Nursing Dx??

[Firemedic7]

OK Guys-

I promise, my questions are winding down...

You have a pt. with cellulitis and skin breaks on lower extremities as well as an IV. You choose "risk for infection". can you put r/t "invasive lines and tissue trauma to lower extremities" and then use "will use aseptic technique when assessing IV site" and "will assess lower extremities for signs of redness and unusual drainage"????

BTW, Thanks soooo much for all of the help:p

[TraciRN]

Are you as nervous as I am about Friday?

I am going to stick to the Nursing Dx's that are simple and easy to prove

ie

impaired mobility

ineffective airway clearance

risk for injury

acute pain

and will only use a substitute if I have to.

Traci:coollook:

[Melinurse]

You are on the right track but I have to agree with TracyLVN. Keep it simple. Something you can do during PCS without adding on too much more time. Time seems to go alot faster when you do your CPNE.:onbch::tbsk: Take a break and de-stress. You're allowed to take time for you. Read sticky thread on Care Plans in the Nursing Students forum. Good stuff there.:lol: Good luck :)

[Medic2RN, BSN, RN, EMT-P]

Wouldn't "Impaired Skin Integrity" work better with the patient's illness?

It's been a while, but I remember staying away from any "risk for infection" dx.

Don't forget to remember the old handy fall/injury risk. Everyone in the hospital has a fall risk asessment performed on them. It's easy, simple and your interventions are going to be performed for every patient anyway (bed in low position, call light in reach, instructions to call for assistance, etc)

If I'm way off base, let me know!

[Baloney Amputation, BSN, LPN, RN]

If they have cellulitis, they will very likely have an antibiotic. I thought in that case that you absolutely cannot use "risk for infection" and may fail for it. However, if there is no antibiotic running in, it would work, I think. KISSS (keep it simple, safe, and specific)!

[BBFRN, BSN, PhD]

OK Guys-

I promise, my questions are winding down...

You have a pt. with cellulitis and skin breaks on lower extremities as well as an IV. You choose "risk for infection". can you put r/t "invasive lines and tissue trauma to lower extremities" and then use "will use aseptic technique when assessing IV site" and "will assess lower extremities for signs of redness and unusual drainage"????

BTW, Thanks soooo much for all of the help:p

Cellulitis is infection, so you wouldn't use 'risk for infection' in this patient. They will most definitely be receiving antibiotics as well, which would be another indication not to use 'risk for infection.'

http://www1.us.elsevierhealth.com/Evolve/Ackley/NDH6e/Constructor/C-G.html

Here is a really good care plan generator that you can use. You can start by picking the health problem and go from there. Cellulitis is listed in there, too.

I think you'll find it very helpful. :)

[Firemedic7]

Wouldn't "Impaired Skin Integrity" work better with the patient's illness?

It's been a while, but I remember staying away from any "risk for infection" dx.

Don't forget to remember the old handy fall/injury risk. Everyone in the hospital has a fall risk asessment performed on them. It's easy, simple and your interventions are going to be performed for every patient anyway (bed in low position, call light in reach, instructions to call for assistance, etc)

If I'm way off base, let me know!

Yes, that does make more sense

[Firemedic7]

Are you as nervous as I am about Friday?

I am going to stick to the Nursing Dx's that are simple and easy to prove

ie

impaired mobility

ineffective airway clearance

risk for injury

acute pain

and will only use a substitute if I have to.

Traci:coollook:

Can impaired mobility be a dx if you are going to use "will keep side rails up on bed and will keep bed in lowest position if leaving patient alone" or does impaired mobility only refer to ambulating? my fear is that I will have 1 at risk dx and cannot use "risk for injury as a second one, am I making any sense?

[Lunah, MSN, RN]

Which dx book are you using? Mosby's has impaired bed mobility as well as impaired physical mobility; I think Carpenito's does, too. Read that dx book! It'll give you all kinds of help.

[Melinurse]

There are soooo many differential dx for the pt. all depends on areas assigned and pt. history. Impaired mobility could be because of a fall rt the cellulitis. Had a pt a few days ago with this problem. Pt had cellulitis and we did the "impaired skin integrity", also included " safety" because leg was so swollen the patient had fallen and broken his arm ( radial fx ). In hospital patient was trying to get OOB on his own. Therefore, always look at pt. history and areas assigned and try to link them together using the books assigned by EC. Your patient can have multiple differential Dx. I see lots of responses, and as many responses as you are getting are as many and more different Dx and different ( but correct ) opinions based on all of our various experiences. There are alot of responses here with great advise, but it all boils down to patient history, Dx, areas assigned, differential Dx, etc. Use your books listed to be used at CPNE in your practice. If still unsure, call someone at EC and talk to them.

[Daytonite, BSN, RN]

before i'd use a potential problem (risk for infection) i'd focus on an actual problem (impaired skin integrity) if the skin has broken. "will use aseptic technique when assessing iv site" and "will assess lower extremities for signs of redness and unusual drainage" are merely interventions that can be used for either nursing diagnosis. assessment interventions, while used a lot for "risk for" diagnoses are still valid for use with actual nursing problems. you could use the words "monitor for" in place of "assess". there are four types of nursing interventions (actions):

• assess/monitor/evaluate/observe (to evaluate the patient's condition)
  
• care/perform/provide/assist (performing actual patient care)
  
• teach/educate/instruct/supervise (educating patient or caregiver)
  
• manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)