struggling with care plan, please help!

  1. I am having the worst time with my care plan for my 94 year old client. My first nursing diagnosis was risk for fluid volume deficit related to delayed thirst response, increased urination, and cognitive and physical limitations. The second part of my care plan has to be a knowledge deficit. I was thinking towards knowledge deficit of fluid volume related to cognitive and physical limitations but I am stuck on goals/interventions. I don't know what to do so any input would help me SO much! Thanks! I'm not sure how to use to site so I don't know if you just reply to it here but if you can't or if it'd be easier you can just send it to my email address..
    Last edit by EricJRN on Oct 15, '07 : Reason: Email removed per TOS - use private messaging system
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  2. 4 Comments

  3. by   maverickemt
    If fluid volume deficit is your first diagnosis than some of your interventions might be to encourage the client to take 1500 ml of fluid a day, monitor Intake and output, moniotr electrolytes and lab values, monitor vital signs. Your goals would be that the client has stable vital signs and that client has an output of at least 30 mL/hour and that his mucous membranes and skin turgor do not show any signs of dehydration.

    If this does not help, here is a great site I use for my care plans at UMASS.
    FYI, I am in the second bachelor's program but I still am nervous when it comes to care plans. Most nursing progress notes have problems, goals, and plans stated out when you do charting in the patient's medical records.

    I don't think anyone has used this at my school. UMASS nursing sucks...I am so nervous about after graduation from this crummy sorry excuse for a nursing program and nursing instructors- they all suck!

    What school do you go to? What is your program (BSN,ADN, Diploma)?

    Use this link for your care plan:

    http://www1.us.elsevierhealth.com/Ev...DH6e/Construct

    Cheers,
    Sachin
  4. by   mel2067
    I'm going to West Chester University for my BSN. I actually got a lot of those interventions and handed that part of the care plan in, the part where I'm struggling with is the knowledge deficit. I don't know what would be a good goal/interventions for my client especially since shes 94 and has mild dementia and short term memory loss. Thank you for that information though! If you have any ideas about the knowledge deficit I would love to hear them.
  5. by   maverickemt
    Hi,

    I usually make care plans (the diagnosis,etc.) up from the signs and symptoms of the admitting diagnosis or what the patient was experiencing (ie. constipation, etc.) and then I make sure I have fully diagnosed the patient and the diagnosis and the nursing diagnosis make sense. For your patient that has dementia, you can look up dementia by using the link I gave you. Dementia and short term memory loss are probably the same thing unless the memory loss has an official medical diagnosis to it. Remember medical diagnosis and nursing diagnosis are two different things. One intervention is orientating the patient to the hospital room or keep on reminding the patient where she is. She probably has trouble with mobility so imobility can be another diagnosis.

    Sachin
  6. by   Daytonite
    hi, mel2067, and welcome to allnurses!

    from reading your two posts i have the feeling that you are approaching this care plan in the wrong way. the writing of a care plan follows the steps of the nursing process.
    1. assessment (collect data and separate out the abnormal data)
    2. nursing diagnosis (group your abnormal assessment data, shop and match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnosis to use)
    3. planning (write measurable goals/outcomes and nursing interventions)
    4. implementation (initiate the care plan)
    5. evaluation (determine if goals/outcomes have been met)
    the whole care plan, and that includes all your goals and interventions, is dependent upon the patient's signs and symptoms (nanda calls them defining characteristics). to use a nursing diagnosis of knowledge deficit of fluid volume related to cognitive and physical limitations you must have defining characteristics (symptoms) that support the cognitive limitations. the defining characteristics for this particular diagnosis are:
    you need to go back through your assessment information for any symptoms the patient displayed that fit this criteria. they then need to be listed as your aeb items in your diagnostic statement. they also become the focus of your goals and interventions. physical limitations would be inappropriate, in my estimation, to use as a related factor for this diagnosis. if the patient has physical limitations then they have a impaired physical mobility and that needs to be addressed in it's own diagnosis.

    a doctor doesn't put a medical diagnosis on a patient until he has done a thorough assessment and considered the symptoms that the patient has. plumbers do the same thing when determining what the problem is with a toilet that is overflowing or a drain that is backing up. and, so too, do nurses who are classifying a patient with a nursing diagnosis--especially if you are using a particular diagnosis for the first time. you need to use a nursing diagnosis reference so you make sure you are diagnosing correctly. i've given you two weblinks to nursing diagnosis information on the diagnosis of deficient knowledge. please take the time to read them.

    you will find care plan and nursing diagnosis information in the posts on these two sticky threads of allnurses:
    i don't think that anyone can give you any appropriate interventions unless we know what your patients symptoms are in relation to the knowledge deficit. it would all just be taking wild pot shots. it would be like a kid going to a doctor and the doc seeing only his red nose and saying, "oh, he just has a cold. do this, this and this," without doing any further questioning or assessment. how bogus and incompetent is that?

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