Help with care plan

Nursie30 · Oct 30, 2003

are you only needing interventions?

Tell me more about your patient

TnkrBell · Oct 30, 2003

Thanks for responding! My pt just had cesarean due to breech presentation, plus she is 317 lbs with high blood pressure. I need rationales too, but I'm required to show where I get those. This is my 1st week in the hospital, it seems so overwhelming right now . But thanks for your help..

memphispanda, RN · Oct 30, 2003

I'm not sure I understand what you are needing...

The things you listed sound like they are interventions. Do you need rationale for those interventions?

Mito · Oct 30, 2003

TnkrBll,

Let me just say I share your pain when it comes to care plans, I remeber as a student (not that long ago) that they gave me some troulbe as well. To give some advice that might help you is:

care plans are based on the nursing process that is to say Assessment , Plan, Intervention, Evaluation now you may have different words in your program for each of these things but essentially this is the different areas of a care plan.

So lets take and example of one of the symptoms your pt has and work through the process:

Assessment:

pt has an abd incision that is let's say painful and swollen related to C section

Plan (what plan are you going to use to do something about it or goals for the pt to improve)

pt will have incision free of infection and pain in 24 hours

Intervention

what are you going to do to carry out this plan or goal for your pt

well your going to offer the pt an ice pak to place on her abdomen to help reduce the swelling

Evaluation

this will be an assessment of how effective the intervention was is the incision still swollen and painful or is it improving you must articulate this in your evaluation. if the intervention was not effective you must state this and start with a new plan and goal and intervention so that the pt will have a clean infection free incision

Hope this helps

Mito RN

TnkrBell · Oct 30, 2003

K, the things I listed are medical orders....they want interventions for these things, and rationales. I have a basic understanding of what I'm supposed to do...but putting it all together is presenting a major problem for me! I really hope I can get to a point where this isn't such a struggle!

I'm glad to know I'm not the only one who feels this way about them tho!! Thanks for the help

fab4fan · Oct 30, 2003

I'm working on my first care plan, and I'm so confused! I need interventions for these things

Routine VS

foley to gravity

ice pack on abd incision

ambulate with assistance

They sound really easy....but when it comes down to writing something for them...I can't determine the correct things to write! I would appreciate any input on this. Thanks

__________________________________________

I'm sorry, but I don't think we do students favors when we give detailed answers to posts like the above. It does not make them think things through. Those of us who went to school prior to the age of instant information had to take the time come up with nsg. dx, interventions, rationales...it can be done!

We need to help students learn how to think, not simply supply answers.

TnkrBell · Oct 30, 2003

Okay, well that's fine. I agree...but did you never go for help when you were struggling? I don't want to sound rude, I completely respect your opinion on that...but I really doubt you were thinking that the last time you were in a bind with a school assignment. But anyways, I appreciate the reply.

flowerchild · Oct 30, 2003

I usually let students figure this kind of stuff out by themselves. It is very important, imo, to really understand the nursing process. A good nurse, again imo, will use this process as second nature and not even have to really think about it.

To start off, let's clarrify that the below activities are some of your interventions:

"I need interventions for these things

Routine VS

foley to gravity

ice pack on abd incision

ambulate with assistance"

For rationales, think of why you need to do these things.

But, first I think you need a nursing diagnosis, as this will head you in the right direction. Look at your patient. What is going on here? You said:

"My pt just had cesarean due to breech presentation, plus she is 317 lbs with high blood pressure. "

This is part of the assessment of the nursing process but not part of the actual care plan usually. The information is used to write the plan.

What complications does she have the potential to develop?

Why is the weight an issue and how does it r/t her BP and how does that affect her recovery from just having a C-sec.?

You can formulate your diagnosis from this information.

Alteration in ___________

Potential Alteration in ___________.

No, I won't do it for you.

Now that you have a diagnosis, what are you going to do?

Diagnosis

Intervention

Goals as eveidenced by your assessments and evaluations----how will you know she is getting better?

Pt. will have decreased ____________ as evidenced by ________

Pt. will have increased knowlege in __________ as evidenced by ________

Start with the nursing diagnosis, (driven by the assessment and medical diagnosis), then the goal, and how you will acheive that goal (interventions), and lastly, how will you know the goal is being met? (evaluation).

I hope this helps!

fab4fan · Oct 30, 2003

Asking for help and asking for answers are two different things.

flowerchild: You did a very good job of showing how to think things through without giving specific answers. I agree with you, students need to learn how to do this independently. It's OK to ask for guidance; it's not OK to want someone to do the work for you.

Tinkrbell: I suggest you get a book of NANDA nursing diagnoses. This will give you good examples of how care plans are written, the kinds of interventions you' d expect, and the outcomes you hope to attain.

Of course I asked for help when I was a student; there's nothing wrong with asking for help. What is wrong is to ask for answers; that doesn't teach you anything. You may be able to finish your assignment, but you won't learn how to figure things out for yourself. You won't always be able to ask someone else when you're in practice, which is why it is vital that you develop critical thinking skills early on.

Mito · Oct 30, 2003

Hello All,

While a I agree my response may have been detailed I felt that was what was needed in this situation. Tnkrbell will never be able to develop critical thinking skills if she doesn't understand how the process works. Using 1 specific example from her list and showing her how it could be developed I feel will be the most help to her. I remember all to well struggling through this stuff and the care plans in the text are completly different than the plan I am working on.

This type of "let the students figure it out on their own" way of thinking is fine if the student is heading down the right path , but they will never get their if they don't get some guidance in the beginning of the journey.

Mito

Nursie30 · Oct 30, 2003

Originally posted by TnkrBell
I'm working on my first care plan, and I'm so confused! I need interventions for these things
Routine VS
foley to gravity
ice pack on abd incision
ambulate with assistance

They sound really easy....but when it comes down to writing something for them...I can't determine the correct things to write! I would appreciate any input on this. Thanks

Okay, you already know what your nursing dx is right?

I think what they are wanting is something like:

Foley cath to dependent drainage:

Intervention: Rationale:

Keep foley cath below pubic area: to prevent backflow

Keep foley cath free from kinks: to facilitate drainage

Measure output from foley cath each shift: to record output

Check for s/s of UTI: to prevent infection

and so on for the other Orders..............

I searched the internet the world over for help with Careplans, and hated them so much, now guess what I do them for a living lol, they aren't as complicated as we try to make them....if you need help you can private message me........I'd be glad to help you.............