Help! Care plan question

[Koyaanisqatsi-RN]

I have read through the care plan thread and am unable to figure out something regarding care plans.

Let's say you have a patient who is entirely unable to speak, and cannot really move much at all. I understand the nursing diagnosis parts, but under the patient/client goals, the phrases are always so ridiculous in that kind of situation.

The client WILL learn range of motion exercises

The client WILL repeat them back to the nurse to show understanding

etc

This is all ridiculous when your patient cannot move or speak, but is still concious and in a lot of pain. What are we supposed to do regarding something like this? None of the patient goals I can find in the NANDA book seem to be applicable or even possible!

I am freaking out and any help would be so appreciated!

[NursingIs4CoolPeople]

That's a tough one, but how do you know the client is in alot of pain? If it was me (I could be wrong), I think one of my goals would be The Clients pain level will reduce from a ? to a ? according to the wong baker scale by the end of the shift or something like that. Just remember your goals have to be measurable, realistic, and time based.

[Koyaanisqatsi-RN]

That's a tough one, but how do you know the client is in alot of pain? If it was me (I could be wrong), I think one of my goals would be The Clients pain level will reduce from a ? to a ? according to the wong baker scale by the end of the shift or something like that.

Let's say the patient is crying and has a visible grimace. The only problem with this particular medical diagnosis is that for this hypothetical patient, management of pain is not in the nursing diagnosis available. Therefore, all the patient actions in each NANDA diagnosis are centered around things that this patient cannot possibly 'do'.

[HonestRN]

Can the patient be taught to communicate through blinking his eyes? Blink once for yes, twice for no? Learning to communicate could be a goal?

[GGT1]

Does it have to be a teaching goal? If not, a goal could be along the lines of "The patient will show no skin breakdown"

You say the pt is in pain, are they able to point to a pain scale? If so, the goal could be along the lines of

"The patient will report pain at 2 or below on the pain scale throught shift"

Care plans. AHHHHHHH

[Daytonite, BSN, RN]

the way you diagnose a problem in the first place is you assess them and pull out abnormal data that sifts out. this abnormal data becomes your aeb items, or defining characteristics, or you can think of them as the patient's signs and symptoms of the nursing diagnosis. they are the proof that the problem exists. so, you come up with strategies to treat them--your nursing interventions. your goals are what you predict will happen if your nursing interventions are performed. just as a doctor writes all those orders on a patient's chart to address the different symptoms that a patient is having, the doctor expects that those order will be carried out and expects to see improvement in the patient's symptoms. in formulating your goal statements, you will consider that one of 3 things will be happening to the patient's signs and symptoms or the underlying cause of the nursing diagnosis:

• improve them
  
• stabilize them
  
• support their deterioration
  

if the patient was never able to speak in the first place, then you will never have a goal that has them verbalizing anything. pain can be assessed in many ways beside a patient telling you they are in pain. read more about the assessment of pain and look at the defining characteristics (signs and symptoms) that are listed for this nursing diagnosis on this webpage: acute pain. your goals, however, are perfectly fine to suggest that a symptom shows a ceratin level of improvement or stability. make more sense now?

[Koyaanisqatsi-RN]

Thanks for the help everyone, I will give this a shot and see how it goes! At least it seems to be not all that common, so hopefully this is not something often seen again.

[Daytonite, BSN, RN]

At least it seems to be not all that common, so hopefully this is not something often seen again.

What are you referring to? Goals for patients who are not able to speak or move? Is this a stroke patient or a person in a coma? There are goals for the nursing problems of these patients. They are dependent on what their symptoms are and what interventions are being done for them. If the nursing process and how it works is understood this all makes more sense.