CAREPLANS HELP PLEASE! (with the R\T and AEB) - page 5

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   ICRN2008
    I am writing a care plan and I would like some help. I have my three nursing diagnoses:
    Activity Intolerance related to impaired oxygen intake/ transport secondary to diminished red blood cell count and chronic obstructive pulmonary disease

    Risk for injury related to inconsistent use of assistive device- cane and related to altered cerebral function secondary to tissue hypoxia

    Risk for infection related to compromised host defenses secondary to immunosuppressive medication therapy

    We have to choose a priority diagnosis and work it up. I was thinking of choosing the activity intolerance (because it has to do with the airway, and that is always the priority). Am I thinking about this correctly?

    Thanks in advance
  2. by   kdeclet
    Quote from RNinJune2007
    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 when we're left on our own, it's extrememly difficult to know where to start!

    It will be the nursing DX r\t (what it's related to), aeb (then the signs and symptoms)

    Does anyone have any pointers to make this easier??

    Thanks in advance!!
    hey - i am currently a pn student - level 3 out 4 - hoping to graduate 12/06! i've been thru nsg process class, and, u r absolutely right! care plans are tough! my whole class agrees - it seems so easy and makes perfect sense while the teacher is explaining it in class, but once u get home and try to come up with stuff on ur own! good luck! ur med/surg book is a good source for ideas...so is www.careplans.com (for examles) we were never given an actual care plan book, but we do have the textbook called Nurse's Pocket Guide: Diagnoses, Interventions, and Rationales. It's good to use if you need Nanda dx! I have found that When coming up with a care plan it is always good to know the med dx and its pathophysiology. that way, u have a better understanding of ur pts needs. Ex: med dx: 3rd degree burn. if u know patho of burns, u will know that pt suffers from fluid loss (fluid volume, deficient), pain, is at risk for infx, impaired skin integ, poss smoke inhalation (airway, ineffective), etc. Then think of ur interventions (what u can do for ur pt) and why u would do this Ex: encourage fluid intake if poss, or iv fluids if NPO (to replace fluids & electrolytes), monitor strict I&0 with urinary outputs q2h (ensure fluid balance), etc. Then u want to set ur goals in a timely manner (pt will report 50% reduction in pain w/i 8hrs) and monitor ur pt closely and eval pt and urself to make sure ur goals were met (is pt able to rest w/o pain during my shift?) sounds like a lot, and it is hard (i'm still struggling) but i'm sure u'll get thru it! don't overthink it or u'll just hurt urself! lol!
  3. by   LadyStar42
    Hello
    Are careplans different for Rn's and LPN's? I'm done with mine (thank-you GOD), ya'll's sound completely different than ours were. A LOT more complicated. We couldn't use actual medical Dx on ours. We had to use nursing Dx only. For instance one of mine was "Airway clearence ineffective R/T retained secretions". Your goal is ALWAYS opposite your problem. "
    Pt. Will Maintain patent airway AEB breath sounds clear/clearing".
  4. by   LadyStar42
    Quote from BSNDec06
    I am writing a care plan and I would like some help. I have my three nursing diagnoses:
    Activity Intolerance related to impaired oxygen intake/ transport secondary to diminished red blood cell count and chronic obstructive pulmonary disease

    Risk for injury related to inconsistent use of assistive device- cane and related to altered cerebral function secondary to tissue hypoxia

    Risk for infection related to compromised host defenses secondary to immunosuppressive medication therapy

    We have to choose a priority diagnosis and work it up. I was thinking of choosing the activity intolerance (because it has to do with the airway, and that is always the priority). Am I thinking about this correctly?

