Need help with my care plan

you haven't supplied enough information for anyone to give you much, if any help on any more diagnosing for this patient. see https://allnurses.com/general-nursing-student/help-care-plans-286986.html - help with care plans. that thread has information and many examples of how diagnosing is done. care planning and diagnosing begins with assessment of the patient. while knowing the patient's medical diagnoses (dementia, alzheimer disease, htn, depression, osteoarthritis, pneumonia, chronic dermatitis) is helpful it is only a small part of the assessment. since this is a resident of a ltc facility the services that are given there are nursing care. one of the things that should have been assessed is how the patient's adls are accomplished. adls minimally include bathing, dressing, mobility, eating, toileting, and grooming. this patient has osteoarthritis and pain. is there a mobility problem? do they use some sort of assistive device to walk or need help to get around? there is a diagnosis for that. how is bathing and dressing accomplished? does this patient do it all by themself? i guarantee that if you saw the facility's care plan for this patient it would look nothing like yours. it would have self-care deficits on it and a number of "risk for" diagnoses, all of them based on assessments which you would have found in the chart in the back pages.

nursing diagnosis #1

at risk for infection r/t chronic dermatitis

goal/probable outcome

resident will not have an infection

intervention

assess skin q shift

what kind of care are you doing for the skin to keep it from becoming infected?

ensure proper am/hs care is performed - what is "proper" am/hs care?

report/chart any signs of infection - list the specific signs of skin infection that you want detected

apply skin barrier cream to prevent any skin integrity breakdown - where?

• strategies to prevent the problem from happening in the first place
  
  
• monitoring for the specific signs and symptoms of this problem
  
  
• reporting any symptoms that do occur to the doctor or other concerned professional
  
  

nursing diagnosis #2

pain r/t osteoarthritis

• 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
  )
  
  
• 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
  )
  
  
  
  

goal/probable outcome

pain level will be controlled

interventions

assess res. comfort and pain level

admin meds as ordered from physician

prn meds given to alleviate pain

perform passive rom exercises while in bed to help loosen up the joints, prevent muscle atrophy and maintain muscle tone

goal statements have four components:

1. a behavior
   
   • this is the desired patient response/action you expect to see/hear as a direct result of your nursing interventions.
     
   • you must be able to observe the behavior
     

[*]it is measurable

• criteria that identifies exactly what you are measuring in terms of
  
  • how much
    
  • how long
    
  • how far
    
  • on what scale you are using
    

[*]sets the conditions under which the behavior should occur

• such conditions as
  
  • when
    
  • how frequently
    

  [*]take into account the patient's overall state of health (this requires knowing the pathophysiology of their disease process)

  [*]take into account the patient's ability to meet the goals you are recommending

  [*]it is a good idea to get the patient's agreement to meet the intended goal so both the nurse and the patient are working toward the same goal

[*]have a realistic time frame for completing the goal

• long-term goals usually take weeks or months
  
• short-term goals can take as little time as a day
  
• it all depends on knowing what your nursing interventions are designed to do and what you believe your patient is capable of doing.
  

what else can be for nursing diagnosis in osteoathritis. if i put on about activity intolerance due to osteoathritis, is it acceptable? or anyone has other suggestion?

Did you read what I wrote above? Diagnosing depends on what you have assessed about the patient not necessarily what their medical diagnosis is. It is the patient's response to the osteoarthritis that will be important and I cannot say if Activity Intolerance is one of those responses for this patient. Activity Intolerance is a respiratory and cardiac problem. You've provided no evidence that your patient has any evidence of that. Before you go attaching diagnoses to someone you must understand how the process of diagnosing works. You don't just pull diagnoses out of a hat. You must assess the patient first and then examine the negative assessment evidence to see what fits with the correct diagnosis. What you are trying to do is no different from a medical student attempting to diagnose a medical disease by only knowing that the patient has certain nursing problems. What would you think about a doctor who does that? Not very scientific, is it?

i am weak in doing nursing diagnosis...please help me....my point is i saw that patient cannot tolerate in activity that means he/she needs help from us...he /she also in pain.Any idea?

You have two posts going. I just posted a reply for you to your post on the General Nursing Student Discussion Forum. Please do as I have asked you there. At this point it sounds as if you are really confused or not willing to put any of your own effort into understanding the diagnosis process. I really am trying to help you.