Help w/NCP for Diabetic Foot Amputation:Ineffective Tissue Perf & Impaired Skin Integ

[slong3812]

I am in need of some input for my nursing diagnoses and short/long term goals. My patient had developed gangrene in his Rt foot and had an amputation of the forefoot, he has DM II, PVD and HTN. Any suggestions would be helpful thanks! I have started over thinking it and now I am going crazy!!!!!

Nursing Diagnoses:

1) Ineffective Tissue Perfusion r/t poor circulation aeb by poor peripheral pulses and cool, pale skin.

st goal:

lt goal:

2) Impaired Skin Integrity r/t surgical amputation of Right Forefoot

st goal: No signs of infection over the wound within three days

lt goal: Skin will remain intact with no ongoing ulcerations within one week.

[Daytonite, BSN, RN]

i am in need of some input for my nursing diagnoses and short/long term goals. my patient had developed gangrene in his rt foot and had an amputation of the forefoot, he has dm ii, pvd and htn. any suggestions would be helpful thanks!

nursing diagnoses:

1) ineffective tissue perfusion r/t poor circulation aeb by poor peripheral pulses and cool, pale skin.

st goal:

lt goal:

2) impaired skin integrity r/t surgical amputation of right forefoot

st goal: no signs of infection over the wound within three days

lt goal: skin will remain intact with no ongoing ulcerations within one week.

1) ineffective tissue perfusion r/t poor circulation aeb by poor peripheral pulses and cool, pale skin.

st goal:

lt goal:

you need to specify which part of the body has the perfusion problem. it is the "peripheral" area. also, "poor circulation" is not a correct way to state that there is an oxygenation problem, which is what this diagnosis is about. "poor peripheral pulses" is not very descriptive and gives you nothing more to work with insofar as a goal is concerned. you need to have better assessment information. pulses can be graded on a scale.

better would be:

ineffective tissue perfusion, peripheral r/t interrupted blood flow aeb (poor peripheral pulses) and cool, pale skin.

your interventions will be things you can do for the pulses and the skin to improve the oxygenation to those peripheral tissues of the leg. your goals, then, will be what you expect to happen as a result of those interventions you will be performing. do not expect them to cure the problem since this patient has pvd and diabetes. the best i would expect is that things stay at status quo.

2) impaired skin integrity r/t surgical amputation of right forefoot

st goal: no signs of infection over the wound within three days

lt goal: skin will remain intact with no ongoing ulcerations within one week.

where is your aeb evidence that supports the existence of this problem? if you are referring to the amputation wound, then you have diagnosed this incorrectly. the correct diagnosis to use for surgical wounds of that depth is

impaired tissue integrity r/t surgical amputation of right forefoot aeb (description of the wound).

interventions are how you are going to restore this patient's tissues

back to normal

and assist them with

healing

.

no signs of infection over the wound within three days

- where do you say this patient has signs and symptoms of infection? this is a wrong goal to have for this diagnosis if you have no interventions for sterile wound changes. goals for this diagnosis should focus on the tissues returning to some kind of state of normal or healing up. if infection is occurring, then another diagnosis needs to be made.

skin will

remain intact

with no ongoing ulcerations within one week.

- this skin was

never

intact. what ulcerations? where did those come from? i thought we were talking about a surgical wound? ulcerations are not caused by "

surgical amputation of right forefoot

". ulcerations depending on their assessment and staging are either

impaired skin integrity

or

impaired tissue integrity

and

they

due to impaired circulation. information on staging ulcers and treating them can be found here:

• http://www.nursingquality.org/ndnqipressureulcertraining/module1/default.aspx
  - pressure ulcer training tutorial (includes photos)
  
  
• http://www.hill-rom.com/usa/pdf/ctg285.pdf
  - guidelines for staging of pressure ulcers
  
  
• http://www.medicaledu.com/staging.htm
  - staging of ulcers
  
  
• http://ame-medical.com/staging_ulcers_guidelines.pdf
  - staging pressure ulcers
  
  
• http://www.medscape.com/viewarticle/581714
  - diagnosis, staging, and treatment of pressure ulcers: an expert interview with carol a. white ms,
  rn
  , anpc, gnpc, dnp©

[slong3812]

Thank you so much for your insight, you make total sense! I appreciate it :nuke:

[Daytonite, BSN, RN]

Thank you so much for your insight, you make total sense! I appreciate it

It is important to understand that everything in a care plan forms a big wheel of connection. The foundation is the abnormal data that is gathered during assessment. That abnormal data drives the care plan and determines the nursing diagnoses, the interventions, the goals and outcomes and the direction of the evaluation. It is all very rationale.

[dslpninla]

Wow you are awesome!!:bow: