Care Plan Assistance

Daytonite, BSN, RN · Mar 14, 2009

your goal needs to reflect your interventions, in other words, your goal is what you anticipate will happen as a result of your interventions being performed. because there are problems with your diagnostic statement and interventions, your goal will not work.

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diagnosis: self care deficit(bathing, dressing, toileting) related to memory deficit as evidenced by inability to perform adl's independently

problem:

bathing, dressing and toileting self-care deficit

etiology (cause):

memory deficit - as in they can't remember. keep that in mind because that is the reason for the symptoms that are supposed to appear next. . .

symptoms (evidence of the problem):

inability to perform adl's independently - what adls? not being mean, but it is important to be specific here because your interventions are based upon what you identify as the symptoms. i have a file that lists a whole bunch of different adls and bathing, dressing and toileting are just the tip of the iceberg. what, specifically, would an alzheimer patient with a memory problem forget to do when it comes to bathing, dressing and toileting? that's what you're supposed to tell us in this part of the diagnostic statement. "inability to perform adl's independently" won't impress your instructor. how about. . .not wash or brush their teeth, have oily dirty hair, forget to put their pants on, forget to change into their jammies to go to bed, forget to change into clean clothes every day (you'd know by the smell and the food spots when you get up close to them), be incontinent, use any receptacle in their pathway to pee into because they can't remember where the bathroom is? those things are evidence of an alzheimer's patient with a

memory deficit

who has

bathing, dressing and toileting self-care deficits

.

interventions:
- assess patient - should have already been done prior to determining the problem (nursing diagnosis) otherwise, how would you have found all the evidence that the problem exists. assessment is step #1 of the nursing process. doing interventions for the nursing problem is all the way down at step #3.
- identify degree of impairment - a nice idea. i worked in long term care for years. i've never heard of any specific scale that rates a degree of impairment for any of these 3 self-care deficits.
- develop plan of care and schedule for adl's - this is mumbo jumbo. that is what this whole assignment is--develop a care plan. now, "schedule for adl's" is getting close to treating the situation. but how, specifically? in ltc we put everyone on a shower schedule. twice a week they were scheduled for a shower on a specific day and shift. when living at my brother's home my elderly mom got showered in the evenings when my brother was home and could help her so she was safe from falling. in ltc clothes were marked with the patient's names and aides assisted the patients with dressing. toileting of the patients was done by the aides q2h.
- allow ample time to complete activities - what does this have to do with memory and forgetfulness?
- identify community resources - how are community resources going to help with a forgetful patient who isn't bathing, dressing or toileting correctly?
- give family information about respite care, home health, social services, occupational therapy - why would these services even be necessary? this diagnosis is about the patient not bathing, dressing or toileting because of memory problems.
- keep journal/list of activities - this, again, is assessment, or maybe evaluation to see if strategies are working. the only thing that is feasible to track would be incontinence. if the patient is incontinent use a different diagnosis such as total urinary incontinence.

well, that doesn't leave too much. and that is why you are having trouble coming up with a goal. identify evidence that proves your problem first. then, make sure you are treating those symptoms as they relate to this memory deficit.

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dressing/grooming self care deficit related to memory deficit as evidenced by patient walking around with only underpants on, not changing into pajamas at bedtime and going to bed in day clothing and not changing into clean underwear or clothes each day.

goal: within one day the patient will be appropriately dressed for the time of day in clean clothing.
interventions:
- at bedtime, one person will accompany patient to bedroom and assist them in choosing pajamas and then helping them dress for bed
- when patient is ready for bed, the clothing the patient wore during the day will be removed and placed in the laundry by the person assisting the patient
- a new clean change of underwear and clothing for the next day can be selected and placed out for the patient for the next day. this can be done with the patient helping.