Nursing Diagnosis

i can tell you are stumped. first of all the care plan is about the problems of the patient who is this 9-year old child who got a rash from contact with poison ivy. it is not about the camp counselor or his classmates. the problems and their solutions have to be focused around the patient. in the interventions you can say "direct patient's caregiver to do such and so" or "instruct patient to keep x area of his body covered so it does not come into direct contact with classmates". sometimes care plan writing is about how skillfully you can play around with words and verb tenses so you can include these people in the care plan--but not directly because they are not technically your patient.

information on how to write a care plan are on the beginning of this sticky thread in the general nursing student discussion forum:

• https://allnurses.com/forums/f50/help-care-plans-286986.html - assistance - help with care plans

just like a mechanic takes a look at your car (investigates) before he does any work on it (diagnoses the problem and fixes it), we nurses do the same. we must assess first, then diagnose and develop nursing interventions to fix the problem(s). we do not do this blindly or without rational thinking and some tools to help us.

before you can determine any patient problems (nursing diagnoses) you must do a thorough assessment. the fact that this is a case study and not a real patient doesn't make a difference. assessment includes:

• a physical assessment of the patient - not physically practical in this case, but in looking up poison ivy rashes make note of what you are likely to find and include these findings as part of your write up for this study. pay attention to any symptoms that the scenario gave you and remember to include them in you study.
  
• assessment of the patient's ability and any assistance they need to accomplish their adls (activities of daily living) with the disease - since this is a child think of how it is likely to affect his ability to eat, bathe, dress and deal with their clothing, move around, participate in activities, etc. there is something important about the contact with the urushiol oil in the plant that is closely involved with adls that is going to play an important part in this care plan.
  
• data collected from the medical record (information in the doctor's history and physical, information in the doctor's progress notes, test result information, notes by ancillary healthcare providers such as physical therapists and dietitians - probably not applicable
  
• knowing the pathophysiology, signs/symptoms, usual tests ordered, and medical treatment for the medical disease or condition that the patient has. this includes knowing about any medical procedures that have been performed on the patient, their expected consequences during the healing phase, and potential complications. if this information is not known, then you need to research and find it.
  • http://www.emedicinehealth.com/allergy_poison_ivy_oak_and_sumac/article_em.htm - poison ivy, oak, and sumac, includes a slide show with poison ivy rash on slide 7
    
  • http://www.aad.org/public/publications/pamphlets/skin_poison.html - poison ivy, oak & sumac
    
  • http://www.mayoclinic.com/print/poison-ivy/ds00774/dsection=all&method=print - poison ivy rash
    
  • http://www.nlm.nih.gov/medlineplus/poisonivyoakandsumac.html

once you have researched this condition and how the doctor treats it, then you need to list the symptoms and abnormal data. it is all these symptoms and abnormal data that point the way to the nursing diagnoses.

nursing diagnoses are merely shortened labels for the longer definitions of the true nursing problem. yes, one diagnosis will likely be impaired skin integrity whose definition is altered epidermis and/or dermis (impaired skin integrity). the patient needs to have disrupted (open) skin to use this diagnosis. deficient knowledge must have a specific focused subject to it--[color=#3366ff]deficient knowledge (specify).

i would not use anxiety unless you look closely at the defining characteristics for it and know or have some good ideas for nursing interventions for the ones you decide the child might have ([color=#3366ff]anxiety). anxiety is a vague uneasy feeling of discomfort or dread accompanied by an autonomic response; a feeling of apprehension caused by anticipation of danger; it is an alerting signal that warns of impending danger and enables the individual to take measures to deal with the threat (nanda-i nursing diagnoses: definitions & classification 2007-2008). appropriate interventions for an anxious child are limited:

• provide a safe, calm environment
  
• decrease environmental stimuli
  
• encourage the patient to talk about their feelings and concerns
  
• give the patient a different perspective
  
• correct distorted perspectives

it helps to have a book with nursing diagnosis reference information in it. there are a number of ways to acquire this information.

• your instructors might have given it to you.
  
• you can purchase it directly from nanda. nanda-i nursing diagnoses: definitions & classification 2007-2008 published by nanda international. cost is $24.95 http://www.nanda.org/html/nursing_diagnosis.html
  
• many authors of care plan and nursing diagnosis books include the nanda nursing diagnosis information. this information will usually be found immediately below the title of a nursing diagnosis.
  
• the nanda taxonomy and a medical disease cross reference is in the appendix of both taber's cyclopedic medical dictionary and mosby's medical, nursing, & allied health dictionary
  
• there are also two websites that have information for about 75 of the most commonly used nursing diagnoses that you can access for free:
  
  • http://www1.us.elsevierhealth.com/evolve/ackley/ndh7e/constructor/
    
  • http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm

hope this information is helpful to you. if not, let me know if you are still stumped.