Care Planning Confusion

[bstewart40]

Hello all!

I'm not sure if this is the right place for this, but I looked for a while under the "student nurse" tab and didn't find what I was looking for.

Anyway, I'm an LPN to RN student and I am working on a care plan for myself in my Mental Health Class and I have a part of my care plan that is driving me crazy (pardon the pun).

The teacher requires 3 "Needs" for every diagnosis. My needs are "Relief from Pain" "Improved Physical Mobility" and "Physical Therapy". The associated diagnosis is "Impaired physical mobility related to musculoskeletal impairment secondary to scoliosis AEB gait changes, limited ROM, and postural instability. "

I don't like it, especially as this is the diagnosis I used for the Education part of my care plan. Let me explain.

I have scoliosis with poor abdominal muscle strength. This means that my back muscles are doing all the work of keeping me upright and this is the perfect storm for the pain that I have. Pain makes me angry, irritable, and it's a significant source of my stress. However, because of my back issues, including the pain, I have the impaired physical mobility that's due to the musculoskeletal impairment. I DO have the limited ROM, postural instability and gait difficulties.

My problem is this: I keep going back and forth over whether or not I need to make pain the diagnosis or keep it as it is. This is one of two diagnosis in this care plan that aren't strictly mental health- the other is imbalanced nutrition more than bodily requirements, but I relate it to my anxiety.

So, can you help me out? I know I am probably over thinking this, but I'm a perfectionist at heart.

[mappers]

What is the bigger priority for the patient? That is what should be the first Nsg DX. For example, if the pt is in so much pain that they really cannot progress with physical therapy, then pain has to be addressed first. If, however, the pain is more chronic and is somewhat under control and the patient is at baseline, and ultimately only physical therapy, exercise, etc will decrease the pain further, then impaired mobility may be a better choice.

[classicdame, MSN, EdD]

Suggestion: While in this class try to have at least ONE nursing diagnosis related to psycho-social topics. This can be fear, lack of information, pain, anxiety---Once you graduate you will realize that every patient has at least one psycho-social nursing diagnosis.

[nurseprnRN, BSN, RN]

suggestion: pull out your copy of the nanda-i 2012-2014 (and if you don't have it, you can have it on your doorstep in two days from your favorite online bookseller) and peruse. fake out your instructor by identifying defining characteristics in your patient for a nursing diagnosis that isn't the same-old, same-old, "pain, knowledge deficit, anxiety" that you and i both know students pull out of the air. look at role changes, sexual function (yes, old people have sex too and still worry about losing it), self-esteem, and others.