Care plans- student nursing - page 5

Hi All, How have you been doing with Care Plans? Want to share any comments or opinions? Thanks, Marie:)... Read More

  1. by   RNConnieF
    A very wise instructor told me to:
    Identify the Nsg Dx.
    Identify the As Evidenced By
    JUMP to the Goals
    THEN do the Interventions and Evaluations. i.e.
    Fluid Volume Deficit, Related to Decreased intake with increased loss, AEB; BP < 120/60 (or what ever the pts norm is), PO intake < 2000 cc/day, output of >3000 cc/day, poor skin turger with tenting. Goal: (look back at your as evidenced by) Pt will have a 500-1000 cc positive fluid balance for the next 24 hours, Pt's BP will return to baseline within 12 hours, urine spacific gravity will be (fill in the spacific numbers your facility uses) within 36 hours; pts skin will show no evidence of tenting in 72 hours. Now go to interventions, it's easy now: encourage PO intake of fluids, assess prefrences for juices, sodas, waters, soups; place dietary order for preferred fluids; record intake and output. Evaluation, again it's not too hard, your goals are either met or unmet, if they are unmet then you have to revise them. Try thinking in terms of :
    This is the problem (Nursing Diagnosis)
    This problem is cause by (Related to)
    I know this is the problem because (As Evedinced By)
    This is the resolution to this problem I want and I want it NOW(Goals, short term and long term)
    This is what I have to do to solve this problem (Interventions)
    This is how I'll know this problem is solved. (Evaluation)
    You'll be surprised, but in a while you'll be thinking in these terms and doing a nursing care plan in your head and USING it every day. Hang in there, it gets easier.
  2. by   Love-A-Nurse
    we begun working (actually) with the care plans yesterday. yes, it is good to know we have the needed resources in books to help us with nursing diagnosis but coming up with the one that fits the patient's individual care is the key.
  3. by   suzielee
    Im in my final year of school. Nursing care plans suck but they do have relevance. Its important to understand what interventions are pertinent to your patient and their condition. Care plans tend to make all the infomration you recieve in that block kind of gel. Dont copy the care plans in the back of your patients chart-your not learning anything that way. Go thru your care plan texts and med surg texts-pick out the interventions and diagnosis that pertain to your patient and use your critical thinking skills to develop others unique to your patient. The one book Ive found completely indespensible during my 4 year stint is Lippincotts Practical Guide to Nursing. This book is amazing. It has condensed patho, nursing diagnosis, tests, surgical and medical procedures and all relevant interventions with raitionale- for 125$ its way more useful then any med surg
  4. by   Mkue
    Originally posted by suzielee
    Im in my final year of school. Nursing care plans suck but they do have relevance. Its important to understand what interventions are pertinent to your patient and their condition. Care plans tend to make all the infomration you recieve in that block kind of gel. Dont copy the care plans in the back of your patients chart-your not learning anything that way. Go thru your care plan texts and med surg texts-pick out the interventions and diagnosis that pertain to your patient and use your critical thinking skills to develop others unique to your patient. The one book Ive found completely indespensible during my 4 year stint is Lippincotts Practical Guide to Nursing. This book is amazing. It has condensed patho, nursing diagnosis, tests, surgical and medical procedures and all relevant interventions with raitionale- for 125$ its way more useful then any med surg
    Thank you for the book suggestion !
  5. by   Mkue
    Originally posted by RNConnieF
    A very wise instructor told me to:
    Identify the Nsg Dx.
    Identify the As Evidenced By
    JUMP to the Goals
    THEN do the Interventions and Evaluations. i.e.
    Fluid Volume Deficit, Related to Decreased intake with increased loss, AEB; BP < 120/60 (or what ever the pts norm is), PO intake < 2000 cc/day, output of >3000 cc/day, poor skin turger with tenting. Goal: (look back at your as evidenced by) Pt will have a 500-1000 cc positive fluid balance for the next 24 hours, Pt's BP will return to baseline within 12 hours, urine spacific gravity will be (fill in the spacific numbers your facility uses) within 36 hours; pts skin will show no evidence of tenting in 72 hours. Now go to interventions, it's easy now: encourage PO intake of fluids, assess prefrences for juices, sodas, waters, soups; place dietary order for preferred fluids; record intake and output. Evaluation, again it's not too hard, your goals are either met or unmet, if they are unmet then you have to revise them. Try thinking in terms of :
    This is the problem (Nursing Diagnosis)
    This problem is cause by (Related to)
    I know this is the problem because (As Evedinced By)
    This is the resolution to this problem I want and I want it NOW(Goals, short term and long term)
    This is what I have to do to solve this problem (Interventions)
    This is how I'll know this problem is solved. (Evaluation)
    You'll be surprised, but in a while you'll be thinking in these terms and doing a nursing care plan in your head and USING it every day. Hang in there, it gets easier.
    THANK YOU for sharing your wisdom Connie !!
  6. by   Bonnie Blue
    My 2 cents. I HATED care plans! More specifically, the nursing dx part and then working the patho backwards to get to the nursing dx. I appreciate the learning about patho and why certain treatments and meds are used. But I am a linear thinker, if x is going on, we need to do w, y, z to try to fix x. This year in our NP classes we're doing that. Also, there were some times that I was grasping at straws for a pertinent nursing dx in a body system that wasn't affected. We weren't allowed to say system healthy, we had to find something that could go wrong, even if it's a remote possiblity. SOAP's aren't going to be easy but at least they make sense.
  7. by   Mkue
    Originally posted by Bonnie Blue
    My 2 cents. I HATED care plans! More specifically, the nursing dx part and then working the patho backwards to get to the nursing dx. I appreciate the learning about patho and why certain treatments and meds are used. But I am a linear thinker, if x is going on, we need to do w, y, z to try to fix x. This year in our NP classes we're doing that. Also, there were some times that I was grasping at straws for a pertinent nursing dx in a body system that wasn't affected. We weren't allowed to say system healthy, we had to find something that could go wrong, even if it's a remote possiblity. SOAP's aren't going to be easy but at least they make sense.
    Thanks Bonne Blue ! Your thinking style makes sense to me !
  8. by   kaytdid
    Originally posted by nurs2b


