newborn care plans

SopranoKris, MSN, RN, NP · Mar 6, 2014

Is there a question you have? We're not just going to create a care plan for you :)

What do you think your care plan & interventions should be? BTW, it's "gestational diabetes". My instructor docks points for spelling.

Esme12, ASN, BSN, RN · Mar 6, 2014

Welcome to AN! The largest online nursing community!

We are happy to help but we need to know what you think first. what semester are you? Spelling is a big deal as misspellings can be something else entirely in nursing.

nurseprnRN, BSN, RN · Mar 6, 2014

Ineffective infant feeding pattern R/T gestational diabetis

It's "diabetes," and there is no such related to/causative factor for this nursing diagnosis in NANDA-I 2012-2014. YOu can't say this infant is feeding ineffectively because his mother had GD. Where did you get that idea?

You can't just make up a "related to/causative factor" because it sounds good to you. You must use approved material from the NANDA-I 2012-2014. See below.

See, you are falling into the classic nursing student trap of trying desperately to find a nursing diagnosis for a medical diagnosis without really looking at your assignment as a nursing assignment. You are not being asked to find an auxiliary medical diagnosis-- nursing diagnoses are not dependent on medical ones. You are not being asked to supplement the medical plan of care-- you are being asked to develop your skills to determine a nursing plan of care. This is complementary but not dependent on the medical diagnosis or plan of care.

In all fairness, we see ample evidence every day that nursing faculty sometimes have a hard time communicating this concept to new nursing students. So my friend Esme and I do our best to reboot you and get you started on the right path. :)

Sure, you have to know about the medical diagnosis and its implications for care, because you, the nurse, are legally obligated to implement some parts of the medical plan of care. Not all, of course-- you aren't responsible for lab, radiology, PT, dietary, or a host of other things.

You are responsible for some of those components of the medical plan of care but that is not all you are responsible for. You are responsible for looking at your patient as a person who requires nursing expertise, expertise in nursing care, a wholly different scientific field with a wholly separate body of knowledge about assessment and diagnosis and treatment in it. That's where nursing assessment and subsequent diagnosis and treatment plan comes in.

This is one of the hardest things for students to learn-- how to think like a nurse, and not like a physician appendage. Some people never do move beyond including things like "assess/monitor give meds and IVs as ordered," and they completely miss the point of nursing its own self. I know it's hard to wrap your head around when so much of what we have to know overlaps the medical diagnostic process and the medical treatment plan, and that's why nursing is so critically important to patients.

You wouldn't think much of a doc who came into the exam room on your first visit ever and announced, "You've got leukemia. We'll start you on chemo. Now, let's draw some blood." Facts should come first, diagnosis second, plan of care next. This works for medical assessment and diagnosis and plan of care, and for nursing assessment, diagnosis, and plan of care. Don't say, "This is the patient's medical diagnosis and I need a nursing diagnosis," it doesn't work like that.

There is no magic list of medical diagnoses from which you can derive nursing diagnoses. There is no one from column A, one from column B list out there. Nursing diagnosis does NOT result from medical diagnosis, period. This is one of the most difficult concepts for some nursing students to incorporate into their understanding of what nursing is, which is why I strive to think of multiple ways to say it. Yes, nursing is legally obligated to implement some aspects of the medical plan of care. (Other disciplines may implement other parts, like radiology, or therapy, or ...) That is not to say that everything nursing assesses, is, and does is part of the medical plan of care. It is not. That's where nursing dx comes in.

A nursing diagnosis statement translated into regular English goes something like this: "I think my patient has ____(nursing diagnosis)_____ . He has this because he has ___(related factor(s))__. I know this because I see/assessed/found in the chart (as evidenced by) __(defining characteristics) ________________. "

"Related to" means "caused by," not something else. In many nursing diagnoses it is perfectly acceptable to use a medical diagnosis as a causative factor. For example, "acute pain" includes as related factors "Injury agents: e.g. (which means, "for example") biological, chemical, physical, psychological." "Surgery" counts for a physical injury-- after all, it's only expensive trauma. :)

To make a nursing diagnosis, you must be able to demonstrate at least one "defining characteristic" and related (causative) factor. (Exceptions: "Risk for..." diagnoses do not have defining characteristics, they have risk factors.) Defining characteristics and related factors for all approved nursing diagnoses are found in the NANDA-I 2012-2014 (current edition). $29 paperback, $23 for your Kindle or iPad at Amazon, free 2-day delivery for students. NEVER make an error about this again---and, as a bonus, be able to defend appropriate use of medical diagnoses as related factors to your faculty. Won't they be surprised! Wonder where you learned that??? :) http://www.amazon.com/Nursing-Diagnoses-Definitions-Classification-International/dp/0470654821/ref=sr_1_1?s=books&ie=UTF8&qid=1393965776&sr=1-1&keywords=nanda-i+2012-2014

I know that many people (and even some faculty, who should know better) think that a "care plan handbook" will take the place of this book. However, all nursing diagnoses, to be valid, must come from NANDA-I. The care plan books use them, but because NANDA-I understandably doesn't want to give blanket reprint permission to everybody who writes a care plan handbook, the info in the handbooks is incomplete. Sometimes they're out of date, too-- NANDA-I is reissued and updated q3 years, so if your "handbook" is before 2012, it may be using outdated diagnoses.

