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Discussion

Help with care plan

I'm doing my very first care plan and i'm so confused. My patient has pancreatic cancer, but she was admitted to the hospital with obstructive jaundice and abdominal pain. my instructor helped me out with a few nursing diagnoses and we only have to pick our priority diagnosis to write a care plan on. Below are some of the diagnoses she helped me come up with. In lecture I've always been told if there isn't an airway issue than pain is always priority, but my clinical instructor says Risk for electrolyte imbalance r/t patient receiving chemotherapeutic medications is my priority but i don't understand how that is true since its a potential problem not an actual problem and her pain is an actual problem. Let me know what you think, am i way off base here?

  • Acute pain r/t biliary stent surgery a.e.b patient rates pain 6 out of 10
  • Risk for electrolyte imbalance r/t patient receiving chemotherapeutic medications
  • Risk for decreased liver function r/t increased bilirubin level of 13 a.e.b yellowing of patient skin and eyes
  • Risk for falls r/t unsteady gait
  • Activity intolerance r/t pain a.e.b patient unable to get out of bed, pain rating 6 out of 10

Featured Replies

Besides the irreplaceable NANDI-I 2012-2-14, I'm going to recommend two more books to you that will save your bacon all the way through nursing school, starting now.

The first is NANDA, NOC, and NIC Linkages: Nursing Diagnoses, Outcomes, and Interventions. This is a wonderful synopsis of major nursing interventions, suggested interventions, and optional interventions related to nursing diagnoses. For example, on pages 113-115 you will find Confusion, Chronic. You will find a host of potential outcomes, the possibility of achieving of which you can determine based on your personal assessment of this patient. Major, suggested, and optional interventions are listed, too; you get to choose which you think you can realistically do, and how you will evaluate how they work if you do choose them.It is important to realize that you cannot just copy all of them down; you have to pick the ones that apply to your individual patient. Also available at Amazon. Check the publication date-- the 2006 edition does not include many current nursing diagnoses and includes several that have been withdrawn for lack of evidence.

The 2nd book is Nursing Interventions Classification (NIC) is in its 6th edition, 2013, edited by Bulechek, Butcher, Dochterman, and Wagner. Mine came from Amazon. It gives a really good explanation of why the interventions are based on evidence, and every intervention is clearly defined and includes references if you would like to know (or if you need to give) the basis for the nursing (as opposed to medical) interventions you may prescribe. Another beauty of a reference. Don't think you have to think it all up yourself-- stand on the shoulders of giants.

Let this also be your introduction to the idea that just because it wasn't on your bookstore list doesn't mean you can’t get it and use it. All of us have supplemented our libraries from the git-go. These three books will give you a real head-start above your classmates who don't have them.

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