Nursing Interventions for Paroxysmal atrial fibrillation?

[mhingis]

Any suggestions will be appreciated

[Rose_Queen, BSN, MSN, RN]

What do you think are some nursing interventions? Based on your previous posts, I think it's safe to assume you are a student. Are you working on a nursing care plan? If so, nursing interventions for nursing diagnoses are based on the nursing assessment of the patient, not the medical diagnosis. Something to keep in mind.

[traumaRUs, MSN, APRN]

Moved to nursing student assistance - what info do you have so far?

[mhingis]

Thank you for your reply. First term student in an associates program. My background in medicine has always been from a provider/medical diagnosis frame of reference. It's a little tougher trying to adjust to a nursing diagnosis point of view. We have only had two clinical days this term so far and have two more this Thursday and Friday. Beforehand, we are assigned age, sex, principle medical dx, and 3 medications the patient is on. We come up with two anticipated priority needs, a goal for each, and two interventions. Certainly it's tougher not yet having laid eyes on the patient and interacted. Certainly, I would think in this case some issues would be decreased cardiac output and activity intolerance would be a couple priority needs. I'm sure I'll add and/or change some of these once I see the patient.

I know I'll get better at the care plans as I progress through the program. It's just a different mind-set than I've been used to. If you have any other helpful tips or good/credible websites for nursing dxs/interventions for various conditions, I would very much appreciate it.

[AliNajaCat]

From anther thread (if you open threads that mention care planning you'll find a plethora of useful stuff to help you wrap your head round learning to think like a nurse, not physician appendage):

OK, let's see if we can't tease this out. You don't have to come up with anything originally here, because, lucky for you, the profession of nursing is evidence-based and all the validated related (causative) factors are easily available in the pages of the single authority for making (not choosing: or "picking") nursing diagnoses: The NANDA-I 2015-2017 (this is the current edition-- it's updated q 2 years).

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. As physicians make medical diagnoses based on evidence, so do nurses make nursing diagnoses based on evidence.

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 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.

You don't "pick" or "choose" a nursing diagnosis. You MAKE a nursing diagnosis the same way a physician makes a medical diagnosis, from evaluating evidence and observable/measurable data.

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'm making the nursing diagnosis of/I think my patient has ____(diagnosis)_______ . He has this because he has ___(related factor(s))__. I know this because I see/assessed/found in the chart (as evidenced by) __(these 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 is a physical injury agent, right? So is a burn or a fracture, right? These are medical diagnoses which cause pain.

To make a nursing diagnosis, you must be able to demonstrate at least one "defining characteristic." Defining characteristics for all approved nursing diagnoses are found in the NANDA-I 2015-2017 (current edition). $39 paperback, $23 for instant download to your Kindle at Amazon, free 2-day delivery for students. This edition also includes an EXCELLENT FAQs section aimed at 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!

If you do not have the NANDA-I 2015-2017, 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. Free 2-day shipping for students from Amazon. 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 mutilation...)

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. If so... there's a match. CONGRATULATIONS! You made a nursing diagnosis! th_bf-swinging-00 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.

About Risk for” diagnoses:

First: "Risk for" nursing diagnoses are very often properly placed first, as safety ranks above all of the physiological needs in Maslow's hierarchy. Faculty often ask specifically for a ranking in Maslow's hierarchy. What are nurses for if not to protect a patient's safety, first and foremost?

Second:

It is a fallacy that "risk for..." nursing diagnosis is somehow lesser or not "real." If you look in your NANDA-I 2015-2017, there is a whole section on Safety, and almost all of the nursing diagnoses in that section are "risk for..." diagnoses. However, because NANDA-I has learned that nursing faculty is often responsible for this fallacy, the language on these has recently been revisited and was changed to include "Vulnerable to ..." in the defining characteristics the current edition.

Prioritizing your diagnoses: This sort of assignment is often made not only to see if somebody can recite rote information but to elicit your thought processes and see how well you can defend your reasoning.

So, you should be prepared to present the reasoning you have applied to your diagnoses and priority ranking. Why is one more important than another? There may be no one answer— just remember, you are supposed to be learning how to figure this out.

Working with a hypothetical patient: If there are only medical diagnoses given, you may have a little more work to do,. But you can also exercise your creativity more, by looking in your books and seeing what kind of symptoms of nursing diagnoses someone with those medical diagnoses may demonstrate. I can't tell you what they might be. You have to have some symptoms in mind, and then identify them in the lists of defining characteristics in the diagnoses you think might apply.

So let's look at yours. Remember, "related to" means "caused by," and nothing else.

I don't see anything that tells me you did any kind of patient assessment. Even if this is a totally hypothetical assignment, you have to have assessment data that a nurse would collect. So read up about these diseases and learn about the nursing care frequently needed for them, which will include assessment data. That should get you on the right track.

[Esme12, ASN, BSN, RN]

Thank you for your reply. First term student in an associates program. My background in medicine has always been from a provider/medical diagnosis frame of reference. It's a little tougher trying to adjust to a nursing diagnosis point of view. We have only had two clinical days this term so far and have two more this Thursday and Friday. Beforehand, we are assigned age, sex, principle medical dx, and 3 medications the patient is on. We come up with two anticipated priority needs, a goal for each, and two interventions. Certainly it's tougher not yet having laid eyes on the patient and interacted. Certainly, I would think in this case some issues would be decreased cardiac output and activity intolerance would be a couple priority needs. I'm sure I'll add and/or change some of these once I see the patient.

