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- by ala2ch Dec 20, '12Hi ! I am a second year nursing student having some difficulties accompanied with low grades in constructing care plan. so basically this is my last care plan for this semester and i want to do extremely well in it. My patient 58 year old was admitted to ER for COPD exacerbation with SOB and chest discomfort accompanied with dyspnea. he has edema in his feet non- productive cough constipation for 8 days and hes known to be HTN DL COPD diabetic and asthmatic so basically i came up with a nursing diagnosis which is Constipation related to decreased peristalsis secondary to pulmonary hypoxia and lack of exercise , obesity manifested by absence of bowel sounds and inability to void is this diagnosis good enough ??? I need its pathophysiology and interventions with rationales and outcomes as soon as possible . Can u find me any good alternative but i prefer to stick to this diagnosis . Thank youuuu !!
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- Dec 20, '12 by ala2chHi !
I am a second year nursing student having some difficulties accompanied with low grades in constructing care plan.
so basically this is my last care plan for this semester and i want to do extremely well in it.
My patient 58 year oldwas admitted to ER for COPD exacerbation with SOB and chest
discomfort accompanied with dyspnea.
he has edema in his feet non- productive cough constipation for 8 days
and hes known to be HTN DL COPD diabetic and asthmatic
so basically i came up with a nursing diagnosis which is
Constipation related to decreased peristalsis secondary to pulmonary hypoxia and lack of exercise , obesity manifested by absence of bowel sounds and inability to void;
is this diagnosis good enough ??? I need its pathophysiology and interventions with rationales and outcomes as soon as possible . Can u find me any good alternative but i prefer to stick to this diagnosis .
Thank youuuu !!
- Dec 20, '12 by SadalaYou said its an ER? Did they want you to do a care plan on constipation? Was just curious why you wouldn't address the more immediate issues. I'm a student also, so don't take what I say as etched in stone, just curious.Last edit by Sadala on Dec 20, '12
- Dec 20, '12 by Esme12threads merged......
- Dec 20, '12 by Esme12Welcome to AN! The largest online nursing community!
We are happy to help with homework but we won't do it for you...(I know you know that )...What do you have so far.......What do you resourced say? What resources do you use for disease process/pathophysiology?
If you have been getting low grades...maybe you need to rethink your nursing process. Is the patient constipation the priority right now? What brought them to the ED. What is your assessment? Many nursing student fall into this trap of medical diagnosis versus nursing diagnosis. Maybe you need to rethink your process.
Here is what I know.....Let the patient/patient assessment drive your diagnosis. Do 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? What are the vital signs? What is your assessment. Is the the patient having pain? Are they having difficulty with ADLS? What teaching do they need? What does the patient need? What is the most important to them now? What is important for them to know in the future.
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 the care plan as a recipe to caring for your patient. your plan of how you are going to care for them. how you are going to care for them. what you want to happen as a result of your caring for them. What would you like to see for them in the future, even if that goal is that you don't want them to become worse, maintain the same, or even to have a peaceful pain free death.
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. You need to use the nursing diagnoses that NANDA has defined and given related factors and defining characteristics for. These books have what you need to get this information to help you in writing care plans so you diagnose your patients correctly. I use Ackley: Nursing Diagnosis Handbook, 9th Edition and Gulanick: Nursing Care Plans, 7th Edition
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. From a very wise an contributor daytonite.......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.
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: ADPIE
- 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)
- 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)
- Planning (write measurable goals/outcomes and nursing interventions)
- Implementation (initiate the care plan)
- Evaluation (determine if goals/outcomes have been met)
Care plan reality: The foundation of any care plan is the signs, symptoms or responses that patient is having to what is happening to them. What is happening to them could be the medical disease, a physical condition, a failure to perform ADLS (activities of daily living), or a failure to be able to interact appropriately or successfully within their environment. Therefore, one of your primary goals as a problem solver is to collect as much data as you can get your hands on. The more the better. You have to be the detective and always be on the alert and lookout for clues, at all times, and that is Step #1 of the nursing process.
Assessment is an important skill. It will take you a long time to become proficient in assessing patients. Assessment not only includes doing the traditional head-to-toe exam, but also listening to what patients have to say and questioning them. History can reveal import clues. It takes time and experience to know what questions to ask to elicit good answers (interview skills). Part of this assessment process is knowing the pathophysiology of the medical disease or condition that the patient has. But, there will be times that this won't be known. Just keep in mind that you have to be like a nurse detective always snooping around and looking for those clues.
A nursing diagnosis standing by itself means nothing. The meat of this care plan of yours will lie in the abnormal data (symptoms) that you collected during your assessment of this patient......in order for you to pick any nursing diagnoses for a patient you need to know what the patient's symptoms are. Although your patient isn't real you do have information available.
