Question about nursing care plan for acute pain
I am in the "intro" semester of the ADN program and we just got our first care plan assignment based off of a case study. My patient is an 8 year old girl who presents to the emergency room with lower abdominal pain and is diagnosed with Appendicitis and is scheduled for surgery. We are to come up with 2 nursing diagnosis, one medical and one psychosocial, a short term goal and long term goal for each diagnosis and 5 interventions for each diagnosis.
For my medical diagnosis I think I am going with Acute pain r/t diagnosis of appendicitis A.E.B. pt reports pain in lower abdomen, rebound tenderness in rt lower quadrant and elevated pulse rate.
I was hoping to receive some feedback as to wether this is worded correctly.
I'm also having some trouble coming up with Goals and interventions. I have a nursing care plan book, but my knowledge is so limited since this is just my intro semester that I am not sure how to individualize the interventions listed for acute pain to be appropriate for an 8 year old. This is what I have for goals and interventions. I was wondering if it was possible to get some feedback on what I have come up with so far. I've spent hours(believe it or not) working on this already and I feel like I have done it all wrong. Not sure if I'm stressing for no reason or what but it's important for me to have this done correctly. ANY help or advice/feedback would be greatly appreciated, especially advice on individualizing these interventions!
Short term goal: Patient will verbalize pain as a 3 or less on a scale of 0-10 within 30 minutes of receiving ordered pain medication.
Long Term goal: Patient/caregivers will describe how unrelieved pain will be managed by date of discharge.
My interventions are
1. Assess pain characteristics including quality, severity, location, onsent, duration and precipitating or relieving factors.
2. Give analgesics as ordered by M.D., evaluating effectiveness and observing for any signs and symptoms of untoward effects.
3. Assess the patients expectations for pain relief.
4. Assess the patients willingness or ability to explore a range of techniques aimed at controlling pain.
5. Eliminate additional stressors or sources of discomfort whenever possible.
- 0Jul 6, '13 by Esme12, BSN, RN Senior ModeratorThis drives me crazy......care plans are all about the assessment.....of the patient. I know you have to start somewhere but it is so difficult to "get the picture" from a bunch of typed words.
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.
So in the future.........What is your assessment? What are the vital signs? What is your patient saying?. 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. What is YOUR scenario? TELL ME ABOUT YOUR PATIENT...
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. From what you posted I do not have the information necessary to make a nursing diagnosis.
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.
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.
check out this thread....http://allnurses.com/nursing-student...085-page2.html
Attachment 12727Critical Thinking Flow Sheet for Nursing Students.docAttachment 12727Attachment 12727Critical Thinking Flow Sheet for Nursing Students.docLast edit by Esme12 on Jul 6, '13
- 0Jul 6, '13 by Esme12, BSN, RN Senior Moderatornow you think about Ericksons growth and development or what ever development resource your program uses. http://psychology.about.com/od/psych...nferiority.htm
Stage Basic Conflict Important Events Outcome Infancy (birth to 18 months) Trust vs. Mistrust Feeding Children develop a sense of trust when caregivers provide reliabilty, care, and affection. A lack of this will lead to mistrust. Early Childhood (2 to 3 years) Autonomy vs. Shame and Doubt Toilet Training Children need to develop a sense of personal control over physical skills and a sense of independence. Success leads to feelings of autonomy, failure results in feelings of shame and doubt. Preschool (3 to 5 years) Initiative vs. Guilt Exploration Children need to begin asserting control and power over the environment. Success in this stage leads to a sense of purpose. Children who try to exert too much power experience disapproval, resulting in a sense of guilt. School Age (6 to 11 years) Industry vs. Inferiority School Children need to cope with new social and academic demands. Success leads to a sense of competence, while failure results in feelings of inferiority. Adolescence (12 to 18 years) Identity vs. Role Confusion Social Relationships Teens need to develop a sense of self and personal identity. Success leads to an ability to stay true to yourself, while failure leads to role confusion and a weak sense of self. Young Adulthood (19 to 40 years) Intimacy vs. Isolation Relationships Young adults need to form intimate, loving relationships with other people. Success leads to strong relationships, while failure results in loneliness and isolation. Middle Adulthood (40 to 65 years) Generativity vs. Stagnation Work and Parenthood Adults need to create or nurture things that will outlast them, often by having children or creating a positive change that benefits other people. Success leads to feelings of usefulness and accomplishment, while failure results in shallow involvement in the world. Maturity(65 to death) Ego Integrity vs. Despair Reflection on Life Older adults need to look back on life and feel a sense of fulfillment. Success at this stage leads to feelings of wisdom, while failure results in regret, bitterness, and despair.
