Do care plans get easier as you go

Luv2BAnurse · Aug 22, 2005

Try living the "part" of the patient. Pretend to have had a CVA with R side weakness. Move about with the weakness. Imagine your daily living with that diagnosis. Then I'm sure several more dx will come to mind. Risk diagnoses....for injury, aspiration, etc...etc...etc....

Daytonite, BSN, RN · Aug 22, 2005

I'll start you off. . .

How will your patient eat? Swallow? Speak? How about hydration?Any problems there.

How about her mental situation, any depression? Confusion? Crying? Potential for seizures? Is she able to call for help? Can she recognize a hazard (cognitive abilities)? Any other sensory/motor/or, cognitive deficits?

Hows her lung status? Any potential for pneumonia? Is the patient able to clear her own airway?

She will have impaired mobility and gait. Her environment will need to be adapted to accomodate her right sided weakness.

Is she incontinent?

Is she going to need community services? Financial help?

Where's her family in all this?

XIGRIS · Aug 22, 2005

I am working on my care plan for case study in school. I am so confused I can't seem to make my brain think like a nurse. My pt has had a CVA c right side weakness. She is complete ADL 's and the only dx i can think of is skin integrity, impaired. my brain won't work.

Care plans get easier as you continue on. Remember it is only a guide you can change it anytime. plus this is only than in nursing school. In a real world you do care plan in your head. You dont write it down. if one intervention doesnt work you go with the other. As a student we are taught to do care plans so and we look for references/rationale why you are doing such intervention.

Care plan is actually nice. It will test you knwoledge in pathophysiology.

Daytonite, BSN, RN · Aug 22, 2005

We had to have a written care plan on every patient, and it became part of the permanent chart.

mhull · Aug 22, 2005

Try this website

http://www1.us.elsevierhealth.com/MERLIN/Ackley/NDH/Constructor/A-B.html

AuntieRN · Aug 30, 2005

I'm with ya on these care plans Navywife. I had an awful time with them last semester. I just do not get them. I know that you are supposed to prioritize your nursing diagnosis and interventions along with the outcomes, but they just do not make any sense to me when I am trying to put them together. It took me almost all semester this summer just to get an S on one. Before that I could not get above an S-. I would spend hours and hours trying to do them. I knew how to take care of my patients though, I just couldn't get it to fit into that care plan. :crying2:

rn/writer, RN · Aug 31, 2005

I don't know how far along you are in school but you either have or will come across Maslow's hierarchy of needs. This is a prioritizing of the concerns a human being faces. The first is physiological needs, second is safety and security, third is belongingness, and so on. When you are trying to to come up with a care plan, do what a previous poster suggested and look out your patient's eyes. Think about what you need to do to feed and clothe yourself, take care of your body's various needs, get around your room or house, provide for yourself, keep yourself safe. Once you have the questions (how do you meet these needs), you can begin to supply the answers.

There are divisions within each category. For instance, the physiological needs category always, always, always begins with the ABCs. No matter what else is going on, if you don't have an airway, breathing, and circulation under control, you don't have a patient. So your care plan should address any difficulty breathing, COPD, oxygenation needs, circulation impairment, etc. Once the ABCs are adequately addressed, you look at the remaining needs in the order of their urgency. Hydration comes high on the list. Nutrition comes before mobility. Look at the general list of needs your patient has and try to organize them in order of which things would cause problems for you patient first.

The one exception is safety, which is really a part of every item on the list. You learn to size up pretty much any situation with safety in mind. For example, you might start an IV because it was ordered after you let the doc know your pt. showed signs of dehydration. But in connection with the IV, you will use the five rights, prime the pump to remove air, discard any sharps, wear gloves, wipe up any spilled fluids, etc. Safety is like air. It's a part of everything.

There are many good websites and books out there to help you make sense of all this. Keeping the Maslow model in mind helps to ensure that you don't knock yourself out coming up with a plan to address your patient's depression while forgetting that she hasn't eaten well in three days. It's all about priorities.

One encouraging note--once you get out into the real world, you will often find that most med-surg floors and specialty units have flow sheets and pathways for the most common types of patients. This keeps nurses from having to re-invent the wheel with every new admission. Just remember that pathways cover the usual and basic and be alert to needs that don't fall into the normal expectations. That's why you are being put through this part of your training now. So that you can use a pathway as a tool but still use your brain for those who need something outside the box.

I wish you well.

Miranda

jerryh55 · Aug 31, 2005

Not sure what care plan book your using, but trust me when I say the care plan book makes a big diff. I struggled with care plans during my first year and found it hard to follow way the book flowed. During the summer i found a book at books a million and finally bouth it on ebay. It's Nursing Care Plans - Nursing diagnosis and intervention - 5th edition from mosby and written by Gulanik. Go take a look at it if you have a books a million or a barnes and noble near you.

Good Luck And Be Safe

Jerry

nayray13 · Sep 12, 2005

i just ordered that book...i am so glad to hear you say that...i have a really hard time like the others were talking about....and i actually ordered that book and a couple others last night....not so nervous about careplans now, thanks

nay

truern · Sep 12, 2005

Think ABCs first...airway, breathing, circulation..when prioritizing. Then go with Maslow's needs...work your way up the pyramid.

Care plan books are great resources, as well as your med-surg books which should have some top nursing priorities already identified for you. Mine even has suggested care plans :)

Just make sure you individualize the care plans to your particular patient. You wouldn't want to say "check pedal pulses q shift" if your patient had both feet amputated!! Yikes!!

It will become second nature, I promise :)

nursern20 · Sep 12, 2005

I had the exact same problem as you my first semester of nursing school. I'm now in my last year and even still i hate doing care plans, the whole process is just so tedious.

But the good part is that you get used to doing them and diagnosis, rationale, interventions, etc... will all start to come to you naturally as you continue learning about the different illnesses and whatnot.

And yes, care plan books are great!