you've got some problems with these diagnoses. let me go through them.
my first diagnosis is: impaired skin integrity r/t scratches amb itching and disruption of skin surface (epidermis).
"itching" is not evidence of damaged skin which is what impaired skin integrity is. it is a related factor, a cause, of it. "disruption of skin surface" is another way of saying impaired skin integrity--this is double talk, gobbledygook. you need evidence, signs and symptoms, of this skin breakdown. what does it look like? describe it.
my short term goal is: client's skin integrity will not diminish within next 6 months.
what did you just write? that makes no sense to me. first of all, 6 months is not short term. secondly, "skin integrity will not diminish" sounds like a mouthful of marbles. what the heck does that mean? i can't even picture skin diminishing. if you had described this skin breakdown you would be able to describe what this ideal skin would be looking like in a week which is how long it takes a scratch to heal.
my interventions are: assess skin on chest and upper extremities every morning.
assess skin on chest and upper extremities every morning. . .and observe for what? what are the signs that skin is healing? what specifically do you want to look for when you assess
apply lotion to itchy area 3 times a day.
apply clean, dry clothing over affected area daily.
where is the affected area?
my second diagnosis is: impaired physical mobility r/t decreased muscle strength amb limited rom and unsteady gait.
clarify "limited rom" and spell it out, i.e. can't bend left knee more than 15 degrees, can't bear weight on right leg or can't raise right arm above the level of the shoulder. describe it and be specific.
my short term goal is: client will increase muscle strength from a level 3 to a level 4 on the muscle strength scale by 12/18/08.
if muscle strength is an etiology (underlying cause) of this problem (impaired physical mobility) and getting rid of it would do away with the problem, why are you making this a short term goal? is this reasonable?
my interventions are: assess for pain before, during and after activities.
neither of your two symptoms suggest the patient has pain.
assist with active rom in mornings on monday, wednesday and friday.
describe the specific rom exercises and to what body parts.
participate in pt/ot 5x week.
again, get specific.
what are you going to do about this patient's unsteady gait? there are nursing interventions for a patient whose walk is unsteady (gait belt, walker, one person assist when ambulating, have patient use call light when needs to get up). and what about the limited rom? does he need referral to pt first? does he need assistive devices such as a cane or walker? do things like the bedside table need to be placed on his left or right side because one arm is stronger than the other (i don't know since you don't specify what the rom problem was)? if walking to a chair is difficult but he can transfer from bed to chair, does a bedside chair need to be placed a certain way for him so he can independently get to the chair? you have to stop thinking about collaborative interventions that involve pt and think about what you
are going to do to help this person be more independent and live with and improve the cards they got dealt. we are nurses. that is what we do.