careplan prioritizing

smk1, LPN · Oct 25, 2006

I need some help on a major careplan
My patients major admitting diagnosis was intractable pain/ lumbar radiculopathy, I took care of her on her sec. hospitalday. She had a PCA pump , was still in strong pain, could hardly move ,crying a lot and very anxious. She also was a diabetic and had hypertension , but these were not here admitting diagnosis.
I have to do careplans on 3 Nanda's and prioritise these. I have come up with 1) pain r/t nerve root irritation ; 2) self care deficit r/t impaired physical mobility ; and 3) anxiety r/t situational crisis and threat of role change. I am just not sure , especially with the second one, it seems to simple, I wonder if should go with some of her other diagonosises , but then they are not priority right now , right?
By the way , I am first semester student, 8 weeks in the programm. Oh and one fo the nursing diagnosis has to be psychosocial.
Also then , I struggle with the goals and outcomes
Help

I woud say that any surgical patient should have a risk for infection diagnosis as a high priority and she is also diabetic which increases her infection risk. I would put that at number 1 or 2. I agree with the pain being 1 or 2 as well, make sure the goals are measurable like: "patient will report pain level at or under 3 (1-10 scale) by 6:00 pm on 10-26-06." and make sure when you evaluate your goals that you don't evaluate your interventions.

mysterious_one, ASN, RN · Oct 25, 2006

i guess i have to clarify , she had no surgery, there was only an MRI done in her lumbar region. She was just admittted the night before.

BeccaznRN, RN · Oct 25, 2006

Yes, pain is definitely a priority in this case. If the patient has pain, it's going to affect a lot of things, for example: heart rate increases, respiratory rate can increases, etc. She has a PCA pump and is still in pain - make sure you are doing pain assessments on a regular basis as an intervention. Once pain is controlled, it will lead into your other diagnoses.....her anxiety can decrease, she can participate in self care, etc. So a priority is definitely pain! Good job!

LKG6 · Oct 25, 2006

I have to do careplans on 3 Nanda's and prioritise these. I have come up with 1) pain r/t nerve root irritation ; 2) self care deficit r/t impaired physical mobility ; and 3) anxiety r/t situational crisis and threat of role change.

Use proper nanda diagnoses.

Pain, acute or

pain, chronic also

self-care deficit, bathing/hygiene or

,dressing/grooming, or

,feeding or

,toileting.

Katie

Daytonite, BSN, RN · Oct 26, 2006

I would like to make a couple of suggestions. First of all, if you are going to use self-care deficit you must specify a type of self-care deficit. Self-care deficits concern accomplishing daily ADLs such as bathing, dressing, eating and toileting. Having some personal experience with radiculopathy in the lower extremities I am wondering why you aren't using a diagnosis of Impaired Physical Mobility. Impaired Physical Mobility is more appropriate to use with someone who has difficulty with the use of any of their limbs--in this case, the leg(s). It is often extremely difficult for people with very painful radiculopathy to ambulate and/or find comfortable positions to sit, lie or stand. That is a mobility problem. If the patient is able to move her arms normally then she should be able to perform nearly all of her own hygiene, toileting, eating and elimination problems with only minor accommodations that she should have figured out herself already. I am also wondering if she is having problems with sleeping due to the pain and positioning which would capture another nursing diagnosis: Disturbed Sleep Pattern R/T positioning. Another potential problem is constipation. Being on PCA narcotics is most likely going to cause some problems with bowel movements. Secondarily, the radiculopathy may also be causing some nerve disturbance to the bowel as well which could also contribute to the development of constipation. Fluids and a high fiber diet are definitely in order for her. Being a "Risk for" nursing diagnosis gives something like this a last place priority because it is an anticipatory problem.

As for a psychosocial diagnosis, I would consider Powerlessness. Having gone through a number of years of lower leg radiculopathy following spinal surgery I could write you a book on the depression and the life changes that accompanied it and the pain that went with it. I suggest it only as an alternative to using the diagnosis of anxiety.

These would be my suggestions, in order of priority, for the nursing diagnoses for this patient based on the information you supplied, what I know about this condition, and based on Maslow's Hierarchy of Needs:

Acute Pain R/T nerve root irritation
Impaired Physical Mobility R/T neuromuscular impairment AEB being hardly able to move
Disturbed Sleep Pattern R/T positioning
Powerlessness R/T life situation of constantly being in pain AEB [crying, anxiety, expressions of dissatisfaction and frustration over inability to perform previous tasks and activities, resentment, anger, guilt]
Risk for Constipation R/T slowed peristalsis

mysterious_one, ASN, RN · Oct 26, 2006

thanks everyone for your help,

Daytonite , thanks for the suggestion of impaired mobility, I like that much better , it makes more sense to me, then the self care deficit.