Can someone help me with proofreading my care plan?

[Janinern84]

I finished the care plan, just was wondering if someone can proofread. Also, I need a deadline...I'm never good at that part. Please help

Care plan

Problem statement: Ineffective Tissue Perfusion (peripheral)

related to interrupted venous flow resulting from statis dermatitis.

Manifested by:

a. errythematous, scaly, and roughness to integument bilaterally to lower legs.

b. +1 pulses posterior tibialis and doralis pedis pulses.

c. Decreased capillary refill to bilateral lower extremities.

Desired goal:

1. The client will demonstrates adequate tissue perfusion.

As evidenced by:

a. The client will have palpable peripheral pulses.

b. The client will have warm and dry skin.

c. The client will have increase capillary refill

Deadline:

Nursing orders:

1. Check dorsalis pedis and posterior tibial pulses bilaterally q shift. Use Doppler is unable to find and notify doctor if unable to find.

2. Elevate edematous legs and ensure no pressure under knee q shift.

3. Observe for signs of deep vein thrombosis, including pain, tenderness, swelling in the calf and thigh, and redness in the involved extremity q8h.

Rationales:

1. Diminished or absent peripheral pulses indicate arterial insufficiency (Harris, Brown-Etris, Troyer-Caudle, 1996).

2. Elevation increases venous return and helps decrease edema. Pressure under the knee decreases venous circulation. Client will obey this once put in the position via the wheelchair.

3. Thrombosis with clot formation is usually first detected as swelling of the involved leg and then as pain. Leg measurement discrepancies >2 cm warrant further investigation. Homans' sign is not reliable (Herzog, 1992; Launius, Graham, 1998). Unfortunately, symptoms of already-developed DVT will not be found in 25% to 50% of clients' exams, even though the thrombus is present (Eftychiou, 1996; Launius, Graham, 1998).

Any help is well appreciated!!!

Thanks!!

~Janine

[Janinern84]

we aren't allowed too bc thats a doctor's order...

[crb613, BSN, RN]

Why not include it as per order/as prescribed ect.You do need to look at these to know what's going on & you do need to monitor. Also what about the other team members....consults w/dietary/PT ect.

[meownsmile, BSN, RN]

But Janine,, the meds are ordered by the doctor, but it is within the nurses scope of practice to teach regarding meds and how those meds affect their health and care while in the hospital. If they arent letting you use meds in your interventions as written by the doctor they are missing a whole aspect of the nursing practice.

If someone is admitted for a blood transfusion and anemia and they are on daily lasix, that should tell you the patient probly is being treated for CHF which while getting the transfusion you would monitor for, such as I&O, decreased salt intake. You would teach foods high in salt content, signs and symptoms of CHF to report , SOB, dependant edema. Iron as a supplement to prevent anemia and what foods can be eaten with increased iron content, warn patients of black stools while on iron, stomach upset with iron administration. ETC...

If they arent having you include meds with your careplans,, boy do i wish i had your instructor. We got ours back to redo if we didnt include meds and how they pertained to the patients care.