated blood pressure of 186/100

the scenario is not listing any other physical symptoms of his hypertension. there are no specific nursing diagnoses for a patient with hypertension. quite honestly, what are you, as a nurse, going to be able to do for a patient with a blood pressure of 180/100 without a doctor's order? that is the idea behind writing a care plan: what can you, as a nurse, do for the patient that the doctor can't necessarily do, that you can do without a doctor's order, and that you can add to what the doctor has already done? as a nurse you have to stop thinking so much like a doctor (although you need to know what the doctor is likely to order) and think more about how you can be of service to the patient based upon what you, the nurse, have been trained to do with patients.

you need to look up verapamil and note why it is given and the side effects, if any of this drug. you need to understand that verapamil is given for other heart problems as well as hypertension. you need this information for the teaching information you are going to give this patient. you also need to look up information on the treatment of the medical diagnosis of hypertension. as a nurse, you still need to know what the physician is likely to order for the patient, and, most importantly, why. if this were an actual patient i would sit down with him and question him further about what the doctor told him to get a better picture of why he has chosen not to take this medication and why he is now curious about it and hypertension.

the suggestions i would give you for nursing diagnoses for this patient are as follows and i've carried them out to a three part nursing diagnostic statement which is often what nursing instructors here in the united states want students to do to show that they understand the critical thing behind the use of the nursing diagnoses and the nursing process:

i would tend to go with the diagnosis of noncompliance since you are able to encompass all the patient's abnormal assessment items within it. you can include all the teaching that the patient needs as nursing interventions under this diagnosis with the way i have worded the 3-part nursing diagnostic statement. you can't do it as effectively with the ineffective coping nursing diagnosis. just so no one thinks i'm giving an off-the-wall nursing diagnosis here, the definition of the noncompliance diagnosis is "behavior of person and/or care giver that fails to coincide with a health-promoting or therapeutic plan agreed on by the person (an/or family and/or community) and healthcare professional. in the presence of an agreed-on, health-promoting or therapeutic plan, person's or caregiver's behavior is fully or partially nonadherent and may lead to clinically ineffective or partially ineffective outcomes." (page 146, nanda-i nursing diagnoses: definitions & classification 2007-2008 published by nanda international) notice that they use the nondescript word "fails". when the person went to the doctor and accepted the prescription from him, he was agreeing to follow the doctor's therapeutic plan. otherwise, he could have crumbled up the prescription, threw it on the floor, laughed in the doctor's face and said, "i don't need this." maybe he's passive aggressive. more importantly, it's not our task to determine that because that is another medical diagnosis!

please check out the posts on this thread on the nursing student assistance forum for lots more information on how to formulate a nursing diagnosis

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I am just starting with care plans and would love some advise on nursing diagnosis for someone with hypertension in the community. Here is the discription:

As an occupational health nurse employed by a mining company 700kms north of Adelaide, one of your primary responsibilities is to provide information to all employees about healthy lifestyles. While waiting in the kiosk line at lunchtime one of the machine operators, Stanley Harris, asks if he may talk to you sometime about some things he doesn't understand. Stanley, a 46 year old Indigenous Australian, tells you his doctor told him he has hypertension and that he must take medication everyday. He tells you that he doesn't take his medication as he feels fine. Stanley also shows you a script he has for Verapamil 120mg daily. 'This is what the doctor gave me, but I feel fine. I don't think I'll get it filled right now.' Nursing assessment reveals: temperature 36.4 C, pulse 94, respiratory rate 20/min, blood pressure 186/100 and weight 119kgs, height 1.70m

HI,

here are the nsg dx....

1.knoweledge deficient R/T misinterpretion of information and new condition

2.altered nutrition:more than body requirement R/T obesity

3.ineffective therapeutic regie R/T knoweledge deficient

4.RISK FOR ineffective tissue perfusion R/T

i think these are the probable nsg dx....do check it out...n also let me knw if they are appropriate or not...and also inform me about any other nsg dx besides thesee..

ok takcare

n hope it helped

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Specializes in aged & med/surg.

