Care Plan for innefective tissue perfusion

[dana_marco]

Hello, I was just wondering if I can help with my care plan.

The case study is:

Pt. is diabetic and has hypertension, eats unhealthy and only checks blood glucose once a week due to poor vision. Also has a sore on right foot.

My nursing dx is:

Ineffective tissue perfusion

r/t high blood pressure and diabetes

m/b open sore on right foot

STG: Patient will show improvement of would healing by end of shift

LTG: patient will verbalize understanding in necessary diet changes to improve quality of life by discharge date

nursing orders:

Will provide wound care

Monitor wound site for infection

Patient will be referred to a dietitian for education on a well-balanced, low saturated fat and low cholesterol diet plan.

I just want to know if I am in the right track. Any feedback would be great!

Thank you.

[amoLucia]

Uh, question - how will you measure your STG of improved wound healing?!?!? And for this a goal has to be realistic. I don't think anybody's THAT good to heal a wound in one shift! How could you even see that?

Please know that I'm not trying to give you a hard time.

What ever you do or implement, you always, ALWAYS have to think "how will you measure"? If you can't measure something, how will you know if a GOAL is being met?

I might pick that she would demonstrate her self glucose monitoring to me. Easy peasy to see if she if she can do it right (regardless of her frequency). You'd then have some discharge direction to do corrective teaching for her technique. To get an eye doctor appt as soon as poss could be a short term goal (or a long term one) depending on the OUTCOME of her demonstration.

Just for the record here, I haven't determined that this might be a more priority thing than something else. In school, they often ask you to select priority problems, ones that have the most impact on the pt at that time. That would be based on YOUR assessment.

And usually there's a time element to be considered, like by 'discharge date' for your LTG. That was possibly reasonable. Wounds usually take some time for improvement (NOT talking about gunshots or stabings) here.

But I just wanted to explain goals (to be realistic and measurable) because that jumped out at me so pronounced here.

Hope I made some sense for you and it helped.

You're trying and that's why folks here usually will jump in to help. Keep it up & good luck.

[dudette10, MSN, RN]

I see two additional issues with this. What is your R/T statement? What is the basic reason for the ineffective peripheral tissue perfusion in a person who has diabetes? That should be your r/t part of the statement.

As for your interventions, while somewhat related to your nursing diagnosis, there are other, more directly related nursing interventions to address ineffective peripheral tissue perfusion. If arterial blood is not getting to the feet as easily as a person without diabetes, what can we do to at least maintain the blood flow to the feet?

[nursej22, MSN, RN]

Piggy backing on to amoLucia's reply, use the SMART acronym for your goals:Specific, Measurable, achievable, relevant and time limited.

Is improved wound healing measurable? maybe, maybe not. Is it achievable by the end of a shift, probably not. It may not be achievable long-term!

How are you assessing tissue perfusion? Pulses? BP? Skin color or blanch-ability? Is this person on any meds to improve perfusion? Monitoring and teaching about meds and glucose is a nursing intervention, too.

[LilyRN99]

I agree that would improvement that fast isn't realistic. You can measure would improvement by decreasing size which is measurable. What about wound infection? I would be more specific with your long term goal. For example, Patient is able to state 4 types of food to avoid, 3 sources of protein, and 5 examples of low carb food.You can measure if she can state those facts or not. Actually, you don't mention what her blood sugars are. Are they within a normal range. I'd be concerned about the wound and prevent new wounds. Maybe patient is able to demonstrate how to do a foot examination. Is her vision correctable? Does she need new glasses that she can't afford? Can she obtain and afford her medication? There is a lot to think about.