Care Plan Help

HouTx, BSN, MSN, EdD · Feb 21, 2017

Does your assessment data have any additional information about mental status? If the patient is experiencing serious cognitive deficits due to dementia, there's no way he is going to be able to maintain a medication regimen on his own. This issue was apparently the underlying cause of his exacerbation & admission.... so unless it is addressed, he's going to be on track for readmission. Goals need to be realistic & achievable. Maybe you need to address his lack of ability to care for himself?

NICUismylife, ADN, BSN, RN · Feb 21, 2017

Here's my take for what it's worth.

He was admitted due to non-compliance, right?

He was non-compliant most likely due to the dementia, right?

Can that be changed? No.

What kind of help does he have at home? Can you educate that person? If there is no one, then my goal would be to get him a social services referral to find him some kind of in-home care or nursing facility.

He is not suddenly going to be able to remember to take his meds. It's an unrealistic goal for this particular patient.

Now, that might need an entirely different dx, which would probably be considered secondary. However, you might be able to list that as an intervention since it has to do with his med compliance.

For a dx of reduced cardiac output, your long-term goal can be along the same lines as your short-term goal. That he will maintain BP, pulse rate, etc. within xxx parameters over the next several months, with no further admissions. As always, consult your instructor.

NICUismylife, ADN, BSN, RN · Feb 21, 2017

lol. Whoops, posted at the same time as HouTX.

Jess2741 · Feb 21, 2017

He lives with his daughter, who is also his caregiver and I included education regarding the benefits of diuretic therapy with the patient and caregiver. But for now he was discharge to an acute care rehabilitation center.

Jess2741 · Feb 21, 2017

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[TD=bgcolor: transparent, align: left]Is this better:??? Are you able to include the caregiver in goals??

The client/caregiver will verbalize three benefits of following the medication regimen as prescribed in order to decrease cardiac output

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NICUismylife, ADN, BSN, RN · Feb 21, 2017

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[TD=bgcolor: transparent, align: left]Is this better:??? Are you able to include the caregiver in goals??

The client/caregiver will verbalize three benefits of following the medication regimen as prescribed in order to decrease cardiac output

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That will be up to your instructor whether you can use it for a goal or not. You want to increase cardiac output though.

AliNajaCat · Feb 25, 2017

So, here is my NANDA: Decreased cardiac output R/T impaired contractility AEB weak peripheral pulses, crackles auscultated in the bases posteriorly, BNP of 1399 & Echocardiogram indicates LVEF 35%
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[TD=bgcolor: transparent, align: left]The client will demonstrate two techniques to allow for an improvement in cardiac output such as energy conserving techniques to reduce the incidence of exacerbations & following the medication regimen as prescribed [/TD]
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You're to going to be able to teach him to decrease his energy expenditure, are you? But can you teach his caregivers? If you were taking care of him, how would you decrease his physical work? This will NOT increase his cardiac output, though-- you don't treat a medical diagnosis.

If his CO can be increased, it'll probably be c meds, and you don't prescribe those. You CAN do some work on being sure he gets the meds he's been prescribed-- think of two ways to do that.

And there is no such thing as "a NANDA." You are making a nursing diagnosis based on defining characteristics as given by the authoritative (this means, "it rules") source, the NANDA-I 2015-2017 (current edition). BNP is not on the list of approved defining characteristics for this nursing diagnosis (page 228, if you're following along in your hymnals), but your other three are, and your related factor (meaning, the cause of all this problem) is. You don't choose or pick a nursing diagnosis from a list, you make a diagnosis in the same way a physician does: by identifying the presence of specific, defining symptoms/characteristics, and a cause. You have done that.