help on a care plan

[carecrafter]

Hey there - I was hoping someone could give me a nudge - I am trying to put together my 2nd care plan and having a little trouble. THis patient is in LTC and has dementia and is wheelchair bound. she also has diabetes.

I have to have 5 diagnoses and then a care plan from one. I am getting stuck because most things I find are geared toward restoring wellness and independence, which isn't going to happen.

I have come up with

1) self-care deficit - this is the primary reason for her being there

2)Imparied skin integrity - (pt has a wound on her arm from a fall - and a history of falls.

3) Risk of falls

3)Risk for imparied skin integrity

4) Maybe impaired memeory ( she thinks she was married almost as long as she has been alive, and repeats herself constantly)

5) I have to have one KNOWLEDGE deficit but am drawing a blank there - how can you teach when she can't remember what she already knows......

ANY hints, tips, advice would be appreciated!!!!!

[Daytonite, BSN, RN]

allnurses has a thread on care plan construction: https://allnurses.com/general-nursing-student/help-care-plans-286986.html - help with care plans that you should check out. it is important when care planning that you follow the steps of the nursing process when you actually sit down to write the care plan. it will help you organize everything much better and help you with the critical thinking. also, i need you to understand that a nursing diagnosis is merely a name that gets attached to a nursing problem so don't get too stressed over them. what is important is knowing what the definitions of these diagnoses are because they are a better description of what the nursing problem is.

your diagnoses are difficult for me to evaluate because you have included very little of the assessment information that supports them. now, i worked in nursing homes and did many care plans for them so i know a great deal about ltc care plans. i also know the nanda diagnoses. the nanda taxonomy of diagnoses is listed in the appendix of recent copies of taber's cyclopedic medical dictionary if you don't have the money to buy an official copy of the taxonomy, nanda international nursing diagnoses: definitions and classifications 2009-2011,from nanda ($35). but i can tell you right off the bat that self-care deficit is not a correct diagnosis. it needs to be more specific. there are 4 self-care diagnoses:

• bathing/hygiene
  
• dressing/grooming
  
• feeding
  
• toileting
  

does this patient actually have deficits in all 4 areas?

i agree with impaired skin integrity for the wound on her arm, but that does not warrant a second diagnosis of risk for impaired skin integrity. that is overkill and the interventions for prevention of wounds would be included with the impaired skin integrity diagnosis.

risk of falls should be risk for falls.

are you sure her impaired memory isn't just chronic confusion? the difference lies in what her symptoms are. since you didn't really post much in the way of symptoms, it is hard to evaluate this. what is her medical condition? any alzheimer's or dementia mentioned in her history and physical by the physician. the patient's chart should always be gleaned for information and background.

as for teaching, anyone can be taught a routine, even someone who is confused. we taught bladder and bowel control on a regular basis in ltc. the patient might need a lot of prompting by staff, but it is doable. do not be fooled into thinking that goals for ltc must be the restoration of wellness and independence. goals can ultimately have 3 objectives:

• improvement of the patient's condition/remedy
  
• stabilization of the patient's condition
  
• support for the deterioration of the patient's condition
  

for ltc stabilizing or supporting their deterioration is about the best we can hope for sometimes. with dying patients we support their deterioration and eventual death. it may sound depressing and negative, but that is the nature of this profession sometimes. unfortunately, not everyone is going to get better, jump out of bed and go back to being a productive citizen again. it is perfectly fine to maintain their current level of functioning or support their deterioration of function and keep them comfortable.

[carecrafter]

Thank you so much for all the advice - I know my original post was vague but didn't want it to be so huge that no one would wade through it.

I am new to nursing AND to posting so hope to get better at both.

This patient does have dementia on her chart.

I will keep cogitating on it - this week is less difficult than last week but I have a LONGGGGG way to go!

Thanks again for the tips

[carecrafter]

Thanks for your help. I was off to a VERY shaky start but after going through all the links you sent me, I have gotten two 100s in a row on my care plans.

[Daytonite, BSN, RN]

Wow! That's wonderful! :redpinkhe Good for you. Keep up the good work. If you have any further problems don't hesitate to ask.