I know I'll get better at the care plans as I progress through the program. It's just a different mind-set than I've been used to. If you have any other helpful tips or good/credible websites for nursing dxs/interventions for various conditions, I would very much appreciate it.

I am curious...in what context have you been exposed to medicine yet you are in an associate nursing program. It helps me taylor my answers. What care plan book do you use? Do you have the NANDA nursing diagnosis book?

Nursing care plans are really rather simple. They focus on what the patient NEEDS not what they HAVE. I am sure you have been exposed to the nursing process and ADPIE. Care plans are like the recipe card to care for your patient. Your care plan should be based off of your assessment. Care plans are all about the patient and the patients problems. 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 the diagnosis.

What is your assessment? What are the vital signs? What is your patient saying?. Is the the patient having pain? Are they having difficulty with ADLS? What teaching do they need? What does the patient need? What is the most important to them now? What is important for them to know in the future. What is YOUR scenario? TELL ME ABOUT YOUR PATIENT...

The medical diagnosis is the disease itself. It is what the patient has not necessarily what the patient needs. the nursing diagnosis is what are you going to do about it, what are you going to look for, and what do you need to do/look for first. From what you posted I do not have the information necessary to make a nursing 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. From a very wise an contributor daytonite.......make sure you follow these steps first and in order and let the patient drive your diagnosis not try to fit the patient to the diagnosis you found first.

Here are the steps of the nursing process and what you should be doing in each step when you are doing a written care plan: ADPIE

1. Assessment (collect data from medical record, do a physical assessment of the patient, assess ADLS, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
   
2. Determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
   
3. Planning (write measurable goals/outcomes and nursing interventions)
   
4. Implementation (initiate the care plan)
   
5. Evaluation (determine if goals/outcomes have been met)
   

Care plan reality: The foundation of any care plan is the signs, symptoms or responses that patient is having to what is happening to them. What is happening to them could be the medical disease, a physical condition, a failure to perform ADLS (activities of daily living), or a failure to be able to interact appropriately or successfully within their environment. Therefore, one of your primary goals as a problem solver is to collect as much data as you can get your hands on. The more the better. You have to be the detective and always be on the alert and lookout for clues, at all times, and that is Step #1 of the nursing process.

Assessment is an important skill. It will take you a long time to become proficient in assessing patients. Assessment not only includes doing the traditional head-to-toe exam, but also listening to what patients have to say and questioning them. History can reveal import clues. It takes time and experience to know what questions to ask to elicit good answers (interview skills). Part of this assessment process is knowing the pathophysiology of the medical disease or condition that the patient has. But, there will be times that this won't be known. Just keep in mind that you have to be like a nurse detective always snooping around and looking for those clues.

A nursing diagnosis standing by itself means nothing. The meat of this care plan of yours will lie in the abnormal data (symptoms) that you collected during your assessment of this patient......in order for you to pick any nursing diagnoses for a patient you need to know what the patient's symptoms are. Although your patient isn't real you do have information available.

What I would suggest you do is to work the nursing process from step #1. Take a look at the information you collected on the patient during your physical assessment and review of their medical record. Start making a list of abnormal data which will now become a list of their symptoms. Don't forget to include an assessment of their ability to perform ADLS (because that's what we nurses shine at). The ADLS are bathing, dressing, transferring from bed or chair, walking, eating, toilet use, and grooming. and, one more thing you should do is to look up information about symptoms that stand out to you. What is the physiology and what are the signs and symptoms (manifestations) you are likely to see in the patient. did you miss any of the signs and symptoms in the patient? if so, now is the time to add them to your list. This is all part of preparing to move onto step #2 of the process which is determining your patient's problem and choosing nursing diagnoses. but, you have to have those signs, symptoms and patient responses to back it all up.

Care plan reality: What you are calling a nursing diagnosis is actually a shorthand label for the patient problem.. The patient problem is more accurately described in the definition of the nursing diagnosis.

Now...tell me about your patient.

[Lev, MSN, RN, NP]

Thank you for your reply. First term student in an associates program. My background in medicine has always been from a provider/medical diagnosis frame of reference. It's a little tougher trying to adjust to a nursing diagnosis point of view. We have only had two clinical days this term so far and have two more this Thursday and Friday. Beforehand, we are assigned age, sex, principle medical dx, and 3 medications the patient is on. We come up with two anticipated priority needs, a goal for each, and two interventions. Certainly it's tougher not yet having laid eyes on the patient and interacted. Certainly, I would think in this case some issues would be decreased cardiac output and activity intolerance would be a couple priority needs. I'm sure I'll add and/or change some of these once I see the patient.

I know I'll get better at the care plans as I progress through the program. It's just a different mind-set than I've been used to. If you have any other helpful tips or good/credible websites for nursing dxs/interventions for various conditions, I would very much appreciate it.

I think your priority needs are spot on a for a patient with paroxysmal afib. If there is a nursing diagnosis related to effective circulation aka prevention of blood clots that is an idea as well.