Careplan help: Vater syndrome

  1. I'm doing a careplan for a little girl 2 yrs old. She is being admitted for colostomy removal after a successful PSARD 6 months ago. Because she is Vater syndrome she has renal failure. Abnormal results are:
    Low Hematocrit: anemia, iron deficiency or other deficiency 27.2
    Low Hemoglobin: kidney disease 8.2
    High BUN 64 & Creatinine 2.4: Renal Failure
    High Protein: kidney disease
    last 12 hrs I/O
    I= 537
    O= 692
    there is talk of dialysis to begin at a later date but soon
    She also has a G-tube (nutrition) and Colostomy and is having bowel prep for surgery.
    My last careplan my instructor told me I had too many interventions, so I should limit my careplan based on a 24-hour period. So now I am second guessing myself. We are to follow our ABC's then pain (I got reemed for using Maslows last time for choosing Immobility over pain)
    Anyway, to make this instructor happy I don't know if I should choose Pain r/t surgical incision since that is what she is there for (surgery)...they are not even addressing her renal problems at this time for this admission. Of course, I naturally want to choose Impaired Tissue perfusion: Renal
    if going by the standard protocol, but I am afraid I'll be choosing the wrong careplan because she is not here for her kidney problems at this time and I am afraid my instructor will go off. Any suggestions?
    Last edit by discobunni on Apr 16, '07
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    About discobunni

    Joined: Nov '05; Posts: 69; Likes: 14
    RN
    Specialty: 1 year(s) of experience in NICU

    8 Comments

  3. by   Daytonite
    you know your instructor better than i do. focus your care plan and your interventions on your patient's primary reason for being admitted. did you look at the doctor's history and physical and his order sheets? the doctor's orders and any information about his medical plan of care that is in the doctor's progress notes will head you in the right direction on this. if your instructor wants pain sequenced before other things, then that's what you need to do. i can tell you how to choose diagnoses, goals, and interventions, but when it comes to the fine tweaking of putting all the elements together for the presentation of the care plan (prioritizing and sequencing the nursing diagnoses) you have to be attentive to what your instructors want. it's your grade at stake here.

    so, i'm not clear here as to what kind of assistance you need. tell me, why was this little girl admitted? what is the surgery to be done? i think that's where i would put the focus of the care plan based on what you've posted. sounds like this a pre-op situation to me that needs to be tweaked to the needs of a two-year old with chronic kidney disease. vater syndrome, i thought, was a congenital malformation of the gi tract involving vater's ampulla. i'm not clear as to how it is related to her chronic kidney disease, but that may not be important to the situation, other than for your explanation of the pathophysiology of what is going on.

    https://allnurses.com/forums/f205/ap...ml#post1969425
  4. by   EricJRN
    VATER syndrome not actually related to the Ampulla of Vater. VATER is an acronym for the various abnormalities/affected systems you will see:

    V = Vertebral
    A = Anal (imperforate anus)
    TE = Tracheoesophageal fistula/esophageal atresia
    R = Renal

    Sometimes you'll hear about VACTERL association. (The C stands for cardiac and the L for limb.)

