Help with Care Plans - page 19

Are you scratching your head or are you maybe even ready to tear your hair out over how to come up with care plans? Here are some words of wisdom from our own beloved Daytonite. Care Plan Basics ... Read More

  1. by   SV RN 2010
    I got a pocket sized book on care planning that was easier to bring with me in clinicals and it really helped me. This book also had a searchable index with medical diagnoses and potential care plans for those patients.
  2. by   FoodieJ
    can someone tell me is this is an appropriate chain of thought on my first care plan? or is it repetitive?

    impaired verbal communication r/t physical barrier aeb presence of mechanical airway, secondary to cva.
  3. by   pumpkinpoptart
    Hi all,

    Im a little confused while working on my first care plan. My pt. has 3+ pitted edema and is dehydrated with a high specific gravity, cracked mucous membranes, and slow returning skin tugor.
    How can she have both excess & deficient fluid volumes?

    Thanks in advance
  4. by   lvloverRN
    Quote from pumpkinpoptart
    Hi all,

    Im a little confused while working on my first care plan. My pt. has 3+ pitted edema and is dehydrated with a high specific gravity, cracked mucous membranes, and slow returning skin tugor.
    How can she have both excess & deficient fluid volumes?

    Thanks in advance

    she has fluid volume imbalance because she has fluid overload in one compartment and deficient in another. have you guys went through fluids and electrolytes yet? it would help if you can review it. we have intracellular fluids and extracellular fluids, the extracellular is divided into 2 , intravascular and interstitial, when we have edema, the fluid from extracellular is leaking into interstitial spaces and thats when we get edema,ascites, etc. when intravascular fluid is leaking out to the interstitial spaces, we're losing fluids in our intravascular compartment and this is where we get dehydrated, we're losing blood volume-- therefore you get fluid volume decifit and the r/t is the cause, why is she getting dehydrated? is it because she's not able to drink fluids? is she on fluid restriction?
    i would also add as my nursing dx, risk for impaired skin integrity, when you have edema like your pt has, she's at risk for skin breakdown. hope this helps.
  5. by   EmilyPatterson
    Ok I have a pt, white, female, 44yo, with pyleonepheritis and MRSA. She has a history of cardiomyapathy and alcoholism. When admitted she had a blood alcohol level of 0.3. She coded the night before I was there and had oxygen deprivation to her brain and is now brain dead. She has a nasal canula on 1 L O2/min. She has a left perriferal IV, foley catheter, and flexiseal (rectal catheter). She has edema of the extremities and pitting. She has course crackles in her lungs bilaterally, anter. 0800 Vitals: BP 125/73, R 14, P 106, Temp 101.8 F (and was given a tyenol 650 mg suppository), and SaO2 91%. She is a NPO and is not going to be provided any food until death (olny fluids IV). She is completely unresponsive and is on morphine 200 mg constant. 1200 Vitals: BP 159/88, R 12, P 106, Temp 101.4, and SaO2 89%. She is a DNR! My teacher told me that my care plan should be completely End of Life Care. Can anyone help me with some nursing diagnosis or anything?? Thanks : ))
  6. by   Krystle*nm*
    Well basically for this pt your primary nursing goal would be total comfort.. IV fluid maintenance, pain management ( which can be determined by HR; elevated HR typically indicative of ^ pain or fever), how constant is the Morphine q6hr q4hr? RR will be decreased due to Morphine... Since End of life care is focused on comfort Acetaminophen to decrease fever (which would also decrease BP, HR, RR.. all are ^ with fever pain) Opioids for pain.. The pt is NPO due to the inability to chew swallow ect. Other than that the other information is just extra info, Pyelonephritis (kidney infection), MRSA, Edema due to Cirrhosis ETOH abuse?? Its good to know the co-morbitities (in this case in the back of your mind to care for comfort) but you will not need to care for any.. she will expire soon. IDK if this helps you with your plan of care but prioritization is what I think is needed to be worked on. You have all the pieces.. Just collectively thinking..
    Watch vitals, environment assessment, head to toe.. Basically with --ANY-- pt what do you need to do to care adequately for the pt.. what do YOU need to know to care for the pt?? I don't know if this helps??
    Last edit by Krystle*nm* on Apr 4, '11 : Reason: typing error
  7. by   nicholsa
    I have a 92 year old, hospice patient that I am attempting to write a care plan on. She is diagnosed with AFIB, CHF, anxiety, debility, gastritis, constipation, and insomnia. Currently she has 2 stage 1 pressure ulcers on her left foot, bilateral edema in LLE, risk for imbalanced nutrition, under body requirements, and has an extensive history of falls. The only subjective data she offered is that she often becomes dizzy upon standing and that causes her to fall. Pulse was 70, respiration 17, BP 130/70. Great capillary refills, no signs of cyanosis, no SOB. She does have a moderate level of confusion, didn't know the day or month, repeated several phrases within a short amount of time (5 min). The first nursing diagnosis I did was decreased cardiac output r/t altered heart rhythm secondary to afib, aeb by dizziness, edema, and variations in blood pressure readings. Please advise on a second diagnosis. THANKS!!!
  8. by   AppalachianRNstudent
    Thanks goodness I found this thread.
  9. by   rn/writer
    Back when Daytonite was still with us, her answers were such gems of illumination and detail that they could be used as templates by many students. We now making this thead a "read only" reference tool to preserve her wisdom and keep it short enough to be easily accessible to current and future students.

    We encourage you to start your own threads in this forum. To do so, click on the "Students" tab, go to General Nursing Student Discussions, and click on New Thread.

    To attract the most attention, make your thread title as specific as you can. Not the generic--"Need help with care plan", but--"Care plan for post-op hip patient."

    We wish you success with your schooling.
    Last edit by rn/writer on Oct 3, '11
  10. by   stimpie777
    ok, I have a concept map to do- need nursing dxs- have two. but I am trying to come up with my #1 priority diagnosis. No airway or breathing problems , but I was considering circulation....know myelitis and tx with plasmapheresis. So...I feel stumped.
  11. by   knicole123
    How do you set goals for patients that are completely dependent for care? My care plan has to be on hygeine. I can come up with tons of interventions (bed bath, routine check on briefs, oral care etc) but how do i set goals if the pt isnt able to verbalize/bed ridden/move.

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