Case study, care plan, is there a difference?

llg, PhD, RN · Jan 12, 2013

It's all a matter of format. Both types of assignments ask you to "think through" the clinical situation and document that thinking in writing. So there are a lot of similarities in the intellectual task. However, they are asking you to document your thinking in different formats. The use of each format teaches you to think about clinical situations in an orderly way -- but the specific order/format being used is probably slightly different.

Another thing is that "care plans" are usually a working document to use in the delivery of care. It starts out as a plan of things you intend to do ... and then evolves and gets updated as the situation moves forward. A "case study" is usually something you write up to summarize the case after the action has happened.

Also, you will find that different instructors may have variations in how they want the assignments for their classes organized and presented. The key is to get the instructor to explain exactly how they want you to organize and format your assignments. Showing you an example is often the best way to do that. Then you should follow the assigned format as closely as possible.

In common usage, a "nursing care plan" usually refers to a document in ADPIE format. Many times, they are written in a column format (but columns are not always nescessary). In the first section, you summerize your Assessment information ... then list the Diagnoses that you formulated based on that assessment ... then your Plan to meet established goals ... then the specific Interventions you will do ... and finally your Evaluation as to whether or not the goals were met ... which then feeds into further assessment, etc.

A "case study" is a format used by many disciplines to summarize a particular case. They can be written in a variety of formats -- so you really need to find out from your instructor what format he/she would like you to use. From your post, it sounds as if your instructor has given you a specific set of questions to answer. Follow those instructions to complete the assignment.

Good luck! Welcome to the world of nursing.

Esme12, ASN, BSN, RN · Jan 12, 2013

I'm a new nursing student, I just got through my first week. So I apologize if I sound confused, silly, or naive.... because right now I probably am!! I've had all of my instructors discuss care plans, and I "sort of" get the ruberic of ADPIE, and what they will be looking for. In pharmacology, I have a 'case study' due on Monday, and I'm not sure if it's the same thing or not. This is more of a critical thinking question with a desired outcome. Such as: Before a nurse begins pt teaching about administering medication, what info does she need to obtain to ensure proper dosage? What instructions should be stressed to ensure proper dose is given?
Is this a care plan? A question to be carefully answered? What is the instructer looking for? I don't wish for the question to be answered, just guide me in the right direction. It is so important to me to do well!!!!

Welcome to AN! The largest online nursing community!

The basics......for ALL case studies.....what you need to do is organize the paper by following the 5 steps of the nursing process......ADPIE. Just like a care plan. The entire thing is then presented, of course, in an essay format....where as the care plan is in a different format. These are the five steps of the nursing process used for care planning. The biggest part of this paper will be the assessment. This is a collaboration with a dear member Daytonite (RIP)

Assessment (collect data from medical record, do a physical assessment of the patient, assess ADL's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
- Knowing the pathophysiology, signs/symptoms, usual tests ordered, and medical treatment for the medical disease or condition that the patient has. This includes knowing about any medical procedures that have been performed on the patient, their expected consequences during the healing phase, and potential complications. If this information is not known, then you need to research and find it.
  - use: medical disease information/treatment/procedures/test reference websites I prefer medscape as on of my go to favorites....Medscape: Medscape Access it requires registration but it is FREE!!!!!!

[*]Reviewing the signs, symptoms and side effects of the medications/treatments that were ordered or that the patient is taking

[*]Data collected from the medical record (information in the doctor's history and physical, information in the doctor's progress notes, test result information, notes by ancillary healthcare providers such as physical therapists and dietitians

[*]A physical assessment of the patient

[*]Assessment of the patient's ability and any assistance they need to accomplish their ADLs (activities of daily living) with the disease/condition that they have

[*]Determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use). It helps to have a book with nursing diagnosis reference information in it. there are a number of ways to acquire this information.

