Constructive Criticism please!

Nursing Students Student Assist

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Ok...these are my instructions...and my careplan. Trouble is...I have a hard time doing only 2 interventions! So which should I use? Also...I am unsure how to write goals. I keep getting dinged on that.

Directions

Read the following case study. After reading, complete a nursing care plan. Write the care plan on the form included in your syllabus. The nursing care plan needs to include major assessment cues, identification of the intra, inter, and extrapersonal stressors, the most relevant nursing diagnosis, one goal, one outcome criteria, and two nursing interventions including referenced rationales. Use provided form to document your nursing care plan. This is your work and is not a group assignment. Late papers are not accepted. The nursing care plan is worth 10 points. See syllabus for grading criteria.

Assessment

88 yo male

Social: lives alone, son lives nearby and checks on client 1X per day

Medical History: Oa X 5 yrs

Pain Scale: 6/10

Medications: Celebrex

Physical Activity: walks 2 miles X3 days per week

ADLs: Independent

Nursing

Diagnosis

Chronic Pain r/t dx of osteoarthritis aeb client report of pain in neck and right hip

Intrapersonal:

Believes pain is a normal part of aging

Dx: osteoarthritis

Pain level: 6/10

Fear of becoming addicted to pain medication

Uncomfortable rating pain on pain scale

Interpersonal

Son lives nearby and checks on him daily

Extrapersonal

Celebrex

Pain Scale

Goal

Client will function at pain level that is acceptable to him.

Outcome Criteria

Pain Control:

Client will maintain a pain diary for 1 week.

Client will function on acceptable ability level with minimal interference from pain and medication side effects within 30 days.

Client will use pain rating scale comfortably to identify current level of pain intensity, determine comfort/function goal within 1 week.

Client will demonstrate understanding or plan for pharmacological and non-pharmacological pain relief.

Nursing Intervention

Nurse will ask the client to maintain a diary of pain ratings, timing, precipitating events, medications, treatments, and steps that work best to relieve pain.

Nurse will review the client's pain diary, flow sheet, and medication records to determine the overall degree of pain relief, side effects, and analgesic requirements for 1 week.

Nurse will question the client regarding the level of pain that he believes is appropriate to achieve a state of comfort and appropriate function.

Discuss the client's fears of addiction.

Rational

Studies have shown that systematic tracking of pain was an important factor in improving pain management.

Systematic tracking of pain was found to be an important factor in improving pain management.

The pain rating that allows the client to have comfort and appropriate function should be determined: this allows a tangible way to measure outcomes of pain management.

Because of the many misconceptions regarding pain and its treatment, education about the ability to control pain effectively and corrections of myths about the use of opioids should be included as part of the treatment plan.

Thank you!:bow:

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Oops...the case study part didn't copy when I copy/pasted. Sorry!

Case Study

R.R. an 88year-old, a widower for the past year, lives alone in his home of 60 years. He is healthy and independent. He has a history of OA for the last five years and is on Celebrex. R.R.’s complains of pain in his neck and his right hip. He walks 2 miles a day, five days a week. He is independent in all ADLs. His son lives near and checks on him daily. He rates his pain 6/10, but he really is uncomfortable rating his pain with the numerically scale. He has taken Darvocet N-100 in the past, but does not want any pain medication for fear of becoming addicted. He thinks his pain is part of aging and he will have to “live” with it.

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

Chronic Pain r/t dx of osteoarthritis aeb client report of pain in neck and right hip

The related factor for pain must be something that is causing damage. It can never be a medical diagnosis, so "osteoarthritis" cannot be used. Did you look up the signs and symptoms and pathophysiology of osteoarthritis? The pain is due to inflammation in the joints. You didn't pick up all the assessment cues of pain from the scenario either.
Chronic Pain R/T inflammation of the joints AEB pain in neck and right hip rated by patient as 6/10
.

There are ways to relieve the pain of arthritis without using medications. You need to research them so you can use them as interventions for this diagnosis and move toward more actual independent patient care interventions for the pain. Your 3 interventions monitor and observe the patient's pain but do not provide any relief for the pain. Ultimately, your goal(s) are to improve, stabilize or support the deterioration of this problem of pain. Which are you going for? I'm looking at "Client will function at pain level that is acceptable to him." and I'm wondering if you gave up on the poor guy.

