Care plan help

[Pleased to care]

Hi I am new to the site I am hoping to gain a lot of knowledge from experienced members of the site.

I have been trying to get my head around a care plan assign for several hours and I am confusing myself more and more.

The scenario is a 78 yr old female with COPD admitted to hospital for med treatment.She is an insulin dependent diabetic who has beginning stages of peripheral vascular disease of her left lower limb.She weighs 105 kg and has a chest infection.She lives at home with her 85 yr old husband who smokes and has dementia.Her grandaugter lives in the same street and often expects her to babysit her 3 children while she works nights or weekends.

I need two actual 1 potential nanda diagnosis.

I am thinking Airway clearance Ineffective, Breathing pattern Ineffective, Tissue Perfusion,Ineffective Peripheral, and Skin integrity,risk for impaired. I am just so going round and round with this and am gettting more and more confused by the minute

I am hoping that someone can share some advice about this care plan.

Thanks in advance

[therooftop]

Yeah your diagnoses are good, Do you need to limit it to just three? because I'd still add Risk for Injury and Infection to that problem list. How are her ADLs? Nutrition? Elimination?

Do you have to limit it to 3 though? Problems are still problems and they should'nt be ignored. If its just top 3, then based on ABCs, I'd choose the first 3 you gave. I always use "Impaired gas exchange" for COPD though, although it really depends on your other data.

[Pleased to care]

Thanks for your reply and so fast !! Yeah they only want 2 actuals and 1 potenial right now. I thought Risk for infection for a potential but then thought skin integrity risk for impaired. The scenario I gave is all the info i have so that does narrow it down, I will go with the airway and breathing for actuals and skin integrity for my potential.Thank you for helping me see this in a clearer perspective I guess i just needed to know I was on the right track

Thanks again,Big hugs

[rachelgeorgina]

With COPD, being 78 and 105kg (because I'm guessing she's no giant) and probably in at least the beginning stages of osteoporosis, too, I'd want to add activity intolerance or potential for it.

& regarding the COPD and respiratory diagnosis, I'd be more inclined to use impaired gas exchange, simply because of the destruction and damage that occurs at the actual alveoli/capillary membrane, which isn't typical of other common respiratory problems such as asthma. That, and, with the chest infection, it's more likely that the lung, as opposed to the airway will be effected.

[Pleased to care]

Thanks for your reply.I have my assignment finished and if I need to resubmit I will certainly use impaired gas exchange. I am finding I am doubting my choices a lot but I guess that is normal, my confidence will grow as time goes by I am sure. I really do appreciate to be able to communicate with you all for advice.

Thanks

[ProudofmyNursingart]

Oh boy!!!

I did this EXACT same care plan in school. You don't happen to be a Spencer TAFE student do you?

My CP went for pages as this is a difficult BUT realistic CP.

To be honest I initially had so much trouble too. Then I mastered it and assisted other's & was the school example. Go figure.

In the end, when you get into the workplace, they are so much easier to do.

Just remember.... break it ALL down to easy, bit sizes.

And use a Medical/Nursing Care book, as you will need it to pass this subject. This is recemmnded by the facilitators.

Good luck with it.

[Pleased to care]

Ha too funny !!, no I am a Barossa Tafe student ... I passed that careplan no worries Pheewww I was worried about a resubmit ...Have done a few more since then but now working on Mr Nemo who has a neurogenic bladder which requires self-catheterisation....Two actuals one potential required not sure at all where to start.Am doing a PC night shift tonight so just maybe I will be able to get my head around it a little...

Thanks for your post !!

[ProudofmyNursingart]

That's great to hear.

Our Facticitators were VERY STRICT on the CP as you need to do them all the time at work.

So many had resubmits. I luckily didn't. I couldn't face it again. I mailed it off with a lucky kiss. A habit I started with nursing correspondence school. A kiss on the work. And three kisses for the back of the envelope. If it was super hard, then more kisses. It sounds stupid. And looked it. But I NEVER had to resubmit once I started it so I wasn't going to stop and maybe, just maybe, risk resub.

Your doing the EXACT same module plans as we did.

Mr Nemo I know him well.

If you need a hand, let me know.

In the mean time I'm going to go and drag out my workbook just in case you do need some assisitance as I'm not going to work my brain too hard when I'm not working. LOL

Have a good, long night.

Wendy