Desperately Need Help With Care Plans

Any help with care plans will be appreciated?

Bowel incontinence r/t decreased awareness of need to defecate/loss of sphincter control.

Deficient knowledge r/t lack of information on normal bowel elimination.

Disturbed body image r/t inability to control elimination of stool.

Risk for impaired skin integrity r/t prescence of stool.

Situational low self-esteem r/t inability to control elimination of stool.

Tolieting self-care deficit r/t toileting needs.

Functional incontinence r/t altered environment; sensory; cognitive or mobility defects.

Reflex incontinence r/t neuro impairment.

Risk for impaired skin integrity r/t prescence of urine.

Stress urinary incont. r/t degenerative change in pelvic muscles and structural supports.

Urge urinary incontinence r/t decreased bladder capacity (h/o PID, abd sx, indwelling cath).

Hope this helps!

Risk for falls r/t history of falls

Patient will verbalize understanding of individual risk factors that contribute to posibility of falls and take steps to correct situation

Urinary incontinence r/t weak pelvic muscles and structural supports

Patient will understand condition and interventions for bladder conditioning

Demonstrate behaviors/techniques to strengten pelvic floor musculature

Remain continent even with increase intra-abdomincal pressure.

Specializes in med/surg, telemetry, IV therapy, mgmt.
FutureNurse35 said:
Risk for falls r/t history of falls

Patient will verbalize understanding of individual risk factors that contribute to posibility of falls and take steps to correct situation

Urinary incontinence r/t weak pelvic muscles and structural supports

Patient will understand condition and interventions for bladder conditioning

Demonstrate behaviors/techniques to strengten pelvic floor musculature

Remain continent even with increase intra-abdomincal pressure.

Nice outcomes! However, you also have to put timed deadlines on them. For example:

  • In two days the patient will give a return demonstration of pelvic floor strengthening exercises and share an exercise plan with nurse.
  • After one week the patient will have no episodes of stress incontinence for one continuous 24 hours period.
Specializes in med/surg, telemetry, IV therapy, mgmt.
x-tremestudent said:
thank you so much for your help. i am a lvn student and am 43 would u recommend me to go on to rn school considering my age and all

If you want to go on to become an rn, then do it. Your age won't matter. My mother went to lvn school when she was 50+ and worked as a nurse until she was 68. Right now rns are needed and the largest group of rns that are presently employed is in their 40s. Go for it!

I hope my reply to your post(s) helped to clear up some of the problems you were having with the case study. Do you have a care plan or nursing diagnosis book to help you with the goals/outcomes and nursing interventions? If so, it is important to review the first chapter(s) on the nursing process and how to write a care plan. Nursing diagnoses are always determined by the assessment data that you have. Case scenarios where you don't have a real live patient are always a little edgier because you have to work with the information given to you and sometimes you have to do a little bit of extrapolating and assume some things which you wouldn't normally do with a real patient. Like the question about the patient using alcohol. I think that the idea there was for you to do a little investigation of the use of alcohol by the elderly, or the effects of alcohol abuse in the elderly since two of the actual symptoms you were given (frequent urination and falling) are symptoms of current alcohol use. Problems with balance, which you would have to assume as a possible cause for the falls (can't assume this with a real patient) would be a long term affect of alcohol abuse. Older people who have been heavy alcohol abusers for many, many years have a lot of chronic neurological problems as a result. So even though they many have stopped drinking by the time they reach their 70s and 80s, the brain damage has already been done.

I had an older assessment book that i used to help form some of the assessment questions for you that i bought about 8 years ago called expert 10-minute physical examinations that was published by mosby-year book in 1997. I don't know that it's even in publication anymore, but the more i use it, the more i realize how simply organized and concise it is. You should explore these three threads on the nursing student forums. The assessment one, in particular, has many links to websites with assessment data on them to help you. I have no quick way to help you be a "question box". This is a skill you have to develop on your own. You have to think about all the possibilities that might be going on and ask questions designed to get you information that will confirm or deny them. That's the best explanation i can think of to tell you at this time. Assessment is not as easy a skill as some would want you to think. You will need to do many assessments of many different types of patients over a long period of time and you still will occasionally forget a question to ask or a subject to explore!

I'm student in my first year nursing and i have assignment that i wish any one help me in it .

The assignment is ( give expected nursing diagnosis for male pt of 70yrs old with ihd, chf , pulmonary odema , aspiration pnemonia and past history of : mi, poor ejection fraction,, arf when the pt. Is sedative)

Specializes in Med/Surg, Home Health.

Altered Tissue Perfusion

Impaired Gas Exchange

Fluid Volume Overload

Dont forget to add the "related to" and define why you choose each dx.

example: Altered Nutrition r/t Weight loss and TPN use

Just think about the s/s r/t each of the medical diagnosis. What would you expect a patient with CHF to experience? What would they look like? What limitations would they have? Then created your nsg dx based on that and not focus so much on the medical diagnosis.

Example for the CHF:

Activity intolerance r/t weakness or fatigue.

Impaired gas exchange r/t excessive fluid in the interstitial space of lungs.

Fatigue r/t disease process.

Decrease cardiac output r/t impaired cardiac function.

Fear r/t threat to well-being.

Good luck!

I'm having a problem stating a proper Nursing Diagnosis. This is the only part of the care plan I'm having issues with. For some reason my brain is just not getting this. For instance I have a client this week that has a dehisced wound on her abdomen that is infected. The wound was caused by surgical removal of a portacath secondary to infection.

