Altered Tissue Perfusion - Total hip/total knee

[mcknis]

To all those wonderful posters:

My instructor this quarter is harping on us to get away from the same care plan diagnoses we have been doing since the beginning of nursing school. I completely understand her rationale for this and how she wants us to be broad-based nurses. I love that, but when you have a post-op pt, what are we checking more often than anything else? Aren't we checking the neuro-circ checks more often than, say, nutritional status?

I am now confused on what other primary care plans to write on. I have already written 3 CPs on Alt tissue perfusion alone, but am now stumped on what else to incorporate into my CPs. She is not giving us any hints, and being mid-quarter and almost graduation, my mind is pooped from thinking. I want to still sound knowledgeable and not feel like I am pulling things out of my butt, but sometimes I feel thats what I am doing. I already know that a priority would be impaired mobility, but that is becoming too worn out as well.

BTW - I cannot use pain or infection as primary CPs because they are "overused" by the other students

Thanks for any help out there...

[Miami NightNurse]

It's been a long time since I was in school. But your biggest issue post op is pain control. Also with knee replacements you got to keep them moving- CPM machine and then with a hip you have to be careful how you move them so you don't pop the prothesis out. I don't know what you would call such care plans, but I know those are important issues with those kind of patients. ? Impaired Mobility

[AprilRNhere]

Are these hypathetical or real patients?

Impaired gas exchange R/T pain control MB dyspnea, hypoxia...etc...

Impaired skin integrity R/T immobility

Impaired elimination R/T narcotic use....

Risk for impaired fluid volume R/T blood loss

[Daytonite, BSN, RN]

i understand your frustration, but any nursing diagnoses you use have to be based upon the patient's symptoms and those come from your assessment of the patient.

ineffective tissue perfusion (specify) is defined as decrease in oxygen resulting in the failure to nourish the tissues at the capillary level (page 228, nanda-i nursing diagnoses: definitions & classification 2007-2008). are you sure that is what is going on with your patient? this diagnosis is usually used when someone has arterial disease (plaque) or some other condition of the veins and arteries that results in poor circulation/perfusion so the tissues are not getting oxygenated very well, resulting in stasis ulcers or poor performance of a body organ (such as chest pain, neurological problems, renal problems). i don't think they would have done a total hip or total knee replacement on someone who had a tissue perfusion problem because there would be a big issue of the surgical wound healing due to a lack of oxygenation of the tissues.

i have to stress again, that the steps of care planning have you doing a thorough assessment of your patient before you can start assigning nursing diagnoses:

1. assessment (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
   
2. determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)

the more information you can collect, the more likely you are to find problems. you can look through the assessment information on this thread to help with assessing:

• https://allnurses.com/forums/f205/health-assessment-resources-techniques-forms-145091.html - health assessment resources, techniques, and forms
  

you can never know too much about a patient. and, it takes time and experience to get really proficient at assessing patients. as a student you will, unfortunately, miss a lot of symptoms that are staring you in the face. over time and with experience you'll learn to notice them.

[mcknis]

Thanks again for all of your wonderful advice guys.