Care plan help!

NewNurse91D · Apr 12, 2015

Your right :) hahaha thank you! I feel better now, I'm once again making it so much more complicated lol

dudette10, MSN, RN · Apr 12, 2015

What can I do about the above issues? education, antibiotics, nutrition...but I kind of run blank after those things.

Good start. Think about the atelectasis and the activity intolerance, too. Don't forget about pain. There are a few more things you can do if you think about nursing interventions associated with those findings.

la_chica_suerte85, BSN, RN · Apr 12, 2015

Thank you :) that's a huge compliment! and she is A&O x4, very easy to talk to. She acknowledges what's going on with her health but it seems like she doesn't acknowledge what's causing it. She is in a great deal of pain, like you said r/t the DM and the poor wound healing. He husband brought her in some juice and kfc for dinner -_- so I'm deff thinking that she obviously isn't followng Her diet. She is mobile; besides her foot and pain-she can walk and move around without difficulty.
I was thinking that the urinealysis was kinda of result of a two different 'beasts'. First-DM poor management and Second-septic shock.

I would then start with managing her pain and getting her to ambulate (see the issue of atelectasis above). So, Dx of acute pain and impaired walking. Then, for a psychosocial (my program requires 2 physio and 1 psychosocial Dx per care plan), deficient knowledge. That's what kind of care plan you could do for her in that shift. She really needs to be able to move around, even with the cellulitis (it's not fun, it's not pretty, it hurts like holy heck, but it's necessary. Easing her pain prior to that should help somewhat but this should be a lesson for her that if she was to get her DM under better control, things would really start feeling better. You can converse with her regarding her situation on being insulin-dependent. I mean, I guess that's what I would do. But otherwise, you've pretty much got it. Don't over-think it!! You got this! Good luck! :)

SopranoKris, MSN, RN, NP · Apr 12, 2015

It is a fallacy that a nursing diagnosis cannot be related to a medical one. A common fallacy, but a fallacy nevertheless.

I absolutely agree. However, when I help lower level students with care plans, they tend to get so hung up over the medical diagnoses that they forget pertinent nursing diagnoses. But you're 100% correct :)

NewNurse91D · Apr 12, 2015

Okay thank you =]

Good start. Think about the atelectasis and the activity intolerance, too. Don't forget about pain. There are a few more things you can do if you think about nursing interventions associated with those findings.

NewNurse91D · Apr 12, 2015

Thank you very much for your helpful advice! =]

I would then start with managing her pain and getting her to ambulate (see the issue of atelectasis above). So, Dx of acute pain and impaired walking. Then, for a psychosocial (my program requires 2 physio and 1 psychosocial Dx per care plan), deficient knowledge. That's what kind of care plan you could do for her in that shift. She really needs to be able to move around, even with the cellulitis (it's not fun, it's not pretty, it hurts like holy heck, but it's necessary. Easing her pain prior to that should help somewhat but this should be a lesson for her that if she was to get her DM under better control, things would really start feeling better. You can converse with her regarding her situation on being insulin-dependent. I mean, I guess that's what I would do. But otherwise, you've pretty much got it. Don't over-think it!! You got this! Good luck! :)

NewNurse91D · Apr 12, 2015

I have a question that might sound really stupid BUT I can't seem to trying to find the answer to it when I look it up. I know HTN decreases CO but how does DM decrease it?

NewNurse91D · Apr 12, 2015

Also, I'm feeling kind of stuck. I know what N/I I can do for my pt. But I'm having trouble with getting 2 dx In order to sum up my N/I.

I have activity intolerance, impaired tissue integrity, ineffective tissue perfusion, impaired physical mobility BUT how do I choose which one to use? I almost feel like my dx's don't really hit the root of the issue. I might be making it too complicated again but I want to make sure that I'm able to condense my N/I into my dx and be able to hit the key points.

SopranoKris, MSN, RN, NP · Apr 13, 2015

I have a question that might sound really stupid BUT I can't seem to trying to find the answer to it when I look it up. I know HTN decreases CO but how does DM decrease it?

OK, walk through this. What are some causes of decreased cardiac output? If you list those and then list the effects of DM on the body, you'll find your answer :)

nurseprnRN, BSN, RN · Apr 13, 2015

Is there some reason you're limited to one or two? If you are, justify your priorities. Learning to do that is part of your education too.

Finally, if she (and her husband! He counts too!) had a better handle on her self-care, is there a chance she wouldn't be in this mess in the first case?

nurseprnRN, BSN, RN · Apr 13, 2015

High BP doesn't necessarily lower CO. When you exercise, your blood pressure goes up because your body needs a bigger cardiac output. Chronic high blood pressure makes the myocardium grow, as with any muscle that works hard.

So ask yourself about the effect of long term increased resistance as a cause for this, and what happens sat the point when the myocardium just can't do it anymore.

NewNurse91D · Apr 13, 2015

Okay =]

SOO decreased CO can be from CAD, atherosclerosis, HTN and anything that really AFFECTS the vessels, right? ITs about the effect on the vessels?

And DM causing macro and micro complications, including big affects on the vessels? which affects CO?

OK, walk through this. What are some causes of decreased cardiac output? If you list those and then list the effects of DM on the body, you'll find your answer :)