well, this is very confusing. the nursing diagnosis you chose was: feeding self-care deficit related to muscular weakness on left side and cognitive deficit secondary to previous stroke (cva) as evidenced by inability to cut food or open packages.
i started looking at your broad goal: to maintain mobility on right side and to encourage use of call light.
i had to go back to your diagnostic statement to see if i had read it correctly. the inability to cut food or open packages
has absolutely nothing to do with maintaining mobility on the right side or using the call light!
not only that, but the definition of the feeding self-care deficit is as follows: impaired ability to perform or complete feeding activities
(page 185, nanda-i nursing diagnoses: definitions & classification 2007-2008
). using a call light is not a feeding activity. mobility has to do with movement and the diagnosis of impaired physical mobility
. it is inappropriate to use it with self-deficit.
1) make sure patient's call light is easily attainable to call for help. (put at bedside table or on bed with patient) - this has nothing to do with assisting the patient with eating
2) open patient's packages and cut food when trays are passed out at meal-time.
3) assess willingness to participate in rom & ability in rom. - this has absolutely nothing to do with assisting the patient with eating
4) ?????? *need help with*
rationale: (match up with interventions)
1) patient will not have to attempt opening packages and cutting food with difficulty, and he will not have to wait long if the call light is used. - this is not the rationale for putting a callbell within a patient's reach
2) patient can eat right away, will not have to use call light and wait for a nurse to come. - why are you opening packages and cutting food for the patient? because he cannot do it for himself.
3) keep movement in his lt arm, move his rt are to keep active to feed self and use call light.
4) ?????? (no intervention yet)
outcomes are your predicted results based upon treating the cause of the problem as well as the symptoms of it and based upon the interventions that you order. i notice you are told the patient's deficit is due to muscular weakness and cognitive deficit because of a stroke. can these be reversed? or, are stroke residuals permanent? do you understand what a cognitive deficit means? it limits the patient's understanding because there was brain damage. not everything is curable. damage from strokes is not usually curable so we work to maintain whatever function the patient does have.
when care planning it is best to work with the nursing process. tear the nursing diagnosis down into its component parts:
- problem: feeding self-care deficit (inability to perform or complete feeding activities)
- etiology: muscular weakness on left side and cognitive deficit (this was due to a previous stroke)
- symptoms: inability to cut food or open packages
the symptoms are what were found during the assessment of the patient. knowledge about strokes is also what you would have learned during assessment as well
you need to be aware that people who have had strokes may also have issues not only with bringing the food up to their mouth physically (that's the left sided muscular weakness referred to in the "related to" part of the nursing diagnostic statement) but also with opening their mouth, and chewing since all these activities involve muscles of feeding that may be weakened or damaged from the stroke. if the patient cannot open their mouth wide enough food must be cut up so it is small enough for them to get it into their mouth. they may not be able to chew larger chunks of food enough to make them smaller before swallowing. rom exercises are not going to correct these problems, especially when the stroke happened "previously". what you are left with is to treat the symptoms
- can't cut up food
- can't open packages
we know there is a left side weakness, but how about the right side? can the patient hold utensils in the right hand? can we have the kitchen send food that is already chopped or soft so the patient merely needs to pick it up with a spoon? there are devices that can be placed around the edge of plates to help patients scoop food onto utensils so it doesn't get pushed off the dish when they are trying to get food onto a spoon or fork. we want to assist the patient to do as much for himself as possible and not do everything for them. we can ask the kitchen to put milk and fluids in a glass rather than send them in individual packages. yes, there are some things that will need to be opened. yes, we will need to make sure that utensils and glasses are placed at the patient's right side where he can reach them easily.
are you getting what i am saying?
outcome. . .patient will eat more at meals, will be more independent in eating, will eat safely
effectiveness. . .how do you know the interventions are working? assess for those symptoms or degree of them to continue occurring. is there still a problem with cutting up food? how much of a problem is it now? is there still a problem opening packages? to what extent?
do you see how we go from the problem to solutions to checking to see if the solutions are working? to come up with solutions you have to know what you are dealing with. go to mcdonalds and order something. put your hand behind your back and try to eat it. pretend that you are 6 years old and don't have the capacity to problem solve. take notes. try to eat a bowl of soup with one hand behind your back. again, pretend that you are brain damaged and don't have the capacity to figure out how to get the soup from the bowl to your mouth with your bad arm. take notes. you will get an idea of the kind of challenges a cva patient faces.
please, rewrite your interventions, outcomes and rationales. rationales are why
we do something. when writing the rationales say to yourself, "the reason i am doing this intervention is because. . ."