dissapointed

SummerGarden, BSN, MSN, RN · Sep 5, 2008

Talk to your CI (clinical instructor) because only he/she knows what he/she was thinking when he/she graded your paper.

Daytonite, BSN, RN · Sep 5, 2008

age of pt: 78

problem identified: decreased mobility

nursing diagnosis: impaired physical mobility related to decreased activity tolereance/strength and endurance

if the patient has an activity tolerance problem then they should be diagnosed as having

activity intolerance

and there is a diagnosis for this.

activity intolerance

has to do with the lack of

energy

to perform adls.

impaired physical mobility

has to do with the

physical/muscular

ability to perform movement. when i saw

weak, slowed movement, and late reaction

i thought of

activity intolerance.

another problem i think you have is with the vagueness in which these symptoms are worded which i address lower down the page.

cause analysis: pt > 65 yrs of age are those who are weak and experiences decreased muscle strenght which results in limitation in independent purposful physical movement of the body or of one or more extremities

objective cues

weak

slowed movement

late reaction

always sitting on chair

small steps

limited rom

weak, slowed movement, and late reaction

have to do with

energy

.

always sitting on chair

is a vague assessment. i would expand more on that. how long does the chair sitting last? did you question the patient about why they sit so long? did you have and observe the patient stand from a sitting position for you? were there problems with the patient doing that which would explain why they kept seated once down? i would have done the same with

small steps.

perhaps there is a balance problem so taking small steps was the way the patient felt safest? describe

limited rom

.

how much movement of each arm and leg does the patient actually have? how much assistance was actually needed when walking? what was the patient's balance like? can the patient stand on one foot?

objectives

short term

after 3 hours of health teaching and nursing intervention, pt will be able to express concerns related to her condition and will be able to verbalize understanding on ways to promote mobility such as performing simple rom exercises and rest

long term

after 8 hours of nursing intervention, pt will show increased capability to perform simple measures to promote mobility such as simple exercises and participating in active/passive exercises.

objectives are the results you expect to see

when your interventions have been performed

.

you mention 3-hours of health teaching, yet nowhere in your list of nursing interventions is any health teaching mentioned!
symptoms + interventions = outcomes/goals

interventions

1)dtermine functional ability and reasons for impairerment and assess for nutritional status

2)encourage active/passive exercises

3)provide ample time to perform mobility related tasks

5)schedule walking exercise activities interperesed with adequate rest periods

collaborative

consult with pt/ot /rehabilitation team

interventions always relate back to and address the patients symptoms (you are calling them

objective cues

). when you are solving this problem, ask yourself, "what am i doing for the

weak
slowed movement
late reaction
always sitting on chair
small steps
limited rom

and see if you are addressing each symptom (objective cue) in some way because you are saying that each of these objective cues is evidence of this patient's problem of

decreased mobility.

think about this. . .to get rid of the problem you also need to get rid of the evidence, right? so, your job as the managing nurse on the case is to do your best to fix the symptoms and, if possible, get rid of what is causing the problem in the first case. getting rid of the underlying cause of the problem isn't always feasible, so you do the next best thing--chip away at the resulting symptoms, in this case the weakness, slowed movement, late reaction, always sitting on chair, small steps, and limited rom.(remember: i think i've mentioned to you before that care planning is problem solving.) the goal of any care planning is to improve, stabilize or support the deteriorization of the problem. in that regard, there are 4 kinds of nursing interventions that you can develop for objective cues:

assess/monitor/evaluate/observe (to evaluate the patient's condition)
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)

(same pt)

second ncp (these are not ncps but nursing diagnoses or patient problems)

problem: knee pain

nursing diagnosis: altered comfort: knee pain related to accumulation of fluid secondary to arthritis

the correct nanda terminology is

acute pain.

i would have written this as

acute pain related to inflammed joint secondary to artritis of knee.

cause analysis: swelling in small joints places pressure on pain receptors causing pain. it is associated with pain stiffness and fatigue

i would have worded this: the inflammatory response causes the build up of waste products and the accumulation of fluid in the area of inflammation. this swelling pushes on surrounding tissues and structures which includes pain receptors.

cues

p=prolonged sitting (this is not evidence of pain)

q=dull

r=knee

s-5/10 (moderate)

t=9

guarding of knee

grimacing when moving

pt appears weak (this is not evidence of pain)

has limited body movment

appears to be lacking of sleep

short term

after 2 hours of providing nursing intervention and health teching, pt will be able to enumerate ways to relieve pain such as ice massage, deep breathing and will be able to express concerns related to her condition

long term

after 8 hours of nursing internvention, the pt will be able to report relief of pain and would demonstrate techniques to minimize pain such as positioning and use of relaxation techniques.

again, no mention of any teaching in your interventions.

internventions

1. assess/monitor vital signs

2. position pt as indicated

3. provide additional comfort measures such as backrub, heat/cold applications

4. encourage use of relaxation techniques such ad deep breathing exercises

5. use of therapeutic touch

6. provide ice massage

collaborative.

administer medications as prescribed (celebrex 200g cap, tramadol, 50mg/1ml ivtt)

a care plan forms a full circle when it is complete. the symptoms must be connected to the interventions. the goals must be connected to the interventions. ultimately, your solution to the problem targets the nursing diagnosis. it is all relative and rational. this is why some instructors use the concept map to teach care planning since it illustrates these connections.