Care plan help!!! Please!!!

[CassieN]

So I’m required to do three different care plans on 1 patient. I need a risk, an actual, and a psychosocial. Each care plan must have two short term goals with 3 interventions each and a long term goal(no interventions) I have an actual, I’m struggling with my risk and have no idea for psychosocial. Here’s the rundown on my patient....

87 year old women, dementia only oriented to name (first) , diabetes type 2 (controlled), hypertension (controlled w/o meds), and hyperlipidemia.

patient came to ER on 7/1 after jumping (yes jumping) over a fence, where she landed on her ankle. Patient was found crawling back to the home by police and family. She suffered from an open tibia fracture. Cultures from wound revealed E.Coli in the wound. Patient sent to OR for I&D and external fixator placement. Currently has a wound vac in place and is on bed rest. Patient has also been to the OR 6 times since admission for I&D and fixator adjustments. OR on 7/11 for removal of external fixator and placement of internal fixator. Hemoglobin dropped to 7.3 had a transfusion on 7/3 hemoglobin level staying around 8.4 no other pertinent abnormal lab findings. PICC line in place for continuous iv antibiotic therapy. Line is patent with no abnormalities.

Assessment findings:

slightly diminished lung sounds (bilaterally, no accessory use or dyspnea)

obese

no other wounds or sores noted

hard of hearing

patient is taking enoxaprin, nametadine, cubicin, and probiotic.

patient lives with her daughter and daughters SO, who are her caregivers. One story house with three steps to get in door. Upon discharge will be going to a SNF. Daughter and SO state she sometimes wanders because she is looking for her mother.

Due to her dementia patient usually answers with one word yes or no, seems to mimic the emotion of the person speaking to her.

care plans so far are:

impaired tissue perfusion r/t trauma of right ankle

risk for venous thromboembolism r/t immobility, poor tissue perfusion

and nothing for psychosocial help please!!!! I don’t know if I’m even on the right track with the other two honestly!!!!

[Rionoir, ADN, RN]

Psychosocial should be the easy one for a patient with dementia?

[CassieN]

You think it would but she’s showing no real emotion, no anxiety, no isolation no nothing really. So there isn’t anything to relate it to other than her dementia.

[Rionoir, ADN, RN]

She is oriented only to name. Have you ever taken care of anyone who's totally disoriented like that?

[CassieN]

Yes I work at a hospital as a nurse tech and have dementia patients like that all the time. But care plan wise for psychosocial....no.

[Misteighbloo, BSN, RN]

how about a psychosocial for her family member, such as caregiver role strain?

[CassieN]

I don’t think he wants us to do it for family, but I’ll have to ask my instructor, because I have been thinking about that.

[CassieN]

So yes he allowed me to do caregiver role strain!!!!

[amoLucia]

How about something about pt & family psycho SOCIAL adaptation to long term placement?

Is the intention that the SNF stay will become permanent? My guess is that she'll be a problem adjusting as will her family.

This may be the juiciest care plan dx.

[CassieN]

Lol I’m doing care giver role strain. There is a weird family dynamic, you can tell there is definitely some strain in the way the daughter speaks to her. I spoke with case management and social worker about talking about long term placement in a memory facility since this apparently is an on going problem with her wandering. But they say the family says no. I used to work in case management as an assistant helping set things up and so forth and i know some families keep the ones like her with them just for the checks every month but I’m not sure I don’t like to be judgmental but it kind of always makes you wonder sometimes what’s really going on behind closed doors and all of that but I did what I could do and I guess that’s it.

[amoLucia]

Cassie, you're right that $$$ freq plays a very significant role when situations like this arise. Money does funny things to people.

She's also at risk for further safety issues and wound infection (OPEN fx).