I feel stupid. Can anyone answer a question about a care plan?

  1. 0
    I have a care plan (my first) due on a hypothetical patient Thursday. I am absolutely lost as to pathophysiology. The dx is "risk for impaired skin integrity d/t moisture from diaphoresis" (something like that). How do I find out what the patho is on that? I'm not even sure what pathophysiology means!

    I have the Ackley Nursing Diagnosis Handbook. It tells me a lot of things to look for, talks about teaching, etc., but I have no idea where to look for the patho -- my Med Surg book has nothing that I can find. I really feel like I am doing this by the seat of my pants and I won't see or be able to talk to my instructor until this thing is due on Thursday.
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  4. 1
    Hi there! I'm also doing my first few careplans and just posted a question for help....they're really difficult so far! Now, I am definitely not an expert on these but I can try to help you. Diaphoresis is increased sweating, so I guess to make a careplan you should address the reason for the increased moisture and your interventions should match that. Interventions could be frequent linen changes, temperature control, etc. Kinda hard to find the pathophysiology of such a vague symptom.
    Not sure if that was any help, I am sure someone much more experienced than I will give you more valuable information!!
    Good luck!!
    DroogieRN likes this.
  5. 1
    the dryness of the skinís outer layer discourages colonization by microorganisms, and the shedding of epidermal cells keeps many microbes from establishing habitation. however, the skinís mechanisms of protection may fail because of trauma, irritation, or maceration (maceration of the skin occurs when it is consistently wet. the skin softens, turns white, and can easily get infected with bacteria or fungi.). with inhibition or failure of the skinís protective mechanisms, cutaneous infections may occur.

    moist occlusion promotes miliaria (sweat rash), and causes an increase in the coefficient of skin friction. skin hydration and an increase in skin ph result in impaired barrier function. skin in this weakened state is susceptible to a variety of biological, chemical, and physical insults that can cause or aggravate diaper dermatitis.


    just a little i found online
    DroogieRN likes this.
  6. 1
    you've told us nothing about this hypothetical patient. what is going on with them that prompted you to decide on using a diagnosis of risk for impaired skin integrity d/t moisture from diaphoresis? that is an anticipated problem. that means it is not a problem that the patient has--it is something you think might happen to them based upon other factors, usually the medical condition they have.

    so, what else is going on here?

    turn to and read section i (pages 2 - 15) of your ackley nursing diagnosis handbook before you do anything else. you need to understand what adpie and the nursing process are.
    1. assessment (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
      • a physical assessment of the patient
      • assessment of the patient's ability and any assistance they need to accomplish their adls (activities of daily living) with the disease
      • data collected from the medical record (information in the doctor's history and physical, information in the doctor's progress notes, test result information, notes by ancillary healthcare providers such as physical therapists and dietitians
      • knowing the pathophysiology, signs/symptoms, usual tests ordered, and medical treatment for the medical disease or condition that the patient has. this includes knowing about any medical procedures that have been performed on the patient, their expected consequences during the healing phase, and potential complications. if this information is not known, then you need to research and find it.
      • http://allnurses.com/forums/f205/med...es-258109.html - medical disease information/treatment/procedures/test reference websites
    2. determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
      • it helps to have a book with nursing diagnosis reference information in it. there are a number of ways to acquire this information.
      • your instructors might have given it to you.
      • you can purchase it directly from nanda. nanda-i nursing diagnoses: definitions & classification 2007-2008 published by nanda international. cost is $24.95 http://www.nanda.org/html/nursing_diagnosis.html
      • many authors of care plan and nursing diagnosis books include the nanda nursing diagnosis information. this information will usually be found immediately below the title of a nursing diagnosis.
      • the nanda taxonomy and a medical disease cross reference is in the appendix of both taber's cyclopedic medical dictionary and mosby's medical, nursing, & allied health dictionary
      • there are also two websites that have information for about 75 of the most commonly used nursing diagnoses that you can access for free:
    3. planning (write measurable goals/outcomes and nursing interventions)
      • goals/outcomes are the predicted results of the nursing interventions you will be ordering and performing. they have the following overall effect on the problem:
        • improve the problem or remedy/cure it
        • stabilize it
        • support its deterioration
      • interventions are of four types
        • assess/monitor/evaluate/observe (to evaluate the patient's condition)
        • care/perform/provide/assist (performing actual patient care)
        • teach/educate/instruct/supervise (educating patient or caregiver)
        • manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)
    4. implementation (initiate the care plan)
    5. evaluation (determine if goals/outcomes have been met)
    DroogieRN likes this.
  7. 0
    Quote from daytonite
    you've told us nothing about this hypothetical patient. what is going on with them that prompted you to decide on using a diagnosis of risk for impaired skin integrity d/t moisture from diaphoresis? that is an anticipated problem. that means it is not a problem that the patient has--it is something you think might happen to them based upon other factors, usually the medical condition they have.

