First Care Plan Dx

Daytonite, BSN, RN · Oct 11, 2008

i reorganized the priority. the order (by maslow) is elimination, movement, comfort, safety, anticipated need.

functional urinary incontinence r/t dementia and impaired physical mobility aeb functional and cognitive impairment.

related factor (cause): the definition of this diagnosis is

inability of the usually continent person to reach toilet in time to avoid unintentional loss of urine.

so, you are saying that this patient is continent except that they cannot get to the toilet in time, right? the related factors for that are impaired cognition which is the dementia. you already have a diagnosis for impaired physical mobility and that is a pretty broad phrase. what specifically hinders this patient from getting to the bathroom?

evidence: functional and cognitive impairment are decisions made about the assessment data. what was the actual evidence that led to determining this problem? did the patient start peeing halfway on the way to the bathroom?

see

[color=#3366ff]functional urinary incontinence

impaired physical mobility r/t pain and contractures of arthritic knees aeb limited ability to perform gross and fine motor skills.

related factor: you can't say "contractures of

arthritic

knees". the word "arthritic" is a medical diagnosis. just say "contractures of knees" or "knee contractures"

evidence: you need to specify the limited ability to perform gross and fine motor skills. name some of the specific things the patient can't do.

see

impaired physical mobility

and

http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=35

chronic pain r/t arthritis of the knees aeb client's vocalized rating of a 2/10 on pain scale.

related factor: "arthritis" is a medical diagnosis and cannot be used. the alternative is to say "inflammation of joints". you could also mention the contractures as a cause of pain.

see

[color=#3366ff]chronic pain

and

http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=41

chronic confusion r/t dementia aeb impaired short-term memory and altered response to stimuli.

evidence: don't you have any specific data from the assessment to use?

see

[color=#3366ff]chronic confusion

and

http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=12

risk for impaired skin integrity r/t incontinence.

it's not entirely the incontinence that causes maceration and breakdown of the skin. it's the fact the patient sits in the moisture.

risk for impaired skin integrity r/t moisture from urine.

whiteoleander5 · Oct 11, 2008

i reorganized the priority. the order (by maslow) is elimination, movement, comfort, safety, anticipated need.
functional urinary incontinence r/t dementia and impaired physical mobility aeb functional and cognitive impairment.
related factor (cause): the definition of this diagnosis is
inability of the usually continent person to reach toilet in time to avoid unintentional loss of urine.
so, you are saying that this patient is continent except that they cannot get to the toilet in time, right? the related factors for that are impaired cognition which is the dementia. you already have a diagnosis for impaired physical mobility and that is a pretty broad phrase. what specifically hinders this patient from getting to the bathroom?
evidence: functional and cognitive impairment are decisions made about the assessment data. what was the actual evidence that led to determining this problem? did the patient start peeing halfway on the way to the bathroom?
see
[color=#3366ff]functional urinary incontinence
impaired physical mobility r/t pain and contractures of arthritic knees aeb limited ability to perform gross and fine motor skills.
related factor: you can't say "contractures of
arthritic
knees". the word "arthritic" is a medical diagnosis. just say "contractures of knees" or "knee contractures"
evidence: you need to specify the limited ability to perform gross and fine motor skills. name some of the specific things the patient can't do.
see
impaired physical mobility
and
http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=35
chronic pain r/t arthritis of the knees aeb client's vocalized rating of a 2/10 on pain scale.
related factor: "arthritis" is a medical diagnosis and cannot be used. the alternative is to say "inflammation of joints". you could also mention the contractures as a cause of pain.
see
[color=#3366ff]chronic pain
and
http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=41
chronic confusion r/t dementia aeb impaired short-term memory and altered response to stimuli.
evidence: don't you have any specific data from the assessment to use?
see
[color=#3366ff]chronic confusion
and
http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=12
risk for impaired skin integrity r/t incontinence.
it's not entirely the incontinence that causes maceration and breakdown of the skin. it's the fact the patient sits in the moisture.
risk for impaired skin integrity r/t moisture from urine.

