the first care plan for that week i had impaired skin integrity ( i don't remember the r/t) the aeb was the two surgical procedures the patient had and i also don't remember the other two aeb.
well, your aeb items must be the symptoms that the patient has. surgical procedures are not symptoms. the incisions resulting from the procedures and a description of them are symptoms.
the last clinical instructer stated that she feels that i got an unsatisfactory from the other teacher because my interventions and rationales leaned more toward the infection diagnosis. her exact words was, "i would write infection secondary to inpaired skin integrity r/t the surgical procedures, abcess, and temperature off 100.4". well, there is no nursing diagnosis for infection, because that is a medical diagnosis, so i used risk for infection (although my patient had an infection) and everything else my teacher said. well, i dinged on that one too because i listed a "slew of aeb" (her exact words), which is not appropriate for a risk diagnosis.
your instructor is correct. there is no nursing diagnosis for infection
. when using "risk for" diagnoses you are talking about problems that don't even exist yet so there can be no symptoms! interventions for those diagnoses is to monitor, observe and prevent the development of those symptoms.
you need to get a better understanding of the nursing process and how it translates into problem solving and writing a care plan. read the information i posted on post #4 of this thread: http://allnurses.com/forums/f205/fir...is-254012.html
the steps of the nursing process that are most critical to writing a care plan are the first three:
every nursing diagnosis has:
- assessment (collect data)
- nursing diagnosis (group your assessment data, shop and match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnosis to use)
- planning (write measurable goals/outcomes and nursing interventions)
- a definition (helps you to differentiate it from other diagnoses that seem like they might be similar)
- a set of defining characteristics (symptoms, inferences or logical conclusions, observable behaviors)
- a list of related factors (etiologies that have already been worked out for you; they are antecedent, or must exist prior, to the nursing diagnosis and the symptoms. in a very slick way many of the related factors slide around medical reasons for what is going on without actually using a medical definition. important note: nanda is a highly evolved system of nursing language [terminology])
- a list of risk factors replaces the defining characteristics and related factors for the "risk for" nursing diagnoses that may develop
as a student, when you are choosing nursing diagnoses for a patient you really need to be using some kind of nursing diagnosis reference to help you out. you need to make sure that your patient has symptoms that match the criteria that go with the nursing diagnosis you want to use. a doctor doesn't tell a patient that they have the flu until they have done an assessment and make a decision that the patient actually has some of the symptoms of the flu
. in that same spirit, a nurse doesn't diagnose a patient as having impaired skin integrity
without having done an assessment and determining that the patient has the symptoms of altered epidermis or dermis (the definition of this diagnosis). the nursing diagnostic statement (that xxx r/t xxx aeb thing) was designed to show that nursing students understood how the steps of the nursing process were used to choose the nursing diagnosis they are using. if you go to the post i referred you to above, i talk about the elements in a 3-part nursing diagnostic statement.
using risk for infection
and then listing all the patients symptoms of their infection was the wrong approach. you will never have aeb items (symptoms) with anticipated problems--ever. what you do is list out the patient's symptoms of their infection and look for other nursing diagnoses that have those symptoms. hyperthermia (fever) is one that can be used. if the surgical wound was infected you can still use impaired skin integrity
or delayed surgical recovery.
by just listing everything you could think of about the patient you were not really thinking about what you were doing. a care plan is a problem solving process. the patient's signs and symptoms which you determine from your assessment is the foundation of the care plan. the care plan is all about treating those signs and symptoms. your goals and interventions are aimed at those signs and symptoms. you choose a nursing diagnosis based upon those signs and symptoms. a nursing diagnosis is nothing more than a fancy label that nanda has already developed for us to use. the trick is to have a reference book to help determine the correct nursing diagnosis until you can start rattling off the top your head the symptoms (defining characteristics) of the various nursing diagnoses. the nursing diagnosis is only a small part of the care plan, but it hangs more students up than any single item about the care plan. the related factors are the underlying cause for why the signs and symptoms are occurring--that's all. when the cause is eliminated the signs and symptoms magically go away. until that happens, we treat the signs and symptoms in the unique way that nurses can treat them. doctors also treat some of the same signs and symptoms in the unique way that doctors can treat them. and that is the difference between medical practice and nursing practice.