concept map/care plan help

[salad725]

Hi.

I am trying to do a pathophysiology concept map and then a care plan for on one of my patients. I am struggling with pulling the pertinent info from a plethra of diseases, medications, procedures and deciding what to link to his current condition. I can't of course list them all, but he was dx with an incarcerated ventral wall hernia, I cared for him post-op, he has a urostomy, from a ileal conduit and a transverse colonostomy, large surgical wound, DM, heart disease, 27 meds, developmental impairment etc. I am not finding a lot of patho on this particular type of hernia if any one has a reference for me. But also advice on going from an overwehlming amount of info and breaking it down enough to be manageable. Maybe just advice on concept mapping! I would appriciate any advice. Thanks!

[Daytonite, BSN, RN]

i found this article on emedicine: http://www.emedicine.com/med/topic2703.htm and http://www.emedicine.com/emerg/topic251.htm when a hernia is incarcerated it means constriction of an intestinal part so that it is in danger of becoming necrotic. it can be incarcerated by being herniated through the torn tissues or the intestines literally fold in half on themselves as a result of the herniated tissue which sometimes cut off the blood supply as well as its ability to achieve its function as intestine. "ventral wall" just locates where the herniation occurred. this sounds like he had an abdominal hernia, probably as a result of his previous surgeries. this was not an inguinal surgery repair, was it?

umbilical hernia repair - http://www.surgeryencyclopedia.com/st-wr/umbilical-hernia-repair.html

inguinal hernia repair - http://www.surgeryencyclopedia.com/fi-la/inguinal-hernia-repair.html

when care planning with complicated cases like this you really have no choice but to utilize the nursing process because it will keep you organized since there is so much going on. your primary problem is all the medical problems and treatments that you have to find information on and list out all the signs and symptoms that the patient has. putting it all on paper helps keep it organized. it takes time, but just keep putting one foot in front of the other until it is done. it is the only way. you will find some crossover and repetition of symptoms with the various conditions the patient has. after completing assessment, you then start to study and analyze the signs and symptoms, to group them in order to see where nursing problems emerge and can be treated.

step 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 and complications, look up the side effects and complications of the treatments including the ostomies and the medications

• incarcerated ventral wall hernia
  
• dm
  
• heart disease - what specific heart disease?
  
• urostomy
  
• a ileal conduit
  
• transverse colonostomy
  
• developmental impairment - what specific developmental delays?
  
• treatment
  • 27 meds - the reason a med is given can clue you in to a symptom the patient is being treated for

step #2 determination of the patient's problem(s)/nursing diagnosis part 1 - make a list of the abnormal assessment data

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

there is information on concept mapping on this sticky thread: https://allnurses.com/forums/f205/care-maps-225330.html - care maps

the 5 steps of the nursing process for care planning are as follows and should be followed in this sequence. assessment will take you the longest but is the foundation of the entire care plan:

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)
   
   • a physical assessment of the patient
     
   • assessment of the patient's ability and any assistance they need to accomplish their adls (activities of daily living) with the disease
     
   • data collected from the medical record (information in the doctor's history and physical, information in the doctor's progress notes, test result information, notes by ancillary healthcare providers such as physical therapists and dietitians
     
   • knowing the pathophysiology, signs/symptoms, usual tests ordered, and medical treatment for the medical disease or condition that the patient has. this includes knowing about any medical procedures that have been performed on the patient, their expected consequences during the healing phase, and potential complications. if this information is not known, then you need to research and find it.
     
     • use: https://allnurses.com/forums/f205/medical-disease-information-treatment-procedures-test-reference-websites-258109.html - medical disease information/treatment/procedures/test reference websites
       

[*]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). it helps to have a book with nursing diagnosis reference information in it. there are a number of ways to acquire this information.

• your instructors might have given it to you.
  
• you can purchase it directly from nanda. nanda-i nursing diagnoses: definitions & classification 2007-2008 published by nanda international. cost is $24.95 http://www.nanda.org/html/nursing_diagnosis.html
  
• many authors of care plan and nursing diagnosis books include the nanda nursing diagnosis information. this information will usually be found immediately below the title of a nursing diagnosis.
  
• the nanda taxonomy and a medical disease cross reference is in the appendix of both taber's cyclopedic medical dictionary and mosby's medical, nursing, & allied health dictionary
  
• there are also two websites that have information for about 75 of the most commonly used nursing diagnoses that you can access for free:
  
  • http://www1.us.elsevierhealth.com/evolve/ackley/ndh7e/constructor/
    
  • http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm
    

[*]planning (write measurable goals/outcomes and nursing interventions)

• goals/outcomes are the predicted results of the nursing interventions you will be ordering and performing. they have the following overall effect on the problem:
  
  • improve the problem or remedy/cure it
    
  • stabilize it
    
  • support its deterioration
    

  [*]how to write goal statements: https://allnurses.com/forums/2509305-post158.html

  [*]interventions are of four types

  • assess/monitor/evaluate/observe (to evaluate the patient's condition)
    
    • note: be clear that this is assessment as an intervention and not assessment done as part of the initial data collection during step 1.
      

    [*]care/perform/provide/assist (performing actual patient care)

    [*]teach/educate/instruct/supervise (educating patient or caregiver)

    [*]manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)

[*]implementation (initiate the care plan)

[*]evaluation (determine if goals/outcomes have been met)