ICU Care Plan

cardiacRN2006, ADN, RN · Feb 19, 2007

Can I offer a suggestion instead?

All ICU pts are at risk for falls, so make sure you have a Risk for Injury R/T falls diagnosis.

Also, pain, comfort, anxiety, fear, and communication are all big issues for pts in the ICU. As well as risk for infection R/T invasive lines and procedures being performed at the bedside.

leesespieces · Feb 19, 2007

thanks for the suggestion... i'm going to have to add that one....these are the ones i have so far:

nursing dx:

impaired gas exchange/ineffective breathing pattern/ineffective airway clearance

related to:

inflammation of the terminal airways and alveoli secondary to bacterial presence in the lungs

nursing dx:

decreased cardiac output

related to:

decreased circulating blood volume, decreases renal perfusion, diastolic dysfunction, backflow of blood into the right and left atrium, increases peripheral vascular resistance, altered electrical conduction, decreases myocardial oxygenation

nursing dx:

fluid volume deficit / ineffective renal tissue perfusion

related to:

fluid volume depletion secondary to increased metabolic demands on the body caused by infectious process in the lung parenchyma.

nursing dx:

altered protection

related to:

loculated fluid in left lateral and upper chest walls, pleural effusion

nursing dx:

activity intolerance

related to:

imbalance between oxygen supply and demand secondary to inflammation of the terminal airways and alveoli secondary to bacterial presence in the lungs

nursing dx:

acute pain

related to:

nursing dx:

altered nutrition; less than body requirements

related to:

increased metabolic demands on the body, decreased appetite, and npo status.

nursing dx:

anxiety

related to:

change/decline in health status, fear of the unknown, respiratory distress

nursing dx:

impaired skin integrity

related to:

multiple invasive access lines and procedures

Daytonite, BSN, RN · Feb 20, 2007

Are you supposed to use NANDA language? Because if so, you've got some problems here with the language you are using. Also, you have some very major problems with the construction of a good deal of these diagnoses.

First of all, you've combined three nursing diagnoses into one. Each of them have different meanings. I can't say that I agree with what you have listed as the etiology ("Related To") part as being the cause of any of the diagnoses.

Second, on your nursing diagnosis for Decreased Cardiac Output all of the etiologies ("Related To" factors) you've listed are all actually defining characteristics.

Third, again you have combined two nursing diagnoses (Fluid Volume Deficit / Ineffective Renal Tissue Perfusion) that have very different definitions and do not belong together. The etiology of deficient fluid volume can be fluid volume depletion, however where is this "secondary to increased metabolic demands on the body caused by infectious process in the lung parenchyma" coming from? Is this "secondary to" statement something that you are supposed to include in your nursing diagnostic statements? If not, don't include it.

Next, altered protection. The correct NANDA language is Ineffective Protection. The etiology is totally wrong. The etiology you have for this diagnosis more appropriately belongs to the nursing diagnosis of Ineffective Airway Clearance or should be used as the defining characteristics to support the etiology of that nursing diagnosis.

Activity Intolerance is OK.

What is main reason the patient has pain. That will be your etiology.

Seventh, Imbalanced Nutrition: Less than body requirements has decreased appetite and NPO status listed as etiologies when they are actually defining characteristics.

Eight, all your etiologies for the nursing diagnosis of Anxiety are actually defining characteristics.

Nine, you can simplify your etiology to "multiple invasive procedures".

And, finally, much of the sequencing is wrong. If this were sequenced according to Maslow's Hierarachy of Needs it would be much different.

I'm sending you a PM.

leesespieces · Feb 20, 2007

Actually I went through some of this with my instructor already and i was told to combine all 3 resp Dx's because they have similar causes and will have similar interventions.

We are told to form our related to statements from the pathophysiology of the etiological cause

I was told by instructor to combine tissue perfusion and fl vol deficit for the same reason I combined the resp Dx's

For whatever reason our instructors like "altered" protection

We are instructed to prioritize our Dx's by ABC's first (airway, breathing, circulation; which covers my first 3) then by what is affecting the patient the most...

NPO status and decreaseds appetite are why his nutritional status is imbalanced

Daytonite, BSN, RN · Feb 20, 2007

OK. I now have no idea what your instructors are asking you to do. It all sounds jumbled and disorganized to me. Please ignore my PM. I don't think I can help you here. Your instructors obviously have a much different idea about writing care plans that I just don't understand. I would have to read up on all their rules and I don't have time to do that. I'm sorry.

charlies · Feb 20, 2007

I am in my final semester, and after 7 different clinical instructors, my experience has been that what one accepts as good nursing diagnosis, the next does not. They all want something different. I got used to it, it is important to find out exactly what the specific instructor wants at the beginning of clinicals, and in the world of academia, that is ALL that matters as far as clinical paperwork goes.

My last careplan was 121 pages long. What a buncha B.S. It currently resides in the county landfill, lol.:stone

cardiacRN2006, ADN, RN · Feb 20, 2007

My last careplan was 121 pages long. What a buncha B.S. It currently resides in the county landfill, lol.:stone

.

Oh, I turned all of mine into greenhouse gasses.

nurse4theplanet, RN · Feb 20, 2007

I am in my final semester, and after 7 different clinical instructors, my experience has been that what one accepts as good nursing diagnosis, the next does not. They all want something different.e

I completely agree with this!

GIRN · Feb 20, 2007

I'm with you guys! Time was so valuable and we spent so much of it working on the Care Plans instead of being out on the floor, learning from the patients and experienced nurses. Once we got into the real world...I've not written one care plan! I've made a lot of check marks on the pre-written ones,... Our school was into mapping...that was a pain but sounds a lot better than 100 pages of care plans. I wonder how many ulcers nursing students get from the resentment that builds up from having to jump through hoops.....

ARRR10 · Feb 20, 2007

60-100 pages careplan!!! As of right now I am just beginning to learn the different phases of the nursing process. I never realized that a care plan could add up to almost 100 pages just for 1 patient:uhoh3: Is it all handwritten?

leesespieces · Feb 21, 2007

i want to thank everyone who added their input and gave me advice. i turned it in this morning...last care plan ever...thank god!!!

i think perhaps asking for advice was not the best thing to do as i didn't realize that expectations from instructors and schools vary widely. it was hard for me to explain to others why i grouped some of my daignoses and repeated intervetions in each diagnoses....

either way, it's over...it's done..and i'm glad!! on a better note i rotated to er today and i loved it!!! time for bed....get to do it all again tomorrow:nurse: