Desperately Need Help With Care Plans

Any help with care plans will be appreciated?

Thank you so much for taking the time to address my little problem. I finally decided that a Nursing Diagnosis of Decreased Cardiac Output more fit the symptoms this patient is having. So I kind of did what you suggested and addressed the symtoms, in a long, round about way. Unfortunately, at this point in our clinic experience, we review the charts the night before and can only visit our patient long enough to introduce ourselves. It is a little frustrating trying to come up with a care plan for a patient you have not yet assessed.

However, my guess is that the instructors are trying to get us used to how to go about creating a care plan. Somehow I know that sentence could make better sense, but I have just packed in the books for the night and am too tired to think straight.

Thank you again for your assistance.

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

Decreased Cardiac Output R/T decreased preload AEB hypotension and oliguria

(The definition of this nursing diagnosis is inadequate blood pumped by the heart to meet the metabolic demands of the body.)

Nursing Interventions/Rationales:

  1. Monitor blood pressure (frequency?) (Maintaining normal parameters assures adequate perfusion of all body tissues with blood, oxygen and nutrients.)
  2. Listen to heart and lung sounds, monitoring for symptoms of heart failure (Looking for dyspnea, 3rd and/or 4th heart sounds and crackles in lungs which indicate heart failure and need to be reported to the physician.)
  3. Monitor intake and output (Decrease cardiac output causes decreased kidney perfusion resulting in a decrease in urinary output.)
  4. Administer oxygen (Supplemental oxygen provides oxygen needed for the heart and other body tissues.)
  5. Place patient in semi-Fowler's postion. (Helps to ease breathing and decreases venous return to the heart.)

So this lady is basically comfort care?

Then she's not being vented, transfused, receiving drugs/fluids for circulatory failure?

Then I would concentrate on her breathing.

I guess i'm not understanding how aggressive they're being.

If she was being aggressively managed, then interventions r/t her sepsis would be more critical.

Is she receiving pressors?

Are her organs being perfused?

Is she managing w/o a vent?

Are you looking for interventions for the sepsis or end of life care?

Leslie

ETA: I reread all the posts. I wonder if she's not receiving aggressive care, then what good is it to monitor bp, uo, etc., if nothing is going to be done about it? Is she only receiving abx? Are they trying to maintain her, even knowing that she's going to die? In the event that she is comfort care, then some of these interventions mentioned, would be a moot point. I guess I do need more info.

I am trying to work up my careplan and need some help. My patient has constipation. He is 4 days postop but I contributing his constipation to all the medication that he is on and not because of the surgical anasthesia. 6 of his 13 medications main side effect is constipation. He said he has not had a BM in 5 days, and now has been ordered a fleets enema. My question is he has some abdomen distension above his umbilicus. Would this be a subjective sign of constipation or could this be something else. I was not sure with constipation where the abdomen distension should be. Thanks R

Specializes in Neuro/Med-Surg/Oncology.

What kind of surgery did your patient have? The distention could be from constipation. It could also be from gas or an ileus. How active has this patient been post-op? How much fluid has he taken in? Increasing activity and encouraging fluids and high fiber foods can be non-pharmacological interventions used alongside the medications. The other reason I wanted to know what kind of surgery your pt had is if it was anywhere in the abd or was a laproscopic surgery, he could be having some gas pain in addition to incisional pain. It's important that the pt be taught to differentiate between the two types of pain so he does not slow his gut down further by taking pain meds for gas pain. Just my .02. Hope it helps.

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

Yes, this is an objective (because you can see and observe it), not a subjective, sign of constipation and flatus build up. 5 days with no bm + air in the bowel from him being under anesthetic = abdominal distension and constipation. As the distension builds up, where's all this air and feces going to go if the patient isn't passing stool or gas? Up and pushing upward on the structures lying under the diaphragm. Even if a patient is npo the body still makes a few grams of stool every day. The peristalsis of the gi tract is slowed immensely by anesthetic agents and narcotics that are given during or. An empty inactive bowel fills with air. This is generally the cause of postop abdominal cramping. Give the fleets enema to relieve the patient of the constipation and flatus. Just as a nursing action i might do an abdominal girth measurement with a tape measure before the enema and again afterward to empirically confirm if the abdominal distension were improved by the enema. Male abdomen's are capable of wondrous stretching. Their signs of bloating aren't quite the same as for females. When they bloat, they will get swelling all throughout the midriff and up to their xiphoid area.