    so, what else is going on here?

    turn to and read section i (pages 2 - 15) of your ackley nursing diagnosis handbook before you do anything else. you need to understand what adpie and the nursing process are.
    1. assessment (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
      • a physical assessment of the patient
      • assessment of the patient's ability and any assistance they need to accomplish their adls (activities of daily living) with the disease
      • data collected from the medical record (information in the doctor's history and physical, information in the doctor's progress notes, test result information, notes by ancillary healthcare providers such as physical therapists and dietitians
      • knowing the pathophysiology, signs/symptoms, usual tests ordered, and medical treatment for the medical disease or condition that the patient has. this includes knowing about any medical procedures that have been performed on the patient, their expected consequences during the healing phase, and potential complications. if this information is not known, then you need to research and find it.
      • http://allnurses.com/forums/f205/med...es-258109.html - medical disease information/treatment/procedures/test reference websites
    2. determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
      • it helps to have a book with nursing diagnosis reference information in it. there are a number of ways to acquire this information.
      • your instructors might have given it to you.
      • you can purchase it directly from nanda. nanda-i nursing diagnoses: definitions & classification 2007-2008 published by nanda international. cost is $24.95 http://www.nanda.org/html/nursing_diagnosis.html
      • many authors of care plan and nursing diagnosis books include the nanda nursing diagnosis information. this information will usually be found immediately below the title of a nursing diagnosis.
      • the nanda taxonomy and a medical disease cross reference is in the appendix of both taber's cyclopedic medical dictionary and mosby's medical, nursing, & allied health dictionary
      • there are also two websites that have information for about 75 of the most commonly used nursing diagnoses that you can access for free:
    3. planning (write measurable goals/outcomes and nursing interventions)
      • goals/outcomes are the predicted results of the nursing interventions you will be ordering and performing. they have the following overall effect on the problem:
        • improve the problem or remedy/cure it
        • stabilize it
        • support its deterioration
      • interventions are of four types
        • assess/monitor/evaluate/observe (to evaluate the patient's condition)
        • care/perform/provide/assist (performing actual patient care)
        • teach/educate/instruct/supervise (educating patient or caregiver)
        • manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)
    4. implementation (initiate the care plan)
    5. evaluation (determine if goals/outcomes have been met)
    i know next-to-nothing about care plans, except that i have to write one -- that is the diagnosis we were given about the pt. i don't understand at all how that can be the dx, but we were told it is. the diaphoresis is d/t fever of several days' duration.

    thank you, though, for all this info! i am making note of everything and setting it aside until tomorrow -- i have a huge test to study for tonight.

    edited to add: the thing that's got me more freaked out than anything is the pathophysiology. first of all, i don't even know what pathophysiology is. second, i don't know where to find out, and we have to put the patho for the dx. i really am at a loss. i am in my 4th week of nursing school and i am usually great at figuring things out but not this.
  8. 0
    Quote from truern
    the dryness of the skinís outer layer discourages colonization by microorganisms, and the shedding of epidermal cells keeps many microbes from establishing habitation. however, the skinís mechanisms of protection may fail because of trauma, irritation, or maceration (maceration of the skin occurs when it is consistently wet. the skin softens, turns white, and can easily get infected with bacteria or fungi.). with inhibition or failure of the skinís protective mechanisms, cutaneous infections may occur.

