I am about to go nuts...

  1. I am a nursing student and I am doing a care plan for L&D.
    I got my three nursing diagnosis but I don't have any outcomes or interventions.... Here there are:

    1. Pain related to uterine contractions as evidence by pain rating of 6-10
    Goal-CW cope with uterine contractions
    2. Impaired skin integrety related to infant passage though birth canal as evidence by cervical dilation
    goal-CW maintain skin integrity
    3. Riskfor infection related to rupture membranes as evidence by leakage of aminiotic fluid and

    I don't have any outcome criteria or interventions and for some wierd reason every book store or library are out of Maternal Nursing care plan books. Can you all please suggest some outcome criteria... Please.
  2. Visit madlc profile page

    About madlc

    Joined: Apr '08; Posts: 3; Likes: 5


  3. by   EricJRN
    I moved your post to the Nursing Student Assistance Forum for more help.
  4. by   Daytonite
    hmmm. . .this is an interesting situation. outcomes and interventions are aimed at aeb items, or symptoms, in the diagnostic statements. outcomes are always what you anticipate will happen as a result of the nursing interventions being done.

    there are some problems with your nursing diagnostic statements:
    pain related to uterine contractions as evidenced by pain rating of 6-10
    goal-cw cope with uterine contractions
    the pain diagnosis is either acute pain or chronic pain. most likely acute pain for an ob patient.

    if your goal is for the patient to cope with uterine contractions, then some of your interventions need to be about how she is going to do that.
    impaired skin integrity related to infant passage though birth canal as evidence by cervical dilation
    goal-cw maintain skin integrity
    won't fly as a diagnosis. cervical dilation is not a symptom that in any way is descriptive of broken skin. there is no way you could assess broken skin in the vaginal or cervical areas. you can't use this diagnosis in this way.
    risk for infection related to rupture membranes as evidence by leakage of amniotic fluid
    why do women get postpartum infections? invasive procedures, multiple cervical exams, prolonged labor over 24 hours, prolonged rupture of membranes, manual extraction of the placenta, diabetes, urinary catheterization, anemia.

    a potential problem ("risk for") is a problem that does not yet exist. therefore, how can the patient have any evidence of a problem that doesn't even exist?

    outcomes for these diagnoses are quite simple. . .you don't want the problem to occur. see the discussion below for the types of interventions.

    using "risk for" diagnoses:
    1. they do not have related factors. instead they have risk factors. risk factors are environmental [conditions] and physiological, psychological, genetic, or chemical elements that increase the vulnerability of an individual, family, or community to an unhealthful event (page 333, nanda-i nursing diagnoses: definitions & classification 2007-2008).
    2. you use a "risk for" diagnosis when you "think" a specific problem "might happen" to the patient
    3. since these are potential, or anticipated, problems there are no defining characteristics (signs and symptoms) to use as evidence to support the diagnosis as there are with actual problems. so your nursing diagnostic statement has only two parts:
      • the nursing diagnosis label
      • the risk factor(s)
    4. you have to have a very clear and defined idea of the problem you are attempting to prevent, know it's signs and symptoms and preventative measures.
    5. interventions for these nursing diagnoses are limited to:
      • strategies to prevent the problem from happening in the first place
      • monitoring for the specific signs and symptoms of this problem
      • reporting any symptoms that do occur to the doctor or other concerned professional
      • if symptoms occur, you have an actual problem on your hands and you need to re-evaluate the care plan and change the nursing diagnosis
    6. as a general rule, these types of nursing diagnoses do not have the same priority as actual nursing problems. actual problems are usually attended to first.
    nursing diagnoses often used for labor are
    • impaired urinary elimination r/t mechanical compression of the bladder, effects of regional anesthesia
    • anxiety or fear r/t inability to meet the demands of labor or the uncertain outcome of labor
    • fatigue r/t increased energy requirements
    • acute pain r/t uterine contractions or vaginal/perineal distention
    • deficient knowledge, progression of labor r/t lack of information, information misinterpretation
    • risk for deficient fluid volume r/t decreased intake, mouth breathing
    • risk for (maternal or fetal) injury r/t invasive procedures, perineal tears with precipitous labor, repetitive vaginal examinations, fecal contamination, tissue hypoxia, hypercapnia, unexpected rapid birth, fetal compromise
    • risk for ineffective coping r/t situational crisis, inadequate support
  5. by   madlc
    Thanks you are a
    I think I will use...
    1. Acute pain r/t uterine contractions
    3. Risk for infection r/t repetitive vaginal exams
    2. Risk for Defient Fluid volume r/t decrease fluid intake.
  6. by   Daytonite
    go for it. make sure you have the supporting evidence for these diagnoses. there is information on how to construct a nursing diagnostic statement on this thread:
    also check out the information on