We see the results here all the time from students who are not clear on what criteria make for a valid defining characteristic and what make for a valid cause.Yes, we have to know a lot about medical diagnoses and physiology, you betcha we do. But we also need to know about NURSING, which is not subservient or of lesser importance, and is what you are in school for.

If you do not have the NANDA-I 2012-2014, you are cheating yourself out of the best reference for this you could have. I don’t care if your faculty forgot to put it on the reading list. Get it now. When you get it out of the box, first put little sticky tabs on the sections:

1, health promotion (teaching, immunization....)

2, nutrition (ingestion, metabolism, hydration....)

3, elimination and exchange (this is where you'll find bowel, bladder, renal, pulmonary...)

4, activity and rest (sleep, activity/exercise, cardiovascular and pulmonary tolerance, self-care and neglect...)

5, perception and cognition (attention, orientation, cognition, communication...)

6, self-perception (hopelessness, loneliness, self-esteem, body image...)

7, role (family relationships, parenting, social interaction...)

8, sexuality (dysfunction, ineffective pattern, reproduction, childbearing process, maternal-fetal dyad...)

9, coping and stress (post-trauma responses, coping responses, anxiety, denial, grief, powerlessness, sorrow...)

10, life principles (hope, spiritual, decisional conflict, nonadherence...)

11, safety (this is where you'll find your wound stuff, shock, infection, tissue integrity, dry eye, positioning injury, SIDS, trauma, violence, self mutilization...)

12, comfort (physical, environmental, social...)

13, growth and development (disproportionate, delayed...)

Now, if you are ever again tempted to make a diagnosis first and cram facts into it second, at least go to the section where you think your diagnosis may lie and look at the table of contents at the beginning of it. Something look tempting? Look it up and see if the defining characteristics match your assessment findings and at least one of the related / caustive factors are present. If so... there's a match. Congratulations! You have made a nursing diagnosis! :anpom: If not... keep looking. Eventually you will find it easier to do it the other way round, but this is as good a way as any to start getting familiar with THE reference for the professional nurse.

I hope this gives you a better idea of how to formulate a nursing diagnosis using the only real reference that works for this.

Now, we're going to look at where to go for outcomes and interventions. I think you can probably imagine what you might want to see for an outcome. Make sure it's congruent with your patient's wishes-- never forget that any patient can refuse any care or intervention, any time.

I'm going to recommend two more books to you that will save your bacon all the way through nursing school, starting now. The first is NANDA, NOC, and NIC Linkages: Nursing Diagnoses, Outcomes, and Interventions. This is a wonderful synopsis of major nursing interventions, suggested interventions, and optional interventions related to nursing diagnoses. For example, on pages 113-115 you will find Confusion, Chronic. You will find a host of potential outcomes, the possibility of achieving of which you can determine based on your personal assessment of this patient. Major, suggested, and optional interventions are listed, too; you get to choose which you think you can realistically do, and how you will evaluate how they work if you do choose them.It is important to realize that you cannot just copy all of them down; you have to pick the ones that apply to your individual patient. Also available at Amazon. Check the publication date-- the 2006 edition does not include many current nursing diagnoses and includes several that have been withdrawn for lack of evidence; you want the most current edition, 2011.

The 2nd book is Nursing Interventions Classification (NIC) is in its 6th edition, 2013, edited by Bulechek, Butcher, Dochterman, and Wagner. Mine came from Amazon. It gives a really good explanation of why the interventions are based on evidence, and every intervention is clearly defined and includes references if you would like to know (or if you need to give) the basis for the nursing (as opposed to medical) interventions you may prescribe. Another beauty of a reference. Don't think you have to think it all up yourself-- stand on the shoulders of giants.

Let this also be your introduction to the idea that just because it wasn't on your bookstore list doesn't mean you can’t get it and use it. All of us have supplemented our libraries from the git-go. These three books will give you a real head-start above your classmates who don't have them.

pocahontas3 · Mar 7, 2014

thank you so much for the info, care plans are one of the hardest things for me. I have the logic and the rationales but coming up with a Nanda dx that makes sense and that follow what I am thinking is choking me.

