CAREPLANS HELP PLEASE! (with the R\T and AEB) - page 12

Hello! I did very well my first unit, taught by a certain teacher. This unit is taught by another and the majority of my class is COMPLETELY lost! When the teacher gives examples, it makes sense but... Read More

  1. by   Daytonite
    nursing diagnosis is based upon the assessment of the patient that you do. this is part of the nursing process. the process of a nurse determining a nursing diagnosis is no different than the process a doctor uses to determine a medical diagnosis or that a plumber uses to figure out why your plumbing isn't working correctly. what is different is that each nursing diagnosis has a set of criteria that the patient must have in order for a nurse to say "this patient has xxx nursing diagnosis". each medical diagnosis has a defined set of criteria that the patient must meet before the doctor can put that medical diagnosis on the patient. the criteria for most nursing diagnoses has been defined by nanda, the north american nursing diagnosis association. some nursing schools have come up with their own nursing diagnoses and the criteria that define them; they instruct their students to use them instead of the nanda diagnoses. there is no guesswork here. there is a specific process (the nursing process) involved in choosing nursing diagnoses for your patients and using them to plan the patient's goals and care. this concept is written about in the first pages of every single care plan book on the market. please take time to read those few pages to understand how the nursing process is put into action to diagnose.

    please note this definition of the words diagnosis and criteria:
    diagnosis: the resulting decision or opinion after the process of examination or investigation of the facts

    criteria: standards, rules or tests by which a judgment of something is made
  2. by   shannonFNP
    I totally recommend this book called "Nursing Diagnosis Handbook" by Judith M. Wilkinson. It is fabulous!!! It has a complete NANDA approved nursing diagnosis list. You can look them in the index to find the page. Under each diagnosis it gives you the 1. Defining characteristics, 2. Related factors, 3. Suggestions for use, 4. Suggested Alternative Diagnoses, 5. NOC outcomes, 6. Goals/evaluation criteria, 7. NIC interventions, and 8. Nursing Activities.

    You can also look up the possible diagnosis' by condition such as "dying patient" or "chest trauma."

    I love this book soooooo much! I'm a begginnning nursing student, so this book is like a bible to me
  3. by   luckynurse17
    :angryfire
    Last edit by luckynurse17 on Oct 2, '07
  4. by   shannonFNP
    Quote from uncled
    Here in Texas we no longer do careplans, but now were are doing concept care mapping, I think it is the same thing.
    Actually, in Central Texas, at least, we still have care plans :spin:
  5. by   aviator411
    Quote from shannon88
    I totally recommend this book called "Nursing Diagnosis Handbook" by Judith M. Wilkinson. It is fabulous!!! It has a complete NANDA approved nursing diagnosis list. You can look them in the index to find the page. Under each diagnosis it gives you the 1. Defining characteristics, 2. Related factors, 3. Suggestions for use, 4. Suggested Alternative Diagnoses, 5. NOC outcomes, 6. Goals/evaluation criteria, 7. NIC interventions, and 8. Nursing Activities.

    You can also look up the possible diagnosis' by condition such as "dying patient" or "chest trauma."

    I love this book soooooo much! I'm a begginnning nursing student, so this book is like a bible to me
    Shannon,

    Hard to believe this book would be that helpful; it was last published in Mar of 95. Next edition not due until Jan 08. Wish I could look at a copy.
    Will look around. I'm a beginning nursing student also and I have yet to find a decent book on this subject. For example, our latest case study was a trauma injury, broken femur w very large wound. The closest NANDA in all the books I've seen is impaired or altered tissue integrity but they all focus on NOCs and interventions for pressure ulcers, not trauma wounds. They just don't fit the problem very well. I know, pressure ulcers have some things in common with trauma but there are substantial differences which none of the books seem to deal with. Seems like all of the books I've seen never quite manage to list classifications which directly apply to the problems we're studying. We use the Nursing Diagnosis Handbook by Ackley, currently in print and recently but the outcomes and interventions never seem to apply to cases we encounter. Surely someone should be able to publish a coherent book on this subject.

