Patients who are bed bound-Need Nursing Diagnosis

[deemarys]

I am 2 months into LPN school and so far all my patients are bound to the bed and maybe in a gerichair 2 hours out of the day. They all have 1 thing in common body contractures. Whether it be hand, arm, and legs. It's very challenging to provide care to these patients. I try my best to clean them but sometimes you can't get into those tight spots, for example(armpit)Patient is so contracted you can't open his arm to clean his armpit well.

Is there many potential nursing diagnosis for patients like this besides high risk for skin break down?

Thanks in advance,

D

[truern]

http://tinyurl.com/dnk9pw

This is a review of a book with some information about needs of bedridden patients. Check out some of Daytonite's posts for help with developing a careplan :)

[Daytonite, BSN, RN]

Impaired Bed Mobility

Impaired Wheelchair Mobility

Impaired Physical Mobility

All the Self-Care Deficits

Risk for Impaired Skin Integrity

Risk for Infection

Ineffective Protection

Risk for Trauma (if restraints are being used)

Chronic Pain

Impaired Comfort

[deemarys]

Daytonite said:

Impaired Bed Mobility

Impaired Wheelchair Mobility

Impaired Physical Mobility

All the Self-Care Deficits

Risk for Impaired Skin Integrity

Risk for Infection

Ineffective Protection

Risk for Trauma (if restraints are being used)

Chronic Pain

Impaired Comfort

At the end of my Care Plan is the Outcome/Evaluation where I have to input whether client has met target goal from nursing interventions. I know my client is not going to meet them, that is how severe his contractures are. I find it difficult to do a Care Plan for a patient like this. The only thing I can do for him is check him q2hrs for incontinence and change his position to prevent skin breakdown. I also spent time chatting with him to make him feel like I am not just there to do care but genuinely have an interest in his well being. He does smile occasionally to me which was very difficult when I first met him. Other students can't seem to get him to smile. I wish there was a Care Plan that I can create for him that will have a positive outcome, besides skin integrity. His last physical evaluation his doctor didn't stipulate depression but I have a feeling he is depressed.

Wondering about doing a Care Plan on chronic pain related to severe contractures? I have to do 2 Care Plans due this Friday on this client.

[waitingforthedream]

What objective/subjective data do you have to back up a nursing dx?? Does he tell you he has pain, is he on meds for pain? Does he have bedsores?

[RochesterRN-BSN, BSN, RN]

Dont forget something that addresses circulation impairment and therefore risk for DVT as well as risks for Pneumonia and atelaectasis.

[deemarys]

waitingforthedream said:

What objective/subjective data do you have to back up a nursing dx?? Does he tell you he has pain, is he on meds for pain? Does he have bedsores?

NO bedsores, or any sign of skin breakdown.

You can see it in his face when we turn him that he is uncomfortable, or when we try to get his blood pressure. He does moan when we turn him but when I ask him if hes in pain he always shakes his head no. He does have pain meds PRN. I think its because he doesn't care or doesn't wish to be bothered. I have never seen such a severe case of contractures ever before even working 10 years as a CNA I have never encountered anything like it. He refuses medication for the pain so my only option is to make him as comfortable as possible by giving him very good care, which is bathing, back rub with lotion, preventative skin ointment in his peri-area and positioning his body q2h, refuses mouth care but hopefully soon he will allow me to do that.

My main goal is maintaining his skin by keeping it clean and turning him every 2 hours. I also visit him often throughout my shift to just let him know I am there, check his foley and gtube site.

[waitingforthedream]

well, I think he would be at risk for infection d/t foley, pain like you said, mobility issues d/t him not getting out of bed, which is what someone mentioned in other post (lung problems, DVT etc), is PT involved with this patient? Psychosocial issues are an issue, Hopelessness is a good one. Try to match up the objective data that you have with some of the DX that are mentioned in all of the posts, they seem perfect for someone like you describe. It should not matter if your interventions are not met, part of the care plan is to change it if needed when you do your evaluation. Good Luck, you sound like your going to be a very caring NURSE!

[DebanamRN, MSN, RN]

Daytonite said:

Impaired Bed Mobility

Impaired Wheelchair Mobility

Impaired Physical Mobility

All the Self-Care Deficits

Risk for Impaired Skin Integrity

Risk for Infection

Ineffective Protection

Risk for Trauma (if restraints are being used)

Chronic Pain

Impaired Comfort

I downloaded these flow sheets. They are fantastic!

Thanks - I print out your posts and keep them in a notebook for reference.