Help with my concept map care plan

  1. 0
    Im having a brain freeze!
    Im trying to work on my concept map right now.
    Post OP Total Hip anthroplasty
    HX COPD, HTN
    My priorities need to be Dislocation, Infection, Venous Thromboembolism, bleeding, Infection
    Im having trouble turning these priorites into Nursing Diagnosies
    His pain is 9/10 edema, redness, warmth, c/o low back pin and knee pain.
    Skipping meals, 3 days post op
    He is on steroids
    HGB 7.4
    HCT 21.4
    MPV 6.9
    CO2 19
    gluc 118

    So far I have
    Risk for infection
    Ineffective Tissue Perfusion
    Risk for impaired skin integrity
    Acute Pain

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  2. 3 Comments...

  3. 1
    maybe:

    Risk for peripheral neurovascular dysfunction r/t vascular insufficiency and nerve compression secondary to edema
    Acute pain r/t tissue trauma, disruption of skin integrity and edema AMB reluctance to move,guarading of affected area, persistent score of >8 on 10-point pain scale

    Risk for impaired skin integrity r/t immobility and shearing forces
    Impaired physical mobility r/t decreased muscle strength, pain, AMB inability to purposefully move, limited joint ROM, inability to bear weight

    Altered nutrition: less than body requirements r/t decreased intake AMB skipping meals for three days
    donsterRN likes this.
  4. 4
    why do your patient's priorities have to be dislocation, infection, venous thromboembolism, bleeding, or infection? where did those come from? they are complications of arthroplasty. potential complications are never more important than the actual problems the patient has. on a care plan (concept map) your priorities should be focused on the actual evidence/data/symptoms that the patient has:
    • pain is 9/10, in the knee, low back
    • edema (where?)
    • redness, warmth (where?)
    • skipping meals (in the hospital?)
    • hgb 7.4
    • hct 21.4
    • mpv 6.9
    • co2 19
    • gluc 118
    priorities don't get turned into nursing diagnoses; data becomes the basis for the nursing diagnoses that you choose. your concept map will clearly show this. that's the beauty of concept maps.

    every nursing diagnosis has a set of signs and symptoms (nanda calls them defining characteristics). a patient must have at least one or more of these defining characteristics before you can assign any nursing diagnosis to the patient. for example, a doctor would never assign a medical diagnosis of pneumonia to someone without having the evidence to back it up and support it. nursing diagnosing is no different.

    so, for the nursing diagnosis of acute pain you have the data of pain of 9/10 in the knee and low back to support it.

    ineffective tissue perfusion (specify) is not normally used for patients who have had this procedure. ineffective tissue perfusion, peripheral has to do with constricted capillaries (you gotta know and understand the pathophysiology behind the etiologies of these physiological based nursing diagnoses!) and that is not what is going on with this patient, is it? the cause of his edema is because of inflammation (pathophysiology of inflammation: http://allnurses.com/forums/f50/hist...ct-244836.html) due to manual manipulation of the tissues by the surgeon and the healing process. you need to read the pathophysiology of tissue damage to understand this. their incisions and bone at the site of surgery, however, are at risk for infection (skin infection, sepsis, osteomyelitis).

    now, you just had a patient who had their whole hip joint replaced. how many cartwheels can he now do? none? well, can he run down the hall now? no, to that too? does he have a continuous passive motion machine connected to the operative limb? an abduction pillow? is he getting physical therapy? don't you think there's enough evidence (which you failed to list) for a diagnosis of impaired physical mobility?

    another student a week ago was working on a care plan for a patient who also had a hip arthroplasty. you might want to see that thread since i discussed the care planning with the student, including the diagnoses and interventions to use as well as weblinks to information about the surgery and nursing diagnosis webpages:
    http://allnurses.com/forums/f205/nur...is-290260.html
    Last edit by Daytonite on Mar 28, '08
    mrnewman, ShionRN, amberfree, and 1 other like this.
  5. 0
    Quote from daytonite
    why do your patient's priorities have to be dislocation, infection, venous thromboembolism, bleeding, or infection? where did those come from? they are complications of arthroplasty. potential complications are never more important than the actual problems the patient has. on a care plan (concept map) your priorities should be focused on the actual evidence/data/symptoms that the patient has:
    • pain is 9/10, in the knee, low back
    • edema (where?)
    • redness, warmth (where?)
    • skipping meals (in the hospital?)
    • hgb 7.4
    • hct 21.4
    • mpv 6.9
    • co2 19
    • gluc 118
    priorities don't get turned into nursing diagnoses; data becomes the basis for the nursing diagnoses that you choose. your concept map will clearly show this. that's the beauty of concept maps.

    every nursing diagnosis has a set of signs and symptoms (nanda calls them defining characteristics). a patient must have at least one or more of these defining characteristics before you can assign any nursing diagnosis to the patient. for example, a doctor would never assign a medical diagnosis of pneumonia to someone without having the evidence to back it up and support it. nursing diagnosing is no different.

    so, for the nursing diagnosis of acute pain you have the data of pain of 9/10 in the knee and low back to support it.

    ineffective tissue perfusion (specify) is not normally used for patients who have had this procedure. ineffective tissue perfusion, peripheral has to do with constricted capillaries (you gotta know and understand the pathophysiology behind the etiologies of these physiological based nursing diagnoses!) and that is not what is going on with this patient, is it? the cause of his edema is because of inflammation (pathophysiology of inflammation: http://allnurses.com/forums/f50/hist...ct-244836.html) due to manual manipulation of the tissues by the surgeon and the healing process. you need to read the pathophysiology of tissue damage to understand this. their incisions and bone at the site of surgery, however, are at risk for infection (skin infection, sepsis, osteomyelitis).

    now, you just had a patient who had their whole hip joint replaced. how many cartwheels can he now do? none? well, can he run down the hall now? no, to that too? does he have a continuous passive motion machine connected to the operative limb? an abduction pillow? is he getting physical therapy? don't you think there's enough evidence (which you failed to list) for a diagnosis of impaired physical mobility?

    another student a week ago was working on a care plan for a patient who also had a hip arthroplasty. you might want to see that thread since i discussed the care planning with the student, including the diagnoses and interventions to use as well as weblinks to information about the surgery and nursing diagnosis webpages:
    http://allnurses.com/forums/f205/nur...is-290260.html
    ineffective tissue perfusion, peripheral
    this is what i have been looking for! thank you!
    i have chosen, pain infection, and mobility due to the increased pain 9/10.
    the warmth edema and redness are all on the upper side of the thigh above and below the incision line.
    this was very helpful thank you!


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