    Thanks for any feedback.
    Last edit by aviator411 on Oct 7, '07
  6. by   Daytonite
    Quote from aviator411
    shannon,

    hard to believe this book would be that helpful; it was last published in mar of 95. next edition not due until jan 08. wish i could look at a copy.
    will look around. i'm a beginning nursing student also and i have yet to find a decent book on this subject. for example, our latest case study was a trauma injury, broken femur w very large wound. the closest nanda in all the books i've seen is impaired or altered tissue integrity but they all focus on nocs and interventions for pressure ulcers, not trauma wounds. they just don't fit the problem very well. i know, pressure ulcers have some things in common with trauma but there are substantial differences which none of the books seem to deal with. seems like all of the books i've seen never quite manage to list classifications which directly apply to the problems we're studying. we use the nursing diagnosis handbook by ackley, currently in print and recently but the outcomes and interventions never seem to apply to cases we encounter. surely someone should be able to publish a coherent book on this subject.

    thanks for any feedback.
    perhaps you are not understanding how nursing diagnoses are supposed to be utilized. they are only a tool for expressing the patient's problems. you determine what your patient's problems are from you assessment, not based, in particular, upon their medical diagnoses. just about every care plan/nursing diagnosis book author got permission from nanda to reprint the definition, related factors and defining characteristics that go with each nursing diagnosis. this is the meat of the nursing diagnosis taxonomy. any nocs and necs that are thrown in are a bonus feature provided by the authors and they pay a royalty to the owners of these two taxonomies to reprint them. the current 188 nanda diagnoses, their definitions, related factors and defining characteristics (the bare bones taxonomy) can be purchased from nanda (http://www.nanda.org/) in this publication, nanda-i nursing diagnoses: definitions & classification 2007-2008, which is the size of a pocketbook for that paltry sum of $24.95. you need to use care plan/nursing diagnosis books as references only to verify that you have classified your nursing diagnoses correctly by comparing your patient's symptoms (defining characteristics) to the ones listed under each nursing diagnosis you have chosen. if your patient doesn't have the symptoms that are listed under a particular nursing diagnosis that you think you should be using for them, then you either need to go back and re-assess your patient to find some of these symptoms, or you can't use it. a doctor can't diagnose you with cancer if you don't have the symptoms. a car mechanic can't tell you that your brake pads need replacing if he has examined them and determined that they are 90% gone. you'd be livid and question the integrity of these guys. well, you need to hold yourself up to the same standards when putting a nursing diagnosis on a patient.

    your example of a traumatic injury: broken femur with very large wound is a good example. what the does the way a wound occurred (trauma) have to do with the problem of caring for the wound? the trauma itself may have resulted in some psychological problems, but a wound is a wound. you are still left with the problem of taking care of the wound--that simple. that's what a nursing care plan addresses--nursing problems. you assess a wound and from your assessment of the wound you get your nursing diagnosis, probably impaired skin integrity because the definition of this nursing diagnosis is "altered epidermis and/or dermis" and one of the defining characteristics for this nursing diagnosis is "disruption of skin surface" (page 199, nanda-i nursing diagnoses: definitions & classification 2007-2008). the fact that it was caused by trauma is not really pertinent to the nursing diagnosis other than you might want to include it as part of the related factor. so, your nursing diagnostic statement for this would be impaired skin integrity r/t disruption of the skin surface [you could add here secondary to "traumatic injury" if you must and your instructor approves doing this] aeb [the assessment information of the wound] or impaired skin integrity r/t traumatic disruption of the skin surface aeb [the assessment information of the wound]. if your care plan book does not have specific information about the healing of a wound that you are looking for then you need to go to other resources to find this information such as your nursing textbooks, a book of pathophysiology or check for an article on emedicine. i have a pathophysiology book (pathophysiology: the biologic basis for disease in adults and children, third edition, by kathryn l. mccance and sue e. heuther) that has information in chapter 2 (altered cellular and tissue biology) that explains how cells heal and repair themselves. that's the kind of information you need to know so you know how the body is going to heal itself and to help you formulate the time elements in your goals. a question about this might show up on a nursing test, you never know. your fundamentals of nursing book or the surgical section of your nursing textbook should also have information on how wounds heal and wound care.

