Please any advice would help!



I'm in my first semester of a nursing problem. So far I'm just two slight issues... Care plan. What is a really good care plan book to buy? We are still focusing on the nursing assessments but my clinical teacher is a real hard ass and she's stressing how important the care plans will be.

Secondly, when taking pulses in having a difficult time counting the ribs. I know the aprial pulse in the 5 intercoastal space midclavial BUT I can't feel the ribs In the slim ppl in my class what will happen if I get a bigger person in clinical? My instructor wants us to go by the " landmarks"

Thanks so much in advance ?. I just can't afford not to do well, this is my dream. I wouldn't be able to handle a setback.


85 Posts

Hi blessedA...our teacher is also talking about care plans, and they looked complex to me until I started reading the threads regarding the nursing process( especially those by Daytonite). Sorry i cant recommend a book:-( my case, We had to do a self-learning care plan, and I just applied what I learned about ADPIE. Google is your friend. Sometimes you can find very helpful info in the Internet. And you can search reviews about different care plan books. But I'm sure someone will recommend a good one here;-)

I also had a hard time finding the landmarks on my partner. She was a little bit chubby and the breast tissue wasn't helping either. The lab instructor told us that an easier way to find the apical pulse was to first find the bump at the top of the sternum. Then go straight to the right and a little bit down and there should be the intercostal space. They told us to practice, practice, practice. Good luck!


15 Posts

Thanks for responding! Did u mean from the top of sternum go to the left?


15 Posts

Oh and what's ADPIE? This was only my first week of classes. Thank you :)


85 Posts

Yes! Sorry I'm dyslexic:-) work your way down pulmonic, Erb's point, tricuspid and farther left is the apical.

ADPIE stands for assessment, diagnosis, planning, implementation and evaluation. Important to write care plans:-)


15 Posts

Lol it's cool! Thanks! I will go to practice the pulses in lab because I just can't get it! I appreciate the tips, definitely will try to implement them. Good luck to you as well :)

allnurses Guide


3 Articles; 5,581 Posts

Specializes in Adult Internal Medicine. Has 12 years experience.

It is important to be comfortable feeling the intercostal spaces, so practice as much as you can. Guesstimating the spaces may get you into trouble in the long run. Start at the sternal notch and then walk your fingers down feeling them

move over the rib and into the next space. You should be able to accurately count them to at least the 6th space. You can also use the Angle of Louis as a landmark for the 2nd ICS.

Don't be shy and put some pressure in your fingers when palpating. Don't do the over and down a bit guesstimate.


4 Posts

We actually have care plan books in Arizona. The Nursing Diagnosis Handbook will give you everything you need in order to correctly and accurately do a Care Plan. The isbn is 9780323071727 I truly hope this helps!


2 Posts


Congrats on beginning nursing school! Besides my med-surg book, I used 3 great books for writing care plans. First is the Handbook of Nursing Diagnosis. Your school probably has this on the required book list. This helps you to identify the exact diagnosis and then you can go from there. The BEST book is called Nursing Care Plans Diagnoses, Interventions, and Outcomes 7th edition by Meg Gulanick and Judith Myers. This book has gotten me through nursing school! It has most all of the diagnoses with expected outcomes, and lots of interventions. I have referred to this book for every care plan I have written. The other book that has been amazing is called: Diseases and Disorders A Nursing Therapeutics Manual 4th edition by Marilyn Sommers. This book covers diseases and disorders and defines them. It includes: the cause, patho., what you should be assessing for, common nursing diagnoses for the illness, collaborative care and interventions, also common lab or diagnostic tests that you would expect to be done for this patient. This is a great resource and will really help you to understand what is going on with your patient. We were required to explain the patho. and plan of care for that day of our patients to our instructor and this book helped me so much to identify specific assessments and needs for that patient. Hope this helps! I am in my last semester of nursing school, I graduate in December 2012. Good luck with your studies and remember you can do it!!



29 Posts

For care plans, I don't have any specific book to recommend, but I'd suggest making acquaintances with students further along in semesters. Ask them to see some of their early care plans. That was really critical for me, seeing one actually done, not just being told what to put where.

For the apical pulse, you want to find the angle of louis on the sternum. It's a distinctly noticeable notch on the sternum. You can find it by running your fingers (generally index & forefinger) along the sternum. Some people start from the top, and work down (it's very near the top), I find it easier to start more towards the bottom of the sternum and run my fingers upwards, towards the persons neck. Pay attention to your fingers, and you'll notice the subtle upward prominence. From that spot, if you move your fingers left (the person's left, not your's), you will be on the second rib. If the person is a little meaty, don't be afraid to push, you'll know you're on a rib because it'll be solid. Right below second rib is the second intercostal space, so on and so forth. You'll feel the intercostal spaces distinctly (if you push hard enough) because you'll feel a rib on either side of your finger(s). Once you can feel the intercostal spaces, just count down the ribs, until you hit the fourth or fifth intercostal space, then move your fingers along the intercostal space to the mid clavicular line. Typically, on men, the apical sits somewhere in-line with, but below the nipple; it's in the same general spot for women, but the nipple isn't as reliable of a landmark b/c of differences in breast size, etc.

Don't get discouraged, especially if it's only your first week. Counting ribs and spaces on an overweight, or muscular person is going to be difficult no matter what.


43 Posts

My teacher actually just did a few examples with us last night for the care plans. They actually seem pretty easy. I did my reasearch and found the book "Nursing care plans Nursing diagnosis and intervention" by Gulanick/Myers was a good one. I have not used it yet because we actualy are not starting care plans until we start clinicals, which is not for a few weeks yet. It does seem like a lot, but I think they will be easy once you get the hang of them. Even my teacher told us that when we get to our 4th semester, we will get through a care plan without even needing to use our book.


15 Posts

Thanks you guys for all the great suggestions! Nursing diagnosis handbook is a required book for my program but I'm not really digging it. Going to order the other one you suggested by Myers!

Congrats on finishing nursing school! :) I can't wait till I get there, I feel crazy overwhelmed already lol.

Angle of Louis .. I think this might save me, I'm practing on myself right now. I live alone so theirs no unwilling suspects to practice my clinical skills on.