Help with Care Plans - page 2

Are you scratching your head or are you maybe even ready to tear your hair out over how to come up with care plans? Here are some words of wisdom from our own beloved Daytonite. Care Plan Basics Don't focus your efforts on... Read More

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    Okay, I don't really know where to post this so I will try here first... I am in L&D rotation right now. I have to do a careplan on a post op cesarean pt. I did one last week on acute pain, and risk for infection... So I would like to do something else for this one. She is a 25yowf, antepartum labs are HGB 4.25, HCT 33.3, PLTS 209... blood loss during surgery was >500mL. I was thinking risk for anemia/iron deficiency something along the lines of this. She has symptoms of PICA, requesting large amts of ice, and stating that she "eats it all the time"... There is nothing in her chart substanciating this, just a hunch. So, with the HCT being the only abnormal lab, can I do risk for anemia, or risk for hypovolemia? I have the 8th edition Nsg Dx handbook, but can find nothing along the lines of this in there. What would the correct NANDA dx be for this? I will probably do acute pain in addition to this, so which one would be highest priority? Any help would be much appreciated.... Thanks

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  2. 0
    I was having problems coming up with the collaborative problem. Our instructor provided us with a list of collaborative problems, but nothing was fitting my data. What I ended up doing was using the collaborative DX only for what they applied to and using the risk for...as evidenced by for others. I'll get it back Monday and have to go from there. It just didn't seem possible to have all collaborative DX, but I am new to the collaborative care planning, so I'll let you know. Thanks for taking an interest in my ques.
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    I'm getting a much better pic of the collaborative process. What I've figured out is that I've been calling it an collaborative DX, but it's just a colloborative problem that is put into the nursing DX column of the care plan. I'll find out for sure if I'm on the right track tomorrow. I'll let you know.
  4. 1
    Quote from rwright15
    okay, i don't really know where to post this so i will try here first... i am in l&d rotation right now. i have to do a careplan on a post op cesarean pt. i did one last week on acute pain, and risk for infection... so i would like to do something else for this one. she is a 25yowf, antepartum labs are hgb 4.25, hct 33.3, plts 209... blood loss during surgery was >500ml. i was thinking risk for anemia/iron deficiency something along the lines of this. she has symptoms of pica, requesting large amts of ice, and stating that she "eats it all the time"... there is nothing in her chart substanciating this, just a hunch. so, with the hct being the only abnormal lab, can i do risk for anemia, or risk for hypovolemia? i have the 8th edition nsg dx handbook, but can find nothing along the lines of this in there. what would the correct nanda dx be for this? i will probably do acute pain in addition to this, so which one would be highest priority? any help would be much appreciated.... thanks
    please read post #1 and post #2 of this thread. you need to go through, assemble and analyze this patient's assessment data.

    by pica, i assume you are meaning the eating disorder where a person will ingest anything that is not fit to be classified as human food such as grass, crayons, and i had a patient once who ate plaster. water is a necessary biological need for our bodies. ice is frozen water and eating it does not qualify as a symptom of pica. additionally, being nurses we cannot medically diagnose! pica is a medical diagnosis. all we can do is note the patient's behavior: "consumes large amounts of ice" which, to me, might be consuming large amounts of fluid depending on how much she is actually consuming and is this really a problem? monitoring i&o would tell us right away.