    i wouldn't put a lot of reliance on all the interventions and goals (outcomes) listed in care plan books. first of all, they are trying to appease a large audience. secondly, the authors are biased by what they have been exposed to in their own practice and experience. third, the actual lists of nics and nocs are much more extensive than any nursing care plan/nursing diagnosis book could ever list. so, the authors of care plan and nursing diagnosis books only pick and choose ones they want to reprint. all the nic and noc information comes from nursing research that was done at the university of iowa and is owned by them. you can actually buy the books that contain the complete listings of nics and nocs if you want.
    • this is the title of the outcomes book: nursing outcomes classification (noc), third edition, by sue moorhead, marion johnson and meridean maas.
    • the interventions book is: nursing interventions classification (nic), by joanne mccloskey mccloskey dochterman, gloria m. bulechek, gloria m. bulechek.
    both books run about $50 each. however, you can find the same information by researching it in any good nursing textbook(s).

    a care plan is the written documentation of the problem solving process. that's all it is. nursing has defined 5 steps that we are to follow in determining these problems and going about solving them. using a nursing diagnosis only involves step #2 and provides us with a label to put on the patient's problem. the goals (outcomes) and interventions are grounded in the nursing theory we learn from our nursing textbooks. each care plan is unique to the patient's circumstances. this is why you do a thorough assessment of the patient starting at step #1 of the process. now, i understand that you are looking for resources to help you out with this, but almost all the information you need for goals and interventions are actually in the books you already have. you just need to find it and dig it out. getting to all this information is part of learning critical thinking which you need to have to demonstrate when you take nursing tests, the nclex and on the job as an rn.
  7. by   aviator411
    Dayonite,

    I always enjoy and learn from your generous contributions here and this is no exception. How may I thank you for the superb lecture you have provided here?

    We (it's a group project) ended up with this for a nursing diagnosis statement: NANDA: Altered Tissue Integrity r/t injury of left thigh AEB infected wound with large qty serosanguinous drainage and yellow film-like substance covering lower wound.

    I think it's not so much a matter of misunderstanding the intent of the process as much as feeling a need for a more systematic method of routing out all the possible and most appropriate outcomes and interventions. Sometimes it seems a bit random at this point; hoping that the references we consult aren't missing something important. We want to be as thorough as possible and often don't feel we know where to look for everything we need. The cases given to us often include some ambiguity with regard to our roles and access to the patient and with regard to what outcomes we can reasonably expect and how soon we can expect them. Sometimes this information is less easy to come by.

    I still have McCance & Heuther from patho; it is a great book. I won't be selling it any time soon.

    We are gradually feeling more comfortable with all of this and your kind remarks have definitely contributed to this progress.

    Thanks again for taking the time to share your hard-earned knowledge and experience with those of us who aspire to becoming the best nurses we can be!
  8. by   shannonFNP
    Quote from aviator411
    Shannon,

    Hard to believe this book would be that helpful; it was last published in Mar of 95. Next edition not due until Jan 08. Wish I could look at a copy.
    Aviator,
    I'm not sure where you got your information from. This book, published by Pearson Prentice hall, was last published in 2005. I'm eagerly anticipating their newest edition, available in 2009. And it is extremely helpful to both my classmates and I. Our nursing instructors highly recommend it.