So I've got the first part of a Ndx: Impaired skin integrity r/t--- then I go blank on what to write.

Now I know her skin is impaired due to a surgical procedure that was done due to an infection.

Can someone help me with the proper way to write this Ndx?

Thanks

How about:

Surgical recovery, delayed

--r/t (not specified by NANDA) but dehiscence and infection would seem to fit

--aeb evidence of interrupted healing of surgical area

Wilkinson notes that this nurs dx is not fully developed, but I like it.

Specializes in med/surg, telemetry, IV therapy, mgmt.
bld24 said:

I'm having a problem stating a proper nursing diagnosis. This is the only part of the care plan i'm having issues with. For some reason my brain is just not getting this. For instance i have a client this week that has a dehisced wound on her abdomen that is infected. The wound was caused by surgical removal of a portacath secondary to infection.
So i've got the first part of a ndx: impaired skin integrity r/t--- then i go blank on what to write.

Now i know her skin is impaired due to a surgical procedure that was done due to an infection.

Can someone help me with the proper way to write this ndx?

Thanks

The actual writing of the nursing diagnosis statement is based on the correct language, or words to use as well as correctly expressing each part of what the diagnostic statement is supposed to contain. The 3-part nursing diagnosis statement follows this format: pes, where p = problem, e = etiology (or cause), and s = symptoms. By the nanda-i (north american nursing diagnosis association, international) guidelines that means writing the nursing diagnostic statement as:

Tthe nursing diagnosis [problem]--related factor(s) [etiology, or cause]--defining characteristics [symptoms]

Most people are pretty good at putting together a list of the patient's symptoms and usually at picking the nursing diagnosis. The bigger problem is that dog gone "related factor", or etiology, which is where you drew your blank. This part of the process involves some thinking since the words you choose are important--and no medical diagnoses are allowed, usually. You need to take your group of symptoms and ask yourself, "what do they all have in common as the cause of this patient's problem?" the people at nanda-i did a lot of this thinking for nurses over the years because this part of the process has been a real stickler. This is sometimes where nursing care plan books and nursing diagnosis books can help you out since they've already worked up some of these things for you.

Actually, in reading your post, i saw that you had the elements for the r/t part of your diagnostic statement right in front of you, but you weren't seeing them for what they were. Looking at my nanda resource for this diagnosis wasn't a lot of help, for the actual wording to use, that is. However, the good thing about nanda is that they encourage creativity with writing these things. So, let me help you out.

  • Nursing diagnosis (problem) = impaired skin integrity
  • Related factor (etiology, cause) = open surgical wound on abdomen
  • Ddefining characteristics (symptoms) = [this part of the statement is the actual abnormal data assessment items you collected. they will be things such as the description of the wound and character of any drainage, results of any culture and sensitivity done of any exudates. in other words, the definition of this diagnosis is altered epidermis. what are you observing or have found in the medical record of this patient that has led you to the conclusion that she has altered epidermis, keeping in mind that wound dehiscence and infection are what are the underlying cause?]

Put all three elements together and you have your nursing diagnostic statement.

Impaired skin integrity r/t open surgical wound on abdomen aeb

To carry this two more steps farther (for others who are reading this), goals, or outcomes, are based on turning around the problems and symptoms. nursing interventions are developed for each of the defining characteristics, or symptoms, listed under each nursing diagnosis.

Purchase the book called "All-in-ONE CARE PLANNING RESCOURSE" It cover; Medical-surgical, pediatric, Maternity, and psychiotric Nursing Care Plans. It 's author is Swearingen and it's IBS is: 0-232-01953-6. It should cover anything you would need to know.

Saltlake

Specializes in med/surg, telemetry, IV therapy, mgmt.
rkdlpn said:
I need to see a care plan !

There are plenty of links to samples of care plans posted here on this thread. You are not always going to find samples of student care plans. I think the main reason is because of the fear of plagiarism. No one wants their hard work to be stolen. Not only that, but there is a patient privacy element to consider as well. The nursing care plan books that are organized by medical diagnosis contain care plans that almost always also include the rationales for the nursing interventions which is probably one of the things you are interested in seeing. Nursing Diagnosis Handbook: A Guide to Planning Care, 7th Edition, by Betty J. Ackley and Gail B. Ladwig includes rationales for the nursing interventions under each nursing diagnosis and extensive references for each rationale. Some of these are also posted on their care plan constructor site. The links to these constructor sites are included in this thread on post #92. Each of these online care plan constructor sites (the Ackley/Ladwig site and the Gulanick/Myers site) contain 50+ different nursing diagnoses pages. Each nursing diagnosis page has much of the same information that is in each authors book. The constructor sites themselves are also meant to format the information you choose or input into a skeleton form which you then print out. Most nursing schools, however, require a much more comprehensive format than what these constructor sites have to offer. The major information I see in them is the actual nursing diagnosis information from their books which is offered online for free.

There are a number of Internet website links where you can view care plans. They are posted on this thread in the following posts: #20, #26, #34, #35, #56, #78 (case studies), #113. Go to those posts, click on the links and you will be taken to those sites to view those care plans.

There is a great deal of information about writing care plans and about care plans, in general, on this thread. Many have contributed to it to make it so. Please, take the time to review the information available to you here. There are some real gems of information that will help you tremendously in understanding the care plan writing process. I would also encourage you to post any questions you have about care plans or a specific care plan you are working on. Questions about care plans are posed all the time on this particular forum, not this thread in particular.

+ Join the Discussion