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Discussion

concept mapping

I am doing a care plan for a patient with leukopenia, low bp , infection & debility

I have rated the prioritys from most to least (although all are important) as

1. low bp

2. infection

3. immunity

4. risk for falls/inability to perform adls

can anyone give me their input in regards to the validity of the diagnosis' and the rating of most important to fourth important. Also any help you could give in regards to possible related to examples and "as evidenced by" would be appreciated. I have this plan done but am trying to see what other perspectives and advice I can get.

Thanks

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Seems infection and immunity go hand in hand and I would consider them the top priority for a patient with leukopenia

  • Experts

you shouldn't have been able to come up with prioritized problems without assessing this patient and having data ("as evidenced by" items) that support them. let me give you an analogy that might help make this clearer to you.

a police detective cannot make an arrest for a crime (the name of the crime is = to a nursing diagnosis) until he/she has evidence ("as evidenced by" items/signs and symptoms/defining characteristics) to support the arrest. otherwise, the suspect cannot be held in custody and when the suspect stands before the judge to be officially charged with the crime, the judge will let him go because there is no evidence proving the suspect committed the crime!

by the same token, you cannot say someone has a risk for falls without evidence to support that. that evidence comes from the assessment you do of the patient. in assessing the patient you

  1. look at their health history (review of systems)
  2. perform a physical exam
  3. assess their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming)
  4. review the pathophysiology, signs and symptoms and complications of their medical condition
  5. review the signs, symptoms and side effects of the medications they are taking

what is this patient's medical disease? how did you determine that this patient was at a risk for falls? inability to perform adls is broad and needs to be specific as to which adls can't be done and in what way. your validity of any diagnosis you use comes from you assessment data--it is the evidence you have to support it.

in its most simple definition care planning is nothing more than determining what nursing problems that a patient has and then developing strategies to do something about them. we use the nursing process to do that. it consists of 5 steps. the first step, assessment, is the most crucial and the entire remainder of the care plan relies on what is found during the assessment. have you heard the expression garbage in, garbage out ? well, it applies to assessment data. if you have lousy data or no data, it affects your problem solving. as nurses, we are constantly on the lookout for information to add to what we know about our patient. any little bit of information can change how we determine what their nursing problem(s) is(are) and how we are going to treat it.

before you even make a list of this patient's problems, you must go through the steps of the nursing process:

step 1 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

  • leukopenia

  • low blood pressure

  • infection - where is this infection?

  • debility - what specific debilities?

step #2 determination of the patient's problem(s)/nursing diagnosis part 1
- make a list of the abnormal assessment data
- this is where you need to list out all the abnormal assessment data that was collected during your examination of the patient, the review of their health history and the assessment of their adls. what evidence (clues/("as evidenced by" items) do you have? now is the time to see them. before nursing diagnoses were introduced by nanda these data items were all we ever listed on care plans as the "problem". so, instead of
risk for falls
we put something like "danger of falling". instead of
excess fluid volume
we put things like "pedal edema" or "lung congestion". list out your abnormal data. it can be organized into body systems and you can start rearranging the items according to maslow's hierarchy of needs (
http://en.wikipedia.org/wiki/maslow's_hierarchy_of_needs
)

step #2 determination of the patient's problem(s)/nursing diagnosis part 2
- match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use
- now you use a nursing diagnosis reference to match the data from the list you would have created just above with defining characteristics of nursing diagnoses. every nursing diagnosis has a definition, related factor and defining characteristics (this is called the taxonomy). it is in the appendix of
taber's cyclopedic medical dictionary
if you do not have a care plan book with this kind of information. some of the most commonly used nursing diagnoses are online at these two websites:

a nursing diagnosis
is a label. it is nothing more than a suggestion of what the nursing problem is. to get the more specific summary of the nursing problem and intention of what the diagnosis covers you must read its official definition.
that assures that you are diagnosing correctly. medical students do the same when they are learning how to diagnose.

your "related to", or etiology, for your diagnostic statement is almost exclusively the pathophysiology for the physiology based nursing diagnoses. that is why you
must
investigate and know the pathophysiology, signs and symptoms and complications of their medical condition and the signs, symptoms and side effects of the medications they are taking as well as the complications of any medical procedures performed on the patient. all are potential etiologies ("related to" factors) for your diagnostic statements.

step #3 planning (write measurable goals/outcomes and nursing interventions)
- goals/outcomes are the predicted results of the nursing interventions you will be ordering and performing - interventions specifically target the etiology of the problem or abnormal data/signs and symptoms/evidence that supports the existence of the problem - your overall goal is always aimed to alter or change something about the problem
- only now can you start to write your goals and nursing interventions and they are based upon those abnormal assessment items that came out of step #1 (assessment). another analogy: just as doctors aim their treatments at patient symptoms, so do we. there is great logic to all this care planning business. that is the scientific part of it.

also see

OMG- Daytonite! Thanks so much. That was a LOt of work. Are you in education? :)

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