Care Plan for Mentally Retarded Patient

  1. 0
    I am a second semester student working in Med-Surg. I had the pleasure of caring for a delightful patient this week who was profoundly retarded (her mental functioning is estimated at approximately 18 months of age). She could not communicate with me verbally or understand my conversation with her (according to her caregiver from her group home). She had pneumonia and couldn't understand "take a breath" or mimic my breathing actions.

    Where would one look for information on careplans for this type of patient? I have 2 nsg dx books (Cox's and another by Gulanick and Myers) but neither touch on this area. "Impaired Social Interaction" and "Impaired Verbal Communication" won't cut it (at least for me--I need to learn something appropriate for this patient). We don't cover psychiatric at my school until 4th semester. Do I write the care plan where the intervention is aimed at the cargiver?

    Thanks in advance for your assistance! :bowingpur

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  2. 14 Comments...

  3. 1
    risk for infxn? bowel or bladder incontinence? any comorbidities?
    Dianacabana likes this.
  4. 1
    I would stick with risk for stuff like Infection as mentioned in pp. Put goals directed towards her care giver since she Pt is at decreased mental capacity. I know if I had a plan in mind my teachers would help me especially if I had specific questions about my plan, if someone went in hoping for the teacher to give them a starting point they left empty handed. Lean on your instructors, they are there to help.
    Dianacabana likes this.
  5. 1
    Thank you so much! I did contact two professors but I was hoping to get a head start while I was awaiting their replies.

    I definitely had some ideas in mind (impaired gas exchange r/t dx pneumonia AEB copious secretions, low SpO2, etc. Risk for skin impairment r/t immobility AEB right sided flaccidity, etc) Just not sure how to write the interventions and goals for the pt. So many of them require pt participation (coughing, deep breathing) which I attempted but to no avail.

    I appreciate your help!
    nursesince2009 likes this.
  6. 2
    this is why i am constantly telling people to follow the steps of the nursing process when sitting down to write a care plan. care plan books only contain care plans for the most commonly encountered medical diagnoses. here is a case in point of a patient with a not so common medical problem. in many ways this is a pediatric patient even though you may not had pediatrics yet. when i was a hospital supervisor this patient, when hospitalized, would have been admitted to the pediatric unit. start working through the steps of the nursing process (which is a problem solving method) to complete this care plan.

    step 1 assessment - assessment consists of:
    • a health history (review of systems)
    • performing a physical exam
    • assessing their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming)
    • reviewing the pathophysiology, signs and symptoms and complications of their medical condition - look up pneumonia and mental retardation; since she has the mental age of an 18-month old child look up the developmental tasks and normal behavior for a child of that age. that will tell you what kind of approaches to use with her that she will be able to understand. there are pediatric links on http://allnurses.com/nursing-student-assistance/medical-disease-information-258109.html that will have this information (called developmental milestones).
    • reviewing the signs, symptoms and side effects of the medications they are taking
    step #2 determination of the patient's problem(s)/nursing diagnosis part 1 - make a list of the abnormal assessment data - list the symptoms of the pneumonia, the developmental lags and the communication difficulties you were having. the evidence is needed in order to support the diagnoses.

    step #2 determination of the patient's problem(s)/nursing diagnosis part 2 - match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use now, with evidence, you start determining what the labels are for the diagnoses
    • ineffective airway clearance (i am assuming this is why you were teaching her how to db and cough)
    • impaired verbal communication (the communication problems)
    • delayed growth and development
    • self-care deficit(s) - as appropriate
    step #3 planning (write measurable goals/outcomes and nursing interventions) - these always target the list of symptoms developed from assessment and listed out in the first part of step #2.
    xobeckyxo and Dianacabana like this.
  7. 0
    Quote from daytonite
    this is why i am constantly telling people to follow the steps of the nursing process when sitting down to write a care plan. care plan books only contain care plans for the most commonly encountered medical diagnoses. here is a case in point of a patient with a not so common medical problem. in many ways this is a pediatric patient even though you may not had pediatrics yet. when i was a hospital supervisor this patient, when hospitalized, would have been admitted to the pediatric unit. start working through the steps of the nursing process (which is a problem solving method) to complete this care plan.
    thanks for your input, daytonite. this was a really difficult assignment for me. i do try to use my nsg process but i was really stuck on the interventions since she was a total care patient and (try as i might) i couldn't communicate with her but for her smiling at me and trying to take off her o2 mask.