What I would suggest you do is to work the nursing process from step #1. Take a look at the information you collected on the patient during your physical assessment and review of their medical record. Start making a list of abnormal data which will now become a list of their symptoms. Don't forget to include an assessment of their ability to perform ADLS (because that's what we nurses shine at). The ADLS are bathing, dressing, transferring from bed or chair, walking, eating, toilet use, and grooming. and, one more thing you should do is to look up information about symptoms that stand out to you. What is the physiology and what are the signs and symptoms (manifestations) you are likely to see in the patient. did you miss any of the signs and symptoms in the patient? if so, now is the time to add them to your list. This is all part of preparing to move onto step #2 of the process which is determining your patient's problem and choosing nursing diagnoses. but, you have to have those signs, symptoms and patient responses to back it all up.
Care plan reality: What you are calling a nursing diagnosis is actually a shorthand label for the patient problem.. The patient problem is more accurately described in the definition of the nursing diagnosis.
Now tell me bout your patient....What do they complain about? What are your vital signs? What is your assessment? What care plan book do you use?Last edit by Esme12 on Dec 20, '12
- Dec 21, '12 by ala2chSadala well i think ur right i may want to choose an alternative diagnosis
as for Esme12 thanks alot for the info it really helped me alot concerning the care plan i submited it with two diagnosis the first is
ineffective breathing patterns related to immobility and stasis of secretionsand ineffective cough secondary to pneumonia manifested by the presence of diffuse expiratory wheezes and rhonchi on right lower lobe and the use of accessory muscles when breathing and increased anterioposterior chest diameter ( you may find it a little bit long because my instructor loves details and thats what i gave her ! )
the second diagnosis which was supposed to be on constipation i did it on
Impaired Gas exchange related to alveolar - capillary membrane changes manifested by inability to move secretions, restlessness, and somnolence
Emphasizing the first diagnosis took me three hours while the second two hours I really hope i did a good job because i really accomplished it from the buttom of my heart
Thank You all again
- Dec 21, '12 by Esme12You're welcome.....let us know how you did!
- Dec 21, '12 by ala2chYes I will surely let you know what my grade is !
Thanks You too Merry Christmas and Happy New Year
- Dec 24, '12 by GrnTea"ineffective cough secondary to pneumonia manifested by the presence of diffuse expiratory wheezes and rhonchi on right lower lobe and the use of accessory muscles when breathing and increased anterioposterior chest diameter"
Think of the way you document your nursing diagnostic process in three parts, alas, not in the usual order you see. "I think my patient has (diagnosis). He has this because he has (related to) .... . I think this is true because I have observed (as evidenced by) .... ."
Taking what you have written here, you think this person's ineffective cough is caused by pneumonia, and you think that this is so because you have observed wheezes, rhonchi, use of accessory muscles, and increased AP diameter. While this is a lot of details, the cause-evidence-effect thing doesn't hang together. You don't know that he has an ineffective cough because he has an increased AP diameter, etc., etc. How do you know his cough is ineffective? He might have a terrifically effective cough even if he does have an increased AP diameter, etc., etc. You have not proved your case or told me why you think it's true.
Common problem, to pick and commit to a sexy-sounding (or plausible-sounding) nursing diagnosis and then try to cram a lot of plausible-sounding details in it. Alas, in this case as in so many others, because you have not really understood cause, effect, and evidence, you have not chosen a nursing diagnosis that you, the nurse, can then treat yourself. This is what a nursing diagnosis is. When you find yourself writing something like, "Administer antibiotics as ordered" for a nursing diagnosis, you're on the wrong track.
In this case, you have fallen in love with "ineffective cough." Alas for you, there is no such nursing diagnosis in the NANDA-I, which is the definitive list of nursing diagnoses (get the 2012-2014 edition stat from Amazon-- you can thank me later). So now we go back to looking at your patient for the diagnostic clues you have observed. You don't give a lot of them besides the rhonchi and dyspnea. So looking in my NANDA-I, I want to see what kind of nursing diagnosis has what you observed in your ptient as defining characteristics. There's "Ineffective breathing pattern," defined as "inspiration and/or expiration that does not provide adequate ventilation," which includes much of what you doubtless observed. The "related to" includes possibilities like spinal cord injury, anxiety, obesity, pain, respiratory muscle fatigue, and a host of other things. If this were what you observed, you would then be able to say, "I think my patient has an ineffective breathing pattern because he has (related to) pneumonia with hypoventilation and fatigue. I know this because he is (as evidenced by) tachypneic and dyspneic, and is using accessory muscles to breathe." See how that works?
- Dec 29, '12 by ala2chummm thanks for the comment GrnTea but I want to tell u that ineffective breathing patterns related to immobility and stasis of secretionsand ineffective cough secondary to pneumonia manifested by the presence of diffuse expiratory wheezes and rhonchi on right lower lobe and the use of accessory muscles when breathing and increased anterioposterior chest diameter is one diagnosis I am sure there is no such diagnosis in NANDA list ([COLOR=#000000]ineffective[/COLOR]cough ...)