Scientific Rationale

Nov 11, 2009 12:41 PM written by Chris189 | 2 Comments

Im having trouble with my rationale. I worked with a 94 yo female in a long term facility last week. I got my care plan back and the only thing she didnt like was my rationale for "assess BP q shift". Heres my data:

94 yo
Osteoarthritis
Osteoporosis
2 assist with t-belt
Glaucoma
History of fall

My daignosis was Impaired Physical Mobility r/t joint stiffness aeb 2 assist with t-belt.

My rationale for "assess BP q shift was "Orthosatic Hypotension as a result of cardio changes, disease, and medication effects are comon in the elderly. Orthostatic hpyotension can cause diziness, and light headedness. Assessing BP can indicate orthostatic hypotension, and impaired physical mobility."

Reading back over it I can see where I veered from the daignosis. She wrote "Relate this back to physical mobility joint stiffness". Can someone give me and idea as to the rationale for BP r/t Impaired physical Mobility? I dont want someone to write a rationale for me, just some direction. Thanks!

NamasteNurse · Nov 11, 2009, 02:25 PM

Usually the nursing diagnosis is written with the related to r/t, followed by "manifested by" m/b then you would say what signs and symptoms the paerson is showing that related to the diagnosis. From what you have so far, I see that you are going towards she can't ambulate because she has orthostatic hypertension, not because of joint stiffness. You have to pick one or the other. And orthostatic blood pressures are done in a certain way, not just a regular BP. Do you want to go with the BP problem? Then say

Impaired Physical mobility r/t joint stiffness, m/b ataxic gait, left sided paresis, and pain on ambulation....something like that.

To incorporate the BP prob, I think you'd do a different thing,
Impaired physical mobility r/t orthostatic hypertension, (are we allowed to use that?) m/b dizziness, syncope and tinnitus on standing.

I think that's the way but not sure, hope that helps...

itsmejuli · Nov 11, 2009, 03:44 PM

Originally Posted by New in NY

Impaired physical mobility r/t orthostatic hypertension, (are we allowed to use that?) m/b dizziness, syncope and tinnitus on standing.

Assessing blood pressure isn't really appropriate.

No, you can't use a medical diagnosis in r/t

"Risk for injury" would be more appropriate for orthostatic hypotension.

Risk for injury R/T light headedness upon rising from supine position AEB patient states she feels woozy when attempting to sit on side of bed after lying down for a long period.

Interventions:

1. ensure bed alarm on at all times
2. advise patient to use call light when she is ready to get out of bed
3. assist patient to upright position
4. have patient dangle legs at side of bed until dizziness passes
5. assist patient out of bed using gait belt or walker.

Rationales explain why each intervention is necessary.