    Thanks in advance
    Go back to the basics. Check for ABCP (airway, breathing, circulation, pain.) I would put impaired 02 intake 1st, then risk for Infection, then risk for injury. But I see a whole different set of problems just on what you wrote. Hope this helps. Donna
  5. by   kdeclet
    Quote from LadyStar42
    Go back to the basics. Check for ABCP (airway, breathing, circulation, pain.) I would put impaired 02 intake 1st, then risk for Infection, then risk for injury. But I see a whole different set of problems just on what you wrote. Hope this helps. Donna
    Hi - i'm a student lpn - hoping to graduate 12/2006...i agree with ur prioritizing - i would definitely stick to impaired o2 first, (ABCP) - i can think of a bunch of other nsg dx's along with interventions and goal before i would worry about acitivity intolerance...airway is always 1st!
  6. by   kdeclet
    Quote from LadyStar42
    Hello
    Are careplans different for Rn's and LPN's? I'm done with mine (thank-you GOD), ya'll's sound completely different than ours were. A LOT more complicated. We couldn't use actual medical Dx on ours. We had to use nursing Dx only. For instance one of mine was "Airway clearence ineffective R/T retained secretions". Your goal is ALWAYS opposite your problem. "
    Pt. Will Maintain patent airway AEB breath sounds clear/clearing".
    i'm a student lpn - from what i understand, care plans are the same for all nurses, i think it's just maybe where you're at, which facility u work for and what their policies are as to how your plan is worded. we were taught to think of it as an exact recipe for other nurses who come after us on the next shift to follow (by listing interventions and evaluations write in the care plan) (Ex. Keep pts head elevated at least 30 degrees while in bed, Check Pulse Ox q4hrs & PRN, Suction q4hrs & PRN, O2 at 2L, If O2 sat >95% remove O2...etc.) Where i'm at, in wilkes-barre, pa, we were taught to use AEB in our nsg dx as well (Ex: Airway clearence ineffective R/T retained secretions AEB gurgling breath sounds), whereas u r writing your AEB in your goal, which i agree makes a whole lotta sense! As for the Med dx, no, we are not allowed to use it in our care plans either, except for maybe as the R/T section (Ex: Gas exchange impaired R/T COPD AEB continuous O2 sats reading below 90%). But i believe that keeping the med dx in the back of your head and understanding its patho, it really helps u to know your pts needs and meet your goals.
    Thanks to u 2, for suggesting that your goal is always opposite your prob! I just never thought of it that way! This thinking will definitely come in handy! In school, we hafta write a care plan for every pt we see while on clinical rotation!
    For your care plans for school, do u also hafta have short-term and long term goal? (Ex: short-term: Pt will maintain patent airway by the end of my shift (8 hrs) AEB breath sounds clearing...long-term Pt will continue to maintain patent airway by time of pts D/C from facility AEB...) Or are my teachers just sticklers for details?
  7. by   julieandtj
    I purchased "Nursing Diagnosis cards" They are put out by lippincott. ISBN#1-58255-218-5. They have everything on them by diagnosis, including r/t, aeb, outcomes, ect...Made my life livable when I had a care plan to write!
  8. by   LadyStar42
    Quote from kdeclet
    i'm a student lpn - from what i understand, care plans are the same for all nurses, i think it's just maybe where you're at, which facility u work for and what their policies are as to how your plan is worded. we were taught to think of it as an exact recipe for other nurses who come after us on the next shift to follow (by listing interventions and evaluations write in the care plan) (Ex. Keep pts head elevated at least 30 degrees while in bed, Check Pulse Ox q4hrs & PRN, Suction q4hrs & PRN, O2 at 2L, If O2 sat >95% remove O2...etc.) Where i'm at, in wilkes-barre, pa, we were taught to use AEB in our nsg dx as well (Ex: Airway clearence ineffective R/T retained secretions AEB gurgling breath sounds), whereas u r writing your AEB in your goal, which i agree makes a whole lotta sense! As for the Med dx, no, we are not allowed to use it in our care plans either, except for maybe as the R/T section (Ex: Gas exchange impaired R/T COPD AEB continuous O2 sats reading below 90%). But i believe that keeping the med dx in the back of your head and understanding its patho, it really helps u to know your pts needs and meet your goals.
    Thanks to u 2, for suggesting that your goal is always opposite your prob! I just never thought of it that way! This thinking will definitely come in handy! In school, we hafta write a care plan for every pt we see while on clinical rotation!
    For your care plans for school, do u also hafta have short-term and long term goal? (Ex: short-term: Pt will maintain patent airway by the end of my shift (8 hrs) AEB breath sounds clearing...long-term Pt will continue to maintain patent airway by time of pts D/C from facility AEB...) Or are my teachers just sticklers for details?
    We have to do most of that stuff as well. We are not allowed to use MDdx at all, but I agree that you need to keep it in mind. We do not do the short term goal, they are all long term as in, what should the goal be before d/c?
    I had one teacher (one only) who told me that our goal is always opposite. She said that the goal should be the last thing that we do so that we can make sure it is the opposite of the problem.
    I think your teachers may be sticklers for details. I had one like that, in my goal it Always had to start with "Pt. will" whatever....drove me nuts. She was the only one who wanted it that way. A lot of the careplan grade is teacher preference.
  9. by   Heavenward
    I was looking for another NANDA list and I found this page. It's helped me, so maybe it will help someone else too

    http://en.wikipedia.org/wiki/List_of_nursing_diagnoses

    *edit, woops! Forgot to mention, if you see an asterisk by the diagnosis, it's not NANDA supported. Otherwise, good to go .
    Last edit by Heavenward on May 19, '06
  10. by   Pbe
    most of my classmates used the nursing dx book to do careplans. And one of the hospitals we were at would have what we need listed on the patients clipboard.
  11. by   bbluvnursing
    I have the "Nursing Diagnosis" manual by Carpenito-Moyet. It pretty much spells it out for you- I absolutely love it! It's pretty simple- let's say your patient is constipated... so you look up Constipation in the table of contents... this book gives you the assessment data your patient should be manifesting in order to consider it constipation... then it gives you your "R/T" options like immobility, effects of medications, etc. The "AEB" is pretty much your assessment data stated all over again.

    An easy way to remember it is...

    1)Decide if this need is ACTUAL or RISK FOR
    2)Write Actual/Risk for _____ [insert need here]
    3)Think of a way to word the client's R/T without using a MEDICAL diagnosis, such as "Diabetes" or "Congestive Heart Failure." In my program, we are allowed to use a medical diagnosis only in this form: "R/T ineffective circulation secondary to diabetes" The "secondary to" is a great way to make your diagnosis sound really smart
    4)Decide what assessment data best reflects your need and put that as your AEB. My program requires that we use at least 3 pieces of data.

    Hope this helps!
  12. by   mwil2378
    Hi,
    My name is Mary . I will graduate Dec 2006 . I would like to thank all of you for the info on careplans.
    May God keep us all Strong
    Best wishes from Georgia
    Mary
  13. by   2lip
    care plans require a lot of practice and studying, try laying your hands on some case studies. there are some very good care plan books around that could help too.

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