Care plans + finding Nsg articles: 2 really good websites everyone should know about!

Nursing Students General Students

Published

http://www1.us.elsevierhealth.com/MERLIN/Gulanick/Constructor/#New

This website is highly recommended by all my friends if you have problems writing care plans. It is actually a care plan generator, all you do is pick what applies to your patient and out pops a complete care plan. I would like to stress DONT RELY to heavily on this website because in my own personal exp. you may have to write a care plan whenever and wherever you instructor see's fit. Make sure you know how to become a generator yourself before using this. :)

http://www.nursingcenter.com/library/index.asp#journals

If you need a nursing journal article, heres your place. It cost money for most of the articles but some are free. In my exp using it I was always able to find a free article for just about any topic I needed. Make sure if it says it cost money for a article to click on it and scroll down, because sometimes it only cost money if you print the article. Great for Nursing research papers. :)

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

that's ok. when you are doing this for the first time or two it is a huge project and can be very overwhelming. i have a much better understanding of what you have to do here. i'm serious about reviewing some of the posts on that "desperately need help with careplans" thread. i write this very same stuff all the time. you are having the same problem in doing this that almost every student that is new to the care plan writing process has. everyone gets stuck at the "pick the nursing diagnosis" part. and, it's at the second step of the process! most tend to shove step #1 under the carpet, but it is critical to getting to the right nursing diagnosis.

with a case scenario of a patient that doesn't exist you still have to develop some kind of an assessment (step #1 of the nursing and care planning process) of the patient. so, you have to look at the information that you were given in the scenario. you also have to look at the symptoms and treatment that underlie any medical diagnosis you are given. in this case, you are specifically told the patient has "hypertension". so, you need to open your books and read about the signs, symptoms and treatment of hypertension. you are also going to find some very good websites on the internet that will have information as well, although they will usually be from the viewpoint of the doctor. our job, as nurses, is to turn it into information we can utilize using our rules for developing nursing diagnoses. i hope this is making more sense to you. i will give you a thumbnail list because i want to illustrate how you get to the nursing diagnoses. here is a list of some physical symptoms often associated with hypertension. if you know of others that you think should be added by all means include them:

  • elevated blood pressure
  • occipital headache upon awakening
  • dizziness, fatigue and/or confusion
  • palpitations
  • chest pain
  • dyspnea
  • epistaxis
  • hematuria
  • blurred vision
  • bounding pulse
  • s4 heart sound
  • late stages
    • peripheral edema
    • hemorrhages
    • exudates
    • papilledema of the eye due to hypertensive retinopathy
    • possible formation of an abdominal aneurysm
    • bruits over the abdominal aorta, femoral arteries and/or carotid arteries

complications of hypertension include:

  • cardiac disease
  • renal failure
  • blindness
  • stroke

because this is a hypothetical patient, all those symptoms that i listed now become "abnormal data". in other words, if you were doing a health history and physical exam on someone, one or more of these symptoms would very likely be present and they would certainly not be "normal" findings. understand? when care planning, step #2 requires you to list out and scrutinize this "abnormal data". they become the foundation, or basis, for the nursing diagnoses that you will choose for the patient. that is one of the most important things you need to understand about the care plan process. your data assessment is everything.

thorough assessment data = a much more focused and accurate care plan

incomplete assessment data = a less accurate care plan

crappy data = a crappy care plan

including the other data from your scenario, you now have a list of abnormal data that looks like this (the ones in dark lavender are the actual symptoms that we know about):

  • he's an indigenous australian (you are going to need to list out the destructive behaviors and behaviors that are going to affect this person's ability to learn and follow medical advice. i would think that there must be a lot of information in australia and on your internet to help you with this.)
  • weight 119kgs, height 1.70m
  • elevated blood pressure of 186/100
  • the patient left his doctor's office not understanding everything he was told
  • the doctor told him he had hypertension
  • the doctor gave him a prescription for medication, but he hasn't taken it because he feels fine
  • he has a prescription for verapamil 120mg which he has not gotten filled and doesn't plan to get filled
  • occipital headache upon awakening
  • dizziness, fatigue and/or confusion
  • palpitations
  • chest pain
  • dyspnea
  • epistaxis
  • hematuria
  • blurred vision
  • bounding pulse
  • s4 heart sound
  • late stages
    • peripheral edema
    • hemorrhages
    • exudates
    • papilledema of the eye due to hypertensive retinopathy
    • possible formation of an abdominal aneurysm
    • bruits over the abdominal aorta, femoral arteries and/or carotid arteries