    moist occlusion promotes miliaria (sweat rash), and causes an increase in the coefficient of skin friction. skin hydration and an increase in skin ph result in impaired barrier function. skin in this weakened state is susceptible to a variety of biological, chemical, and physical insults that can cause or aggravate diaper dermatitis.


    just a little i found online

    thanks! can i ask where you found it?
  9. 1
    Pathophysiology: "an explanation of the processes in the body that result in the signs and symptoms of a disease, the study of the biologic and physical manifestations of disease as they correlate with the underlying abnormalities and physiologic disturbances. Pathophysiology does not deal directly with the treatment of disease." Mosby's Dictionary of Medicine, 7th edition, pg 1411.

    You can explain the process that causes us to sweat to do the pathophysiology or the process that happens when our skin breaks down...hope this helps. Get a medical dictionary if you don't already have one...they have helped me so much when I find words in my textbook that I don't understand!
    DroogieRN likes this.
  10. 2
    ok, so you are told to do a care plan on risk for impaired skin integrity d/t moisture from diaphoresis. the diaphoresis is due to fever of several days' duration.

    pathophysiology defined is "the study of how normal physiological processes are altered by disease" (page 1421, taber's cyclopedic medical dictionary, 18th edition, published in 1997 by f.a. davis company). when you are referring to the pathophysiology of something, you are usually referring to a disease or an abnormal condition. in this case, it would be skin breakdown because that is what impaired skin integrity means. the definition of impaired skin integrity is "altered epidermis and/or dermis" (page 199, nanda-i nursing diagnoses: definitions & classification 2007-2008). the taxonomy gives description of this as destruction of skin layers, disruption of skin surfaces or invasion of body structures. maceration is a term that means "the dissolution of skin". what you are looking for is how the process of maceration occurs as a result of sweating. the moisture weakens the skin so that friction or sheering forces against the skin causes it to be torn away. that is the pathophysiology of skin breakdown due to moisture from diaphoresis. you can read about this on several websites to verify it.

    this article (http://www.nursingcenter.com/library...icle_id=810532) indicates that "moisture raises the surface temperature and humidity and contributes to maceration" which accounts for elevated body temperature and diaphoresis. then, "partial-thickness skin loss caused by maceration of the skin and friction may occur". this site http://www.pathguy.com/lectures/skin.htm talks about intertrigo and maceration--"maceration: wet keratin eventually tends to break down, destroying its protective function. mild cases in body creases become intertrigo, which can get fungal or bacterial superinfection and so forth. the worst cases can lead to "jungle foot", etc." it is not until these areas become open that bacteria or yeast then invade. this article on emedicine also refer to both types of skin maceration mentioned in the two articles referred above: http://www.emedicine.com/derm/topic67.htm

    there is information on how to write a care plan on this sticky thread:
    you still follow the steps of the nursing process as i listed them above for you. if you ever see a copy of the book nursing care planning made incredibly easy you will see that it is organized the same way. everything starts with the assessment and that includes the pathophysiology.

    to complete this care plan for this diagnosis, see the information about the nursing interventions for anticipated problems on this post: http://allnurses.com/forums/2751313-post8.html keep in mind that you anticipate that there is going to be skin opening due to diaphoresis, so you will aim your interventions at preventing the diaphoresis or maybe the fever (although i am skeptical about focusing on interventions for the fever since there is a nursing diagnosis that specifically addresses fevers--i would stick to things regarding the skin) as well as protecting the skin. you don't want the skin breakdown to happen and that is the focus of your interventions: preventing it from happening, not treating actual skin break down because that hasn't happened--yet. remember that.

    good luck!
    DroogieRN and beth66335 like this.
  11. 1
    Daytonite, your wonderful and detailed responses never cease to amaze me. Where do you come up with all those web sites to reference?

    My advise to the OP, is to go with those links given by Daytonite. They really helped me through nursing school.

    DroogieRN likes this.
  12. 3
    We have a Medsurg book, look up the problem and the patho would be in that section also, all of your interventions and dx would be their.
    Daytonite, Melinurse, and DroogieRN like this.


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