'What's your plan of care?'

Sour Lemon · Aug 30, 2018

This may seem like a silly question, but how do I respond to my instructor in clinicals when she asks me, "what is your plan of care for this patient?" I know this is very patient dependent, so could someone give me an example of what you'd say?
Example:
72 year old female with a UTI, A&Ox2, with type 2 DM. WBCs are 13, platelets are 145,000, electrolytes are WNL.
My plan of care is for the patient to be free from injury as a result of her confusion by keeping the bed in the lowest position, reorienting her q2-4h, keeping stimulation minimal and promoting a relaxing environment. I am also assessing her BS levels ac hs and providing antibiotics while monitoring her WBC trends. Her platelets are also slightly below normal levels so I am assessing for hematuria, GI bleeding (melena), and bleeding gums.
Would something along those lines be acceptable?
This is just an example, please feel free to provide your own or add to this one.

I don't know what your instructor is looking for, but orienting a patient Q2-4 hours jumps out at me. It should be "as needed" or "Q2 hours and PRN".

Our plans of care were typically required to have nursing diagnoses along with interventions.

carti, BSN, RN · Aug 30, 2018

pretty much what is going to kill your patient first and how to stop it. I agree with your list. Is she Aox2 becomes it's normal for her due to her past conditions like dementia, or is that something she got at the hospital?

Delite · Aug 30, 2018

I don't know what your instructor is looking for, but orienting a patient Q2-4 hours jumps out at me. It should be "as needed" or "Q2 hours and PRN".
Our plans of care were typically required to have nursing diagnoses along with interventions.

It was just an example I made up on the spot when writing the post. Assess orientation PRN makes more sense.

Delite · Aug 30, 2018

pretty much what is going to kill your patient first and how to stop it. I agree with your list. Is she Aox2 becomes it's normal for her due to her past conditions like dementia, or is that something she got at the hospital?

I should have clarified further. It was a scenario I made up on the spot while writing the post in order to provide an example.

Rocknurse, MSN, APRN, NP · Aug 31, 2018

Work through each system....neuro, respiratory, cardiac etc. If they have a problem within that system then address is. Here's an example:

Neuro - patient is elderly and has a UTI (can cause confusion).

Plan: orient and maintain a safe environment. Monitor neuro status

GI: - Patient has DM.

Plan: check blood sugars Qx

GU: Patient has UTI and low platelets

Plan: check for hematuria, send a UA, monitor urine output.

If you have some kind of framework you can apply it to every patient.

Hope that helps.

TessLJ · Sep 1, 2018

Example:
72 year old female with a UTI, A&Ox2, with type 2 DM. WBCs are 13, platelets are 145,000, electrolytes are WNL.

Do they still teach you nursing diagnoses in Nursing School? (Honest question.)

I think first, consider the primary issue: UTI: what should your plan of care be for someone suffering a UTI? Monitor UOP, assess for pain. Is this lady incontinent? Also, since you're administering Abx for the infection, monitor for potential allergic or adverse reactions to the Abx.

Does she have a catheter in her bladder? - foley care

Or does she ambulate to the bathroom/have a bedside commode? - safety and fall precautions

A&O x 2 - agree with the poster who said orient as needed. Sometimes constantly re-orienting a patient with mild dementia can be agitating. It's not always necessary to keep insisting to a patient that it's not 1999.

It's always important to include integument assessment, especially if the patient has limited mobility.

Hope this is helpful.

Ruby Vee, BSN · Sep 1, 2018

This may seem like a silly question, but how do I respond to my instructor in clinicals when she asks me, "what is your plan of care for this patient?" I know this is very patient dependent, so could someone give me an example of what you'd say?
Example:
72 year old female with a UTI, A&Ox2, with type 2 DM. WBCs are 13, platelets are 145,000, electrolytes are WNL.
My plan of care is for the patient to be free from injury as a result of her confusion by keeping the bed in the lowest position, reorienting her q2-4h, keeping stimulation minimal and promoting a relaxing environment. I am also assessing her BS levels ac hs and providing antibiotics while monitoring her WBC trends. Her platelets are also slightly below normal levels so I am assessing for hematuria, GI bleeding (melena), and bleeding gums.
Would something along those lines be acceptable?
This is just an example, please feel free to provide your own or add to this one.

You're going to want to be re-orienting your patient a lot more frequently than every four hours! Probably every time you go to see her. You'll also want to keep an eye on her in case her behavior deteriorates . . . will she need a sitter? Minimal stimulation and relaxing environment is a nice idea, but you won't have much control over that. Is her roommate also confused? You may find they escalate each other. Is your patient being seen by PT, OT, Respiratory therapy, the Diabetic Nurse Educator, the Hematology Team, Infectious Disease or a loud housekeeper cleaning up the stuff she spills?

Otherwise, nice job.