Your instructors might have given it to you. NANDA nursing diagnoses 2012-2014
you can purchase it directly from Nanda.NANDA nursing diagnosis home page
Many authors of care plan and nursing diagnosis books include the NANDA nursing diagnosis information. I use Ackley: Nursing Diagnosis Handbook, 9th Edition and Gulanick: Nursing Care Plans, 7th Edition
the NANDA taxonomy and a medical disease cross reference is in the appendix of both Taber's Cyclopedic Medical Dictionary and Mosby's medical, nursing, & allied health dictionary
always sequence actual nursing problems before potential (risk for) or anticipated problems
use Maslow's hierarchy of needs to sequence the diagnoses in order of priority of importance
- http://en.wikipedia.org/wiki/maslow'...archy_of_needs - Maslow's hierarchy of needs

[*]Planning (write measurable goals/outcomes and nursing interventions)

Goals/outcomes are the predicted results of the nursing interventions you will be ordering and performing. They have the following overall effect on the problem:
- improve the problem or remedy/cure it
- stabilize it
- support its deterioration
[*]How to write goal statements: from a dear contributor Daytonite........see post #157(https://allnurses.com/general-nursing...28-page16.html) on thread https://allnurses.com/general-nursing...se-121128.html
[*]Interventions are of four types
- assess/monitor/evaluate/observe (to evaluate the patient's condition)
  - note: be clear that this is assessment as an intervention and not assessment done as part of the initial data collection during step 1.
  [*]care/perform/provide/assist (performing actual patient care)
  [*]teach/educate/instruct/supervise (educating patient or caregiver)
  [*]manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)

[*]Implementation (initiate the care plan)

[*]Evaluation (determine if goals/outcomes have been met)

Esme12, ASN, BSN, RN · Jan 12, 2013

So for your question

Before a nurse begins pt teaching about administering medication, what info does she need to obtain to ensure proper dosage? What instructions should be stressed to ensure proper dose is given?

You will need to ASSESS what the drug is...what does it do....how does it work...what are the side effects...the DETERMINE how this applies to your patient.....PLAN how you are going to teach them about their drug...for example: Injectable insulin gather information and tools to teach the patient how to give their insulin...you will them IMPLEMENT the teaching process as you EVALUATE the effectiveness of your teaching by the patient return demonstrating knowledge and ability to self inject and verbalize knowledge about the drug.

This is preparing you for the nursing process....Here are the steps of the nursing process and what you should be doing in each step when you are doing a written care plan/care map: ADPIE. From our beloved Daytonite....RIP

Assessment (collect data from medical record, do a physical assessment of the patient, assess adls, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
Determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
Planning (write measurable goals/outcomes and nursing interventions)
Implementation (initiate the care plan)
Evaluation (determine if goals/outcomes have been met)

A Care plan/care map/case study is nothing more than the written documentation of the nursing process you use to solve one or more of a patients nursing problems. These are done in different formats but contain similar information. The nursing process itself is a problem solving method that was extrapolated from the scientific method used by the various science disciplines in proving or disproving theories. Tune of the main goals every nursing school wants its RNs to learn by graduation is how to use the nursing process to solve patient problems.

Care plan reality: The foundation of any care plan is the signs, symptoms or responses that patient is having to what is happening to them. What is happening to them could be a medical disease, a physical condition, a failure to be able to perform ADLs(activities of daily living), or a failure to be able to interact appropriately or successfully within their environment. Therefore, one of your primary aims as a problem solver is to collect as much data as you can get your hands on.......the more the better. You will have to be a detective and always be on the alert and lookout for clues.......at all times. That is within the spirit of step #1 of this whole nursing process.

Assessment is an important skill. It will take you a long time to become proficient in assessing patients. assessment not only includes doing the traditional head-to-toe exam, but also listening to what patients have to say and questioning them. history can reveal import clues. It takes time and experience to know what questions to ask to elicit good answers. part of this assessment process is knowing the pathophysiology of the medical disease or condition that the patient has. But, there will be times that this won't be known. Just keep in mind that you have to be like a nurse detective always snooping around and looking for those clues.

A nursing diagnosis standing by itself means nothing.

The meat of the care plan of yours will lie in the abnormal data (symptoms) that you collected during your assessment of this patient. In order for you to pick any nursing diagnoses for a patient you need to know what the patient's symptoms are.