another clue in the scenario that i was trying to get you to notice concerns the verapamil. this is not a drug that is given to everyone with hypertension. it is a calcium channel blocker and antianginal drug as well. makes me wonder if your instructors want you to think that this man may already have some heart problems such as chest pain or arrhythmias. verapamil is sometimes used for cardiomyopathies and migraine headaches. that brings up another burning question i have: why did this man go to the doctor in the first place??? that one little piece of information could change the whole direction of this care plan. so, you australian you, why would this indigenous native go to a western type medical doctor? hmmmm? still, you can only work with what you know or what you can reasonably extrapolate from the information you were given about a non-existent patient. this is all part of the critical thinking process that all nursing instructors want their students to learn. isn't this fun?

ok, step #2. we need to shop around and match as many of those abnormal assessment items to likely nursing diagnoses as we can, 5 in your case. you are going to find that some of the assessment data is going to group together and apply to one specific nursing diagnosis, as i found with noncompliance, while, perhaps, only one data item will match with another nursing diagnosis. as you work with nursing diagnoses more and more you begin to see that certain types of assessment data seem to appear together in groups and the same nursing diagnosis is going to apply to them. you'll find this, in particular, with cardiac and pulmonary problems.

important point here: remember i talked about the criteria (rules, standards) in the formation of nursing diagnoses? well, here it is:

every nursing diagnosis has:

  • a definition (helps you to differentiate it from other diagnoses that seem like they might be similar)


  • a set of defining characteristics (symptoms, inferences or logical conclusions, observable behaviors)


  • a list of related factors (etiologies that have already been worked out for you; they are antecedent, or must exist prior, to the nursing diagnosis and the symptoms. in a very slick way many of the related factors slide around medical reasons for what is going on without actually using a medical definition. important note: nanda is a highly evolved system of nursing language [terminology])


  • a list of risk factors replaces the defining characteristics and related factors for the "risk for" nursing diagnoses that may develop


let me clarify something that i don't think many people understand about nanda. one of their missions is to develop a standardized nursing terminology for all nurses to use. we all know what medical terminology is because many of us had to take a class in it and we hear the term tossed around all the time. well, say hello to the new buzz word of our profession:
nursing terminology
. and, i don't think it's going to go away. fight against it, if you want, but you need to be aware that it is out there. you can't miss nursing terminology when you see it. who else says stuff like self-care deficit or impaired comfort?

for this reason, when you are new at doing this care planning process, using some resource or guide that has nursing diagnosis information in it is going to be a tremendous help for you. i use nanda-i nursing diagnoses: definitions & classification 2007-2008 published by nanda international because it's simple and to the point. many students, however, need a bigger boost and use nursing care plan books or a nursing diagnosis book which adds goals/outcomes and nursing interventions to them based on the defining characteristics of each nursing diagnosis. we have one book that is published here in the u.s. (nursing diagnosis handbook: a guide to planning care, 7th edition, by betty j. ackley and gail b. ladwig) where the authors included an alphabetical index of symptoms, problems with adls, medical diagnoses and other clinical states in the front of the book in which you can find suggestions for nursing diagnoses. it saves a lot of time in thumbing through lists of 188 nursing diagnoses trying to find which one(s) are going to fit with your patient's list of abnormal assessment data. do i need to tell you that this book is a huge seller here in the u.s.?

next, is the putting together of the nursing diagnosis statement. you've used 2-part statements, but i'm used to working with 3-part ones because it shows the rationale of what is going on here. the construction of these statements is in the form of

p(problem)-e(etiology)-s(symptom)

where

problem(nursing diagnosis)-etiology (related factor)-symptom(abnormal assessment data)

or

nursing diagnosis r/t (related to) xxx aeb (as evidenced by) xxx

working with the actual information you were given i get these nursing diagnoses:

  1. imbalanced nutrition, more than body requirements r/t excessive food intake in relation to metabolic needs aeb weight of 119 kgs and height of 1.70m.
  2. noncompliance r/t insufficient knowledge relevant to the therapeutic regime aeb the patient's statement that there are some things he doesn't understand since visiting his doctor, he has not filled his prescription for verapamil and is not planning on taking it because he feels well.

