HELP with evil care plans

Columnist · Sep 10, 2014

Moved to Nursing Student Assistance for more response.

Esme12, ASN, BSN, RN · Sep 10, 2014

What does she need NOW? What is her assessment? Let the patient/patient assessment drive your diagnosis. Do not try to fit the patient to the diagnosis you found first. You need to know the pathophysiology of your disease process. You need to assess your patient, collect data then find a diagnosis. Let the patient data drive the diagnosis.

The medical diagnosis is the disease itself. It is what the patient has not necessarily what the patient needs. the nursing diagnosis is what are you going to do about it, what are you going to look for, and what do you need to do/look for first. From what you posted I do not have the information necessary to make a nursing diagnosis.

Care plans when you are in school are teaching you what you need to do to actually look for, what you need to do to intervene and improve for the patient to be well and return to their previous level of life or to make them the best you you can be. It is trying to teach you how to think like a nurse.

Think of the care plan as a recipe to caring for your patient. your plan of how you are going to care for them. how you are going to care for them. what you want to happen as a result of your caring for them. What would you like to see for them in the future, even if that goal is that you don't want them to become worse, maintain the same, or even to have a peaceful pain free death.

Every single nursing diagnosis has its own set of symptoms, or defining characteristics. they are listed in the NANDA taxonomy and in many of the current nursing care plan books that are currently on the market that include nursing diagnosis information. You need to have access to these books when you are working on care plans. You need to use the nursing diagnoses that NANDA has defined and given related factors and defining characteristics for. These books have what you need to get this information to help you in writing care plans so you diagnose your patients correctly.

Don't focus your efforts on the nursing diagnoses when you should be focusing on the assessment and the patients abnormal data that you collected. These will become their symptoms, or what NANDA calls defining characteristics.

Now tell me about your patient and we will go from there....what resource do you have?

StudentOfHealing · Sep 11, 2014

I am in my last semester in nursing school and I am awesome at everything BUT evil care plans.

I think first this "I am awesome at everything" attitude should be addressed. You obviously weren't too awesome at obtaining an assessment or focusing on the issue(s)at hand. Stop throwing medical diagnoses around. I've seen people with an EF of 20 below walk/talk and have good neurovascular status. You need to focus on YOUR patient. Not the diagnosis. For example, a patient may have afib but they may also be receiving metoprolol for rate control. Afib isn't their primary problem. Also, just because your patient was admitted with hypoglycemia it may not be her primary problem or your primary concern (unless she's actively hypoglycemic) However if she was c/o of hypoglycemia you should ask questions like:

Does she take any insulin or antidiabetic medication?

What is her baseline bg?

Is she compliant?

akulahawkRN, ADN, RN, EMT-P · Sep 11, 2014

I am in my last semester in nursing school and I am awesome at everything BUT evil care plans. I need examples and guidance for a patient in telemetry who has CHF, DM, HTN.

Trust me, I loathe nursing care plans. Guess what? I got good at them because they're my recipe for providing care for my patient. You can't directly translate between medical and nursing diagnoses, so don't try. Your assessment, or at least reading the H&P, should drive the process. What you find are defining characteristics. When the defining characteristics match a nursing diagnosis, then you've found it.

Should I do my etiology on CHF? Her admitting dx was "c/o of hypoglycemia" I just don't get the related to (cellular level) crap.

What's the primary problem right now? Sure, the admit dx was hypoglycemia, but what does the body need now? What's the first item you need to address? Of the patient's medical problems, which one do you think contributed most to the major problem? How does it affect the other problems the patient has and the body's systems? That's the etiology you'll want to focus on.

The "cellular level crap" as you put it, is simply this: if you were a cell in your patient's body, how would you see/feel/experience/contribute to the problem? Since the cell is the most basic major component of the body, how the cells "feel" and "respond" to their immediate environment is what you need to focus on. When you find ways to support those cells, you're helping create the conditions for those cells to thrive.

I'm struggling bc I do better in the moment with the patient and what is going on with "here and now." I'm losing sleep over this while literally staring at a blank care plan sheet with 5 books in front of me. References (if any) please.
Am I on the right track?
ex: Decreased cardiac output R/T freq. PVCs AMB EF at 5%

Think of a nursing diagnosis as a statement of I know my patient has this (Decreased Cardiac Output) because my patient has this -R/T-(impaired contractility) because my patient has these issues -AMB-(EF at 5%, frequent PVC's, et al...).

So, working from the data: Your patient has an EF of 5% and frequent PVC's. These problems result in the heart being unable to contract effectively and efficiently, and therefore the nursing diagnosis associated with this is Decreased Cardiac Output.

Now then, for your patient, what's the primary problem? This is the problem, if not addressed, would result in your patient getting worse instead of maintaining or improving.

It very well could be that the hypoglycemia is what made the patient come in to the hospital, but perhaps another problem is really the problem... always remember that.