    Quote from daytonite
    step 1 assessment
    Quote from daytonite
    - assessment consists of:
    • a health history (review of systems)
    • performing a physical exam
    • assessing their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming)
    • reviewing the pathophysiology, signs and symptoms and complications of their medical condition - look up pneumonia and mental retardation; since she has the mental age of an 18-month old child look up the developmental tasks and normal behavior for a child of that age. that will tell you what kind of approaches to use with her that she will be able to understand. there are pediatric links on http://allnurses.com/nursing-student-assistance/medical-disease-information-258109.html that will have this information (called developmental milestones).
    • reviewing the signs, symptoms and side effects of the medications they are taking
    the assessment data i obtained was a health history (from her caregiver and chart), physical exam i performed, adls--she was a total care, patho of pneumonia i know, s/e of meds i researched.

    Quote from daytonite
    step #2 determination of the patient's problem(s)/nursing diagnosis part 1
    Quote from daytonite
    - make a list of the abnormal assessment data - list the symptoms of the pneumonia, the developmental lags and the communication difficulties you were having. the evidence is needed in order to support the diagnoses.

    this is a very helpful tip about examining the developmental lags she has. i will look at the peds information as well.




    step #2 determination of the patient's problem(s)/nursing diagnosis part 2 - match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use now, with evidence, you start determining what the labels are for the diagnoses
    • ineffective airway clearance (i am assuming this is why you were teaching her how to db and cough)
    • impaired verbal communication (the communication problems)
    • delayed growth and development
    • self-care deficit(s) - as appropriate
    step #3 planning (write measurable goals/outcomes and nursing interventions) - these always target the list of symptoms developed from assessment and listed out in the first part of step #2.
    [/quote]

    i did a lot of research online to try to find articles about nursing developmentally challenged patients, which i hoped would give me some insight (not much luck there--none of them at my local libraries). my goal here was to determine what to do about the interventions since many of the ones having to do with airway require pt participation. i hadn't considered delayed growth and development but i will look carefully at that one.

    thanks again!
  8. 1
    when you sit down to write this care plan work on it as if this were a pediatric 18 month old patient. the twist to it is that she isn't. but, in reality, you are dealing with someone who has the cognitive (mental) age of an 18 month old with the physical age body of ___. your psychosocial is for an 18-month old. the physiological (the pneumonia) is for the ___ year old. but for all your interactions with the patient you are, in essence, dealing with an 18 month old and that's how you must communicate and deal with this person--as an 18-month old child. if you haven't had pediatrics yet that may be a tad difficult to understand at this point in your training. on the peds websites are milestone developments that tell us what a child of that age is capable of doing and reacting to cognitively and behaviorally and that is how you deal with children of that age. there are just things that a child of that mental age cannot understand. peds nurses might use a doll or a favorite stuffed toy to demonstrate procedures or for the children to do the same procedures on in play. also, there is erickson's developmental stage to consider. she is probably in the trust vs mistrust stage so it is important that interactions promote trust.
    Dianacabana likes this.
  9. 0
    Thank you for your help. The approach you explained it makes so much sense in this case. I'm sure I wouldn't have come up with this on my own! :bowingpur

    I'll let you know how it turns out. Much appreciated.
  10. 0
    This post is excellent, I'm glad I came across it. Very interesting to base all of your teachings and interventions as if your patient were 18 months old. Thanks for all the good info!!
  11. 0
    hi i'm a new member here i need nusing diagnosis about mental retardation for child have 13 yrs old plz answer me quickly


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