Any help with Rationale's

IndyElmer · Jun 24, 2012

I bookmarked thiis a while ago. Daytonite always had great answers and VickyRN's usually got great ones too.

https://allnurses.com/nursing-student-assistance/care-plan-rationale-134987.html

Esme12, ASN, BSN, RN · Jun 25, 2012

welcome to an! the largest online nursing community.

what do you men by rationale. thenrationale as to why you did something or the rationale why you chose the nursing diagnosis itself.

i ahte it when instructors give these "careplan" assignments withouth there biing a patient or patient senario for the care plan is all about the patients assessment.

the biggest thing about a care plan is the assessment, of the patient. the second is knowledge about the disease process. 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.

the medical diagnosis is the disease itself. it is what the patient has not necessarily what the patient needs. the medical diagnosis is what the patient has and 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.

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 them as a recipe to caring for your patient. your plan of care. you need a good care plan book. i prefer gulanick: nursing care plans, 7th edition. they have an online care plan constructor. it used to be free but they caught on so now you need to buy the book to use the constructor.

care plans must be chosen from the "approved" script....nanda. i think the biggest mistake students make is that the need to let what the patient says, does and feels (the assessment) dictate what you do next. not the medical diagnosis and try to fit the patient into diagnosis. some other helpful links.

https://allnurses.com/nursing-student...ml#post6283634

https://allnurses.com/nursing-student...te-225330.html

https://allnurses.com/lpn-lvn-nursing...ml#post6052759

https://allnurses.com/lpn-lvn-nursing...lp-665349.html

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)

a dear friend to an, daytonite (rip) always had the best advice.......check out this link.

https://allnurses.com/nursing-student...is-290260.html

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.

care plan reality: 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). [thanks daytonite]

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). what i would suggest you do is to work the nursing process from step #1

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.

nursing care plan (impaired skin integrity)

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 · Jun 25, 2012

I have to do 2 care plans on wound care and pain management, also an action plan to prevent obesity. Can someone explain what a rationale actually is and what needs to be there as i dont want to be repeating my self from care plans?
TIA

Now what hapens with a wound? What nursing diagnosis would apply?

Imparied skin intgegrity? related to......as evidenced by......

NANDA-I

DefinitionAltered epidermis and/or dermis

Defining Characteristics

Destruction of skin layers; disruption of skin surface; invasion of body structures

NOC

Outcomes (Nursing Outcomes Classification)

Suggested NOC Outcomes

Tissue Integrity: Skin and Mucous Membranes, Wound Healing: Primary Intention, Secondary Intention

Example NOC Outcome with Indicators

Tissue Integrity: Skin and Mucous Membranes will be intact as evidenced by the following indicators: Skin integrity/Skin lesions not present/Tissue perfusion/Skin temperature/Skin thickness (Rate the outcome and indicators of Tissue Integrity: Skin and Mucous Membranes: 1 severely compromised, 2 substantially compromised, 3 moderately compromised, 4 mildly compromised, 5 not compromised see Section

or a deeper wound......Impaired tissue integrity related to.....as eveidenced by......

NANDA-I

Definition

Damage to mucous membrane, corneal, integumentary, or subcutaneous tissues

Defining Characteristics

Damaged tissue (e.g., cornea, mucous membrane, integumentary or subcutaneous tissue); destroyed tissue

Related Factors (r/t)

Altered circulation; chemical irritants; fluid deficit; fluid excess; impaired physical mobility; knowledge deficit; mechanical factors (e.g., pressure, shear, friction); nutritional factors (e.g., deficit or excess); radiation; temperature extremes

http://wps.prenhall.com/wps/media/objects/3918/4012970/NursingTools/ch27_STP_WoundCare_500.pdf

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