that really is all you actually have to work with. your other three nursing diagnoses are going to have to address anticipated problems that don't exist--yet, but are likely to occur based on his racial genetics and what we know happens to untreated htn (hypertension). scroll back up and look at that little list of complications of hypertension that i listed. i've been a nurse for 30+ years and have had hypertension myself for many years. my choice (you may choose to go a different way, especially if your instructors have given you lectures on hypertension stressing other factors) would be to go with (1) stroke (2) chest pain, which would most likely be a manifestation of atherosclerosis that is occurring in the heart with this hypertension, and (3) blurred vision. heart conditions and stroke are big reasons for hospital admissions here in the u.s. so, this is what i would do, and keep in mind that you can make any nanda nursing diagnosis a "risk for" diagnosis, but they do not have any defining characteristics (symptoms) because they do not exist--yet:

  1. risk for injury r/t failure to take antihypertensive medication, obesity, cultural beliefs, and tissue hypoxia [this covers the risk for a stroke]
  2. risk for decreased cardiac output r/t cardiac ischemia [this covers the underlying reason for chest pain]
  3. risk for disturbed sensory perception, visual r/t physiological changes in the anatomy of the eye secondary to the elevated blood pressure [this covers the visual disturbances and potential blindness as untreated hypertension gets worse]

i would actually sequence them in the following order (anticipated problems are never sequenced before actual problems). i've also given you links to any nursing diagnosis pages that pertain to the diagnoses that are on the internet at two of the online care plan constructor sites. they will have the diagnosis, defining characteristics, related factors, outcomes (goals), nursing interventions, and, in some cases, references and rationales for some of the nursing interventions to help you out.

  1. imbalanced nutrition, more than body requirements r/t excessive food intake in relation to metabolic needs aeb weight of 119 kgs and height of 1.70m. http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=38 [color=#3366ff]imbalanced nutrition: more than body requirements
  2. noncompliance r/t insufficient knowledge relevant to the therapeutic regime aeb the patient's statement that there are some things he doesn't understand since visiting his doctor, he has not filled his prescription for verapamil and is not planning on taking it because he feels well. http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=36
  3. risk for injury r/t failure to take antihypertensive medication, obesity, cultural beliefs, and tissue hypoxia [this covers the risk for a stroke] [color=#3366ff]risk for injury
  4. risk for decreased cardiac output r/t cardiac ischemia [this covers the underlying reason for chest pain] http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=09 [color=#3366ff]decreased cardiac output
  5. risk for disturbed sensory perception, visual r/t physiological changes in the anatomy of the eye secondary to the elevated blood pressure [this covers the visual disturbances and potential blindness as untreated hypertension gets worse] http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=46 [color=#3366ff]disturbed sensory perception specify: visual, auditory, kinesthetic, gustatory, tactile, olfactory

there's 5 nursing diagnoses for you based on the information you've supplied for me. now, you might have other things to add to it because you sat in the classroom and i didn't.

step #3 is to add goals/outcomes and nursing interventions to each of your nursing diagnoses. now, this is not as hard as you might think it's going to be. let me show you how to approach it with the first nursing diagnosis

imbalanced nutrition, more than body requirements r/t excessive food intake in relation to metabolic needs aeb weight of 119 kgs and height of 1.70m.

your goals and nursing interventions are aimed (important point coming here!) at those abnormal assessment data items (defining characteristic, symptoms) because those are the true specific problem(s) the patient has and that you have to do something about. for this diagnosis, there is only one assessment item and it is:

weight of 119 kgs and height of 1.70m

basically, he's overweight. look up what the normal weight for a man of his height should be. you might even, as part of your nursing interventions determine a bmi (body mass index) for him, all the rage these days [never miss a chance to impress the teacher]. it can be done with his height and weight (weight in kg divided by height in meters squared). you know, and i know, that this guy needs to be on a weight reduction diet. here are some of the kinds of nursing interventions for this man (and keep in mind that you'll have to incorporate his cultural mores and behaviors into these and alter some of your nursing interventions to accommodate them--critical thinking, again!):

  • have him keep a daily food diary for you of everything he eats
  • give him recommended dietary guidelines for someone with hypertension
  • establish a program of weight loss and a weight loss goal
  • have the patient record his weight weekly
  • assess for depression
  • teach the patient about various kinds of weight loss programs and behavior modification techniques
  • encourage a program of regular physical activity

as i said in my earlier post, goals/outcomes are solely based on what you expect to happen as a result of the successful performance of the nursing interventions you've developed for this nursing diagnosis.

