care plan question

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    This may seem obvious to most people, but I'm curious to know what you think. During clinical today I had a patient post op hip surgery. He also was Diabetic, in renal failure, and had diarrhea. He goes to dialysis 3x a week. What would be a priority nursing diagnosis? I'm starting to get used to these care plans but my teacher didn't like my care plan last week on a very similar patient. Also, can a person in renal failure increase fluids? (Wouldn't they just retain the fluid)? This has been my most complex patient yet and I would appreciate your help.
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  3. 9 Comments so far...

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    The one thing my instructor always asked was, what is going to kill them first? That's top priority. What is the most danger to their health? Still a little tricky though. I might pick At Risk for Infection because they are diabetic and just had surgery. I feel like I need more information in general and about their renal failure though.
    Normally, I believe renal failure patients are on some kind of fluid restriction. The dialysis will pull off some excess fluid but even still, you don't want to fluid overload them.
    JMederich likes this.
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    make sure you follow these steps first and in order and let the patient drive your diagnosis not try to fit the patient to the diagnosis you found first. you need to know the pathophysiology of your disease process. you need to assess your patient, collect data then find a diagnosis. let the patient data drive the diagnosis. what is your assessment? how many days post op? is the patient having pain? are they having difficulty with adls? what teaching do they need? what do you want to push fluids? most renal patients are on fluid restrictions. what does the patient say? what are the labs? is the patient compliant with the dialysis? what does the patient need? what is the most important to them now?

    the medical diagnosis is the disease itself. it is what the patient has not necessarily what the patient needs. the nursing diagnosis is what are you going to do about it, what are you going to look for, and what do you need to do/look for first.

    care plans when you are in school are teaching you what you need to do to actually look for, what you need to do to intervene and improve for the patient to be well and return to their previous level of life or to make them the best you you can be. it is trying to teach you how to think like a nurse. think of them as a recipe to caring for your patient. your plan of how you are going to care for them.

    from a very wise an contributor daytonite.......

    every single nursing diagnosis has its own set of symptoms, or defining characteristics. they are listed in the nanda taxonomy and in many of the current nursing care plan books that are currently on the market that include nursing diagnosis information. you need to have access to these books when you are working on care plans. there are currently 188 nursing diagnoses that nanda has defined and given related factors and defining characteristics for. what you need to do is get this information to help you in writing care plans so you diagnose your patients correctly.

    don't focus your efforts on the nursing diagnoses when you should be focusing on the assessment and the patients abnormal data that you collected. these will become their symptoms, or what nanda calls defining characteristics.

    here are the steps of the nursing process and what you should be doing in each step when you are doing a written care plan:
    1. assessment (collect data from medical record, do a physical assessment of the patient, assess adls, 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)
    3. planning (write measurable goals/outcomes and nursing interventions)
    4. implementation (initiate the care plan)
    5. evaluation (determine if goals/outcomes have been met)

    a dear an contributor daytonite always had the best advice.......check out this link.
    http://allnurses.com/nursing-student...is-290260.html

    you need a good care plan book. i prefer gulanick: nursing care plans, 7th edition. they have an online care plan constructor. it used to be free but they caught on so now you need to buy the book to use the constructor.

    care plans must be chosen from the "approved" script....nanda. i think the biggest mistake students make is that the need to let what the patient says, does and feels (the assessment) dictate what you do next. not the medical diagnosis and try to fit the patient into diagnosis. some other helpful links.
    http://allnurses.com/nursing-student...ml#post6283634
    http://allnurses.com/nursing-student...te-225330.html
    http://allnurses.com/lpn-lvn-nursing...ml#post6052759
    http://allnurses.com/lpn-lvn-nursing...lp-665349.html

    here are some useful care plan sited with examples to follow
    nursing care plan | nursing crib
    nursing care plan
    nursing resources - care plans
    nursing care plans, care maps and nursing diagnosis
    http://www.delmarlearning.com/compan.../apps/appa.pdf


    Last edit by Esme12 on Apr 19, '12
    tnbutterfly likes this.
  6. 0
    I agree with JMederich. Without knowing much info about this patient, I would assume Risk for Infection would be a priority, r/t post op and diabetes. As for the renal failure, yes, most that I have seen have been on some sort of fluid restriction. Even if they aren't, it is expected that they drink a regular amount of fluids (no blousing, etc.). Hope this helps.
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    before we do your homework for you we usually ask what your thoughts on the matter are. then we know where you're coming from and it's easier to help you, not just give you what we think is the answer.

    so... what do you think, and why?

  9. 0
    Thanks for your help. I have already turned in my paper and I do think his priority nursing diagnosis was risk for infection r/t impaired skin integrity and also r/t his underlying diseases. I had a very similar patient the week before (pt in renal failure) and since I'm only in my first year we haven't gone over a lot of these symptoms yet and my last care plan came back with a lot of pen marks on them. So I came here for help. I don't appreciate people posting and accusing me of having you do my homework for me. But thank you to the people who did send some great advice and remind me how to look farther into my assessment data to make a nursing diagnosis. I was able to make a care plan that my teacher approved of.
  10. 0
    Wound infection won't kill him (at least not for a 7-10 days, IF undetected AND if untreated) but a potassium issue could do so, and Quickly. Look up what renal failure and diarrhea do to K+ levels. Fluid volume excess can also lead to resp and heart failure. You need to get pout your books and read.
  11. 1
    As a faculty member, it is frustrating to see students come here and ask others to tell them what to do or what to think when it is quite clear that they didn't first try to deeply understand the issues first. Will you be able to post uestions here when you are in the nmidst of the NCLEX exam? Will your employer go along with emailing questions in when you can't figure otu what to do on the job.

    There is no such thing as an easy nursing program. To be a safe, effective nurse, you need to learn, understand, and apply a huge amount challenging information. Relying on us to help direct you to the answers may not help you achieve that. Nursing is a field where you will need to be highly self-directed and know how to find, read, interpret and evaluate information. I suggest you start working on that now.
    GrnTea likes this.
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    Just another thought. Renal Failure, Diarrhea, and Diabetes are extremely common. In fact, I've had several patients with either one or a combination of those problems during clinical. I would recommend becoming very familiar with the pathophysiology, medical treatment/diagnostics and nursing implications of each problem. Now. It will serve you well during school and out of school.
    GrnTea likes this.


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