need help with interventions for decreased cardiac output!!!

[christiestudentnurse]

Hey guys,

ok my pt is a 68yr old female, she's dx w/ After effects of a CVA, CVD, HTN and Hyperlipidemia are my most important ones. she has a ® leg contracture, wears patch over ® eye (also pupils don't react to light), VS are 95/74/16/(90/60) pulse is just a guestimate because its very hard to palpate when you can finally find it, then it fades completely out on you! Learned from her chart that she has a pacemaker from a prev MI, also has Nephrectomy to her (L) kidney. She sits up in a Geri chair (which I don't think is a good idea b/c of possible shearing out of the chair!) She's on a Pureed Diet w/ Nectar Thick Liquids i'm assuming because she's lost function of her tongue and gag reflexes from her prev CVA, there's SOB (she has 2 types of NEB for this), she bruises easily, muscle spasms...also her CBC, BMP, CMP and urine screen labs are abnormal. So as u can see I've done my research on her (a little too well I think), its hard to tie all this information in together for a good careplan. I'm not sure what interventions would help for short-term goals (We only have this pt for 2 days!!!!)....PLEASE HELP I'M STUCK!

[Leomom]

I'm going into my last semester so I will give you my thoughts on this. My first suggestion is to write out your nsg dx, depending on what its r/t & aeb will help to guide you towards your interventions. Decreased CO can be r/t so many things. So an intervention for one cause might not apply for another cause of the same problem. Start there & see what you come up with, you might surprise yourself. Good luck & let us know what you come up with

[Samantha79]

I was at a LTC facility for my clinicals this past semester and our instructors advised us to do our NDX and interventions based on their admitting diagnosis. In LTC there are usually multiple "serious" DX and trying to create a careplan for every single one is unrealistic. Pick one DX, create a NDX based on that and go from there. I think if you try to look at everything all at once it seems impossible, and kind of is.

Just my 2 cents.

[Esme12, ASN, BSN, RN]

http://www1.us.elsevierhealth.com/MERLIN/Gulanick/Constructor/index.cfm

This is a good tool!

[Despareux]

I just finished my 1st quarter, so I'm still new to writing care plans, but I hope my advice on this will help you through this.

I always ask myself what can I do for my patient and how does my scope of education fit into these interventions. I'm not going to do something for my patient that is completely outside of what I have learned.

Don't tie all your information into this careplan. Choose one body system that you would like to focus on; for example, skin--is your pt. at risk for impairment? What are you going to do (monitor, teach, assess) to ensure your patients skin remains in tact? Or you could choose something respiratory--is she at risk for aspiration? If so, what are you going to do during your shift to make sure she doesn't aspirate?

I hope I've helped answer some of your questions.

[christiestudentnurse]

Thanks guys! After staying up all most all night working on decreased c/o, my instructor advised me that there were easier nandas that I could do on her! Go figure!!! So i've done Risk for impaired skin integrity now I need 1 more nanda. I'm torn between Tissue Perfusion and Impaired Phyiscal Mobility. I have got to stop over-analyzing things! Thanks for your help

[turnforthenurse, MSN, NP]

Thanks guys! After staying up all most all night working on decreased c/o, my instructor advised me that there were easier nandas that I could do on her! Go figure!!! So i've done Risk for impaired skin integrity now I need 1 more nanda. I'm torn between Tissue Perfusion and Impaired Phyiscal Mobility. I have got to stop over-analyzing things! Thanks for your help

I would pick ones that would be more priority to the patient. Think of your ABC's