NCP for foot DM amputation,PLS HELP

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I'm a nursing student and asking help for the NCP for the foot DM amputation,,,,,,

discharge plan for foot DM amputation......

PLS HELP.....

Thank you.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

when writing a care plan you need to follow the steps of the nursing process because it is a problem solving method. care planning is how we solve patient problems. the steps of the nursing process are:

  1. assessment (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
  2. 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)
  3. planning (write measurable goals/outcomes and nursing interventions)
  4. implementation (initiate the care plan)
  5. evaluation (determine if goals/outcomes have been met)

step 1 - assessment. this patient has diabetes and has had a foot amputated. peripheral vascular disease (circulation problems) that results in stasis ulcers, gangrene and sometimes no other recourse but amputation are a complication of diabetes. so, this patient has some serious problems going on with their circulation. that is part of the pathophysiology that you need to be reading about in order to understand what is going on.

when you assess this patient there are a number of things that you may or may not find that are not normal about their physical exam and adl assessment.

  • systems assessment
    • skin assessment may show shiny, taut skin, cool extremities, cyanosis or redness of extremities when in dependent position, thickened nails, stasis ulcers, edema, other nonhealing wounds
      • there may be skin color differences when the two limbs are compared
      • there will be an incision; describe the appearance of the skin and sutures - if the circulation to those tissues is poor the incision may look reddened
      • the surgical wound may not show evidence of healing and may look inflamed or even necrotic

      [*]cardiovascular assessment may show capillary refill time greater than 3 seconds, severe, cramping pain with exercise, usually relieved by rest, diminished or absent peripheral pulses in both the affected limb and the other remaining limb

      [*]musculoskeletal assessment may show impaired limb movement, pain, contractures, guarding of affected extremity

      • surgical pain, odd paresthesias, a tingling or burning sensation or complete loss of sensation in the affected limb, or there may be phantom pain

      [*]psychosocial

      • the patient may exhibit symptoms of anxiety, anger, fear, grief, or false cheerfulness
      • the patient may have difficulty sleeping
      • the patient may have difficulty coping the fact that one foot is now gone
      • they may fear rejection by others
      • the patient may have many questions about wound care, adaptation to normal life, ambulation and self-care.

    [*]complications to assess for include: hemorrhage, infection, skin breakdown, phantom limb pain and depression

step 2 - determination of the patient's problem(s)/nursing diagnosis. your first task is to assemble a list of all the patient's abnormal data that you collected about them. that is all evidence proving the existence of their nursing problems. for example, since they have had surgery, there is an incision. it is not normal to have an incision. do you have one? unless you had surgery yourself in the past few weeks, i don't think so! so, the incision and it's description is evidence, or proof, that there is a problem of something going on with the tissues of the body. and other things that you have found are evidence of other problems as well.

what gets a little difficult in determining patient problems, or nursing diagnoses, is not being familiar with the system of nursing diagnosis that you may be required to use. the most common system is the one by nanda. however, some schools and instructors have students use systems they have modified from nanda or they use older versions of nanda that have not been updated. there are a number of ways to get the nanda information. some is free; some you have to pay for.

i will give you one likely nursing diagnosis for this patient based on the fact that there is a 99% chance there is an incision that needs attention: impaired tissue integrity r/t surgical amputation of foot aeb [description of the incision]. here is a website with the nanda information as well as some suggestions for nursing interventions and goals: [color=#3366ff]impaired tissue integrity

step 3 - planning. planning involves writing measurable goals/outcomes and nursing interventions. they are based upon the underlying cause of the patient's nursing problems and the evidence (signs/symptoms and patient responses to their problems) that prove the existence of the problem. your goals are to (1) improve, (2) stabilize, or (3) support these conditions. your nursing interventions or strategies come in four types:

  • assess/monitor/evaluate/observe (to evaluate the patient's condition)
  • care/perform/provide/assist (performing actual patient care)
  • teach/educate/instruct/supervise (educating patient or caregiver)
  • manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)

so, for example, with impaired tissue integrity you will have interventions such as:

  • note the condition of surgical incision and document the findings every 8 hours
  • perform sterile dressing changes daily as ordered by the physician
  • teach the patient to inspect the stump daily and use a mirror to inspect all bottom parts that cannot be seen easily
  • notify the surgeon if there are any signs or symptoms of wound infection.

these are all interventions that are targeting the incision which is the evidence that supports why the patient has impaired tissue integrity.

steps 4 and 5 - depend on patient response

discharge plan

a discharge plan is not a part of a nursing care plan in the u.s. here in the u.s. we generally have a separate form in the hospitals that is filled out on which we document what we are teaching the patient prior to their discharge. teaching is also included throughout the care plan as intervention items where they apply to the appropriate nursing problem.

discharge planning is determining what the patient's medical needs will be after discharge from a hospital. discharge planning includes addressing the following subjects with the patient:

  • their diet

  • allowed physical activity

  • medications they need to take

  • any treatments and tests they need to be doing after discharge

  • referrals to any outside agencies or support groups

  • follow up appointments with doctors have been made and patient understands

  • teaching materials and/or contact with outpatient professionals for continued care and teaching have been provided to the patient

here is one article on the subject:
https://nursing.advanceweb.com/ce/testcenter/course.aspx?courseid=647&creditid=1
- "discharge planning"

for weblinks you can search for patient information on amputation, see
https://allnurses.com/forums/f205/medical-disease-information-treatment-procedures-test-reference-websites-258109.html
-
medical disease information/treatment/procedures/test reference websites