From everyones help I have come up with the following:

Impaired adjustment related to new condition

Non-compliance related to the belief that treatment is not needed without the presence of symptoms

Ineffective Health Maintenance related to sedentary lifestyle, excessive weight and lack of cardiovascular fitness

Alteration in nutrition: more than body requirement related to excessive food intake

Knowledge deficient related to cultural beliefs.

What do you all think???

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Specializes in med/surg, telemetry, IV therapy, mgmt.

nursing diagnoses are always, always, always based upon the symptoms the patient is having. (i swear i'm going to have that tattooed to my chest!). did i miss something here beside failing to recognize the obesity (it was stated metrically and i'm used to working with pounds--sorry)? i read your scenario over very carefully. i saw nothing in it about this patient being sedentary, cardiovascular unfit or anything that sounded like cultural beliefs were in conflict with medical and/or nursing advice. true, i do not live in your corner of the world and i am not familiar with the cultural beliefs of the indigenous australians so it would be appropriate to figure that in to the patient's behavior. but outside of that, you can't just pull data and descriptive information out of the air. there has to be rational thinking guided by the nursing process in your development and decision on what nursing diagnoses to use.

[evil]the steps of the nursing process (written care plan)

  1. assessment (collect data)


  2. nursing diagnosis (group your assessment data, shop and match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnosis to use)


  3. planning (write measurable goals/outcomes and nursing interventions)


  4. implementation (initiate the care plan)


  5. evaluation (determine if goals/outcomes have been met)


[/evil]

there has to be a critical thinking process that went into your decision to use these nursing diagnoses. because you are a student you have to be able to articulate what your critical thinking process was.

so i have questions. . .

  1. how did you come to the conclusion that this man had a sedentary lifestyle? how do you define sedentary? what information you were given led you to the conclusion that he had a sedentary lifestyle?


  2. where in the scenario does it mention that the doctor told this man that he lacked cardiovascular fitness? i read your scenario over probably 10 times, copied it to a word document and pulled it apart word by word and never saw the word "cardiovascular fitness". nor, did anything else i saw set me along the path of thinking there was cardiovascular unfitness. is this a medical diagnosis?


  3. are you using nanda based nursing diagnoses? because. . .


    • there is no nanda nursing diagnosis of impaired adjustment. impaired adjustment is, in fact, a medical diagnosis. you can't use medical diagnoses as nanda nursing diagnoses.


    • the nanda nursing diagnosis of ineffective health maintenance is "inability to identify, manage, and/or seek out help to maintain health". (page 103, nanda-i nursing diagnoses: definitions & classification 2007-2008 published by nanda international). it specifically has to do with the doing of the things required to keep up one's health. how are sedentary lifestyle, excessive weight and lack of cardiovascular fitness suited to the definition of this nursing diagnosis? the definition of a nursing diagnosis is the ultimate judge as to whether or not it is appropriate to use. it is appropriate to use cultural beliefs as a reason for having this problem of ineffective health maintenance.


    • while it is appropriate to connect cultural values and norms with the nursing diagnosis of deficient knowledge, you have to clearly show that it is creating a barrier to the patient's ability to learn and you would complete that connection with your patient's symptoms (nanda term: defining characteristics) that lead you to decide upon this


it sounded to me from the way you described this assignment that you needed one nursing diagnosis: "would love some advise on nursing diagnosis for someone with hypertension". the word diagnosis refers to the number one. the plural of diagnosis is diagnoses.

i think you have too many nursing diagnoses. i would trim this down to two.

you do realize, don't you, that any nursing interventions you develop are based upon the patient's actual symptoms that express the etiology (related factors or the related to part of your nursing diagnosis) and represent the problem (nursing diagnosis)? in all three of your posts regarding this scenario you have made your focus the nursing diagnosis and kind of ignored the patient's symptoms when they should, in fact, be the primary focus of what you are doing here.

