Care Plans Help Please! (with the R\T and AEB)

Nursing Students General Students Nursing Q/A

Hello! I'm struggling with one of my classes, when the teacher gives examples it makes sense but when we're left on our own, it's extremely difficult to know where to start.

Specifically, trying to understand 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?

Specializes in med/surg, telemetry, IV therapy, mgmt.
TaraRN07 said:

Thank you!!! I was battling myself with this just a little while ago...thinking how can I use AEB with at risk for!!! Although still struggling with my care plan...I do feel better knowing that my thought process was on the right track...somewhat!!

"Aeb can "Not" be used with an at "Risk for" dx."

Just to clarify for anyone who might read this... AEB's are the symptoms that are the cause of a person's nursing diagnosis. Because a nursing diagnosis that begins with the words "Risk for" is not an existing nursing diagnosis, but one that we are attempting to prevent from happening, there are NEVER going to be any AEB's in that kind of diagnostic statement-EVER. This is a NANDA guideline.

The only exception to this would be specific directions from your instructors to do this. But, please don't assume that all other students in the country are supposed to do this also. Most nursing instructors teach their students to follow the NANDA guidelines.

Hey! I'm in my 3rd semester of nursing and I've had problems with care plans too!! They suck! Anyways... Here's a tip.

Example:

Impaired physical mobility r/t (pathophysiology)...

In other words, after r/t, think of it as describing what's going on in the body. So, if impaired physical mobility was the nursing dx, an example could be...

*impaired physical mobility r/t diminished muscle tone, acute pain in joints, limited range of motion, ordered bed rest secondary to (surgery/sickness?)....

Or

*risk for falls r/t confusion, poor eye sight, unsteady balance, ...

You're just taking your nursing dx and breaking it down into whats literally going on in the body to cause this, without using a medical dx.

As for the "AEB", at our school, we use as evidenced by in our goal statements...So ...

"Patient will have improved physical mobility within 24-48 hours. AEB: displaying increased range of motion, verbalizes

Daytonite said:
Just to clarify for anyone who might read this... AEB's are the symptoms that are the cause of a person's nursing diagnosis. Because a nursing diagnosis that begins with the words "Risk for" is not an existing nursing diagnosis, but one that we are attempting to prevent from happening, there are NEVER going to be any AEB's in that kind of diagnostic statement-EVER. This is a NANDA guideline.

The only exception to this would be specific directions from your instructors to do this. But, please don't assume that all other students in the country are supposed to do this also. Most nursing instructors teach their students to follow the NANDA guidelines.

That's what I thought. Thanks for the clarification. I suppose I will just continue with it until I finish my class.

Specializes in telemetry/hemodialysis.

You can check the back of the taber's med dictionary, there's a section labeld ndx (nursing diagnosis). If your pt has pneumonia, chf, htn, hypoglycemia etc look it up, and then it will give you a great nursing dx.

Also getting a nursing care plan book is very helpful, I have the ackley ladwig 6th ed. Nursing diagnosis handbook. Well worth the money. Nursing dx, interventions, goals etc are in there. Look into it, hope this was helpful!

Specializes in None yet!.

Hey I didn't scroll too far back in this thread, so I don't know if anyone has posted this yet...

At clinicals, we have to make a concept map and most of the time our patient has been discharged, so we have to scramble around and make another one. I have started carrying this book:

"Clinical Companion to Medical Surgical Nursing", by Dirkensen. Its like the huge one, but smaller and fits into a lab coat.

Inside the book has diseases and good diagnoses that match them.- and on the back and front cover, has all of the NANDA diagnoses just like the regular ones.

I love it and it has helped me SO much.

I need a good care plan with interventions and goals for a trach patient who is being weaned from the vent. I have chosen to use the Dx Dysfunctional ventilatory weaning response. I can't seem to find it anywhere in my care plan book and it was new this year. I know it is a NANDA approved Dx, but I am having trouble finding interventions and goals. Thanks.

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

Dysfunctional Ventilatory Weaning Response is listed in Nursing Diagnosis Handbook: A Guide to Planning Care, 7th Edition, by Betty J. Ackley and Gail B. Ladwig, pages 1283 - 1289 complete with definition, defining characteristics, related factors, NOC outcomes, and NIC interventions and rationales. Maybe you know someone who has a copy of this book that you could look at it. I've checked both the Gulanick and Ackley/Ladwig careplan constructor sites and neither has this nursing diagnosis on their website.

To cheekybutts,

Dysfunctional ventilatory weaning responses r/t knowledge deficit of the weaning process (clients role)

Goal:

Patient should be able to demonstrate increased tolerance for activity and participate in the weaning process

Interventions:

- Ascertain clients understanding of weaning process, expectations, and concerns.