Airway

observe and provide oral care q __ hrs

i hate it when staff neglects the mouth...

How are his bowel sounds?

And a rectal tube will help pass the flatus.

If he's on constipating meds, combined w/the known effects of anesthesia and immobility, he should be on a bowel regimen until he's off some of these meds, up and about w/pt....

Specializes in Pulmonary.

I have a question about sleep that I need answered for class. Can anyone help?

Pt. complains of difficulty falling asleep, awakening earlier than desired, and not feeling rested. She attributes these problems to leg pain that is secondary to her arthritis. What would be the appropriate nursing diagnosis for her?

a. sleep pattern disturbances related to arthritis

b. fatigue related to leg pain

c. knowledge deficit related to sleep hygiene measures

d. sleep pattern disturbances related to chronic leg pain

I am pretty sure it is between a and c, but we have hardly talked about nursing diagnoses at all yet. I don't quite get how to pick the "related to" portion. Thanks for any help in advance.

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

The answer is "D". The "related to" factors are those things that are the etiology or cause of the nursing diagnosis. As a nurse, it is not within the scope of your practice to say that the cause of the person's sleep disturbances is arthritis. That would be in a physician's realm to state that a patient had arthritis. You can, however, use the terminology "chronic leg pain". It is not a medical diagnosis and is, per the patient, the reason she is not able to sleep.

In NANDA's world, the cause, or "related to" factor should be something that the nurse can do something about through his/her own independent actions. Now, I know people are going to say that there are independent actions a nurse can take for a patient with arthritis. And, that is true, but arthritis is still a medical diagnosis and also requires medical intervention. A rule of thumb when working with or developing nursing diagnostic statements is not to use medical diagnosis or medical disease terms as "related to" items. Arthritis would be considered a medical diagnosis; chronic leg pain would not--it is a symptom and a vague one at that. There are very few exceptions to using medical diagnoses as "related to" items, but they are rare.

Just to throw a monkey wrench in here, there could also be a case for answer "B", fatigue related to leg pain. The only reason I would not choose it is because the patient is not complaining of exhaustion and inability to perform normal activities of daily living at her regular level of functioning which is the definition of that diagnoses. Had that been the case, fatigue would have been the diagnosis of choice.

If you have a care plan or a nursing diagnosis handbook, read the very early chapter(s) where it talks about the nursing process and forming the nursing diagnosis. One reading is not enough. It needs to be read and mulled over several times before getting a grasp on these concepts.

To skip ahead of your instructor a bit, the complete nursing diagnostic statement for this particular patient would be: Sleep pattern disturbances related to chronic leg pain as evidenced by difficulty falling asleep, awakening earlier than desired, and not feeling rested.

I am clueless on what diagnosis is suitable for this particular problem of a patient of mine.

She's 42. She tells me that she has a lump on her urethra and she doesnt want to seek medical help because of financial problems.. She also says that if she'll undergo an operation of her lump, there will be no one to work for the family because of the recovery time needed (she's the only one working in the family..)

She also says that everytime she experiences fatigue (where she experiences it during work.), the lump grows bigger..

i was thinking of these 3: ineffective coping, non-compliance and ineffective health maintenance. but it does not seem right.. and i do not have a clue on what will be my "related to"..

any suggestions..??

thanks..

Specializes in OB, ortho/neuro, home care, office.

risk for decreased urinary output would be another (if indeed she has a 'lump' on her urethra OR there's another

Health Maintainance Alteration r/t lack of financial resources

Risk for Role performance alterations r/t primary provider

Nursing Diagnosis Reference Manual

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