Hello Everyone!

SuesquatchRN, BSN, RN · Nov 7, 2008

I would go with a simple risk for "impaired tissue perfusion" r/t fracture.

You need TWO interventions that can be carried out during the PCS.

:)

txspadequeenRN, BSN, RN · Nov 7, 2008

glad your back...now once you become the cpne master you will need another cruise.....lol:nuke:

Editorial Team / Moderator · Nov 7, 2008

I'm not sure if the second intervention for your first diagnosis really moves the patient towards the goal of increased strength. I think it's likely you could have ROM exercises for this patient, and that might be a better intervention.

NC Girl BSN · Nov 7, 2008

I'm not sure if the second intervention for your first diagnosis really moves the patient towards the goal of increased strength. I think it's likely you could have ROM exercises for this patient, and that might be a better intervention.

Now that I look at it. The second intervention does not mask sense. On my Kardex it says the patient has an overhead trapeze bar.

Could I use:

Instruct patient to use trapeze bar when moving in bed.

Raggedy Ann · Nov 7, 2008

You are further along than I...just wanted to say glad that you could chill before the CPNE, maybe that will be something you can think about to help calm your nerves during your CPNE. Good Luck! Will be sending motivating thoughts to help you stay on task with the studies. Traci

txspadequeenRN, BSN, RN · Nov 8, 2008

tell me do you recommend the care planning conference ...ill do anything to get this baby down pat...:wink2:

hello everyone! i just got back from a wonderful cruise traveling to the grand cayman island and cozumel mexico. the beaches were everything i had seen in magazines and the weather was perfect. now i must erase that beautful thought out of my mind for the moment and think about the dreaded cpne!!!!!!!! i have 28 days and counting. i am 3 days behind in the careplan conference and i feel so lost. could someone look at my care plan and tell me if i am on the right track. we are only going the planning stage. thanks!

Daytonite, BSN, RN · Nov 8, 2008

i am not familiar with the cpne rules, but i do know nursing diagnoses and how to construct a care plan. please understand that i am not being mean, but there are some problems with the construction of your diagnoses, goals and interventions that i will point out to you. whether or not you use my advice is your choice. just know that what i am offering you is not being done in a mean spirited manner. you did not give any medical information about this patient, but i am assuming from the care plan that there is some sort of fracture involved, possibly of the lower extremity or ankle? think of me as someone coming along and reading your care plan knowing nothing else about this patient.

you have several spelling errors in your document: the words "reposition" and "feeling" in the first diagnosis.

first diagnosis

impaired physical mobility r/t limb immobilization aeb restricted rom of right ankle.

the definition of impaired physical mobility is

limitation in independent, purposeful physical movement of the body or of one or more extremities.

(page 138,

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

) impaired mobility implies immobilization, so using "limb immobilization" as a related factor seems redundant to me. what are you getting at here? if the patient has a cast or external fixation device on the leg, state so ("impaired physical mobility r/t presence of cast/external fixation device"). if you just want to convey that the bone is fractured state that as the related factor because that is why the patient's movements are restricted (impaired physical mobility r/t skeletal impairment")

if i were the instructor i would not accept "restricted rom of right ankle" as evidence of this problem because it is too vague a description of the problem and indicates lack of assessment (the first step in the nursing process when problem solving). assessment of the rom of the ankle encompasses 4 movements:

plantar flexion (bending foot downward) - normal is 45-50 degrees
dorsiflexion (bending foot upward) - normal is 20 degrees
inversion (pointing the toes and turning the foot inward) - normal is 5 degrees
eversion (pointing the toes and turning the foot outward) - normal is 5 degrees

since you bring up strength in your outcome you ought to assess for strength and mention whether or not the patient has any as part of your evidence supporting this diagnostic problem. muscle strength is tested by asking the patient to move against resistance that you supply. strength is rated as follows:

0 flaccid
1 trace (slight contractility, but no movement)
2 weak (there is movement when gravity is eliminated)
3 fair (can move against gravity but not against resistance)
4 good (can move against gravity and with some resistance)
5 normal (moves against gravity and resistance)

outcome: the patient will verbalize feeing of increased strength ability to move.