I chose risk for unstable blood glucose R/T maternal gestational diabetis.

the baby was 9.5 lbs 19 inches long and according to the RN we had to check his sugars every 1/2 hour because the initial sugar was high.

after 3 hrs the sugar was low and baby was fed.

short term goal will be for the newborn to maintain normal glucose levels.

now I need a second diagnosis which I originally was thinking risk for infection related to blood sticks or I was also thinking ineffective maternal bonding.

please help

Esme12, ASN, BSN, RN · Mar 7, 2014

What resource are you using for your ND?

Think about the risks to the newborn....any newborn....why are we concerned about the baby being kept warm? What do we instruct mother to look for on the umbilical cord stump? The heel sticks might be a source to become infected but wouldn't the stump be more important? Why would the mother have ineffective bonding? What about your assessment supports this diagnosis? Is this her first baby? Is she breast feeding? Was the baby full term? was this a lady partsl birth?

TELL ME ABOUT YOUR PATIENT. Let the patient/patient assessment drive your diagnosis. Do not try to fit the patient to the diagnosis you found first. You need to know the pathophysiology of your disease process. You need to assess your patient, collect data then find a diagnosis. Let the patient data drive that diagnosis.

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 the care plan as a recipe to caring for your patient. your plan of how you are going to care for them. how you are going to care for them. what you want to happen as a result of your caring for them. What would you like to see for them in the future, even if that goal is that you don't want them to become worse, maintain the same, or even to have a peaceful pain free death.

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. You need to use the nursing diagnoses that NANDA has defined and given related factors and defining characteristics for. These books have what you need to 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.

nurseprnRN, BSN, RN · Mar 7, 2014

thank you so much for the info, care plans are one of the hardest things for me. I have the logic and the rationales but coming up with a Nanda dx that makes sense and that follow what I am thinking is choking me.
I chose risk for unstable blood glucose R/T maternal gestational diabetis.
the baby was 9.5 lbs 19 inches long and according to the RN we had to check his sugars every 1/2 hour because the initial sugar was high.
after 3 hrs the sugar was low and baby was fed.
short term goal will be for the newborn to maintain normal glucose levels.
now I need a second diagnosis which I originally was thinking risk for infection related to blood sticks or I was also thinking ineffective maternal bonding.
please help

Alas, the nursing diagnosis "risk for unstable blood glucose level" does not include "maternal gestational diabetEs" as a risk factor, either, so you can't make that diagnosis for this baby. You really need to get the book.

And you don't choose a nursing diagnosis and then look for ways to justify your choice. You assess your patient and then make a nursing diagnosis based on your findings.

There is a nursing diagnosis of "Risk for disturbed maternal-fetal dyad,"defined as "at risk for disruption of the symbiotic maternal/fetal dyad as a result of comorbid or pregnancy-related conditions." One of the risk factors is "impaired glucose metabolism (e.g., (which means, "for example") diabetes, steroid use). How do you see this in your baby?

NicuGal, MSN, RN · Mar 8, 2014

I have to beg to differ, a gestational diabetic baby CAN have an ineffective eating pattern. They are pretty notorious for this. Is there someway to fit this into a NANDA format? They tend to be more on the immature side regarding eating. Risk for unstable blood glucose is good. Checking BS prior to feeds, good. What other things should you watch for?

nurseprnRN, BSN, RN · Mar 8, 2014

I hear you, and there may be, for a given baby.

Defining characteristics for the nursing diagnosis "ineffective infant feeding pattern" are:

inability to coordinate sucking, swallowing, and breathing

inability to initiate an effective suck

inability to sustain an effective suck

The related/causative factors for this nursing diagnosis are:

anatomical abnormality

neurological delay

neurological impairment

oral hypersensitivity

prematurity

prolonged NPO stats

While you may make a case for any given GD newborn having one of the defining characteristics and one of the related factors, you have to say which ones you assessed, and note that merely the fact of having a GD mother is not on either list. That's the point.

As for how to get a NANDA-I nursing diagnosis approved or revised, many nurses (not just academics) follow the process for submission every year, and NANDA-I members (who can be any nurse, not just academics) vote on the resulting submissions. You can read about it in the book.

NicuGal, MSN, RN · Mar 8, 2014

I am not familiar with the format, that is why I asked, no reason to be flip at the end of your post. Our care plans at work don't follow this format. Just saying they have an immature eating pattern and are usually horrible feeders, so that is something that shouldn't be overlooked in these kids.

nurseprnRN, BSN, RN · Mar 9, 2014

Absolutely no flipness intended, on my honor. I didn't read who sent your post and thought it was a student (if I had I certainly would have recognized you, my apologies), and you know how I am about making sure students understand about the requirements for NANDA-I.

Fact remains, though, that it is literally not possible or supportable to make a nursing diagnosis, any nursing diagnosis, without using the validated NANDA-I definition, defining characteristics, and related/causative factors. This does not invalidate the experienced nurse's opinion that, for example, a GD baby may be a horrible feeder and to watch out for that. That's different, though, from making a nursing diagnosis, and students must be aware of the difference.