Redoing a nursing care plan...

  1. Hello all, I am almost finished with my 3rd semester of a 4 semester program. I have always done well with my previous NCPs (4 of them, with 4 different professors) however, my latest professor said I need to do a redo...Please help, I used the Ackley constructor as well as the Gulanick book...I'm on a med-surg psych floor for my rotation and my pt came in with suicidal ideation, uncontrolled HTN, hx of MI, uncontrolled DM, major depression, neuropathy, & schizophrenia. I chose knowledge deficit r/t htn & its management, chronic pain r/t neuropathy & fluid volume deficit r/t, my professor it needs to be more cardiac & possibly respiratory as these are the areas that are presently being emphaised in med-surg. Could anyone please suggest some diagnoses as I'm stumped and am now starting to panic. Thank you all so very much in advance, I look forward to hearing from the wise experienced ones that post.
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    About landesmummy

    Joined: Feb '08; Posts: 63; Likes: 36
    from AU


  3. by   landesmummy
    oh and the reasons why I chose these were, he had been in our facility 1 month before he was my pt which is why the DM, & htn were being controlled and there wasn't a suicide danger, hence the 3 I chose. My PC was hyperglycemia
  4. by   morte
    well, i dont get what your instructor wants for resp, unless you have left something out.....did they do blood gases and she is thinking some compensation going on there? and if you are doing PSYCH med surg why isnt she looking for a pysch dx? or is that plan separate? also, not all neuropathy is painful....i am not sure how to word it, but ? at risk for repeat MI, r/t uncontrolled HTN? I will be curious what Day has to say.....i usually learn something new when she weighs in!......i remain concerned/interested about the lack of psych dx here, it would seem from a distance that his/her schiz. is the underlying issue, that may be preventing the patient from "managing" the rest of his/her issues
  5. by   Daytonite
    i'm very sorry, but all you have posted is the patient's medical diagnoses and those are of little help in nursing care planning since a nursing care plan is about determining the patient's nursing problems. the process of diagnosing for us, as nurses, is no different than it is for doctors. we still have to go through a similar process that the doctors (or a car mechanic or a plumber) go through. that includes making an assessment of the situation to determine what is going on. we gather up a list of what is abnormal and use that as clues to name the diagnosis. car mechanics and plumbers do the same thing in their line of work except they don't have as many diagnoses to work with. i constantly advise students when they sit down to work on a care plan to look up the signs and symptoms of their patient's medical diagnoses (all medical diagnoses can be broken down into signs and symptoms) because you may have missed seeing them when you were working with the patient in clinicals and now is a good time to refresh your memory. assessment, for the purpose of care planning, consists of:
    a health history (review of systems)
    • a health history
    • performing a physical exam
    • assessing their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming)
    • reviewing the pathophysiology, signs and symptoms and complications of their medical condition
    • reviewing the signs, symptoms and side effects of the medications/treatments that have been ordered and that the patient is taking
    and until you provide that kind of specific information this care plan is on hold.

    - - - - - - - - - - - - - - -

    i can tell you a few things about the nursing diagnoses you did post:
    knowledge deficit r/t htn & its management
    the diagnosis deficient knowledge (specify), or if your nursing program is requiring that you use knowledge deficit, must have an etiology (cause) that explains why the person doesn't have the information. htn & its management or the disease itself cannot be the reason that the person lacks the knowledge. that doesn't make sense. a person lacks the knowledge for a lot of different reasons. they just never heard of the disease is the biggest reason. they can't find the information is another one. to see the related factors (causes) for this diagnosis, see these web pages:
    chronic pain r/t neuropathy
    neuropathy is a medical decision and can't be used in a nursing diagnostic statement as the cause of this patient's pain. you have to break the neuropathy down into its pathophysiological cause for why it is the source of the pain. it is doing damage to nerves of the peripheral system. the cause of pain is whatever is causing tissue damage, so your related factor in your diagnostic statement must explain that. to see the related factors (causes) for this diagnosis, see these web pages:
    fluid volume deficit r/t dehydration
    the definition of deficient fluid volume includes "this refers to dehydration" in it. so, stating r/t dehydration is redundant, a restatement of the diagnosis and tells us nothing about how the patient's fluid volume deficit occurred. the r/t should tell the reader the cause of the fluid volume deficit, or dehydration. it is going to be some kind of fluid loss or a body process that is failing and resulting in dehydration. you have to know the pathophysiology of the disease processes going on with uncontrolled dm and why it results in dehydration.
    needs to be more cardiac & possibly respiratory
    you must have the signs and symptoms to assign a diagnosis which is actually a nursing problem. these are the diagnoses of cardiac problems:
    • decreased cardiac output
    • risk for decreased cardiac tissue perfusion
    • ineffective tissue perfusion
    • risk for ineffective cerebral tissue perfusion
    • risk for ineffective gastrointestinal perfusion
    • risk for ineffective renal perfusion
    • ineffective peripheral tissue perfusion
    • risk for shock
    these are the diagnoses of respiratory problems:
    • ineffective airway clearance
    • risk for aspiration
    • ineffective breathing pattern
    • impaired gas exchange
    • risk for suffocation
    • impaired spontaneous ventilation
    • dysfunctional ventilatory weaning response
    some of the information about these are listed on these diagnostic pages
  6. by   landesmummy
    Dear Daytonite, THANK YOU, THANK YOU AND THANK YOU so much for your invaluable advice. Wow, you certainly opened my eyes and I so appreciate all of the information you gave. I am sorry to have taken a while to get back to you but there life has been very hectic around here for the past couple of weeks...Once again, thank you so much for your teaching and thank you for caring enough to make sure we students get it!
  7. by   Daytonite
    While I appreciate the Thank You's, I am more concerned about your work on this care plan. Where are you with the restructuring in the construction of these diagnoses now? You haven't said. I am more than willing to help you if you just post your work.
  8. by   landesmummy
    LOVELY DAYTONITE--A HUGE THANK YOU!!!!! After reading what you had posted to me & for previous students looking for help and the amazing hints you so kindly threw my way, the light bulb went on and thanks to you, kudos for 'an excellent ncp' by my professor...the only student to recieve that comment on my clinical group. Also at my school we have 4 hour written competencies, and to study for them, I decided to do an ncp per pt--16 pts--which is why I haven't been back on here--been a wee bit busy, and following your advise, proceeded to do brilliant on the written comps. Thank you, thank you and thank you. I certainly now see the error of my ways on what I had written out. Thank you for not rolling your eyes or blasting me, but for truly being gentle and truly willing to help. Its a special person to take the time out of your life to help us students. From the bottom of my heart, once again, thank you. P.S. My husband just read over my shoulder and said 'thank you for helping my wife so she won't drive us nuts going over ncps'! cheers
  9. by   Daytonite
    I'm glad to hear you are doing well. Keep up the good work. You know where we are if you have questions.