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hi daytonite...thanks a lot i already have basis for making NCP and discharge plan.... it really helped me a lot....God bless..... :)

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when writing a care plan you need to follow the steps of the nursing process because it is a problem solving method. care planning is how we solve patient problems. the steps of the nursing process are:

  1. assessment (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
  2. 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)
  3. planning (write measurable goals/outcomes and nursing interventions)
  4. implementation (initiate the care plan)
  5. evaluation (determine if goals/outcomes have been met)

step 1 - assessment. this patient has diabetes and has had a foot amputated. peripheral vascular disease (circulation problems) that results in stasis ulcers, gangrene and sometimes no other recourse but amputation are a complication of diabetes. so, this patient has some serious problems going on with their circulation. that is part of the pathophysiology that you need to be reading about in order to understand what is going on.

when you assess this patient there are a number of things that you may or may not find that are not normal about their physical exam and adl assessment.

  • systems assessment
    • skin assessment may show shiny, taut skin, cool extremities, cyanosis or redness of extremities when in dependent position, thickened nails, stasis ulcers, edema, other nonhealing wounds
      • there may be skin color differences when the two limbs are compared
      • there will be an incision; describe the appearance of the skin and sutures - if the circulation to those tissues is poor the incision may look reddened
      • the surgical wound may not show evidence of healing and may look inflamed or even necrotic

      [*]cardiovascular assessment may show capillary refill time greater than 3 seconds, severe, cramping pain with exercise, usually relieved by rest, diminished or absent peripheral pulses in both the affected limb and the other remaining limb

      [*]musculoskeletal assessment may show impaired limb movement, pain, contractures, guarding of affected extremity

      • surgical pain, odd paresthesias, a tingling or burning sensation or complete loss of sensation in the affected limb, or there may be phantom pain

      [*]psychosocial

      • the patient may exhibit symptoms of anxiety, anger, fear, grief, or false cheerfulness
      • the patient may have difficulty sleeping
      • the patient may have difficulty coping the fact that one foot is now gone
      • they may fear rejection by others
      • the patient may have many questions about wound care, adaptation to normal life, ambulation and self-care.

    [*]complications to assess for include: hemorrhage, infection, skin breakdown, phantom limb pain and depression

step 2 - determination of the patient's problem(s)/nursing diagnosis. your first task is to assemble a list of all the patient's abnormal data that you collected about them. that is all evidence proving the existence of their nursing problems. for example, since they have had surgery, there is an incision. it is not normal to have an incision. do you have one? unless you had surgery yourself in the past few weeks, i don't think so! so, the incision and it's description is evidence, or proof, that there is a problem of something going on with the tissues of the body. and other things that you have found are evidence of other problems as well.

what gets a little difficult in determining patient problems, or nursing diagnoses, is not being familiar with the system of nursing diagnosis that you may be required to use. the most common system is the one by nanda. however, some schools and instructors have students use systems they have modified from nanda or they use older versions of nanda that have not been updated. there are a number of ways to get the nanda information. some is free; some you have to pay for.

i will give you one likely nursing diagnosis for this patient based on the fact that there is a 99% chance there is an incision that needs attention: impaired tissue integrity r/t surgical amputation of foot aeb [description of the incision]. here is a website with the nanda information as well as some suggestions for nursing interventions and goals: [color=#3366ff]impaired tissue integrity

step 3 - planning. planning involves writing measurable goals/outcomes and nursing interventions. they are based upon the underlying cause of the patient's nursing problems and the evidence (signs/symptoms and patient responses to their problems) that prove the existence of the problem. your goals are to (1) improve, (2) stabilize, or (3) support these conditions. your nursing interventions or strategies come in four types:

  • assess/monitor/evaluate/observe (to evaluate the patient's condition)
  • care/perform/provide/assist (performing actual patient care)
  • teach/educate/instruct/supervise (educating patient or caregiver)
  • manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)

so, for example, with impaired tissue integrity you will have interventions such as:

  • note the condition of surgical incision and document the findings every 8 hours
  • perform sterile dressing changes daily as ordered by the physician
  • teach the patient to inspect the stump daily and use a mirror to inspect all bottom parts that cannot be seen easily
  • notify the surgeon if there are any signs or symptoms of wound infection.

these are all interventions that are targeting the incision which is the evidence that supports why the patient has impaired tissue integrity.

steps 4 and 5 - depend on patient response

discharge plan

a discharge plan is not a part of a nursing care plan in the u.s. here in the u.s. we generally have a separate form in the hospitals that is filled out on which we document what we are teaching the patient prior to their discharge. teaching is also included throughout the care plan as intervention items where they apply to the appropriate nursing problem.

discharge planning is determining what the patient's medical needs will be after discharge from a hospital. discharge planning includes addressing the following subjects with the patient:

  • their diet

  • allowed physical activity

  • medications they need to take

  • any treatments and tests they need to be doing after discharge

  • referrals to any outside agencies or support groups

  • follow up appointments with doctors have been made and patient understands

  • teaching materials and/or contact with outpatient professionals for continued care and teaching have been provided to the patient

here is one article on the subject:
https://nursing.advanceweb.com/ce/testcenter/course.aspx?courseid=647&creditid=1
- "discharge planning"

for weblinks you can search for patient information on amputation, see
https://allnurses.com/forums/f205/medical-disease-information-treatment-procedures-test-reference-websites-258109.html
-
medical disease information/treatment/procedures/test reference websites

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.

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Specializes in med/surg, telemetry, IV therapy, mgmt.
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:

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