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haha...no I did not give up on him! I get confused because my instructor will only allow 2 interventions, but this man has so many issues regarding his pain! AND....she is big on dispensing narcotics for pain. Personally, I would like to talk to him about nonpharmalogical interventions and about pacing himself during his physical activity...but there are at least 4 more interventions that I can think of...including using a different pain scale that is acceptable to him, having him keep a pain diary, dispelling the myths around addiction in pain management and so on. I am trying desparately to gear this toward what this instructor wants because she won't come right out and tell us what she is looking for and just expects us to know which TWO out of the dozen or two possible interventions SHE wants us to focus on. This is so hard!

I decided to go with the following and tell me if they are alright:

Nursing Dx: Chronic pain r/t inflammation of the joints aeb client report of pain in neck and right hip of 6/10

Goal: Pain will be less than 6/10. Target Date 12/01/08

Outcome Criteria: Clent will use Abbey Pain scale rating comfortably to identify current level of pain intensity, determine comfort/function goal within 1 week.

Client will demonstrate understanding of plan for pharmacological and nonpharmacological pain relief by end of doctor visit.

Nursing Interventions:

Nurse will questions the client regarding the level of pain that he believes i approprite to achieve a state of confort and appropriate function.

Discuss clien's fears of addiction.

In addition to use of analgesics, support the client's use of nonpharmacological methods to help control pain, such as physical therapy, guided imagery, relaxation and application of heat and cold.

Does that sound better?

Thank you so much for your help. I really appreciate it!

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

you still don't have any specific care listed for the pain. i fear that "in addition to use of analgesics, support the client's use of nonpharmacological methods to help control pain, such as physical therapy, guided imagery, relaxation and application of heat and cold" is too generalized and nonspecific and you will get dinged for it. you need to take more of a leadership position and guide the patient on what to do. assume the patient is also a partner in this care plan and wants to get help for the pain. "nurse, help me. but i don't want to do drugs". if questioning and discussing his level of pain and fear of addiction (in other words, how come you're so afraid to take the pills, buddy?) then this guy is going to look for someone else to help him. your two interventions are still assessments and not really giving him constructive help.

watch me. . .

see if reading this article from the nih doesn't help (http://www.niams.nih.gov/health_info/osteoarthritis/default.asp). i pulled out the information they list for nondrug pain interventions:

nondrug pain relief

people with osteoarthritis may find many nondrug ways to relieve pain. below are some examples:

  • heat and cold: heat or cold (or a combination of the two) can be useful for joint pain. heat can be applied in a number of different ways - with warm towels, hot packs, or a warm bath or shower - to increase blood flow and ease pain and stiffness. in some cases, cold packs (bags of ice or frozen vegetables wrapped in a towel), which reduce inflammation, can relieve pain or numb the sore area. (check with a doctor or physical therapist to find out if heat or cold is the best treatment.)

  • transcutaneous electrical nerve stimulation (tens): tens is a technique that uses a small electronic device to direct mild electric pulses to nerve endings that lie beneath the skin in the painful area. tens may relieve some arthritis pain. it seems to work by blocking pain messages to the brain and by modifying pain perception.

  • massage: in this approach to pain relief, a massage therapist will lightly stroke or knead the painful muscles. this may increase blood flow and bring warmth to a stressed area. however, arthritis-stressed joints are sensitive, so the therapist must be familiar with the problems of the disease.

goal: the client will report improved pain in the neck and hip by 12/1/08 aeb a verbalized level of 4/10.

outcomes: i am not understanding exactly what you are to achieve with these.

nursing interventions:

  1. nurse will ask the client to maintain a diary of pain ratings, timing, precipitating events, medications and results, and treatments and results. rationale: the effectiveness of these modalities can only be evaluated when there is evidence to support their success or failure.
  2. instruct patient to try the application of ice packs to the back of neck and right hip for 20 minutes four times a day. rationale: the cold constricts blood vessels and reduces blood flow to and helps reduce swelling around the arthritic site. ice also numbs the area and helps to reduce pain and help prevent muscle spasms.
  3. make a referral to a massage therapist for recommendation for treatment and ask that attention be made to the neck and hip areas or other areas of pain brought about by the osteoarthritis. rationale: it is within the scope of the rns practice to refer the patient to other professionals for treatment. massage stimulates the release of endorphins by the body, a natural pain killer.

hope that helps. you need to put it in the context of your assignment.

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Wow! Those interventions are not even in my book!

You know...I get confused with the outcomes, as well and it is not really being explained very well.

