Care plan assistance

nurseprnRN, BSN, RN · Apr 3, 2012

i cannot read most of this chart in this format, so i'll just address what i can figure out. in general, though, you will want to be sure that your interventions result in change for the better. so if you have a patient with a chronic wound due to bad perfusion, and your nursing diagnosis is ineffective tissue perfusion, your (measurable) goals have to be related to making this perfusion deficit better, or at least to mitigating its effects.

if you have a goal of having the patient know about his condition, the therapy for it, and when he has to contact a treater, that's fine, but it doesn't really address the problem of his ineffective perfusion. it might, though, address another problem you could diagnose, and presumably have, since you have some very specific interventions in mind. might it be for a knowledge deficit? what makes you think he doesn't know these things? what do you think he needs to know? how are you going to teach him? how will you know that he's learned something useful?

doesn't he have more than one problem? of course he does. and he has assessment and interventions for each. but they aren't interchangeable.

your measurement criteria (your assessment) have to be related to your goals, because that is how you can see whether you are making progress towards goals. how does taking pulses and checking for dvt further your goals as stated? hint: while they are good things to do, they have nothing to do with a teaching plan, and monitoring activities are not interventions.

see, you've got a lot of good buzzwords and useful actions in there, but they don't all hang together as a plan. needs work. can you try again (and please, please, please, don't use that columnar format)?

(i'll let esme post daytonite's words of wisdom here!)

cassi8619 · Apr 3, 2012

Thanks! I have changed a few things - As far as taking pulses/checking for DVTs, for our interventions we have to have an "assess" one and I thought pulses/DVT would be good since those are indicators for poor perfusion. Anyway, changes below - love the feedback!

Assessment - Physiological:

O: 86 yo male, chronic HTN. Ulcers to LLE. Thick nail beds, cap refill

S: Client stated pain in left great digit and second digit was at a 2. Client’s wife reported redness in heal of foot. Client stated that the ulcer below and medial to the great toe “showed up in just two weeks”

Psychological

O: AOx3. Client does seem to have some short term memory loss.

S:

Sociocultural:

O: Married. Lives at home with elderly wife. Children do not live nearby.

S:

Developmental

O: Ego Integrity vs. Generativity

S:

ANALYSIS -Ineffective peripheral tissue perfusion R/T Inflammatory response secondary to cellulitis or reduction of arterial blood flow AEB diminished pulses in LLE, ulcers to the foot, thickened toe nails, cap refill

Goals - STG: Client will verbalize understanding of condition, therapy regimen, and when to contact a healthcare provider by end of shift.

LTG: The client will demonstrate increased perfusion as individually appropriate (e.g. skin warm and dry, absence of edema, free of pain, peripheral pulses present)

Interventions - Assess

Secondary Independent

The nurse will assess peripheral pulses 2x per shift using handheld doppler if indicated.

Care/Perform/Provide

Secondary independent

The nurse will provide pressure relieving devices for immobilized client throughout shift.

Secondary Independent

The nurse will administer fluids, electrolytes, nutrients, and oxygen as indicated each shift.

Teach/Supervise

Secondary independent

The nurse will educate client/SO in reportable symptoms, including change in pain level, difficulty walking, nonhealing wounds, change in skin color etc., each shift.

Secondary independent

The nurse will stress importance for regular exercise, even if it’s just foot pumps, each shift

Secondary independent

The nurse will educate client on his condition and relevant risk factors each shift

nurseprnRN, BSN, RN · Apr 4, 2012

"*goals - *stg: client will verbalize understanding of condition, therapy regimen, and when to contact a healthcare provider by end of shift.

ltg: the client will demonstrate increased perfusion as individually appropriate (e.g. skin warm and dry, absence of edema, free of pain, peripheral pulses present)

is this something that nursing interventions can make happen? hint: if he's got such bad perfusion, it's likely that nothing nursing does will make it better. but (hint) there are things that nursing can do to help him live with it more safely. what if you look at this as not a perfusion diagnosis but a knowledge deficit, or a self-care deficit, or a readiness to improve self care thing?

*interventions - **assess*

_secondary independent_

the nurse will assess peripheral pulses 2x per shift using handheld doppler if indicated. assessments are not interventions and will not teach him anything.

*care/perform/provide*

_secondary independent_

the nurse will provide pressure relieving devices for immobilized client throughout shift. good idea. will not improve arterial flow. so what does it do? does it perhaps address a different problem, and a different nursing goal? is it something he or his home caregiver can learn about? (that was a huge hint)

_secondary independent_

the nurse will administer fluids, electrolytes, nutrients, and oxygen as indicated each shift. not nursing interventions. these are nursing tasks to implement the medical plan of care. what we are looking at in a nursing plan of care are interventions that nurses implement independently because of their specialized nursing education and assessment. this is a hard concept for students to grasp but it is the central concept of nursing. this is not to say that we don't know a lot about medicine, surgery, physiology, pharmacology, and biomedical engineering-- we do, and we apply all of it. and this exercise is about nursing, our specialty.

*teach/supervise*

_secondary independent_

the nurse will educate client/so in reportable symptoms, including change in pain level, difficulty walking, nonhealing wounds, change in skin color etc., each shift. also good ideas, but still will not alter his perfusion. i am trying to get you to change that to something that is addressed by many of your nursing actions.

_secondary independent_

the nurse will stress importance for regular exercise, even if it’s just foot pumps, each shift. getting there. but i don't think dvt is his problem.

_secondary independent_

the nurse will educate client on his condition and relevant risk factors each shift. bingo. this is a knowledge/self-care thing. whew..