ICU Care Plan

  1. [font=book antiqua]just wondering if anyone is willing to proofread my icu careplan. i just need to know if i'm missing and important interventions or rationales pretty much. i'm about 60 pages into it and still have a little to go. but when it gets this long i feel like i'm all over the place and forgetting to add things. i wouldn't blame a soul who didn't want to look over 60 pages of this stuff...just thought i'd throw it out there. although it would possibly help you out if you ever need to do one of these in the future.......
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    [font=book antiqua]it would mean the world to me.....this is worth about 30% of my final grade!!!! thanks!!!!!!!!
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    :smilecoffeeilovecof :smilecoffeeilovecof :smilecoffeeilovecof :smilecoffeeilovecof :smilecoffeeilovecof :smilecoffeeilovecof :smilecoffeeilovecof :smilecoffeeilovecof :smilecoffeeilovecof :smilecoffeeilovecof :smilecoffeeilovecof :smilecoffeeilovecof :smilecoffeeilovecof :smilecoffeeilovecof :smilecoffeeilovecof
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  2. 14 Comments

  3. by   cardiacRN2006
    Can I offer a suggestion instead?

    All ICU pts are at risk for falls, so make sure you have a Risk for Injury R/T falls diagnosis.

    Also, pain, comfort, anxiety, fear, and communication are all big issues for pts in the ICU. As well as risk for infection R/T invasive lines and procedures being performed at the bedside.
  4. by   leesespieces
    [font=book antiqua]thanks for the suggestion... i'm going to have to add that one....these are the ones i have so far:
    [font='book antiqua']nursing dx:
    [font='book antiqua']impaired gas exchange/ineffective breathing pattern/ineffective airway clearance


    [font='book antiqua']related to:
    [font='book antiqua']inflammation of the terminal airways and alveoli secondary to bacterial presence in the lungs


    [font='book antiqua']nursing dx:
    [font='book antiqua']decreased cardiac output


    [font='book antiqua']related to:
    [font='book antiqua']decreased circulating blood volume, decreases renal perfusion, diastolic dysfunction, backflow of blood into the right and left atrium, increases peripheral vascular resistance, altered electrical conduction, decreases myocardial oxygenation


    [font='book antiqua']nursing dx:
    [font='book antiqua']fluid volume deficit / ineffective renal tissue perfusion


    [font='book antiqua']related to:
    [font='book antiqua']fluid volume depletion secondary to increased metabolic demands on the body caused by infectious process in the lung parenchyma.


    [font='book antiqua']nursing dx:
    [font='book antiqua']altered protection


    [font='book antiqua']related to:
    [font='book antiqua']loculated fluid in left lateral and upper chest walls, pleural effusion


    [font='book antiqua']nursing dx:
    [font='book antiqua']activity intolerance


    [font='book antiqua']related to:
    [font='book antiqua']imbalance between oxygen supply and demand secondary to inflammation of the terminal airways and alveoli secondary to bacterial presence in the lungs


    [font='book antiqua']nursing dx:
    [font='book antiqua']acute pain


    [font='book antiqua']related to:
    [font='book antiqua']


    [font='book antiqua']nursing dx:
    [font='book antiqua']altered nutrition; less than body requirements

    [font='book antiqua']related to:
    [font='book antiqua']increased metabolic demands on the body, decreased appetite, and npo status.

    [font='book antiqua']nursing dx:
    [font='book antiqua']anxiety


    [font='book antiqua']related to:
    [font='book antiqua']change/decline in health status, fear of the unknown, respiratory distress


    [font='book antiqua']nursing dx:
    [font='book antiqua']impaired skin integrity


    [font='book antiqua']related to:
    [font='book antiqua'] multiple invasive access lines and procedures


    [font='book antiqua']
    [font='book antiqua']




  5. by   Daytonite
    Are you supposed to use NANDA language? Because if so, you've got some problems here with the language you are using. Also, you have some very major problems with the construction of a good deal of these diagnoses.

    First of all, you've combined three nursing diagnoses into one. Each of them have different meanings. I can't say that I agree with what you have listed as the etiology ("Related To") part as being the cause of any of the diagnoses.

    Second, on your nursing diagnosis for Decreased Cardiac Output all of the etiologies ("Related To" factors) you've listed are all actually defining characteristics.

    Third, again you have combined two nursing diagnoses (Fluid Volume Deficit / Ineffective Renal Tissue Perfusion) that have very different definitions and do not belong together. The etiology of deficient fluid volume can be fluid volume depletion, however where is this "secondary to increased metabolic demands on the body caused by infectious process in the lung parenchyma" coming from? Is this "secondary to" statement something that you are supposed to include in your nursing diagnostic statements? If not, don't include it.