    Here's a link: http://www.kumc.edu/gec/support/vater.html
  5. by   discobunni
    hi there,
    first of all thanks for the reply! :spin: this little girl has all kinds of problems, the real medical dx is actually v.a.t.e.r., (or vacterl) which stands for
    v: vertebral dysgenesis
    a: anal atresia
    c: cardiac anomalies
    t-e: fistula +/- esophageal atresia
    r: renal or radius anomalies
    l: limb anomalies
    but in this case she did not have cardiac or limb anomalies, they say it is used more as an acronym rather than a diagnosis so that if there are two or more anomalies then the physician knows to look for the other ones. from what i read it is a fairly rare type of birth defect.
    they fixed her imperforated anus 6 months ago,
    so the chief complaint is (or reason for admission):
    is the colostomy removal. you hear so much to follow your abc's but i guess what i am asking is if there are exceptions to the rule? i mean in a case like this she has had this since birth and is being followed by a nephrologist and they already have a plan of care in place, and her renal needs are not being addressed at this time. so i guess i am confused...i mean i know i would be monitoring this anyway because that is all you can really do is monitor vitals, i/o and weight and that is not even what she is here for...ugh i wish all instructors would tell us what they want! i've tried to get in touch w/her but have been unable and i'm coming up on a deadline to email this in so i'm pulling my hair out! i may just include a note explaining my reasoning so maybe she won't count off too much because i am unclear on what she wants!
  6. by   discobunni
    Oh I see someone beat me to the Medical DX... heheheheh
    But anyway, I'm just wondering for most nursing schools are there exceptions to Nursing DX Prioritizing for careplans? Or do you ALWAYS follow the ABC's/Maslow for the entire person, no matter what?
    Who knew there were gray areas! UGH UGH UGH!
  7. by   Daytonite
    Thanks, Eric. I could only find it in my ICD-9-CM code book and it sent me to the GI section as a congential malformation, but gave nothing more specific.
  8. by   Daytonite
    Quote from discobunni
    Oh I see someone beat me to the Medical DX... heheheheh
    But anyway, I'm just wondering for most nursing schools are there exceptions to Nursing DX Prioritizing for careplans? Or do you ALWAYS follow the ABC's/Maslow for the entire person, no matter what?
    Who knew there were gray areas! UGH UGH UGH!
    Care plan writing is "artistic" in many ways. Your instructors and the facilities you end up working for can very much mandate how they want them constructed. About the only authority I know of that has had any say in the whole business has been NANDA and that has been regarding the 188 specific nursing diagnoses. Still, there are schools and facilities out there in the world that have developed their own lists of nursing diagnoses that they want the nurses who work for them to use. Schools and facilities can also make rules as to how they want the nursing diagnoses prioritized. The only reason I follow Maslow when I prioritize is because students typically don't give any information as to how their programs want their nursing diagnoses prioritized. My BSN program was very clear with us as to how they wanted us to format and present the information on our care plans. If we didn't follow the rules we had been given (in a 3-credit hour class, no less!) we got big time points deducted from the grade for them.

    The one thing that doesn't change, however, is the nursing process part that goes into putting together all the elements of a care plan. The assessment information is still used to determine the patients problems. The patients problems get turned into nursing diagnoses by whatever system you are asked to use. Goals and interventions are developed from the patient problems which you got from the assessment information. If you understand how each of those different steps of the nursing process work then you should be able to write care plans using any formatting system you are given. This is one of the reasons why I often explain so much about assessment being so important to determining your nursing diagnoses and why I'm always quoting nursing diagnosis definitions, related factor and defining characteristics from my NANDA resource. I'm trying, and hoping, that some are seeing the rationale behind it all. Understand that rationale and you are in a much better position to reason out answers on tests and pass the NCLEX.
  9. by   Daytonite
    I would, as I said above, take my cues from the medical plan of treatment. Look to the medications and treatments that are ordered. Also, since the patient is pre-surgical, pre-op teaching is appropriate. You'll definitely want to get information about the surgery as some patient (actually, parent) teaching is appropriate as well. When there is already an established plan of therapy in place you really don't want to mess with it. There is a nursing diagnosis for that if you want to include it in your care plan: Effective Therapeutic Regimen Management.
  10. by   Daytonite
    Quote from discobunni
    you hear so much to follow your abc's but i guess what i am asking is if there are exceptions to the rule? i mean in a case like this she has had this since birth and is being followed by a nephrologist and they already have a plan of care in place, and her renal needs are not being addressed at this time. so i guess i am confused...i mean i know i would be monitoring this anyway because that is all you can really do is monitor vitals, i/o and weight and that is not even what she is here for...ugh i wish all instructors would tell us what they want! i've tried to get in touch w/her but have been unable and i'm coming up on a deadline to email this in so i'm pulling my hair out! i may just include a note explaining my reasoning so maybe she won't count off too much because i am unclear on what she wants!
    there are always going to be exceptions. look, the writing of a care plan for nursing school is as much a work of composition and art as it is an expression of scientific process. so, use that knowledge and your writing skills to your advantage. you know that patient better than the instructor. the instructor is only going to know what little contact she might have had with the patient and what you are going to tell him/her in your care plan. you have to make your case on paper is all. if your nursing diagnosis and interventions that are included with it don't indicate that a problem is serious, then what is your instructor who is only reading a piece of paper to conclude as to the importance of that problem and interventions? sometimes your grade depends on being able to dazzle the teacher, patient aside.

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