whew! i've given you a lot to think about and assimilate. you many need to read this information over a couple of times spread out over a few hours or days to help it solidify in your mind. when you do "get" this, you are going to see that there is a rational flow from the patient's problem to the interventions. this nursing diagnosis stuff is kind of a fancy magic act to show just how well you are able to incorporate some critical thinking into the whole process. it is painstaking at first. it is a skill like any other nursing skill. the more care plans you do, the better you get at it. in the process of doing these you will also learn a great deal about various medical disease processes and treatment modalities. and that is also something nursing instructors are wanting you to do.

good luck with this assignment.

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Specializes in general.

thanks a great deal here where i study u just have to crack brains

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I need help coming up with a nursing diagnosis and care plan my pt is a 77 year old white male with end stage liver disease he is ambulatory has memory impairment any ideas would be greatly appreciated

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Specializes in med/surg, telemetry, IV therapy, mgmt.
i need help coming up with a nursing diagnosis and care plan my pt is a 77 year old white male with end stage liver disease he is ambulatory has memory impairment any ideas would be greatly appreciated

any nursing diagnoses that you end up with are based upon the symptoms you find after doing a thorough assessment of your patient and not upon his end stage liver disease. the only abnormal assessment item that you have given that i can work with is that he has memory impairment which is a very non-specific term. what are the manifestations of this memory impairment?

  • forgetfulness?
  • forgetting to do specific things at specific times?
  • unable to remember if he did something he was supposed to do?
  • inability to learn or recall new information
  • inability to learn or recall new skills
  • inability to perform a skill he was previously taught
  • unable to recall events

is this memory problem related to the liver disease?

what are the manifestations of his liver disease?

  • jaundice?
  • darkened urine?
  • abdominal tenderness or pain? describe it.
  • ascites?
  • peripheral edema? anasarca?
  • altered level of consciousness?

what adls does he need assistance to perform?

  • eating and drinking
  • toileting
  • bathing
  • dressing
  • communicate his needs
  • movement
  • sleep

the answers to all those questions underlie the nursing diagnoses that will apply to this patient, not necessarily his medical diagnosis. list that information for me and i can help you chose nursing diagnoses for this patient.

here is a list of possible nursing diagnoses that may be applicable to this patient, but they mean nothing without the above information that is crucial to supporting them:

  • acute pain
  • anxiety
  • diarrhea
  • fear
  • imbalanced nutrition: less than body requirements
  • ineffective tissue perfusion: gi, cerebral
  • self-care deficits (bathing, hygiene, toileting, dressing, feeding)
  • impaired verbal communication
  • risk for infection
  • risk for injury

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hi! im really in a rush for possible diagnoses... need your help guys:uhoh3: my patient is a neonate, 6 days old, male, and had an imperforate orifice... the patient is for possible discharge but the family has poor compliance to the treatment regimen and before i forget, he's post op 4 days for opening of anal fistula... any idea and websites are greatly appreciated :)

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

http://www.pedisurg.com/pteduc/imperforate_orifice.htm

http://www.umm.edu/ency/article/001147.htm

http://www.umm.edu/ency/article/002926.htm - repair

http://www.emedicine.com/ped/topic1171.htm

see

for information on how to make nursing diagnoses. nursing diagnoses are based upon the symptoms your patient has--not upon their medical condition.

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How do you make the best @ clinicals when the nurses don't want to teach you? Any suggestions!!!!:idea::idea:

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Bookmarked! You can also check some of my care plans. I'll be including new NCP's in December.

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thank you, it realy helpful

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Wow!! thank you!! this would really be a great help...thanks a lot!!

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hey guys, i need some help for my nursing care plan....i need to due tmr.

Edema on both legs

Prevent tissue damage

l Encourage the patient to exercise

l Elevate both legs with pillow

l Weigh patient daily on same scale at same time of day

l Documented patient's input and output.

l It could help the blood circulation

l To prevent all the fluid go down to the legs

l

l To make sure patient's input equal to their output

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hey guys, i need some help for my nursing care plan....i need to due tmr.

nursing diagnosis is edema on both legs

goal is prevent tissue damage

i need 5 interventions and 5 rationale. plz help T.T

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