I have several questions

[Peachez8207]

Hello all. I recently posted on this site trying to get help with my care plan for a patient I had last week. The wonderful Daytonite helped me tremendously with my nursing diagnosis and I really appreciate it. So first off thank you again.

Okay here are my questions:

1. would self care deficit (bathing,grooming,feeding) r/t decreased LOC be considered a psychosocial nursing diagnosis.

2. I just received my new care plan book in the mail today and I think it is really helpful. I have the ALL in One Care Planning Resource book. My question is does anyone have any suggestions for other care plan books.

3.Daytonite gave me a really good psychosocial nursing diagnosis to use:

Impaired Verbal Communication R/T decreased oxygenation to brain AEB unable to awaken and communicate with patient

I really want to use this nursing dx but my problem is coming up with both a short term goal and long term goal for this patient. He was asleep pretty much the whole time and when he was awake he was unresponsive and hard to understand. I was only with this patient for three days so I am trying to figure out how anything can be accomplished in such a short time. Meaning my short time goal time limit would have to be by the end of the first shift and long term by discharge.

So I guess the question here would be how to come up with goals for a patient that is unconscious 98% of the time.

In my care plan book they goals they have seem totally unattainable and unrealistic for this patient.

Iam racking my brain trying to figure out a short term and long term goal that would be attainable for a lient in this state.

Here is the brief info again if it helps anyone to help me.

63 y/o CHF exacerbation, uncontrolled HTN

Very lethargic, thready pulse, shallow respirations, on O2 6L, hard to wake, low bp, crackles and wheezes in both lungs.

I just remebered some more info-- all B/P's I took on the patient were around 90/68 no higher than 93/72 he had left eye blindness d/t a previous trauma, left the hospital AMA a week prior to this hospitalization, lives in a shelter, no family that I am aware of none listed in contacts, Now that I think of it would I still be able to use the nursing diagnosis of:

Impaired Verbal Communication R/T decreased oxygenation to brain AEB unable to awaken and communicate with patient

All of his O2 sats were 98 and above his resp were 24bpm but like I said they were shallow. Was the fact that he was on O2 account for the high O2 sats?

I know a lot of questions in one post. I can't wait until I am able to do these care plans with a little more ease.

Now that I posted some more info on my patient could I use the Nursing diagnosis of:

Impaired Verbal Communication R/T drug therapy AEB decreased LOC

I'm say drug therapy because when I took a look at some of the meds some s/e were sedation and drowsiness. The drugs are Librium and Ativan

any help would be aprreciated.

Crystal

[Daytonite, BSN, RN]

Impaired Verbal Communication R/T decreased oxygenation to brain AEB unable to awaken and communicate with patient

First of all, if the patient never speaks you are probably never going to get him to speak back. So, trying to get him to communicate with the nursing staff is going to be a monumental feat. Did you ever have a cat or dog who you spoiled? Well, that is what you do with these patients. They are like, forgive the analogy, pets that cannot speak who you must do for. They depend on you for protection and care.

Goal: By ____ patient will acknowledge the presence of caregiving staff by opening eyes and looking at them when he is greeted and his name is spoken.

• Assess patient's nonverbal responses to caregivers as they perform treatments and care to determine what patient is capable of understanding.
  
• Assign the same personnel to care for the patient.
  
• Address the patient by his name when approaching.
  
• Caregivers should attempt to ask the same simple "yes" and "no" questions of the patient when proving daily care, speak distinctly and face the patient when asking these questions. Allow time for an answer.
  
• If any type of nonverbal response is noted, provide praise, and anticipate and watch for it in subsequent interactions.
  
• All care and procedures are to be explained to the patient before they are performed.
  
• Consult with family and find what things were important to the patient, do them and keep favorite objects in his room, include them in his daily care and discuss them while working with the patient