Nursing Care Plan Help

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Hi Everyone,

I have just written my first nursing care plan and must rewrite it.

My instructor is happy with the chosen Nanda but not the Noc and Nic.

My patient admitted with lower GI bleed, Profound Anemia and Diarhhea at the age of 93, she has been NPO for 2 days.

I chose Fluid Volume Deficient... As I was going over it with her she lead me to believe that a better NOC would be Fluid Balance, but thought there was something even better than that ??

Any suggestions would be great.

Thanks.

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

what was your nursing diagnostic statement? deficient fluid volume and telling us the medical diseases isn't enough information for me to help you. noc is nursing outcomes classifications and nic is nursing interventions classifications. these are lists of outcomes and nursing interventions. when you say "fluid balance" you are referring to the noc outcomes and nic interventions linkage of "fluid balance" (0602) water balance in the intracellular and extracellular compartments of the body. " fluid balance" is one of the links suggested to be used with the nursing diagnosis of deficient fluid volume. your instructor must feel that the aeb items in your diagnostic statement closely meet the definition of "fluid balance" and the interventions listed in the nic manual. you need a copy of nursing interventions classification (nic), by joanne mccloskey mccloskey dochterman, gloria m. bulechek, gloria m. bulechek in order to see what the specific nursing interventions are that are listed for "fluid balance". of course, a great deal has to do with the cues (defining characteristics) that support your nursing diagnosis of deficient fluid volume. remember that your nics are often aimed at treating the defining characteristics (symptoms of the problem). since you didn't post what those were it is hard to determine if "fluid balance" is appropriate or not for this care plan. the nursing problem, deficient fluid volume, is based upon the abnormal assessment data that you have that proves the problem exists. what is that data? your nursing interventions often target the abnormal data. the outcome often deals with the predicted result of your interventions and sometimes, if there is any way, with the etiology of the problem can be altered.

other noc and nic linkages that can possibly be used with deficient fluid volume are:

  • electrolyte & acid/base balance
  • hydration
  • nutritional status: food & fluid intake
  • appetite
  • blood loss severity
  • bowel elimination
  • cognition
  • knowledge: medication
  • nausea & vomiting severity
  • thermoregulation
  • urinary elimination

if what i am saying is not making any sense to you, let me know so i can explain more to you about what is going on.

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Thanks for the reply..

My patient is 93, and admitted with severe dehydration, profound anemia and lower GI Bleed.

I have the NIC and NOC books. I chose Fluid Volume, Deficient (Nanda) R/T: Active Fluid Volume Loss, Secondary to : NPO 2 days, Profound Anemia, Diarrhea and Hematochezia.

My AEB's: Are Decreased Skin and Tongue Turgor and Increased Furrows, as well as Decreased Urine Output.

I was going to chose for my NOC: Fluid Balance and my NIC Fluid Managment or Fluid Monitoring.

I got the feeling from her that she thought there was something better. So as I look at these, I also could chose Hydration as my NOC but then I am stumped on what to use for my NIC other than Hypovolemia Management?

Does that help?

I'm so confused......:cry:

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

Since you have the NOC and NIC books did you look at what was listed with Fluid Managment and Fluid Monitoring? Since the patient had diarrhea and GI bleeding, why aren't you considering Blood Loss Severity or Bowel Elimination? Why not the Urinary Elimination because of the decreased urine output? I wouldn't have listed decreased urine output as an AEB. I would have re-written it as increased urine concentration. Sometimes its how you write it.

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I was going to chose blood loss severity, but she didn't want that because it was directed at the Anemia only, and not total body fluid (in other words, didn't totally address the dehydration).. She is extremely strict, and unfortunately does not give much guidance so I feel like I am out on a limb. I addressed it as Hydration (NOC) and Fluid management and Hypovolemia Management as my NIC since she allowed us to use more than one. Hopefully it will work out this time.

I think that she did not want Blood Loss Severity because the patient received two pints of blood and her levels were still below normal.

Thanks again for the help.

:wink2:

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