Need care plan help for PVD

[croakyfrog]

Hi there-

I need help with a care plan. My pt is 55 y/o female with PVD, DMII, CHF, CAD, neuropathy, chronic pain, hx of CABG. She was admitted for surgery- (her operation dx was: Ischemic rt leg w/impending limb loss) She had an open arteriogram of popliteal anterior tibial, tibiopernoeal, and peroneal arteries via rt groin. Cryoballoon angio x6 of popliteal artery. She has been seeing a pain mgmt dr for over 6 years and is taking methadone as well as other pain meds.

I feel her primary nursing dx should be acute pain b/c it was so hard to control and was really the main thing requiring constant attention, but I've already done an acute pain care plan, so I can not do that this week. I was thinking the next would be Impaired tissue perfusion, but she had surgery to open up these arteries to restore blood flow, so I don't think I can still say that it's impaired. Any ideas? Is there an appropriate dx for neuropathy of her lower limbs? That along with her pain was huge. Thanks in advance for any insight!

[Daytonite, BSN, RN]

you stated that this lady has been seeing a pain management doctor for over 6 years. the diagnosis you are looking for is

• chronic pain - definition: unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage (international association for the study of pain); sudden or slow onset of any intensity from mild to severe, constant or recurring without an anticipated or predictable end and a duration of more than 6 months. (page 355, nanda international nursing diagnoses: definitions and classifications 2009-2011)
  

this differs from acute pain which is

• acute pain - definition: unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage (international association for the study of pain); sudden or slow onset of any intensity from mild to severe with an anticipated or predictable end and a duration of less than 6 months. (page 354, nanda international nursing diagnoses: definitions and classifications 2009-2011
  

you need to become familiar with the nanda nursing diagnosis taxonomy. the taxonomy contains the definition, defining characteristics (signs and symptoms) and related factors (causes) for all the nursing diagnoses. many current care plan books have this information. nursing diagnosis references are also on the market. the taxonomy is in the appendix of current editions of taber's cyclopedic medical dictionary. about 80 of the most commonly used nursing diagnoses, their taxonomy information as well as suggestions for outcomes and interventions can be found on these two websites:

• http://www1.us.elsevierhealth.com/evolve/ackley/ndh7e/constructor/
  
  • chronic pain
    

  [*]http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm

  • http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=41 - chronic pain
    
    

cryoballoon angio x6 of popliteal artery didn't cure her pvd. she still has it in all the other veins of her legs. they just treated the largest one they could get to. all this surgery is going to do is improve her ischemia for the time being, but the atherosclerosis process is chronic and going to continue in all the blood vessels until the day she dies. ineffective peripheral tissue perfusion r/t atherosclerotic process secondary to pvd is the current correct diagnosis you should be using for this. you also need to read about pvd and get a better understanding of this disease process.

• http://emedicine.medscape.com/article/761556-overview - peripheral vascular disease
  
  • "pvd, also known as arteriosclerosis obliterans, is primarily the result of atherosclerosis."
    

  [*]http://www.fpnotebook.com/surgery/cv/prphrlartrloclsvds.htm

the neuropathy in her lower limbs is a symptom (aeb item) of this diagnosis. here is the taxonomy information for this diagnosis since it was added by nanda in 2008 and you may not be able to find this information readily:

• ineffective peripheral tissue perfusion
  
  • definition: decrease in blood circulation to the periphery that may compromise health (page 141, nanda international nursing diagnoses: definitions and classifications 2009-2011)
    
  • defining characteristics (signs and symptoms - can be one or more of these):
    
    • absent pulses
      
    • altered motor function
      
    • altered skin characteristics (color, elasticity, hair, moisture, nails, sensation, temperature)
      
    • blood pressure changes in extremities
      
    • claudication
      
    • color does not return to leg on lowering it
      
    • delayed peripheral wound healing
      
    • diminished pulses
      
    • edema
      
    • extremity pain
      
    • paraesthesia
      
    • skin color pale on elevation
      

    [*]related factors (causes):

    • deficient knowledge of aggravating factors (e.g., smoking, sedentary lifestyle, trauma, obesity, salt intake, immobility)
      
    • deficient knowledge of disease process (e.g., diabetes, hyperlipidemia)
      
    • diabetes mellitus
      
    • hypertension
      
    • sedentary lifestyle
      
    • smoking
      
    • venous insufficiency
      

[croakyfrog]

Thank you so much for the clarification. This is my first semester of clinicals so I'm still trying to get the hang of writing care plans. Thanks for the resources as well, I just never know where to look- this is very helpful!