CPNE careplans

Daytonite, BSN, RN · Jun 28, 2009

i do not pretend to understand this cpne stuff, but i do understand the nanda construction of nursing diagnoses and critical thinking.

respiratory management

ineffective airway clearance r/t (admitting diagnosis) aeb abnormal breath sounds

outcome: pt will maintain a patent airway at all times.

interventions: 1.) assess lung sounds

2.) ask pt to perform deep breathing and coughing exercises

rationale: a patent airway is a physiological need. without a patent airway, it may interfere with the pt's ability to perform adl's, progress towards healing, and pt's participation in treatment plan.

the related factor of your diagnostic statement can

never

be a medical diagnosis. the nanda taxonomy gives a good listing of what your related factors (etiologies) can be for this diagnosis. if you have a cpne guideline for this diagnosis, use it. or, the appendix of

taber's cyclopedic medical dictionary

includes the nanda taxonomy information for the nursing diagnoses.

the patent airway being a physiological need, performing adls, progress toward healing and patient's participation in a healing plan are not valid rationales for nursing interventions. rationales are

the reason

why

you are doing

a

specific intervention

.

the rationale (reason) for assessing lung sounds is to evaluate the effectiveness of the patient's coughing efforts. the lungs change constantly, so lung assessment needs to be done all the time.

i wouldn't "ask" the patient to perform deep breathing and coughing exercises without instructing them in how to do them first.

the rationale (reason) for doing deep breathing and coughing is that it increases the volume of air in the lungs and promotes the expulsion of secretions. (do not forget that the title of this diagnosis is ineffective

airway clearance

which is defined as the

inability to clear secretions or obstructions from the respiratory tract to maintain a clear airway

[page 308,

nanda-i nursing diagnoses: definitions & classification 2007-2008

]

)

musculoskeletal management

impaired physical mobility r/t musculoskeletal impairment aeb limited range of motion

outcome: pt will increase physical activity

interventions: 1.) assess pt's mobility status

2.) perform passive or active rom on designated extremities

rationale: mobility is a physiological need. without adequate mobility, it may interfere with pt's ability to perform adl's, progress towards healing, and pt's participation in treatment plan.

the first intervention of

assess pt's mobility status

is invalid. in order to have diagnosed this problem of

impaired physical mobility

, the patient's mobility status would have to have been assessed to come to the conclusion that there was a physical mobility problem.

your rationales are all wrong.

the rationale (reason) for performing active and passive rom is that it helps maintain the integrity of joint function and helps maintain or increase muscle strength.

risk for injury r/t impaired mobility

outcome: pt will be free from injury during pcs

interventions: 1.) call light within reach when pt is left unattended

2.) bed in low position when pt is left unattended

rationale: safety is a physical and physiological need. pt need to be free from injury in order to progress towards treatment goals, and be able to perform adl's as independently as possible.

if the only cause (risk) for injury is

impaired mobility

then i would not even use this diagnosis since

impaired mobility

is another nursing diagnosis. just use

impaired physical mobility

.

the outcome is not to have any injury occur during pcs.

why do we put a call bell within reach of a patient when they are going to be left unattended?

rationale: putting a call bell in reach of the patient is so they can use it to call for assistance.

why are beds left in their lowest position when patients are left in them unattended?

rationale: a low bed position is easier for the patient to get in and out of bed.

oxygen management

activity intolerance r/t (admitting diagnosis) aeb exertional dyspnea.

outcome: pt will participate in activity without experiencing dyspnea.

interventions: 1.) assess pt's response to activity

2.) provide frequent rest periods

rationale: being able to tolerate activity is a physiological need. if the pt is able to tolerate activity without dyspnea, he/she will be able to fully participate in his plan of care and his risk for respiratory problems will be decreased.

the related factor of your diagnostic statement can

never

be a medical diagnosis.

the first intervention of

assess pt's response to activity

is invalid. in order to have diagnosed this problem of

activity intolerance

, the patient would have to have been assessed to come to the conclusion that there was a activity intolerance problem. you don't diagnose this problem and then continually assess for it.

your rationales are all wrong.

rationale (reason) for

provide frequent rest periods

is that providing rest periods allows the patient to have periods of time of low energy expenditure as well as time to recuperate.

pain management

acute pain r/t (admitting diagnosis) aeb pt rating pain (#) on a scale of 1-10.

outcome: pt will report pain management regimen relieves pain to a satisfactory level of 3 or less on a scale of 1-10.

interventions: 1.)assess pt's level of pain

2.) report pt's level of pain to the primary nurse

rationale: freedom of pain is a physiological need. without freedom of pain, it may interfere with pt's ability to perform adl's, progress towards healing, and pt's participation in treatment plan.

the related factor of pain is always something that causes injury and can never be a medical diagnosis.

rationale (reason) for assessing the patient's level of pain is to establish a baseline objective measure of the patient's subjective experience of pain [otherwise how will you be able to know if they are experiencing pain relief later after pain medication has been given?]

rationale (reason) for

report pt's level of pain to the primary nurse

is, i assume, because she is the one who gives pain medication? this is passing the buck, dude! even as an lpn who can't give pain medication there are things you can do to help the patient relieve their pain such as reposition the patient, give them a back massage, use short, simple relaxation exercises to distract them, dim the lights in the room and keep noise down, or play soft, soothing music.

LPN_2005/RN_10 · Jun 29, 2009

Thanks for replying! Your comments were very helpful!

As far as the intervention of informing the primary nurse of pt's pain level for the ND Acute pain, for the CPNE, the students can also provide the comfort measures first, but always, always, have to report the pt's pain level to the RN taking care of him or else it's a fail for not completing one of the critical elements. Yes, as an LPN I can administer oral pain meds, but as an Excelsior student I have to go by their rules. I figured since I will be telling the RN of the pt's pain level anyway, I can keep it short and simple by putting that as one of my interventions. I really do appreciate your helpful comments, and will continue working on my careplans! Thanks again!