- Determine the psychologic readiness, presence/degree of anxiety.

- Explain weaning techniques (t-piece, simv, cpap and pressure support). Discuss individual plan and expectations (it will help the client reduce anxiety and enhances sense of trust)

- Time medications during weaning efforts to minimize sedative effects.

- Involve so, family as appropriate at bedside (moral support)

- Provide diversionary activity (watching tv) to focus attention away from breathing

- Note response to activity/client care during weaning and limit as indicated to prevent excessive o2 consumption/demand with increased possibility of failure

- Acknowledge and provide ongoing encouragement for clients efforts.

- Minimize setbacks, focus client attention on gains and progress to date to reduce frustration that may further impair progress

Specializes in Corrections, neurology, dialysis.

Any advice on prioritizing diagnoses? I know the basic abc - airway, breathing, circulation, but after that, what is more important; Elimination? Safety? Pain? Mobility?

Specializes in Photolab technician.
Natkat said:

Any advice on prioritizing diagnoses? I know the basic abc - airway, breathing, circulation, but after that, what is more important; Elimination? Safety? Pain? Mobility?

Look at all the subjective and objective data and focus on the area that seems to have the greatest number of issues. If you have two separate diagnosis' picked out, pick whichever one meets more of the major and minor defining characteristics.

When writing your R/T, ask yourself "is this something a nurse can help fix?" If you can't find something to place after the R/T then your diagnosis is probably a poor choice and you should consider another.

You might have two diagnosis' that meet all the major and minor defining characteristics, but when you start writing out your R/T clause then it becomes evident which one would be the best choice.

Specializes in Corrections, neurology, dialysis.

Thanks for the tip.

I have no problem with the r/t and AEB. I was having trouble figuring out how to prioritize things past ABC. I can find a ton information about r/t and AEB but nothing about prioritizing. The Ackley and Ladwig book says nothing about it at all.

Specializes in med/surg, telemetry, IV therapy, mgmt.
natkat said:
Any advice on prioritizing diagnoses? I know the basic abc - airway, breathing, circulation, but after that, what is more important; Elimination? Safety? Pain? Mobility?

Nursing diagnoses are often prioritized according to a specific system of priority. Each of you must be attentive to your instructors when you are being given information at the beginning of your nursing programs on care plan construction and the nursing process. The most common prioritizing system used is Maslow, however, there might be another system that your instructors might be wanting you to use. If you are not sure, you should ask your instructors to be sure you have your school program instructions correct. Your grade on care plans may depend upon this.

Each of the nursing diagnoses has a definition. That definition tells you what the intent of the diagnosis is and, therefore, will direct you as to what specific need it is addressing in the patient. Maslow is very clear in his hierarchy of needs as to what is to be placed first and in what order of importance. You can find a nice pyramid of these broken down for you on page 1325 of Nursing Diagnosis Handbook: A Guide to Planning Care, 7th edition, by Betty J. Ackley and Gail B. Ladwig if you happen to have a copy of this book. The authors also go on to classify the nursing diagnoses into the major Maslow groupings. You can see a very detailed explanation of Maslow's hierarchy at this website: https://en.wikipedia.org/wiki/Maslow's_hierarchy_of_needs

The major groupings in maslow's system are:

  • Physiological needs
  • Safety and security needs
  • Love and belonging needs
  • Self-esteem needs
  • Self-actualization needs

They are actually sequenced in his pyramid with the physiological needs at the bottom and self-actualization needs at the top. The importance of this is that the person, according to Maslow, will first seek to fulfill essential needs--physiological needs being the first because they are minimally needed for the organism to survive. The nursing diagnoses that address the physiological needs should be sequenced first and in this order:

  • Oxygen - those diagnoses that address oxygen to the brain are sequenced first, followed by those oxygenating the lung, then the heart and finally the other tissues of the body. Some of the activity tolerance diagnoses are included here because they involve oxygenation.
  • Food - this includes nutrition, food, fluid and electrolytes to not only the entire system, but to the cells as well. Diagnoses involving wound and wound healing should be sequenced with this group.
  • Elimination - bowel and bladder
  • Temperature control - fevers, hyperthermia, hypothermia
  • Sex
  • Movement - all the diagnoses pertaining to mobility and movement
  • Rest - sleep
  • Comfort - pain, self-care and hygiene

Again, I strongly urge you to clarify with your nursing instructors exactly how they want you to prioritize. I have found that some student's instructors are requiring them to move nursing diagnoses such as acute pain to the top of the list of priority. This is contrary to Maslow, but needs to be done by those students because their nursing program is requiring it to be done that way.

+ Add a Comment