outcomes are the predicted results of the nursing actions (interventions) you will prescribe. and these interventions target the etiology (related factor) of the problem as well as the supporting evidence (the signs and symptoms of the problem. so, your outcome(s) should result in an improvement, stabilization or support the deterioration (in some cases) of

limb immobilization (
your
identified etiology of this problem, not mine)
restricted rom of the right ankle

so, my $64,000 question is, "how is the

patient verbalizing

feeling

increased strength [and] ability to moveresulting in improved limb mobility or better rom of the right ankle?" (1) i don't like "the patient verbalizing feeling" part. it is going to make the evaluation vague and unscientific when there are very standard assessments available to measure the patient's progress with their mobility (the rom % and strength scale). (2) this is the first and only time strength is being introduced into this plan. the cheese stands alone. you have given "strength" no foundation upon which it can make an appearance. you just threw it into the mix; let it suddenly cut into the front of the line at the very end when no one was watching. but i noticed. if you want muscle strength as an outcome, design interventions to assess and work on it.

interventions:

reposition x 1 during pcs
- i'm looking at the outcome. how is changing the patient's position (the position of what? entire body? just the ankle? the entire involved leg?) going to result in increased strength [and] ability to move? i don't get a rationale for this. especially since the evidence of this problem is based on "restricted rom". now, if the repositioning addressed rom in some way. . .
[*]elevate right leg above the heart with 2 pillows.
- this totally baffles me. again, how is elevating the right leg, in particular, above the heart, and on 2 pillows, going to result in increased strength [and] ability to move? i really don't get this one. i can see it preventing a dvt or edema and improving circulation, but that is not what this diagnosis is about! truly, i would consider eliminating this intervention entirely and finding another strategy to use.

second diagnosis

risk for peripheral neurovascular dysfunction r/t treatment of fracture

"risk for" diagnoses mean you are trying to prevent something from occurring. in this case, "neurovascular dysfunction". that means compromise of the circulation and sensation of the extremities.

outcome: the patient will maintain circulation of right lower leg extremities

maintaining circulation is a wrong outcome. you are

always

preventing the occurrence of something with a "risk for" diagnosis. so, the outcome statement wording needs to be changed. in its broadest sense your goal is to prevent neurovascular dysfunction. based on what kind of interventions you have in mind you will have a more specific outcome statement.

interventions:

you had only one intervention listed and it was repeated. you need to correct that. interventions for these "risk for" diagnoses are as follows:
- strategies to prevent the problem from happening in the first place
- monitoring for the specific signs and symptoms of this problem (so, have a very clear and defined idea of the problem you are attempting to prevent, know it's signs and symptoms and preventative measures) remember, the focus is not wanting the problem to happen
- report any symptoms that do occur to the doctor or other concerned professional
- if symptoms occur, you have an actual problem on your hands, you need to re-evaluate the care plan and change the nursing diagnosis

palpate most distal pulse in lower extremities (how frequently?)
palpate most distal pulse in lower extremities (repeated intervention) - this would be a good place for: elevate right leg above the heart with 2 pillows

BBFRN, BSN, PhD · Nov 9, 2008

Daytonite is the care plan queen. :bowingpur

It's amazing how you can whip these care plans off the top of your head like that. Have you ever thought of writing a care planning book, Daytonite? If you did, I would definitely buy several copies. :up:

Daytonite, BSN, RN · Nov 9, 2008

Daytonite is the care plan queen. :bowingpur
It's amazing how you can whip these care plans off the top of your head like that. Have you ever thought of writing a care planning book, Daytonite? If you did, I would definitely buy several copies.

I think that if I had written a book, I wouldn't admit it. Wouldn't it be a violation of the TOS? What I post on allnurses is a gift to all.

SuesquatchRN, BSN, RN · Nov 9, 2008

I think that if I had written a book, I wouldn't admit it. Wouldn't it be a violation of the TOS? What I post on allnurses is a gift to all.

I think that probably there would be a special place even with the mods for "Daytonite's Book."