a doctor diagnoses on the basis of the symptoms he observes. he finds these symptoms by doing a ros (review of systems) and a physical examination. he mentally compiles the abnormal data (symptoms) and makes a medical decision (medical diagnosis). a good mechanic determines what is wrong with your car by the very same process. he goes through a check list of performance indicators, listens to what the car owner tells him and does a physical inspection of the vehicle. he mentally compiles the abnormal data (symptoms) and makes a decision and gives you an estimate (similar to a care plan) of the cost. a professional nurse does an assessment of the patient that involves talking to the patient and going through a similar review of symptoms as well as assessing adls. we also read the patient's medical record and perform our own physical assessment. we compile the abnormal data (symptoms) and make a nursing decision (nursing diagnosis).
the criteria (rules, standards) for the formation of nursing diagnoses is different from the criteria for the formation of medical diagnoses
just like the determination of problems with your car are based on a whole other set of criteria. using a nanda publication like
nanda-i nursing diagnoses: definitions & classification 2007-2008
or a care plan/nursing diagnosis reference that contains that same information will spell out the specific criteria required for each nursing diagnosis.
[the definition of
criteria
: standards, rules or tests by which a judgment of something is made.]

each nursing intervention must specifically refer to and link back to a symptom that the patient has. those symptoms determine how you get to the nursing diagnosis(es) that you eventually use. this is why nursing schools usually want a 3-part nursing diagnostic statement. it helps you see the relationship between all these things. you really haven't presented any of the patient's symptoms that you have extrapolated from the given information and upon which your etiologies and nursing diagnoses are based. i think that might be why you're having trouble with this. in addition, goals and/or outcomes are based upon the behavior you expect the patient to exhibit. goals and/or outcomes are directly affected by the nursing interventions you order.

i write about this stuff on the student forums all the time. there are lots of examples of it in the "desperately need help with careplans" thread on nursing student assistance forum at https://allnurses.com/forums/f205/desperately-need-help-careplans-170689.html.

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Specializes in aged & med/surg.

Sorry Daytonite, Im am new at this. I picked up on the Impaired adjustment related to new condition last night, and made it knowledge def. As I was a first time user I didnt know how much information to put out there and in hindsight should have told you I needed 5 diagnosises or potential ones (I have now just been told) from the senario (which I think is really hard with this senario). So I am clutching at straws with the sedentary lifestyle & lack of cardio fitness. I just assumed as he was overweight with hypertension that something like that might come into it. The cultural stuff is a big thing here in Australia with the Aboriginals, as there has been alot of things done to them over the years, and they are very weary of hospitals, drs etc. So I thought that may be a factor to consider. If he was in a hospital environment it would be easier I believe, especially with potential factors. For potential I was thinking something along the lines of there is a risk of diabetes, stroke etc (I know these are medical diag, but something along these lines?) I am a distance learner and am finding this really difficult, nearly ready to drop out in fact!! Thank you for all your help, I really appreciate it :)

Here is a response to a post from my lecturer, and what she wants. I believe once I have the diagnosises down pat I will be alright with researching the other stuff. I just didnt want to start with rubbish if you know what I mean.

a. Identify and justify a minimum of 5 actual and potential nursing diagnoses (i.e. for each state the diagnosis and explain why you have chosen the particular nursing diagnosis)

b. Prioritise these diagnoses and justify the chosen order.

c. State the appropriate nursing interventions (minimum of four) for each of these nursing diagnoses.

d. Include the appropriate rationale for each of these nursing interventions.

e. Discuss the specific discharge planning needs or appropriate care needed following the client’s discharge from the health care agency.

f. Discuss the legal and ethical issues appropriate to the client scenario chosen.

g. For all of the points you identify above, rationales (reasons, explanations) are needed. It is the discussion of the rationales that will make up most of the essay. It is in the rationales where you will use reference material (ie evidence) gained from books and articles to support your decisions.

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