Eight year-olds are waking up to the wider world, and are beginning to discover more about how they fit into the bigger picture of society. If you are in charge of the care of an 8 year-old girl, it is important to recognize her growing awareness and sense of responsibility.
Give the child a couple of chores to do. This will increase her sense of responsibility and make her feel that she is needed
Talk about what is important to the child. Find out what interests the child has. Listen to them and take an active interest in what they say. Talk to them like they are an adult is an adult whose questions are worth listening to. After all they "aren't babies any more"
Give the child independent play and work time.
Build the patients confidence by helping them establish and meet goals.
Thanks for responding back to me. I thought I had considered the assessment data before I formed my nursing diagnosis and interventions. I didn't include the assessment data in my original post but I do have it.
This is the full case study,
KT, who is 8 years old, and her family have returned from a weekend camping trip. KT presents to the emergency room department with lower abdominal pain with nausea and vomiting. She is very tired and irritatable.
Vital Signs: Temp=101.8
The ER doctor ddoes a thorough history and physical examination. KT has moderate to severe tenderness in the right lower abdomen when the doctor pushes there. She has rebound tenderness. Rebound tenderness is pain that is worse when the doctor quickly releases his or her hand after gently pressing on the abdomen over the area of tenderness. An ultrasound of the abdomen is done which indicates KT has appendicitis. She is scheduled for surgery.
All of the above is the information I used to make my nursing diagnosis. Broken down into objective and subjective data I specifically focused on the vital signs, the complaint of lower abdominal pain with nausea and vomiting, the tiredness and irritability and the findings of the doctors examination.
All of this led me to the nursing diagnosis of Acute pain.
I am thinking that assigning this particular 8 year old a couple of chores to do isn't really feasible in this situation considering 1. she is ill and in pain and about to have an appendectomy and 2. She's in the emergency room.
Most of what you wrote I understand and we have covered most of that in class. I guess I was just looking for some feedback on how to effectively individualize the NANDA interventions to a child who is sick.
- 0Jul 7, '13 by Esme12, BSN, RN Senior ModeratorWhat care plan book do you have? Over all You did OK....of course you would not assign house hold chores ...LOL...but what can you assign the child to do while hospitalized? How would you engage them in their care to feel as if they have some control? How would you prepare them for surgery? How does this affect the family dynamics?
Other thoughts...while acute pain is important ....what would be vital to this child's recovery/survival......what could be life threatening for that would make that a priority. I ahve highlighted what caught my eye as important.
KT, who is 8 years old, and her family have returned from a weekend camping trip. KT presents to the emergency room department with lower abdominal pain with nausea and vomiting. She is very tired and irritable.
The ER doctor does a thorough history and physical examination. KT has moderate to severe tenderness in the right lower abdomen when the doctor pushes there. She has rebound tenderness. Rebound tenderness is pain that is worse when the doctor quickly releases his or her hand after gently pressing on the abdomen over the area of tenderness. An ultrasound of the abdomen is done which indicates KT has appendicitis. She is scheduled for surgery.
What is peritonitis?
What are signs of dehydration?
What are the normal vital signs for an 8 year old child?
So what can hurt this child's recovery/life the most........Infection........right? fluid status.....right? You prioritize according to what will do them the most harm first...then knowing what you know about an 8 years old...how will the impending surgery affect them and what would you do to prevent/help this?
- 0Oh man, you know my first instinct was to choose Risk for Infection and then I questioned myself. Just shows how completely inexperienced I am at this. Thank you so much for your feedback. I think I am in for a shock next semester when I have to do multiple care plans in a week because this ONE is taking me days to complete!
- 0Quote from Esme12Thank you!!It gets easier and never forget....we are here! It might take me and other's that hang out here like GrnTea whop help with care plans to get back to you but we will answer.....and walk you through... OPNce you get 15 posts you can PM us as well!