Anxiety (care plans)

  1. 0
    Hi everyone. I am so thankful that I just found this forum, and I'm really hoping that someone who has been through this already can offer words of advice, etc.

    I started my full-time, 10 month LPN program in January and am now out on my first clinical rotation in the afternoons (class in the a.m.) In class, I have been maintaining a 90+ average and although it's been difficult, somehow I have exceeded my expectations for myself. Now our class has gotten full swing into the nursing process module and while in clinical we have an assignment to write two care plans, each with 5-7 interventions for two physical, 1 psychosocial, and 1 spiritual diagnosis. Also, we only started our first clinical rotation this past week, and on Monday we are already expected to have our own patient, do a complete assessment and document. It is this patient that we are basing our first care plan off of for an exam grade.

    I'm lost! I feel so inadequate. I do my assessment, come out of the exam room and am at a complete loss of words for proper documentation. This is not coming easy for me. Some others seem to have no problem. I'm started to become scared to death that I will not be able to be a nurse if I can't get this. Has anyone else who made it through ever felt this way? Does it get easier? Will it ever just click? I'm kinda freaking out right now. Any help would be appreciated!!

    Thank you

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  2. 1
    Well, we just started our assessments the class I just finished also. so i definately know where you are coming from. my instructor told me that I was putting too much info!! she said just get strait to the point, because i found that I was being redundant. for example, I would write "all lobes are clear"...but then put no productive cough, no adventitious lung sounds..etc. So, if lungs sounds are clear, there would be none of that other stuff obviously lol. I was thinking the more I wrote down the better it look, which was not the case...its just too much extra. Just remember to document what procedures you do, they're pain and what you observe( inspect, auscultate, and palpate).

    I'm sure it will get easier for us with experience. And plus in my class we are doing full assessments just to get used to documenting, but we will be doing more focused assessments when we start med- surg.

    Idk if that helped, but thats my experience so far...Good luck!
    lpnstudent2008 likes this.
  3. 1
    what, specifically, do you need help with in writing a care plan? there is information on these sticky threads in the student forums:
    lpnstudent2008 likes this.
  4. 1
    I have been where you are now. I have 6 weeks left in my program. I just start from the top and work my way to the bottom.
    Example of general assessment:

    A&OX3, Apical pulse Reg at 80bpm. Lungs clear and equal Bi-lat. ABD soft, and non-tender. Bowel sounds acitve. (+) pedal pulses, (-) pedal edema bi-lat lower extremities.

    I go in to more detail in certain body systems depending on abnormal findings or diagnosis.

    Diagnosis: Pneumonia

    A&OX2 oriented to person and place only. Apical pulse irregular at 110bpm RN notified. Crackles bi-laterally, diminished at the bases. Occasional cough produces moderate amounts of yellow sputum. O2 sat 90% on 2 lpm via NC. Resp 12 and unlabored. Patient denies shortness of breath or dizziness at this time. Teaching done about incentive spirometer use. ABD soft and non-tender. Bowel sounds active. Trace edema noted in feet and ankles. Thigh high Teds stockings in place (+) circulation, (+) sensation, (+) movement, (+) pedal pulses bi-laterally. Patient denies any pain at this time.

    My instructors tell us that we should document any interventions that we do for abnormal findings in our assessment. We also need to document that we notified our co-assign or the MD.

    A cheat sheet of possible findings while you do your assessment can also help you when you are writing. Hope this helps!

