Help with care plan

[mohd6411]

hi

can someone help me in this case study?

mr jackson is a 45 yr old man admitted to hospital following an mva.

mr jackson sustained multiple lacerations and a fractured right femur during the accident.

he has required surgical repair of his right femur

and multiple sutures to his lacerations.

mr jackson has been admitted to an orthopaedic ward.

during this admission mr jackson presents with low mood, poor appetite, and early morning wakening and reports weight loss

he has revealed to his nurse that he has recently lost his job, is currently going through a difficult divorce and may need to sell his house.

mr jackson also feels his children may be 'better off' without him and believes he is a failure

- list the physical and mental health issues presented by mr jackson.

- devise a plan of care to address mr jacksons physical and mental health needs.

- give rationales for strategies chosen.

this is my nursing problems

1- risk of impaired skin integrity related to surgical incision and sutured lacerations

2- risk for suicide related to depression, feelings of hopelessness and worthlessness

3- impaired physical mobility related to bed rest and a fractured right femur

4- anxiety related to fear of inability to meet own needs, financial position feeling of hopelessness, low self-esteem and diverse.

can anyone please give me adive if it is correct or not and prioritise them please ?

thanks

[DayDreamin ER CRNP]

We don't really like to do your homework for you. Why don't you work on it a little and post what you have and maybe we can help you better. At least give it a try.

Remember Maslow when you are prioritizing.

[mohd6411]

thanks for your reply

as you can see i prioritize my nursing problems

1- risk for suicide related to depression, feelings of hopelessness and worthlessness

2- impaired physical mobility related to bed rest and a fractured right femur

3-anxiety related to fear of inability to meet own needs, financial position feeling of hopelessness, low self-esteem and divorse

4-risk of impaired skin integrity related to surgical incision and sutured lacerations

i finished writing my care plan but i just need to know whether those problems are relevant and advise in prioritizing those problems

thanks very much

[Moogie]

I think you're on the right track in terms of considering the patient holistically but think about the rationale for prioritizing his needs the way you did. His mood can certainly impact upon his recovery but would a risk for suicide be the highest priority for someone who is immobile? I'm not saying that you are either right or wrong here but if I was the instructor grading your care plan I would want to know why you considered this to be the most important need. What's important here is that you are making a nursing judgement and can justify why you would make this your priority.

[CT Pixie, BSN, RN]

You should prioritize starting with actual problems (in ABC order) and then go to your potential problems/risk for, again ABC's first.

Oh and his skin integrity is impared already, he has a surgical incision and lacerations. He has risk for infection from his impared skin integrity.

And don't you need AEB (as evidenced by) for your actual and potential/risk for nursing diagnosis? For example: Risk for suicide related to depression, feelings of hopelessness and worthlessness as evidence by patient stating he feels his children may be ‘better off’ without him and believes he is a failure.

[mohd6411]

thanks very much for commenting. i jsut prioritize my problems again according to the comments that i received.

please go through them and give me feedback

thanks

1- impaired physical mobility related to bed rest and a fractured right femur

2- anxiety related to fear of inability to meet own needs, financial position feeling of hopelessness, low self-esteem and divorse

3- impaired skin integrity related to surgical incision and sutured lacerations

4- risk for suicide related to depression, feelings of hopelessness and worthlessness as evidence by patient stating he feels his children may be ‘better off’ without him and believes he is a failure.

[CT Pixie, BSN, RN]

thanks very much for commenting. i jsut prioritize my problems again according to the comments that i received.

please go through them and give me feedback

thanks

1- impaired physical mobility related to bed rest and a fractured right femur

2- anxiety related to fear of inability to meet own needs, financial position feeling of hopelessness, low self-esteem and divorse

3- impaired skin integrity related to surgical incision and sutured lacerations

4- risk for suicide related to depression, feelings of hopelessness and worthlessness as evidence by patient stating he feels his children may be 'better off' without him and believes he is a failure.

you still don't have your abe (as evdence by) for your 4 problems. what is showing you that these are problems? lets take #1. impaired physical mobility..related to bed rest aeb?? whats showing you he's immobile? plenty of people on bed rest are still mobile. is he on traction that stops him from moving? is he in extreme pain that makes it near impossible for him to move? does he require assistance in order to move about? what is it that is making him not able to move? and then move to the other nursing diagnosis and tell us what the evidence is. (i see you used my example i gave for risk of suicide for #4)

you're listing of them is a bit off still. i'd think impaired skin integrity is a little more important than anxiety and impaired mobility.

