HELP! does my care plan make sense

[ndh_cna_studentRN]

This is the first major care plan I've had to do (aside from a few basic PES statements). I must have 7 intervents and rationals. Please let me know what you think and feel free to give me some pointer/advice/sources to use. I'd really appreciate it!! Thanks!

Maslow: physiology

Erickson: Integrity versus Despair

P. Ineffective Tissue Perfusion

E. R/T Anemia

S. as evidence by abnormal lab results (H&H 9.1 and 27), need for supplemental oxygen @ 3L via NC, and Physician's order for PRBC transfusion.

Outcome: Pt will have normal H&H lab results and be weaned from supplemental oxygen and have an oxygen saturation >90% prior to discharge.

Interventions:

1) Transfuse packed red blood cells as ordered by physician. (collaborative)

2) Monitor hemoglobin and hematocrit lab values Qdaily. (collaborative)

3) Monitor v/s q4h and document. Notify physician if significant deviation from baseline occurs.

4) Administer Oxygen as ordered.

5) Provide pt with information on normal tissue perfusion and possible causes for impairment.

6)

Rationales:

[xtxrn, ASN, RN]

What's the diagnosis?

Where are your rationales?

Where is the 7th intervention?

You only need one problem?

Did something get chopped off? It looks like you started "Rationales" but it cut out.....

[ndh_cna_studentRN]

The pts admitting diagnosis was acute diverticulitis. upon testing they discoverd a perforated bowel and then went to surgery for a sigmoid colon resection and temp colostomy placement. pt has hx of lung CA, COPD, asthma, IDDM, peritoneal mass, anxiety. O2 sat was 98% on 3L. hgb= 9.1. LOC= x2. Pt is on several antibiotics, bronchodilators, insulin, lovenox, dilaudid PCA, and ketoralac.

I am only half way done with it. what you see is where I stopped. I wanted to make sure I was on the right track before I put more work into it. I need one more intervention and to look up my rationales and cite them. Then I have to do a pathophysiology paper on Acute Diverticulitis.

[xtxrn, ASN, RN]

How many problems are you supposed to have?

I see the following w/the info you gave:

-risk for infection (surgery- incision)

-infection (bowel perforation- peritonitis)

-alteration in body image (colostomy)

-risk for impaired air exchange (anesthesia, hx COPD, lung CA, asthma)

-risk for bleeding (surgery, Lovenox)

-risk for alterations in blood sugar (DM)

-pain (surgery)

-risk for activity intolerance (surgery and hx COPD, lung CA, asthma and Hgb 9.1)

-self-care deficit (colostomy)

-knowledge deficit (colostomy)

-risk for nutritional deficits

Please forgive me- I don't have a NANDA book around here. I'm winging it - but going with general post-op/med.surg care. I learned the Maslow and Erickson stuff, but NEVER had to put it in a care plan. SO, I'm not much help there.

With # 5- the probable cause for the anemia is the surgery/bowel perf; I'm not sure what you're going to tell him re: the cause. :)

Another intervention could be monitoring activity tolerance. If the H&H stays low, it is a probable problem.

If you only have to have one problem for this diagnosis, I'd definitely pick something besides the tissue perfusion. I understand about the whole ABC thing- but there are so many other things that could kill him (peritonitis being first thing I'm thinking) that I'd look at that. If you know you need to go with tissue perfusion, ok (the instructor said to focus on this?) Just work on # 5, 6, 7- and the rationales. You KNOW the rationales (or you wouldn't have picked them :heartbeat). It's a matter of wording them....

I'll check back, and perhaps others will also chime in :)