Published Apr 7, 2004
I'm a first semester nursing student learning to write careplans.
I need help in wording nursing diagnoses correctly and rank them by priority. This is what I have:
Medical diagnosis: metastatic prostate cancer
Medical history: pressure ulcer. constipation
Priority 1. Pain related to biological injury agent (tumor)
Priority 2. Impaired skin integrity related to immobility
Priority 3. Constipation related to immobility
Thanx if you can help...
I think you did a good job at prioritizing them. However, it depends on the patient as well. Relieving the pain could help him mobilize which reduces his skin integrity as well as relieving constipation.
Any other questions?
I would have put skin first (since its the first line of defense) but like previous poster said I guess it depends on pt.
i agree with how it's prioritized. I was always taught that ur first priority deals w/ ABC's...but if not applicable, and pain is there...pain is definately a first.
man i dont miss care plans..and sure am dreading doing them again for the Rn program. Nothing like "Impaired skin integrity related to.....as manifasted by...." *shivering* baddddd memories of 24 paged care plans
This is cut from another post I made on this topic:
This article is fantastic if you can find it, really helped me to clarify ND's.
Tribulski, Jean A. (1988). Nursing diagnosis: waste of time or valued tool? Registered Nurse Dec 1988, pp 30-34.
In a nutshell just in case you cant' get the article anywhere:
Example: Fluid volume excess related to excess sodium intake.
Condition (nursing diagnosis) = patient goals.
i.e. fluid volume excess = goals, weight loss, no pulmonary edema, choose low sodium items from menu.
Etiology (related to factors) = interventions
i.e. excess sodium intake = interventions, weight QAM, monitor I & O, assess breath sounds...etc.
Another example: your priority 1.
Pain related to biological injury agent (tumor)
What is the real issue here, other than pain...is the client having difficulty sleeping, moving, etc? I would put these 'nursing' things as my dx so that your goals could be "will sleep 4 hours uninterrupted", "will mobilize 3x on my shift" instead of something vague like "will decrease pain" (but this is good to have too).
Can you make interventions to make the fact that this client has cancer go away? Nope. I try to avoid using medical dx's as related to statements (but will sometimes put them in as causative factor).
Personally, I would change this one to:
Sleeplessness, anxiety, immobility, and difficulty concentrating related to pain caused by tumor.
Goals: client will sleep 4 hrs unintertrupted, client will appear to have less anxiety, client will mobilize 3x on my shift, client will have a conversation with me and not seem distracted by pain as evidenced by position changes, etc).
Interventions: medicate regularly for pain, assess pain on a numeric/qualitative scale Q2H, assist client in positioning/mobilizing to decrease pain.
As for your prioritising, I think that's great. If there's no immediate airway, circulatory problems, pain is always priority #1 because it can affect so many things. With skin breakdown there's risk for infection, with constipation there's risk for impaction.
Very sorry for the long (long) post. This is something that I really struggled with my first 2 years of school, this year I finally got it (I think *lol*) and would love to help someone else get it too ;-) It's a great feeling when a tutor/preceptor/teacher says "that's perfect" :-D
Much luck with those, keep up the good work!! :balloons:
I was also wondering if you would include something like
fear and/or anticipatory grieving, and risk for spirtual distress...
I had a clinical teacher once that made quite an impression on me to always include psychosocial in care plans in some way, shape or form..
Just a thought.
the other posts have great ideas but I agree you really need to see what is most crucial to that particular patient. You did a really good job of looking at the physiological issues and prioritizing them over psychosocial but my question is what is the clien't primary complaint. If their pain is their number one concern then go with that. But for some people a large amount of pain is more tolerable than a large wound, surgical incision, etc. It really depends on that particular patient. Sometimes if I am having trouble prioritizing - and it isn't clear (except with the abc's - I will ask the client, if possible, what is their primary concern. Some may think this is inappropriate but for some clients this allows them to participate in their healthcare and make decisions about their care. It also lets them know that we are there for them and what ever they need.
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