    Next, altered protection. The correct NANDA language is Ineffective Protection. The etiology is totally wrong. The etiology you have for this diagnosis more appropriately belongs to the nursing diagnosis of Ineffective Airway Clearance or should be used as the defining characteristics to support the etiology of that nursing diagnosis.

    Activity Intolerance is OK.

    What is main reason the patient has pain. That will be your etiology.

    Seventh, Imbalanced Nutrition: Less than body requirements has decreased appetite and NPO status listed as etiologies when they are actually defining characteristics.

    Eight, all your etiologies for the nursing diagnosis of Anxiety are actually defining characteristics.

    Nine, you can simplify your etiology to "multiple invasive procedures".

    And, finally, much of the sequencing is wrong. If this were sequenced according to Maslow's Hierarachy of Needs it would be much different.

    I'm sending you a PM.
  6. by   leesespieces
    Actually I went through some of this with my instructor already and i was told to combine all 3 resp Dx's because they have similar causes and will have similar interventions.

    We are told to form our related to statements from the pathophysiology of the etiological cause

    I was told by instructor to combine tissue perfusion and fl vol deficit for the same reason I combined the resp Dx's

    For whatever reason our instructors like "altered" protection

    We are instructed to prioritize our Dx's by ABC's first (airway, breathing, circulation; which covers my first 3) then by what is affecting the patient the most...

    NPO status and decreaseds appetite are why his nutritional status is imbalanced
  7. by   Daytonite
    OK. I now have no idea what your instructors are asking you to do. It all sounds jumbled and disorganized to me. Please ignore my PM. I don't think I can help you here. Your instructors obviously have a much different idea about writing care plans that I just don't understand. I would have to read up on all their rules and I don't have time to do that. I'm sorry.
  8. by   charlies
    I am in my final semester, and after 7 different clinical instructors, my experience has been that what one accepts as good nursing diagnosis, the next does not. They all want something different. I got used to it, it is important to find out exactly what the specific instructor wants at the beginning of clinicals, and in the world of academia, that is ALL that matters as far as clinical paperwork goes.

    My last careplan was 121 pages long. What a buncha B.S. It currently resides in the county landfill, lol.:stone
  9. by   cardiacRN2006
    Quote from charlies

    My last careplan was 121 pages long. What a buncha B.S. It currently resides in the county landfill, lol.:stone
    .


    Oh, I turned all of mine into greenhouse gasses.
  10. by   nurse4theplanet
    Quote from charlies
    I am in my final semester, and after 7 different clinical instructors, my experience has been that what one accepts as good nursing diagnosis, the next does not. They all want something different.e
    I completely agree with this!
  11. by   GIRN
    I'm with you guys! Time was so valuable and we spent so much of it working on the Care Plans instead of being out on the floor, learning from the patients and experienced nurses. Once we got into the real world...I've not written one care plan! I've made a lot of check marks on the pre-written ones,... Our school was into mapping...that was a pain but sounds a lot better than 100 pages of care plans. I wonder how many ulcers nursing students get from the resentment that builds up from having to jump through hoops.....
  12. by   ARRR10
    60-100 pages careplan!!! As of right now I am just beginning to learn the different phases of the nursing process. I never realized that a care plan could add up to almost 100 pages just for 1 patient Is it all handwritten?
  13. by   leesespieces
    [font=book antiqua]i want to thank everyone who added their input and gave me advice. i turned it in this morning...last care plan ever...thank god!!!
    [font=book antiqua]
    [font=book antiqua]i think perhaps asking for advice was not the best thing to do as i didn't realize that expectations from instructors and schools vary widely. it was hard for me to explain to others why i grouped some of my daignoses and repeated intervetions in each diagnoses....
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    [font=book antiqua]either way, it's over...it's done..and i'm glad!! on a better note i rotated to er today and i loved it!!! time for bed....get to do it all again tomorrow
  14. by   Daytonite
    Quote from leesespieces
    [font=book antiqua]...last care plan ever...
    oh, how wrong you are. you will be expected to write care plans on the job, where ever that job is.

    i'm sorry the advice i gave you wasn't helpful. i hope you got some of the problems resolved to your satisfaction. in the end, it is your work and you have to be satisfied with the end product. it is never my intention to do anyone's classwork for them, but to offer suggestions. sometimes i come across as being overly confident and authoritarian about it. however, bottom line is that you students are the ones who know what the requirements are for your assignments, not i. the parts of your care plan that you did send to me indicated that you did an immense amount of research to support your interventions and i can see how the paper ran to the lengths it did. i hope your instructors feel the same about your work. when i was in my bsn program i had to do care plans that were exactly the same way. sometimes when you are so involved with them you can't always see some of the little nuances you might be missing that a fresh pair of eyes can. i'm hoping you get a great grade on this.

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