I think for most of us, when we first start writing care plans
there seems to be so much emphasis on the diagnosis part of things that many of us fail to simply start basic and look at what is going on with our patient and what we can do to improve their health, comfort, etc.
When I started writing care plans I would look through my nanda list first, grab a DX I thought might fit, then look for symptoms and RT... you get the picture. Now I look at symptoms, lab values etc first, find the problems, decide what I need to do to treat the problem or help the situation, then find the dx that matches.
I also do not start my care plan till I look up all abnormal labs, medical diagnosis, and medications as they will give me a much better idea of what I am looking at.
I think all of this can be a difficult process of learning. Sure it isn't rocket science, but it is a foreign language one needs to learn on the road to RN. If it were as easy as pie (not adpie) then anyone could do it and anyone could be a nurse eh?