Adult Failure to Thrive AEB BMI of 17.8%?

Esme12, ASN, BSN, RN · Mar 11, 2012

i think that if your patient is as you describe she is thin enough to qualify for malnutrition, inadequate intake, what other issues? is she anorexic? does she has the proper resources?

ok....first to write a care plan there needs to be a patient, a diagnosis, an assessment of the patient which includes tests, labs, vital signs, patient complaint and symptoms. let me try to help you. there are many nurses here and many who came before me to this site but one nurse stands out.....daytonite(rip) https://allnurses.com/general-nursing...ns-286986.htmlyou can also use the search on this site to lead you to care plans. i have supplied links of examples at the bottom for care plans. think maslows hierachy of needs. maslow's hierarchy of needs - enotes.com virginia henderson's need theory

maslow's hierarchy of needs is a based on the theory that one level of needs must be met before moving on to the next step.

self-actualization - e.g. morality, creativity, problem solving.
esteem - e.g. confidence, self-esteem, achievement, respect.
belongingness - e.g. love, friendship, intimacy, family.
safety - e.g. security of environment, employment, resources, health, property.
physiological - e.g. air, food, water, sex, sleep, other factors towards homeostasis.

assumptions

maslow's theory maintains that a person does not feel a higher need until the needs of the current level have been satisfied.

b and d needs

deficiency or deprivation needs

the first four levels are considered deficiency or deprivation needs ("d-needs") in that their lack of satisfaction causes a deficiency that motivates people to meet these needs

growth needs or b-needs or being needs

the needs maslow believed to be higher, healthier, and more likely to emerge in self-actualizing people were being needs, or b-needs.
growth needs are the highest level, which is self-actualization, or the self-fulfillment.
maslow suggested that only two percent of the people in the world achieve self actualization. e.g. abraham lincoln, thomas jefferson, albert einstein, eleanor roosevelt.
self actualized people were reality and problem centered.
they enjoyed being by themselves, and having deeper relationships with a few people instead of more shallow relations with many people.
they tended to be spontaneous and simple.

application in nursing

maslow's hierarchy of needs is a useful organizational framework that can be applied to the various nursing models for assessment of a patient's strengths, limitations, and need for nursing interventions.

care plans

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:

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. there are currently 188 nursing diagnoses that nanda has defined and given related factors and defining characteristics for. what you need to do is 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.

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:

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)

now, listen up, because what i am telling you next is very important information and is probably going to change your whole attitude about care plans and the nursing process. . .a care plan is nothing more than the written documentation of the nursing process you use to solve one or more of a patient's nursing problems. the nursing process itself is a problem solving method that was extrapolated from the scientific method used by the various science disciplines in proving or disproving theories. one of the main goals every nursing school wants its rns to learn by graduation is how to use the nursing process to solve patient problems.

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 a medical disease, a physical condition, a failure to be able 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 aims 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 a detective and always be on the alert and lookout for clues. at all times. and that is within the spirit of step #1 of this whole 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. 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.

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 (ex: activity intolerance) is actually a shorthand label for the patient problem. the patient problem is more accurately described in the definition of this nursing diagnosis (every nanda nursing diagnosis has a definition).

activity intolerance

(page 3,

nanda-i nursing diagnoses: definitions & classification 2007-2008

)

definition

:

insufficient physiological or psychological energy to endure or complete required or desired daily activities

(does this sound like your patient's problem?)

defining characteristics (symptoms):

abnormal blood pressure response to activity, abnormal heart rate to activity, electrocardiographic changes reflecting arrhythmias, electrocardiographic changes reflecting ischemia, exertional discomfort, exertional dyspnea, verbal report of fatigue, verbal report of weakness

related factors (etiology):

bed rest, generalized weakness, imbalance between oxygen supply and demand, immobility, sedentary lifestyle

i've just listed above all the nanda information on the diagnosis of activity intolerance from the taxonomy. only you know this patient and can assess whether this diagnosis fits with your patient's problem since you posted no other information.