I will try again...thank you so much!:nurse:

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Daytonite rocks when it comes to giving our resources.

She is the walking-nursing-encyclopedia.

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

Not really, I just knew there were other resources besides drugs and was lucky when it came to looking for them on the Internet is all. I also put myself in the shoes of the patient. Lately, I've been seeing PAs rather than doctors when I've been going to appointments. One PA has been trying to shove drugs down my throat for my nerve damage from my chemotherapy and both times I had terrible reactions. I told the doctor that if he sent me to this same PA again I was gonna punch her in the face, walk out and tell my internist to send me to someone else. He switched me to another PA and we discuss other options.

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Oh I am with you. If the patient doesn't want drugs, don't make him take them. I just feel that this is one of those classes where I have to give my gear everything to my instructor's opinion. She does not seem to allow free thinking. grrrr

How about this one? Remember though...I have to remove 2 of these interventions. I have to only use 2. He obviously needs much more than that.

Assessment

88 yo male

Social: lives alone, son lives nearby and checks on client 1X per day

Medical History: Oa X 5 yrs

Pain Scale: 6/10

Medications: Celebrex

Physical Activity: walks 2 miles X3 days per week

ADLs: Independent

Nursing

Diagnosis

Chronic Pain r/t inflammation of the joints aeb client report of pain in neck and right hip

Intrapersonal:

Believes pain is a normal part of aging

Dx: osteoarthritis

Pain level: 6/10

Fear of becoming addicted to pain medication

Uncomfortable rating pain on pain scale

Interpersonal

Son lives nearby and checks on him daily

Extrapersonal

Celebrex

Pain Scale

Goal

The client will report improved pain in the neck and hip by 12/01/08 AEB a verbalized level of 4/10.

Outcome Criteria

Pain Control:

Client will use Abbey pain rating scale comfortably to identify current level of pain intensity, determine comfort/function goal within 1 week.

Client will demonstrate understanding of plan for pharmacological and non-pharmacological pain relief by end of doctor visit.

Client will function on an acceptable ability level with minimal interference from pain and medication side effects by 12/01/08

Client will demonstrate compliance with treatment plan by making appointment with massage therapist within 1 week and by keeping the appointment.

Nursing Intervention

Instruct client on importance of ability to express pain level in order to help care providers adjust treatments.

Discuss the client’s fears of addiction and use of nonpharmacological pain relief.

In addition to the use of analgesics, support the client’s use of nonpharmacological methods to help control pain, such as massage therapy.

Make a referral to a massage therapist for recommendation for treatment and ask that attention be made to the neck and hip areas or other areas of pain brought about by the inflammation.

Rational

The pain rating that allows the client to have comfort and appropriate function should be determined: this allows a tangible way to measure outcomes of pain management.

Because of the many misconceptions regarding pain and its treatment, education about the ability to control pain effectively and corrections of myths about the use of opioids should be included as part of the treatment plan.

Cognitive-behavioral strategies can restore the client’s sense of self-control, personal efficacy, and active participation in his or her own care.

It is within the scope of the RNs practice to refer the patient to other professionals for treatment. Massage stimulates the release of endorphins by the body, a natural pain killer.

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

Sounds much better.

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Thank you!

I e-mailed it to my instructor and according to her it is all wrong.

Goal should be short term, broad with no time frame.

Intervention is long term with time frame.

She ones one goal and two interventions.

She said they don't do it right in the real world. She's driving me nuts. Told you...no matter what I do it is wrong!

I will do it her way and turn it in. If it's wrong, oh well. criminy....4 more weeks with this instructor...thank GOD!

Now...where can I find a really good form for the glasgow coma scale?

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Specializes in Future ICU nurse.
Wow! Those interventions are not even in my book!

You know...I get confused with the outcomes, as well and it is not really being explained very well.

I will try again...thank you so much!:nurse:

I am also a BSN student and for our outcomes we must use the SMART criteria.

S- short

M- measurable

A- attainable

R- realistic

T- timed

We are tought that pain relief is a priority.

A sample nursing dx for us:

Chronic pain r/t progression of joint degeneration aeb pt report of pain level of 6 on 0-10 scale

If only using 2 interventions I would use the 2 that are more likely to generate pain relief

1- teach pt about analgesic medication use and the risk of dependency

2- administer perscribed analgesic

Outcome:

Pt will verbalize pain score of

Normally my time table would be 1-2 hrs but this pt needs teaching in order for him to accept medication.

Intervention

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