Assingnment help

Editorial Team / Admin · Oct 17, 2016

If you are unsure about an assignment, the best path is to ask your instructor- no two schools or even instructors are identical. Most likely it is nursing diagnoses, but we cannot answer that with certainty.

San1995 · Oct 17, 2016

Ok the question says that I should identify five priority needs for the patient.a 35 year old homeless woman was admitted for acute asthma a cellulitis of her right foot.she had a very restless night,she is dyspneic at 28 brwaths and still demonstrating wheezes and complains of shortness of breath,she is maintaing an oxygen saturation of 90-92 on oxygeb 2L via nasal cannula.on examination she is restless and dosent and her feet is hurting,she dosent want to eat and she also has trouble going to the bathroom

San1995 · Oct 17, 2016

The prioty needs that i choose or rest and comfort,safety,elimination,oxgenation.but am on sure of what are prioty needs

Here.I.Stand, BSN, RN · Oct 17, 2016

Think back to BLS -- those CABs. What is going to kill or seriously harm the pt first? That's going to be your priority. You can think of Maslow's heirarchy also.

I would think they want you to use NANDA nursing diagnoses, but like Rose Queen said you should clarify that with your instructor who gave you the assignment.

San1995 · Oct 17, 2016

The instructor stated that I should use NANDA.thank u so much though

Been there,done that, ASN, RN · Oct 17, 2016

The prioty needs that i choose or rest and comfort,safety,elimination,oxgenation.but am on sure of what are prioty needs

This oldy moldy has never heard of NANDA. But I sure like to breathe !

Best of luck with your studies, check out Maslow's hierarchy.

Esme12, ASN, BSN, RN · Oct 17, 2016

Welcome to AN! The largest online nursing community!

What semester are you? What care plan book do you have? Do you have the NANDA guide?

Here is how to begin:

Let the patient/patient assessment drive your diagnosis. Do not try to fit the patient to the diagnosis you found first. You need to know the pathophysiology of your disease process. You need to assess your patient, collect data then find a diagnosis. Let the patient data drive the diagnosis.

The medical diagnosis is the disease itself. It is what the patient has not necessarily what the patient needs. 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 the care plan as a recipe to caring for your patient. your plan of how you are going to care for them. how you are going to care for them. what you want to happen as a result of your caring for them. What would you like to see for them in the future, even if that goal is that you don't want them to become worse, maintain the same, or even to have a peaceful pain free death.

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. You need to use the nursing diagnoses that NANDA has defined and given related factors and defining characteristics for. These books have what you need to 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. From a very wise an contributor daytonite.......make sure you follow these steps first and in order and let the patient drive your diagnosis not try to fit the patient to the diagnosis you found first.

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: ADPIE from our Daytonite

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)

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 the medical disease, a physical condition, a failure 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 goals 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 the detective and always be on the alert and lookout for clues, at all times, and that is Step #1 of the 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 (interview skills). 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. Although your patient isn't real you do have information available.

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 is actually a shorthand label for the patient problem.. The patient problem is more accurately described in the definition of the nursing diagnosis.

Another member GrnTea say this best......

A nursing diagnosis statement translated into regular English goes something like this: "I think my patient has ____(nursing diagnosis)_____ . I know this because I see/assessed/found in the chart (as evidenced by) __(defining characteristics) ________________. He has this because he has ___(related factor(s))__."

"Related to" means "caused by," not something else.

Esme12, ASN, BSN, RN · Oct 17, 2016

So....we prioritize the care plan by Maslow's Hierarchy of needs...and essentially by the ABC's. What can hurt/kill them first.

Ok the question says that I should identify five priority needs for the patient.a 35 year old homeless woman was admitted for acute asthma a cellulitis of her right foot.she had a very restless night,she is dyspneic at 28 breaths and still demonstrating wheezes and complains of shortness of breath,she is maintaining an oxygen saturation of 90-92 on oxygen 2L via nasal cannula.on examination she is restless and doesn't and her feet is hurting,she doesn't want to eat and she also has trouble going to the bathroom (can you clarify this???)

So....looking at your patients history, what is important here. Sometimes it helps to think if this was my Mother.... what would alarm me? (besides the homelessness)

Now, look at the highlighted things the patient is

very restless

dyspneic

28 respirations/min

wheezing

pt complains of SOB

O2sat on O2 is 90-92%

Pain

not eating

which of these is the most important?

AliNajaCat · Nov 13, 2016

Remember also that when they ask you to set priorities (which means, "list her problems, in order of how important you think her problems are") they are also giving you the opportunity to think about why you made those decisions and then to practice justifying them. Sometimes there is no ONE answer (though sometimes there is, like-- "Hmmmm, breathing or enjoying dessert? I'll take Breathing for 1000, Alex!"). When there isn't one very clear do-it-or-die answer, you get to say what your reasons are. Your faculty want to know what you think and if you can defend it with evidence-based facts. Don't disappoint them-- this is why you're in school to learn how to think like a nurse.