in order to choose nursing diagnoses, you also need to have some sort of nursing diagnosis reference. there is some free information on the internet but it is limited to about 75 of the most commonly used nursing diagnoses. so you will need some sort of reference book. i like this one (i have no affiliation) [h=1]nursing care plans: diagnoses, interventions, and outcomes [paperback] [/h][color=#004b91]meg gulanick (author), [color=#004b91]judith l. myers (author)amazon.com: nursing care plans: diagnoses, interventions, and outcomes (9780323065375): meg gulanick, judith l. myers: books

one more thing . . . care plan reality: nursing diagnoses, nursing interventions and goals are all based upon the patient's symptoms, or defining characteristics. they are all linked together with each other to form a nice related circle of cause and effect.

you really shouldn't focus too much time on the nursing diagnoses. most of your focus should really be on gathering together the symptoms the patient has because the entire care plan is based upon them. the nursing diagnosis is only one small part of the care plan and to focus so much time and energy on it takes away from the remainder of the work that needs to be done on the care plan.

you may also like these resources...... i strongly suggest you budget for a good care plan book as you will need it...alot! i hope this helps.

nursing care plan | nursing crib

nursing care plan

nursing resources - care plans

understanding the essentials of critical care nursing

nursing care plans, care maps and nursing diagnosis

http://www.delmarlearning.com/compan.../apps/appa.pdf

cns: problem oriented nursing care plans

Esme12, ASN, BSN, RN · Mar 11, 2012

https://allnurses.com/lpn-lvn-nursing/questions-about-writing-661965.html#post605275

forum on care maps:

https://allnurses.com/forums/f205/care-maps-225330.html. there are links there to information on what a concept map is and how to put one together

blank cm.doc‎(76.0 kb, 3773 views)

concept map v.f1.doc‎(32.0 kb, 14111 views) c.g. concept map1.doc‎(24.0 kb, 12011 views)

c.g. addendum1.doc‎(40.5 kb, 8960 views

https://allnurses.com/general-nursing...445-page2.html

check out these links and documents they will provide a wealth of information.

https://allnurses.com/nursing-student-assistance/suggestions-concept-mapping-677492.html#post6180966

https://allnurses.com/lpn-lvn-nursing/i-need-help-665349.html

know your pathophysiology of the patients disease and symptoms present.

https://allnurses.com/nursing-student...on-258109.html

https://allnurses.com/nursing-student-assistance/understand-how-write-225330.html

i hope at least some of this helps.

nurseprnRN, BSN, RN · Mar 11, 2012

if she has the defining characteristics for adult failure to thrive, of course you can use it. it's on page 360 of my nanda 2012-2014. (if you don't have that, get it now at your favorite online bookseller. i hear amazon gives two-day delivery for free to students.) a related factor to the long list of defining characteristics is "depression."

just by scanning the title pages for the domains i can come up with a long list of possible nursing diagnoses; you would have to see which are supported by your own assessment findings. remember: assessment first, diagnosis second, never the other way around. never choose your diagnoses and then try to cram your patient into them. the patient's condition is what you wrap the diagnoses around.

you can choose possibles, in the same way the medical diagnostic procedure has a list of differential diagnoses, but this is not the same as saying, "she has medical diagnosis x, so therefore her nursing diagnoses are..." you cannot do that. nursing diagnosis is not a consequence of or dependent on a medical diagnosis or a medical plan of care.

traumaqueen36467 · Mar 12, 2012

Thanks so much guys. I feel stupid for even asking that. This is my last semester but it has been the hardest yet. I took a two semester break in between medsurg and my final semester and I'm a bit out of my element at this facility. On top of that we only get one day on the floor and do not even get to touch the charts until 20 minutes before we leave. So I have to base my nursing diagnosis on the assessment before charts. My nursing diagnosis never includes lab data because well, I can't plan for that implement it and get an outcome in 20 minutes. I've always been on it with my care plans I don't know why I'm so confused and lost this semester. But honestly thank you both!

nurseprnRN, BSN, RN · Mar 12, 2012

you're welcome. i am sure i speak for esme when i say we appreciate that.

many students feel this way in their last semesters. the workload steps up, the faculty's expectations of real progress towards "thinking like a nurse" step up, and the self-pressure to get there combined with the fear of not being able to do it can become intense. it seems to me as if you've covered a lot of the things you have to consider.