Constructive critism for care plan / nsg Dx

[blackvans1234]

Hey all, get your reading glasses on.

My clinical instructor has been a bit hard to please, and i'm currently on spring break so I can't visit during her office hour.

Anyways, in general she is a bit vague with what she wants, and hasn't really been happy with anyone's care plan / nsg dx.

I have (I think) a strong grasp on the idea of the nsg dx and care plan. It is to ID any problems or possible problems and prevent them from happening or getting worse. It is our assessment and critical thinking skills that are what makes the DX and care plan come together.

I actually enjoy the idea of thinking critically (who knew!)

Without further adeiu, and rambling.

My pt was a 49 yr old lymphoma pt. My assessment found nothing abnormal, except he did not want to get out of bed.

Bingo, @ risk for impaired skin integrity. I could probably do @ risk for infection due to the disease process, but we haven't really learned about lymphoma yet.

One week my instructor said she wanted us to use our nsg Dx books and take all the info out of there, so I did. However I am not happy with the result, it seems like it is a 'copout' for critical thinking. Then the next week she said that we didn't need to use the Dx book for everything, just for terminology. She has not seen either care plan from me.

What I have done is made two Nsg dx / care plans for the same dx, one using the book, one using my brain

Book only:

Assessment

Subjective: "I don't feel up to walking today"

Objective: Pt did not exit bed during day shift

Nsg Dx: @ Risk for alteration in epidermis r/t pain and discomfort

Goal: The patient will... Demonstrate skin integrity free of pressure ulcers...

Outcomes: As evidenced by... participation in risk assessment, express willingness to participate in prevention of pressure ulcers, describe etiology and prevention measures.

Interventions + Rationale:

-Encourage ROM excercises, and weight bearing mobility whenever possible

+ To increase blood flow to all areas

- Instruct client to shift weight every thirty minutes

+ Allow skin to recover from pressure

- Suspend heels off of bed surface

+ Allow skin to recover from pressure

- Pad the chair with pressure relieving cushion

+ distribute pressure from high pressure areas

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My ''critical thinking'' care plan

Assessment

Subjective: "I don't feel up to walking today"

Objective: Pt did not exit bed during day shift

Nsg Dx: At risk for impaired skin integrity r/t disinterest in ADL's (Activities of daily living)

Goal: The patient will... Remain free from breaks in skin integrity...

Outcomes: As evidenced by... Intact skin and no areas of non-blanchable reddened skin by end of hospital stay.

Interventions + Rationale:

-Educate patient of importance of ADL's, and consequences of immobility (constipation, pressure ulcers, atelectasis)

+ Pt may not understand risks involved with prolonged immobility

- Pt will sit in chair during all three meals

+ Decrease pressure on sacrum, builds strength during transfers

- Monitor skin integrity Q shift

+ Identify stage I decubitis before skin integrity is broken

-Ambulate TID

+ Ambulation will allow high pressure area's to be relieved and circulation restored

- Turn and position Q2H while in bed

+ Turning will give opportunity for return of circulation.

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Personally I feel like my care plan is more individual based, and the book is just general and non-specific. However I do appreciate some of the rationales and ideas (I wouldn't have remembered to elevate the heels - without doing it in practice). I also appreciate the wording that the book uses, when compared to some of my wording.

Anyways, thanks for reading, and any suggestions would be appreciated.

[blackvans1234]

I suppose I could change ''disinterest in ADL's" to "Increased bedrest"

[Esme12, ASN, BSN, RN]

Why is this patient in the hospital? What drugs are they on? I don't understand about the care plan books for you need to use them for the NANDA I taxotomy. I use Ackley: Nursing Diagnosis Handbook, 9th Edition

Just looking at I don't feel like getting OOB.....why don' they want to get OOB? what are the complications of bedrest? Are they depressed? These are the NANDA diagnosis that come to mind that might apply to your patient.

Activity intolerance: Are they fatigued? has medical RX ie: chemo taken their toll?

Impaired Comfort: Are they in pain?

Ineffective Coping: are they depressed withdrawn?

Risk for compromised Human Dignity: are they afraid about their diagnosis and the future?

Adult Failure to thrive: are they depressed and unable to help themselves?

Fear: are they afraid about their diagnosis and the future?

Grieving: are they grieving about their diagnosis and the loss of their health?

Ineffective self Health management: are they unable to follow their health regime

Hopelessness: do they feel that there is no hope

Risk for Infection: are they on chemo that will depress their response to infection

Self Neglect: are they withdrawn that they can't follow perform daily routine

Impaired individual Resilience: are they unable to process their diagnosis and still take control over daily routine?

For example.....adult failure to thrive ....evidenced by patients inability to participate in care and daily activities

NANDA-I Definition adult failure to thrive Progressive functional deterioration of a physical and cognitive nature. The individual's ability to live with multisystem diseases, cope with ensuing problems, and manage his or her care is remarkably diminished.

Defining Characteristics

Altered mood state; anorexia; apathy; cognitive decline: demonstrated difficulty responding to environmental stimuli; demonstrated difficulty in concentration; demonstrated difficulty in decision making; demonstrated difficulty in judgment; demonstrated difficulty in memory; demonstrated difficulty in reasoning; decreased perception; consumption of minimal-to-no food at most meals (i.e., consumes

Related Factor (r/t)

Depression

Does your patient fit any of these categories?