Patient care plan for drugs

nurseprnRN, BSN, RN · Mar 19, 2012

i can't tell what you assessed in this patient, although these sound generally plausible. what are your assessment data?

many nursing students think there is a big list somewhere where column a is the medical diagnosis and column b is the nursing diagnosis. this is wrong-headed for several reasons. one is that nursing diagnoses are made by nurses using the nursing process (which i know you don't have a good handle on yet but we're trying to help), not dependent on a medical diagnostic process. nursing diagnosis is in no way subservient to or inferior to medical diagnosis.

yes, experienced nurses will use a patient's medical diagnosis to give them ideas about what to expect and assess for, but that's part of the nursing assessment, not a consequence of a medical assessment.

for example, if i admit a 55-year-old with diabetes and heart disease, i recall what i know about dm pathophysiology. i'm pretty sure i will probably see a constellation of nursing diagnoses related to these effects, and i will certainly assess for them-- ineffective tissue perfusion, activity intolerance, knowledge deficit, fear, altered role processes, and ineffective health management for starters. i might find readiness to improve health status, or ineffective coping, or risk for falls, too. these are all things you often see in diabetics who come in with complications. they are all things that nursing treats independently of medicine, regardless of whether a medical plan of care includes measures to ameliorate the physiological cause of some of them. but i can't put them in any individual's plan for nursing care until *i* assess for the symptoms that indicate them, the defining characteristics of each.

it might help you to think that a nursing plan of care is developed from the nursing diagnoses you come up with from your nursing assessment, in a parallel way to how the medical plan of care is developed from the medical diagnosis obtained from the medical work-up. but there is no list of medical diagnoses with a second column for associated nursing diagnoses. nursing develops nursing diagnoses from nursing assessments.

some data may overlap from the medical assessment. for example, the medical diagnosis of anemia is made by looking at blood work that tells the physician about a shortage of (at least) red blood cells. one associated nursing diagnosis might be fatigue, since deficient red cells mean there is less oxygen to deliver to the body. another might be activity intolerance, for the same reason. however, some people tolerate anemia pretty well and may not exhibit characteristics of either of these, so you can't just say, "hmmm, medical diagnosis = anemia, must include activity intolerance in my care plan," because, well, maybe not. the physician has done the medical assessment; you have to do a nursing assessment.

so-- what did you find with this patient?

Esme12, ASN, BSN, RN · Mar 19, 2012

I am trying to come up with a diagnosis for someone using "bath salts" (a new drug that people are using instead of cocaine.)
I have:
Risk for injury
Increased cardiac output
Disturbed Sensory Perception
Disturbed Thought Process
Am I missing anything major????

What is the age of your patient? What are bath salts? What is their effect? What about addiction and high risk behaviors in these situations not only injury but infectious disease.

First of all, what are bath salts? "The presumption is that most bath salts are MDPV, or methylenedioxypyrovalerone, although newer pyrovalerone derivatives are being made by illegal street chemists. Nobody really knows, because there is no way to test for these

substances.

What do you experience when you take bath salts?"Agitation, paranoia, hallucinations, chest pain, suicidality. It's a very scary stimulant that is out there. We get high blood pressure and increased pulse, but there's something more, something different that's causing these other extreme effects.

The clinical presentation is similar to mephedrone [a chemical found in other designer drugs], with agitation, psychosis, and stimulatory effects. Both of these agents should be of concern, as severe agitated behavior, like an amphetamine overdose, has occurred.

A second concern is the ongoing suicidality in these patients, even after the stimulatory effects of the drugs have worn offhttp://www.webmd.com/mental-health/features/bath-salts-drug-dangers

laurasgodwin08 · Mar 20, 2012

Thanks for the help, I really appreciate it! This assignment is a group project for class to design a careplan on a pt that has used bath salts, not based on a patient that I had in clinicals. The assessment data would probably something along the lines of, tachycardia, SOB, aggression, suicidal/homicidal thoughts, hallucination, or delusions. Based on those potential findings, I came up with the 4 diagnoses that are in my original post. Again, thanks so much for the help!!!