    Many hospitals use "generic" care plans... The same plan for every person... But in nursing school they want "individualized" care plans... You may use those to get you started but they probably won't be everything you need... And as far as them being hard... My personal opinion is that they aren't hard, its more of they are VERY time consuming and take ALOT of critical thinking...
  9. by   kaytdid
    we all hate care plans, they are basically outdated due to the quick turnover of patients in the hospitals now, you only have time to carry out Dr. orders. But they are still the backbone of nursing care, and i hate it when the older nurses say, "in my day,", so i would like to master the art of care plans. so far, so good.
  10. by   teeituptom
    Howdy yall
    from deep in the heat of texas

    Nowadays with computerized charting you make care plans by just clicking on the applicable items. When they first came out we had to make them up using our mind and write them out long hand. The catch nowadays is that if you have an item in the care plan, it has to be addressed daily in the notes even on a computer system. But there again computerized charting makes it so much easier.



    doo wah ditty
  11. by   jdomep
    I type mine too. Our instructor gave us forms so I just put them in "excel" and tomorrow when I go in to get all of the info on Saturdays client I will type in what I need and print it out. Then Saturday at 6am I will go in and write what changed.

    My hand writing is terrible unless I really concentrate and then it takes too long

    And Connie, I just cut and pasted your words of wisdom to tape to my clipboard - Thanks :kiss
  12. by   RNConnieF
    Glad to help. Dispite the posts here, I do find that my experience doing care plans has helped me in my nursing practice. I no longer write a care plan for my patients but I do find myself THINKING in terms of the nursing care plan, i.e. when I first see a patient I start trying to determin what is the priority for nursing care, what makes me think this, what do I have to do to correct/prevent this problem, and how will I know if I did a good job. Just last night I had a patient with end stage COPD who had just been place on hospice. By assessment, my priority was to provide comfort in the dying process. Now I have my priority I can plan what I need to do next, and I can self evaluate if I met my own priority for care. My whole night was determined by my plan of care for this patient. I got my assessments and meds done early, got other nurses to keep an eye on my patients and spent the remaining hours of my shift and well into the next shift just sitting with this man so that there was someone with him when he died. How do I know I met my goals? My patient died with me holding his hand and just gently slipped over to the other side. This is why we work on care plans in school. Care plans train the mind to think in a certain way and this way of thinking benefits us as nurses and it benefits our patients. Hnag in there with the care plans, you'll see the benefit to you.
  13. by   Love-A-Nurse
    originally posted by rnconnief
    glad to help. dispite the posts here, i do find that my experience doing care plans has helped me in my nursing practice. i no longer write a care plan for my patients but i do find myself thinking in terms of the nursing care plan, i.e. when i first see a patient i start trying to determin what is the priority for nursing care, what makes me think this, what do i have to do to correct/prevent this problem, and how will i know if i did a good job. just last night i had a patient with end stage copd who had just been place on hospice. by assessment, my priority was to provide comfort in the dying process. now i have my priority i can plan what i need to do next, and i can self evaluate if i met my own priority for care. my whole night was determined by my plan of care for this patient. i got my assessments and meds done early, got other nurses to keep an eye on my patients and spent the remaining hours of my shift and well into the next shift just sitting with this man so that there was someone with him when he died. how do i know i met my goals? my patient died with me holding his hand and just gently slipped over to the other side. this is why we work on care plans in school. care plans train the mind to think in a certain way and this way of thinking benefits us as nurses and it benefits our patients. hnag in there with the care plans, you'll see the benefit to you.
    how compassionate and professional, connie. you get a big ((((((connie))))) from me. keep being the wonderful person you are. i too re-read your post about care plans and thought, i need to save this. i start clinical on the 22nd of this month and it will come in handy to have another approach to thinking, thanks.

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