i took all of my r/t and aeb specifically from the nursing diagnosis handbook by ackley. i probably shouldn't rely on it word for word (other than the problem part of the pes...) but i think because its my first careplan, i am a little hesitant to not write exactly what is written...:imbar

i find it tricky to prioritize them. wouldn't pain come first? or no, because it is chronic? .. whats the reasoning behind it? i would think you would want to eliminate the pain before anything else, but thats not true following maslow and i dont understand why. i reordered mine to what you said, so thank you.

i tried to fix them...:

functional urinary incontinence r/t dementia and impaired physical mobility aeb functional and cognitive impairment. -??i really dont know what to change for this one. i am confused, can i just write "urinary incontinence r/t...."? i wasnt sure which urinary incontinence to choose from my book but i chose this one bc it was the only one that discussed dementia in its definition. she has dementia, she cant move-- i'm not sure of the exact reason for her incontinence, but i'm assuming it involves those two factors. my only evidence that she is incontinent is that she wears diapers and is what i was told before i walked in the room. so what should i write for that?..."it whats i was told" lol.. :stone

impaired physical mobility r/t pain and contractures of knees aeb inability to ambulate without assistance and wheelchair use. -?

chronic pain r/t imflammation of knee joints aeb client's vocalized rating of a 2/10 on pain scale.

chronic confusion r/t dementia aeb impaired short-term memory and inability to communicate effectively.

risk for impaired skin integrity r/t moisture from urine.

hopefully these are better. i am really just not liking the incontinence one, and why pain doesnt come before any of the others. :rolleyes:

Daytonite, BSN, RN · Oct 11, 2008

i find it tricky to prioritize them. wouldn't pain come first? or no, because it is chronic? .. whats the reasoning behind it? i would think you would want to eliminate the pain before anything else, but thats not true following maslow and i dont understand why. i reordered mine to what you said, so thank you.

i listed the reasoning for the way i prioritized them: the order (by maslow) is elimination, movement, comfort, safety, anticipated need. on the maslow hierarchy elimination (functional urinary incontinence) comes before movement, movement (impaired physical mobility) comes before comfort (chronic pain), comfort comes before safety (chronic confusion), and an anticipated need (risk for impaired skin integrity) always come after actual problems.

see

http://en.wikipedia.org/wiki/maslow's_hierarchy_of_needs

for an explanation of maslow's hierarchy of needs. maybe your instructors want you to prioritize another way. ask them.

why do you think

chronic pain

should be listed first? this is your care plan. you can do what you want with it. i am giving you my opinions. i may not have the same views as your instructor who is going to be grading the care plan. i am not sitting in class listening to the lectures or seeing the syllabus with the assignment instructions. you are.

functional urinary incontinence r/t dementia and impaired physical mobility aeb functional and cognitive impairment. - my only evidence that she is incontinent is that she wears diapers and is what i was told before i walked in the room. so what should i write for that?

can't help you here. a diagnosis is based on what was assessed and observed in the patient. you always want to ask "why" is something happening and look for those answers. "why is this patient incontinent" would probably lead to the correct type of incontinence diagnosis here. she is probably more like

total urinary incontinence r/t neurological impairment

aeb unawareness of urinating

. it's too bad that you don't have any information about her medical conditions.

impaired physical mobility r/t pain and contractures of knees aeb inability to ambulate without assistance of wheelchair.

chronic pain r/t inflammation of knee joints aeb client's vocalized rating of a 2/10 on pain scale.

chronic confusion r/t dementia aeb impaired short-term memory and inability to communicate effectively .

"inability to communicate effectively" is the identification of a problem:

impaired verbal communication

. it is not evidence that supports this nursing diagnosis.

risk for impaired skin integrity r/t moisture from urine.

spongebob6286, BSN, RN · Oct 12, 2008

based on maslow's hierarchy of needs, elimination is under the physiologic need, and its the 1st thing to be met before you can go to another level.