    Danielle
    lpnstudent2008 likes this.
  5. 0
    thank you everyone for trying to help. your advice on a cheat sheet of possible findings until it starts to come more naturally for me sounds very like a very good idea.
    But I guess I'm really just looking to hear other's experiences about how they felt. Is it normal for me to be feeling this way? Do others struggle with this when they first get care plans? At what point did it start to get easier for you and how did you get to that point? I suppose I'm looking for a little reassurance that me being overwhelmed and freaking out right now is normal & that I'll get through this ok. hopefully.
  6. 1
    everything is a struggle at first. i can speak to care plans because i teach about them. i didn't begin to understand care plans until i was graduated and out of school. when you are in school you just keep putting one foot in front of the other and moving on as best you can. the missing element with most things is seeing how patients affect all of this. when you finally get finished with school, start working and actually seeing patient after patient with the many nursing situations you are only talking about in class, things finally start to click into place. unfortunately, as students there just isn't the time or opportunity to have all those experiences. so, again, keep putting one foot in front of the other, do the best you can and take solace in the fact that you are not alone. many others feel the same and many more before you went through the same anxiety; even more after you will go through it as well. so, hang in there. it's part of the learning process of this profession. think about the many years doctor spend in training. it is for the very same reason--limited patient contact to help them learn, apply and solidify the knowledge (4 years of classroom study and the another 4+ years of hands on clinicals).
    lpnstudent2008 likes this.
  7. 1
    i definitely understand your stress!! i have been doing care plans for months! they do get a lil easier. every school has a different idea of what a care plan is and how it is written. for me doing my maslow's (all five w/ 2-3 interventions/goals, problems etc) are a pain!! the rest is ok!! i have always gotten a+ on mine, so at least i know i am doing something right. for the head to toe assessment, the more you do them the easier they get. i have made myself a spreadsheet so to speak to put my documentation on while in the patient/client room and then use it to transfer it to my chart or computer. my first couple of assessments would take 1-2 pgs of nursing notes!! i get alot of information from my med surg book! good luck!
    lpnstudent2008 likes this.
  8. 0
    I got a bad grade on my first careplan because I picked the wrong priority. I think that if you look at all of the abnormals, the priority stands out. I get 95% on my careplans now, and I think that just takes practice. I also had bought a careplan book, but I only use that for ideas. The book is too general. Good resource though, especially on med/surg when your main nsg dx is pain!
  9. 2
    for prioritizing i was taught to go by maslow's hierarchy of needs. the trick is to know which need each nursing diagnosis addresses so you classify it correctly. the appendix of nursing diagnosis handbook: a guide to planning care by betty j. ackley and gail b. ladwig does classify all the nursing diagnoses into the 5 major maslow tiers, but no further within the tiers themselves. here is a weblink to maslow's pyramid:

    this is the hierarchy:

    1. physiological needs (in the following order)
      • the need for oxygen and to breathe [the brain gets top priority for oxygen, then the oxgenation of the heart followed by oxygenation of the lung tissue itself, breathing problems come next, then heart and circulation problems--this is based upon how fast these organs die or fail based upon the lack of oxygen and their function.]
      • the need for food and water
      • the need to eliminate and dispose of bodily wastes
      • the need to control body temperature
      • the need to move
      • the need for rest
      • the need for comfort
    2. safety and security needs (in the following order)
      • safety from physiological threat
      • safety from psychological threat
      • protection
      • continuity
      • stability
      • lack of danger
    3. love and belonging needs
      • affiliation
      • affection
      • intimacy
      • support
      • reassurance
    4. self-esteem needs
      • sense of self-worth
      • self-respect
      • independence
      • dignity
      • privacy
      • self-reliance
    5. self-actualization
      • recognition and realization of potential
      • growth
      • health
      • autonomy
    Last edit by Daytonite on May 13, '08
    lpnstudent2008 and p2o8 like this.
  10. 0
    Ms. Williams is a 68 year old patient with 3 married children and 6 grandchildren. Ms. Williams has a history of cigarette smoking, but quit 20 years ago when her first grandchild was born. She is married. She underwent a lobectomy for lung cancer six months ago. She underwent aggressive treatment with radiation therapy and chemotherapy. On her most recent visit to the oncologist, she is told that despite the treatments, there is evidence of metastatic disease in her spine. The physician explains that there are no further treatment options, and refers Ms. Rogers to Hospice for continuing care. After the visit with the physician, Ms. Williams looks at you and begins to cry. She says, “I just don’t understand, why me, why now? I quit smoking! What am I going to tell my family? What do I do now?”


    what is the best care plan i can choose for this scenario???? help please ASAP
    Last edit by cadette on Jul 11, '11 : Reason: wrong info.


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