I need help with some case scenarios for PLAN OF CARE

CT Pixie, BSN, RN · Jun 3, 2012

Hello all, I have to do a nursing case scenario on a fake patient for my Med Surge class... I have been working on it since Thursday. I need help as to how I would complete this in the order of importance...I'm lost because our teacher, he doesn't give a lot of detail... He just kinda throws it at you. So any suggestions and all help in any way will be greatly appreciated...
The patient, has arrived on the medical surgical unit following surgery for a ruptured appendix. The abdominal wound has a Pen rose drain in place and is dressed with an abdominal (ABD) pad. The patient has the following: 1000mL 0.9NS is infusing at 125mL/hr., 14F Foley catheter connected to straight drainage, and a nasogastric tube (NG) in the right nares connected to low intermittent suction, and oxygen at 2L via nasal cannula.
Physician’s orders:
- 1000mL 0.9NS at 125 mL/hour
- NG to low intermittent suction
- Oxygen at 2L via nasal cannula
- Foley catheter to straight drainage
- Post-operative teaching
- Incentive spirometer
- Cough & deep breath (C&DB)
- Anti-embolism hose
- Reposition every 2 hour
- NPO
- Pain management
- IV antibiotics
- Intake & Output (I&O)
Additional Details
I have to write 8 Nursing Diagnosis statements and use the priority problems to write the nursing care plan. Would I get that from the scenario? Where would I find them?

Ok "how you complete this in order of importance"..are you asking how you'd complete the Doc orders?..always remember your ABC's (airway, breathing, circulation) and Maslow (physiological needs before psycho-social ones.

8 nursing diagnosis would come from the scenerio and any objective and/or subjective data you are given. Again, remember ABC's and Maslow.

Esme12, ASN, BSN, RN · Jun 3, 2012

welcome to an! the largest online nursing community.

grrrrrrrr......i hate fake scenarios the whole premise of a care plan is to learn how to plan the care of your patient by their complaints and needs. the biggest thing about a care plan is the assessment, of the patient. the second is knowledge about the disease process. first to write a care plan there needs to be a patient, a diagnosis, an assessment of the patient which includes tests, labs, vital signs, patient complaint and symptoms.

the medical diagnosis is the disease itself. it is what the patient has not necessarily what the patient needs. the medical diagnosis is what the patient has and 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.

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 them as a recipe to caring for your patient. your plan of care.

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. there are currently 188 nursing diagnoses that nanda has defined and given related factors and defining characteristics for. what you need to do is 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.

here are the steps of the nursing process and what you should be doing in each step when you are doing a written care plan:

assessment (collect data from medical record, do a physical assessment of the patient, assess adls, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
planning (write measurable goals/outcomes and nursing interventions)
implementation (initiate the care plan)
evaluation (determine if goals/outcomes have been met)

a care plan is nothing more than the written documentation of the nursing process you use to solve one or more of a patient's nursing problems. the nursing process itself is a problem solving method that was extrapolated from the scientific method used by the various science disciplines in proving or disproving theories. one of the main goals every nursing school wants its rns to learn by graduation is how to use the nursing process to solve patient problems.

do you have a nanda nursing diagnosis and care paln book? i prefer......

gulanick: nursing care plans, 7th edition and ackley: nursing diagnosis handbook, 9th edition

to prioritize think of maslows heirarcy of needs.

look at maslow's to tell you which priority precedes the next.

maslow's hierarchy of needs - enotes.com virginia henderson's need theory

maslow’s hierarchy of needs is a based on the theory that one level of needs must be met before moving on to the next step.

self-actualization – e.g. morality, creativity, problem solving.
esteem – e.g. confidence, self-esteem, achievement, respect.
belongingness – e.g. love, friendship, intimacy, family.
safety – e.g. security of environment, employment, resources, health, property.
physiological – e.g. air, food, water, sex, sleep, other factors towards homeostasis.

assumptions

maslow’s theory maintains that a person does not feel a higher need until the needs of the current level have been satisfied.

b and d needs

deficiency or deprivation needs

the first four levels are considered deficiency or deprivation needs (“d-needs”) in that their lack of satisfaction causes a deficiency that motivates people to meet these needs

growth needs or b-needs or being needs

the needs maslow believed to be higher, healthier, and more likely to emerge in self-actualizing people were being needs, or b-needs.
growth needs are the highest level, which is self-actualization, or the self-fulfillment.
maslow suggested that only two percent of the people in the world achieve self actualization. e.g. abraham lincoln, thomas jefferson, albert einstein, eleanor roosevelt.
self actualized people were reality and problem centered.
they enjoyed being by themselves, and having deeper relationships with a few people instead of more shallow relations with many people.
they tended to be spontaneous and simple.

application in nursing

maslow's hierarchy of needs is a useful organizational framework that can be applied to the various nursing models for assessment of a patient’s strengths, limitations, and need for nursing interventions.

Esme12, ASN, BSN, RN · Jun 3, 2012

Now for your fake patient..........

First what is Appendicitis? Medscape: Medscape Access medscape requires registration but it is free and an excellent reference and resource.

What is a ruptured appendix and what complications can it cause? Appendicitis: Complications - MayoClinic.com What is peritonitis?

What is the "normal" post op care for a patient? What would you look for? What would you do for them. What would they need? What do you need to look for for a patient with an NGT? What complications can arise form this?

SO .............the patient will have pain (alteration in comfort) so they will want pain relief (readiness for pain relief). The patient will have difficulty getting around and performing their daily care (activity intolerance)(impaired physical mobility)(bathing self care deficit). The NGT removing gastric contents can cause electrolyte imbalances (risk for electrolyte imbalances). Because the patient is NPO, had surgery, and has the NGT they are at risk for deficient/excess fluid imbalances (risk for deficient/excess fluid imbalance) The appendix ruptured and can cause peritonitis/infection/sepsis (infection/risk for infection). The patient will need to be taught the incentive spirometer (deficient knowledge). They are NPO so they aren't getting nutrition (imbalanced nutrition: less that requirements)

Just for a few ideas.

Esme12, ASN, BSN, RN · Jun 3, 2012

the patient, has arrived on the medical surgical unit following surgery for a ruptured appendix. the abdominal wound has a pen rose drain in place and is dressed with an abdominal (abd) pad. the patient has the following: 1000 ml 0.9ns is infusing at 125ml/hr., 14f foley catheter connected to straight drainage, and a nasogastric tube (ng) in the right naris connected to low intermittent suction, and oxygen at 2l via nasal cannula.

physician’s orders:

- 1000ml 0.9ns at 125 ml/hour

- ng to low intermittent suction

- oxygen at 2l via nasal cannula

- foley catheter to straight drainage

- post-operative teaching

- incentive spirometer

- cough & deep breath (c&db)

- anti-embolism hose

- reposition every 2 hour

- npo

- pain management