Care plan help.....URGENT!!

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Okay, so we have a specific mode we have to use each week (Roy modes) and this week it's Oxygenation - Circulation. So my pt. has Diverticulitis. The only one I can see that REMOTELY goes along with this diagnosis is Altered Tissue Perfusion (GI) r/t inflammation 2nd to Diverticultis. But I am having a huge problem coming up with Goals and interventions. Can someone help me??? I've been through the NANDA book and on the internet. I see that altered GI tissue perfusion is an actual nsg dx but I can't figure out what goals and interventions to use. I need to have this done in a few hours, and I'm lost.

Also want to say that I think it's silly that we have to make the patient fit the nursing dx each week. My pts biggest problem right now is pain, not tissue perfusion. GRRRR

Help from experienced nurses or nursing students would be appreciated.

Thanks.

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just throwing some things out at ya: interventions-fluid/'lyte replacement, abx's, antispasmodics, stool softener therapy. Goals-pt will not have any adverse rxn's to therapy, pt will not have blood in stool, no leucocytosis, pt will rest, not lift, strain, or cough, increase diet as tolerated, to understand disease process and well-balanced diet. Hope this works!

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Specializes in med/surg, telemetry, IV therapy, mgmt.

you're talking about inflammation and possible infection here. think about the inflammation response. it involves dilation of the blood vessels which brings more blood and fluid into the area involved. the area is going to be edematous. that means a possible bowel obstuction due to the tissues being swollen and the patency of the bowel literally being choked off. a possible bowel obstruction will get you all kinds of goodies. in general, people's heart and respiratory rate increase with inflammation and infection (hey, i know this is a long shot) which would result in some mild hypoxia. your patient's pain is partly from the swelling of the tissues of the bowel and partly from the spasm of the smooth muscle of the bowel caused by the release of histamine that is brought to the area by the mast cells via the blood.

addendum: undigested food can accumulate in the diverticular sac that can cut off the blood supply to the thin walls of the sac. this makes them susceptible to bacterial invasion. inflammation follows. patient can develop perforation, abscess, peritonitis, obstruction or hemorrhage. i would image due to a cut off of the blood supply and lack of oxygen that gangrene could be a real threat due to no oxygen supply reaching the diverticular sac. when there is hemorrhage there are usually problems with enough oxygen being distributed throughout the body by what blood remains in the circulatory system.

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You're talking about inflammation and possible infection here. Think about the inflammation response. It involves dilation of the blood vessels which brings more blood and fluid into the area involved. The area is going to be edematous. That means a possible bowel obstuction due to the tissues being swollen and the patency of the bowel literally being choked off. A possible bowel obstruction will get you all kinds of goodies. In general, people's heart and respiratory rate increase with inflammation and infection (hey, I know this is a long shot) which would result in some mild hypoxia. Your patient's pain is partly from the swelling of the tissues of the bowel and partly from the spasm of the smooth muscle of the bowel caused by the release of histamine that is brought to the area by the mast cells via the blood.

Thank you both for your responses - I am learning here! Daytonite - could you suggest some possible goals, perhaps?? I understand what you're saying but the verbage is messing me up - how about something like "Pt will be free from constipation..." or "Pt will...." heck, I can't even think of a second one. I appreciate it, I'm getting somewhere here, but not quite THERE.

Thanks.

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Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

What I always did is use another NANDA as the "as evidenced by."

Impaired ts perfusion AEB inflammation of diverticulum.

goal....pt will have no adverse event r/t ts perfusion.

Now remember it's been 7 years since I was a floor nurse so I hope I got this somewhat near what you're asking.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

Write these down somewhere. Verbs and phrases to use in forming goal statements:

  • The nurse will be able to detect
  • The nurse will manage
  • The nurse will minimize
  • The patient will have
  • The patient will report (or relate)
  • The patient will be able to list
  • The patient will be able to state
  • The patient will be able to verbalize
  • The patient will be able to identify
  • The patient will demonstrate

What are you trying to accomplish in order to close the book on this diagnosis while the patient is under hospital care? That will be your final goal. Some suggestions might be:

  • The patient will have normal circulation restored to the lower bowel.
  • The patient will remain free of circulation complications of diverticulitis.
  • The nurse will manage the complications of diverticulitis.
  • The nurse will manage the complications of hemorrhage.

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