[mohd6411]

Thanks for the explanation. I really found it very hard to have ABE because the case study as you can see does not have any sings and symptoms. Should i really have ABE. What do you think? can i get any recommendations.

Thanks for being patient with me

[CT Pixie, BSN, RN]

it was drilled into my head..must always have an aeb for actual problems. you can always ask your instructor (since he/she will be grading your work, not me if they want an aeb) :)

and you do have all the info you need just from what you posted about this man to get an aeb.

the r/t is what caused the problem or what might cause the potential problem. the aeb is whats there to show the skin integrity is impaired.

1. what caused the impaired skin integrity ?? (there's your r/t), and what on him shows you there is impaired integrity? (thats your aeb)

(an example of how i did one for a newborn baby...impaired skin integrity r/t umbilical stump aeb open umbilical stump (sounds redundent but thats what the evidence is)

2. whats causing his anxiety? (r/t), what tells you that he's anxious (aeb)

3. what is the cause of his impaired physical mobility? (r/t) and what does he do/not do that proves he has an impairment of physical mobility? (aeb)

and #4 since we already did this one i'll show you the steps.

risk for suicide (what makes you think he's a risk for suicide?) related to depression, feelings of hopelessness and worthlessness (what has he said/done to prove he feels depressed, hopeless and worthless) as evidence by patient stating he feels his children may be 'better off' without him and believes he is a failure.

[mohd6411]

thanks so much ct pixie . you been really very helpful. i just rewrite my nursing problems adding aeb. i also prioritize them. can you please go through them and give me feedback. i need to submit them soon.

thanks for your cooperation

1- ineffective individual coping related to low self-esteem and inability to handle the current situation as evidenced by loss of job, selling his house and divorce

2- decreased physical mobility related to musculoskeletal impairment as evidenced by fractured right femur and multiple lacerations.

3- impaired skin integrity related to mva as evidenced by surgical incision and sutured lacerations.

4- risk for suicide related to depression, feelings of hopelessness, worthlessness and failure as evidenced by patient stating he feels his children may be ‘better off’ without him and believes he is a failure.

[CT Pixie, BSN, RN]

thanks so much ct pixie . you been really very helpful. i just rewrite my nursing problems adding aeb. i also prioritize them. can you please go through them and give me feedback. i need to submit them soon.

thanks for your cooperation

1- ineffective individual coping related to low self-esteem and inability to handle the current situation as evidenced by loss of job, selling his house and divorce

2- decreased physical mobility related to musculoskeletal impairment as evidenced by fractured right femur and multiple lacerations.

3- impaired skin integrity related to mva as evidenced by surgical incision and sutured lacerations.

4- risk for suicide related to depression, feelings of hopelessness, worthlessness and failure as evidenced by patient stating he feels his children may be 'better off' without him and believes he is a failure.

they are still in an incorrect order, skin integrity should be first, decreased mobility, then the two mental health needs..remember..maslow.

i prefer the dx of anxiety over ineffective coping..he lost his job but do you know its his low-self esteem that caused that, he sold his house..probably due to not having a job to afford it or the divorce judge mandated that it be sold and the proceeds split between his ex wife and him..but that doesn't make him unable to cope and his divorce could have been for any number of reasons..not necessiarly because he had low self esteem or inablility to cope. stick with the anxiety as he is displaying s/s of anxiety as stated in your case study.

[Moogie]

Moved to Nursing Student Assistance forum to increase thread visibility and responses.