    Thanks,though :spin:
  9. by   Rage
    first and foremost above all else is the need to assess.........it is the first step in the nursing process known as ADPIE....but then you assess every time you meet someone, which is the reason that communication is 90% non-verbal........you ARE assessing. In the nursing process you have to focus the assessment process to the prevailing aspects that are affecting your patient. Assessment procedures are both formal and informal, visual and tactile. I'm sure your nursing books are filled with most of the assessments that are done for different situations.........in clinicals you get a cardex on the patients and a update from the previous shift nurse as to the current condition of your patient. Then you go and assess your patient to draw your own conclusions as to how that patient is responding to treatment, conditions, medications, procedures, etc.........
    But now that you have gotten your assessment criteria and you have the medical diagnosis from the cardex, what do you do? Based on medical diagnosis and your assessments you create a "nursing diagnosis" that reflects real/potential problems your patient is/could face. ARF: medical------Excess fluid volume: Nursing / Decreased Cardiac Output: Nursing / Risk for Infection: nursing.........etc.

    Now you need the "P" in ADPIE and this is where most students have the difficulties...........everything else can be found in books including the interventions, but most students want to include aspects in their plans that aren't the same as everyone has in their plans..........(Read as well worn care plans). Understanding this (Since I'm a graduating student who has receiving excellent on all of my care plans) pm me and I'll let you know the site I used to create my care plans.........
    Understand that what is good in school isn't necessarily what is good in the real world............so where as I humbly bow to those with many years of experience (yes I have shown my care plans to experienced nurses in clinical and got the raised eyebrows, but still made an excellent in school), in school it is a different ballgame. Not all schools but most that I have encountered via the students.
  10. by   juli44
    We were given a care plan example - a plant with droopy leaves. The way it simplified the knowledge worked for me. When ever I get stuck I go back to the plant. My suggestion is to make a simplified care plan and have it checked by your teacher and use it as a reference.
  11. by   trepinCT
    our "related to" is the etiology and has to be something we can change or improve..we cannot say r/t surgery because we cannot change the surgery..
  12. by   mabton8
    Does anyone have any ideas as to a nursing diagnosis for hypotension?
  13. by   Daytonite
    hi, mabton8, and welcome to allnurses!

    i say this so much that i wonder if it is even posted on this thread: you cannot determine a patient's nursing diagnosis from his/her medical diagnosis. burn that statement into your brains. it would be like a doctor asking you if you have any ideas as to a medical diagnosis for a patient who has ineffective tissue perfusion. you'd look at the doctor and wonder what was wrong with his thinking.

    when you are writing a care plan and determining the patient's problems (labeling them with a nursing diagnosis) you must follow the nursing process. the nursing process is the problem solving process that we use, plain and simple. there are plenty of posts on this thread that go through those 5 steps and you should read the posts on this thread to learn about them if you do not know them already.

    the most important step is the first one--assessment. from your assessment of the patient which includes a thorough review of the patient's medical record, an interview of the patient about their health and medical history and your own physical examination you learn what their problems and signs and symptoms of their health are. it is these signs and symptoms that will give you any ideas as to nursing diagnoses your patient has, not necessarily the fact that he/she has a medical diagnosis of hypotension. you will use these signs and symptoms and compare them to signs and symptoms listed under the various nursing diagnoses to find a match for your patient. every nursing diagnosis has a list signs and symptoms (they are called defining characteristics) that goes with it. you need a nursing diagnosis reference book of some sort in order to correctly make these matches. this patient needs to be assessed for the ability to achieve daily adls and that is not something that is part of the signs and symptoms of the medical diagnosis of hypotension. this patient may have other problems that don't even relate to hypotension that you would not know about without performing your own assessment. in fact, the remainder of your care plan is going to be nearly entirely based on your assessment information--not on the fact that the patient has a medical diagnosis of hypotension although the hypotension may affect some judgments that you will make about the etiology of some of the patient's problems.

    so, the question you should be asking is "any ideas as to a nursing diagnosis for a patient that has these signs and symptoms. . .?

    if you are still having problems determining your nursing diagnoses, post a question along with your patient's signs and symptoms in either the nursing student assistance forum (http://allnurses.com/forums/f205/) or the general nursing discussion forum and you will get help.(http://allnurses.com/forums/f50/)

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