Care plan reality: Is actually a shorthand label for the patient problem. The patient problem is more accurately described in the definition of this nursing diagnosis (every nanda nursing diagnosis has a definition). [thanks daytonite]

What I would suggest you do is to work the nursing process from step

#1. Take a look at the information you collected on the patient during your physical assessment and review of their medical record. Start making a list of abnormal data which will now become a list of their symptoms.

#2. Don't forget to include an assessment of their ability to perform adls (because that's what we nurses shine at). The ADLS are bathing, dressing, transferring from bed or chair, walking, eating, toilet use, and grooming. and, one more thing you should do is to look up information about symptoms that stand out to you.

#3. What is the physiology and what are the signs and symptoms (manifestations) you are likely to see in the patient. Did you miss any of the signs and symptoms in the patient? If so, now is the time to add them to your list.

This is all part of preparing to move onto the next step of the process which is

#4. Determining your patients problem and choosing nursing diagnoses. but, you have to have those signs, symptoms and patient responses to back it all up.

#5. How are all your interventions changing/helping this patient.

You, I and just about everyone we know have been using a form of the scientific process, or nursing process, to solve problems that come up in our daily lives since we were little kids.

For example: As a contributor to AN....Daytonite said best.

You are driving along and suddenly you hear a bang, you start having trouble controlling your car's direction and it's hard to keep your hands on the steering wheel. You pull over to the side of the road. "What's wrong?" You're thinking. You look over the dashboard and none of the warning lights are blinking. You decide to get out of the car and take a look at the outside of the vehicle. You start walking around it. Then, you see it..............a huge nail is sticking out of one of the rear tires and the tire is noticeably deflated.

What you have just done is.......

Step #1 of the nursing process--performed an assessment. You determine that you have a flat tire. You have just done.....

Step #2 of the nursing process--made a diagnosis. The little squirrel starts running like crazy in the wheel up in your brain. "What do i do?" You are thinking. You could call AAA. No, you can save the money and do it yourself. You can replace the tire by changing out the flat one with the spare in the trunk. .......Good thing you took that class in how to do simple maintenance and repairs on a car! You have just done.....

Step #3 of the nursing process--planning (developed a goal and intervention). You get the jack and spare tire out of the trunk, roll up your sleeves and get to work. You have just done.....

Step #4 of the nursing process--implementation of the plan. After the new tire is installed you put the flat one in the trunk along with the jack, dust yourself off, take a long drink of that bottle of water you had with you and prepare to drive off. You begin slowly to test the feel as you drive....... Good....... Everything seems fine. The spare tire seems to be ok and off you go and on your way. You have just done

Step #5 of the nursing process--evaluation (determined if your goal was met).

Does this make more sense? Can you relate to that? That's about as simple as the nursing process can be simplified to... BUT........ you have the follow those 5 steps in that sequence or you will get lost in the woods and lose your focus of what you are trying to accomplish.

Critical thinking involves knowing:

1) the proper sequence of steps in the nursing process

2) the normal anatomy and physiology of the human body

3) how the normal anatomy and physiology are changed by the medical and disease process that are going on

4) the normal medical treatment that the doctor(s) are likely to order to treat 5) the medical and disease process going on

6) the nursing interventions that you have learned for the things that support 7) the medical and disease process that is going on

8) making the connection (this is the critical thinking part) between the disease, the treatment and the nursing interventions and where on the sequence of the nursing process you are

Esme12, ASN, BSN, RN · Jan 12, 2013

You may find this helpful.....Nursing Proccess & Critical Thinking Guide | NursingProccessSteps.com

So I am sure this is now clear as mud.......questions? So now that you are completely confused.....simply put

ADPIE...

Assessment- You asses where the patient currently is.

Dianosis- Your create you nursing diagnosis

Plan- You and you patient create goals and a strategies for the patient to obtain those goals

Implementation- You implement your plan

Evaluation- you come back later and evaluate if the goals where met

When you get to patients here are some "cheat sheets" to help you collect and organize information......they were made by Daytonite....although she in no longer physically her presence remains.

Critical Thinking Flow Sheet for Nursing Students.doc

Student Clinical Report Sheet(1).doc

klandrn2b14 · Jan 12, 2013

Thanks everyone for your help, it is most appreciated.