    a post op cesarean patient is basically a surgical patient subject to the complications of a patient who undergoes general or epidural anesthetic. i'm still talking about knowing the signs/symptoms/complications of
    • the surgical procedure that was performed (the c-section)
    • the type of anesthetic used
      • complications of epidural anesthesia are:
        • hypotension
        • rash around the epidural injection site
        • nausea and vomiting from the opiates administered
        • pruritis of the face and neck caused by some epidural narcotics
        • respiratory depression up to 24 hours after the epidural
        • cerebrospinal fluid leakage and spinal headache from accidental
        • dural puncture
        • sensory problems in the lower extremities
      • complications of general anesthesia are:
        • breathing problems (atelectasis, hypoxia, pneumonia,
        • pulmonary embolism)
        • hypotension (shock, hemorrhage)
        • thrombophlebitis in the lower extremity
        • elevated or depressed temperature
        • any number of problems with the incision/wound (dehiscence,
        • evisceration, infection)
        • fluid and electrolyte imbalances
        • urinary retention
        • constipation
        • surgical pain
        • nausea/vomiting (paralytic ileus)
    • how this affected their ability to perform their adls (activities of daily living)
      • movement and walking - yes, they have pain, but how is it affecting their endurance, the amount of time they can be up and moving around at any one time period - this is activity tolerance and there is a nursing diagnosis relating to it
      • is the mother breast feeding? whether she does or doesn't have problems with breastfeeding, there are three nursing diagnoses that address breastfeeding.
    • the patient has an incision. what's being done for it? how will she know what to do in caring for it when she is discharged? who's going to teach her?
    • problems bonding with the infant?
    after considering all these things, then you make a list of the actual symptoms she does have. that list is what you use to look for nursing diagnoses that having matching symptoms (nanda calls them defining characteristics). use a nursing diagnosis reference so you can see all the diagnoses that are available (there are currently 188 of them). there are a number of ways to get this information.
    rwright15 likes this.
  5. 0
    Thank you for all of this useful info. I am confused on the pica definition though. Not to argue, by no means can I possibly know more than an actual practicing nurse, but I thought that pica was a craving for anything that was of little nutritional value, food or non-food items. In fact, here is a little snippet from www.americanpregnancy.org
    [What are typical pica cravings during pregnancy?

    The most common substances craved during pregnancy are dirt, clay, and laundry starch. Other pica cravings include: burnt matches, stones, charcoal, mothballs, ice, cornstarch, toothpaste, soap, sand, plaster, coffee grounds, baking soda, and cigarette ashes.]

    They state that a craving for items such as this might indicate an iron deficiency. So, what I am wondering, would it be a medical diagnosis still if we said risk for low blood volume r/t pregnancy ?? The only post surgical problem this pt had was pain. I may use self care deficit, but my instructor is always asking "what will kill your patient first".... In this case, all I can think of is the blood loss, and infection..... Thanks
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    Quote from rwright15
    I am wondering, would it be a medical diagnosis still if we said risk for low blood volume r/t pregnancy ?? The only post surgical problem this pt had was pain. I may use self care deficit, but my instructor is always asking "what will kill your patient first".... In this case, all I can think of is the blood loss, and infection..... Thanks
    My advice is not to address pica. The actual problems this patient are going to have for sure are related to her incision and mobility. Then, she has potential problems related to possible complications (fluid loss due to blood loss, infection due to incision infection, thrombophlebitis if she is spending more time in bed than she should, UTI)
    ren246 and rwright15 like this.
  7. 0
    Thank you so much, that sounds great!! I think I will go with mobility.... Thank you again for the wisdom. You are truly an asset to this website...
  8. 0
    Thank you all for helping me sort out the Potential Complication part of my last 2 care plans. My instructor wrote that I had really good data and did a good overall job. I will continue to work on wording..... Others had to redo theirs, so I'm grateful that I found this site or I'd be burning the midnight oil so to speak instead of relaxing and spending time cruising this site .
    Thanks again!
  9. 0
    My clinical instructor requires us to list 'as manifested by' for risk diagnoses. She said to ignore our textbooks that say 'risk for' is a two-part.

    In fact, we had a major paper due recently (not part of weekly clinical care-plans) and she booted my paper right back to me to fix and make 'risk for' a three part diagnosis. I thought she was just doing this in our weekly carepans for clincal, but no. It's for major papers as well. Is this unusual?
  10. 1
    Quote from multicollinearity
    my clinical instructor requires us to list 'as manifested by' for risk diagnoses. she said to ignore our textbooks that say 'risk for' is a two-part.

    in fact, we had a major paper due recently (not part of weekly clinical care-plans) and she booted my paper right back to me to fix and make 'risk for' a three part diagnosis. i thought she was just doing this in our weekly careplans for clinical, but no. it's for major papers as well. is this unusual?
    it doesn't follow nanda guidelines. however, this is a school and grading situation and you are obliged to follow the rules you are given. this is really not a problem as long as the instructor applies the rules consistently in grading. i would make sure that your manifested evidence for these diagnoses clearly relates to a specific problem that you're addressing.

    in my bsn program we were not allowed to use nanda wording (language) for our nursing diagnoses. we had to construct nursing diagnoses using language that conveyed the nursing problem but did not duplicate what nanda said. it was possible to do that using a copy of roget's thesaurus for reference.
    Multicollinearity likes this.


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