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Desperately need help with careplans



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No. 190
Old Feb 01, 2009, 06:16 PM

Default Re: Desperately need help with careplans
hi my name is mary, iam a second year rpn student the course is 4years part-time
I have just found this site and i am amazed at the questions and the marvalous
replys. Idont know if this is the kind of reply Iam to give but as I have not learned how to navigate yet I apoligise. Iam 52 years old, and yes the oldest person in the class, so I need all the help i can get. THANKS
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No. 191
Old Apr 12, 2009, 02:28 PM

Agreement Re: Desperately need help with careplans
Originally Posted by mary vandersluis View Post
hi my name is mary, iam a second year rpn student the course is 4years part-time
I have just found this site and i am amazed at the questions and the marvalous
replys. Idont know if this is the kind of reply Iam to give but as I have not learned how to navigate yet I apoligise. Iam 52 years old, and yes the oldest person in the class, so I need all the help i can get. THANKS

Mary, I'm 55 and in my 3rd semester of nursing school. And I'm the oldest in my class, too, but not by much. Your life experience will prove itself as you get into the critical thinking part of nursing, because you've lived long enough to know there's always a "big picture", so hang in there and keep blogging.
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No. 192
from rwt'smom
Old Jun 19, 2009, 09:43 PM

Default Re: Desperately need help with careplans
i am new to the site and i cannot seem to find a plce to post a question. i am doing a care plan on a pt that dehisced after have a lobe of the liver removed due to cancer. hospital stay is 3 weeks. i am thinking that one a few of my nursing diagnosis' could be impaired mobility, infection and i have no idea of what to do for the third diagnosis. any ideas would be greatly appreciated.

thanks
rwt'smom
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No. 193
from Daytonite
Old Jun 19, 2009, 10:34 PM

Originally Posted by rwt'smom View Post
i am new to the site and i cannot seem to find a plce to post a question. i am doing a care plan on a pt that dehisced after have a lobe of the liver removed due to cancer. hospital stay is 3 weeks. i am thinking that one a few of my nursing diagnosis' could be impaired mobility, infection and i have no idea of what to do for the third diagnosis. any ideas would be greatly appreciated.

thanks
rwt'smom
Nursing diagnoses, like medical diagnoses, must be based upon the signs and symptoms that the patient has to support them. Nursing diagnoses are about the patient's responses to their medical diseases and conditions, not re-diagnosing them with another medical condition. Infection is not an official NANDA nursing diagnosis. Infection is a medical diagnosis and a medical decision and cannot be used as a nursing diagnosis. You need to break the signs and symptoms of the patient's infection down into its component symptoms and use them to come up with a nursing diagnosis. For example, if fever is one of the symptoms of the infection, then use the nursing diagnosis of Hyperthermia.

If this patient has liver cancer and had surgery, they are a postoperative patient. They need to be monitored for side effects from general anesthesia. Those include:
  • breathing problems (atelectasis, hypoxia, pneumonia, pulmonary embolism)
  • hypotension (shock, hemorrhage)
  • thrombophlebitis in the lower extremity
  • elevated or depressed temperature
  • any number of problems with the incision/wound (dehiscence, evisceration, infection)
  • fluid and electrolyte imbalances
  • urinary retention
  • constipation
  • surgical pain
  • nausea/vomiting (paralytic ileus)
and there are nursing diagnoses for some of those. A dehiscence is a break in the skin and tissues and is Impaired Tissue Integrity. Does this patient need any post op teaching? What will they need to know about incision care upon discharge?

To see more on how care plans are constructed and diagnosed, see this sticky thread: http://allnurses.com/general-nursing-student/help-care-plans-286986.html - Help with Care Plans
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No. 194
from rwt'smom
Old Jun 20, 2009, 06:39 PM

Default Re: Desperately need help with careplans
hi daytonite,

thanks for the reply. the patient has already had the liver surgery and two days later the incision dehisced and they repaired it. i was trying to do some type of diagnosis dealing with the dehisced wound and the impaired healing of a paitent with diabetes. that is where my problem is. i understand that a diabetic has impaired tissue prefusion but i cannot phrase the implimentations or rationale . any ideas for that?
denise
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No. 195
from rocell
Old Jun 21, 2009, 05:54 AM

Discuss Re: Desperately need help with careplans
aLways make sure that your goaLs are S.M.A.R.T

S- specific.. You don't want to place a hammer on your head because your goal is too broad. right?

M- measurabLe..

A- AttainabLe.. Don't pressure yourself too much. you have to think that what you're dong is for the fast recovery of your patients. If you think you can't attain your goaLs, find alternatives..

R- Realistic.. Your dealing with real life here so make sure that in doing your interventions, make sure that your base is REALITY and not some comic strip you want to put to life.

T- time-framed.. whether your duty shift is 8 hrs. or 16 hrs., always keep in mind that time is very important in our lives as nursng students. So, what i aLways do is, after checking the patient's chart, I always make a time table of everything i will do in the 8 hrs. of duty. And i see to it that n making my care plans, my goals are time-framed to provide my patient maximum care as possible for the whole 8 hrs.

And Lastly, I read Nursing Care Plans books as my guide in making care plans.

I hope I helped you..
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No. 196
from Daytonite
Old Jun 21, 2009, 11:19 AM

Originally Posted by rwt'smom View Post
hi daytonite,

thanks for the reply. the patient has already had the liver surgery and two days later the incision dehisced and they repaired it. i was trying to do some type of diagnosis dealing with the dehisced wound and the impaired healing of a paitent with diabetes. that is where my problem is. i understand that a diabetic has impaired tissue prefusion but i cannot phrase the implimentations or rationale . any ideas for that?
denise
There is a nursing diagnosis that specifically handles a case like this. Having a nursing diagnosis reference (not just a list of the NANDA diagnoses) that contains the definition, defining characteristics and related factors for each of the diagnoses is really helpful. What you are looking for is the diagnosis of Delayed Surgical Recovery R/T postoperative complications. Your defining characteristics (AEBs, or evidence) are everything about the wound and impaired healing including anything that has to do with it that is diabetes related. Here is online information about this diagnosis: Delayed Surgical recovery
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No. 197
from rhampton47
Old Oct 09, 2009, 07:03 PM

Default Re: Desperately need help with careplans
Great Point. I keep forgetting to bring it all back to Maslow.
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