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Discussion

Need help with care plan

I am doing a care plan for a patient that has a history of pancreas and liver cancer. He was admitted from the ER exhibiting sever abd. pain and N&V. He had had the whipple procedure done in january 2010 and had received chemo. He would found to have iron deficiency anemia and they suspected the pancreatic and liver cancer was still active. He was only 39 with 2 small children. I have my first dx as acute pain, but I can not come up with something else. I have thought of using risk for activity intolerence r/t pain. I have also thought of using a one of the family dx because of his age and children and him having a terminal illness. I am at a loss and still new at these care plans. Can someone offer some advice or good websites that could help? Thanks!

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    • Featured Replies

    He has activity intolerance r/t iron deficiency, therefore not a risk. He is at risk for electrolyte imbalance r/t N/V though. I always loved knowledge deficit r/t disease process. How about caregiver roll strain?

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    • Author

    I don't really know how to use the caregiver roll strain. I have a lot of issues with my care plans because I don't understand them. We were basically given a Nanda list told about the R/T and A.M.B. and told to go at it. I did think of the knowledge deficit but he was more knowledgeable of his condition than I was. (For some reason we started clinicals a couple weeks after starting school. We do not have the knowledge of disease processes or anything so it is hard for me to say I could teach them about it)

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    Since the pt. was receiving chemo. he not only has anemia, but low WBC's and platelets. How about risk or infection r/t surgical incision, impaired nutrition and low WBC's?

    I would agree with the risk for electrolyte imbalance r/t chemo and n/v and diarrhea also.

    risk for bleeding r/t to low platelets (thrombocytopenia) secondary to chemo.

    interrupted family processes

    disturbed body image

    impaired comfort

    Hope that helps! I miss doing care plans, I know that's kind of warped!:D

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    When doing care plans, you have to go with the most pressing need. I would say fluid volume deficit r/t nausea and vomiting. Usually, fluid volume deficit takes precedence over all other diagnoses.

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    • Experts

    Have you actually assessed this patient? What was the pain assessment? You could, as you said, form an ND with Pain as the diagnosis or as the etiology of something else. But you must have pain data for your evidence -- that comes from your assessment.

    If you did a resp assessment you would know if he had issues with breathing pattern r/t abdominal pain (for example).

    If you are doing care plans always assess then diagnose. If you have Ackley read the first several ages on how to make a nursing diagnosis (and how to use her book).

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    just what you need...another 1000 pg book to have as a reference. but in my nursing program, we use edition 11 of the nurse's pocket guide, a handy little book that explains nrsg dx, how and when to use the correct one.

    so now I can tell the difference between breathing pattern, gas exchange, airway clearance. when and why to use impaired, ineffective, R/F. wonderful explanations, examples of problems, interventions, goals.

    at first they all seemed the same, but I'm getting it now!

    geeeez, so much to know, so little time!

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