please critique my care plans for CPNE practice

NC Girl BSN · Apr 13, 2009

1. impaired tissue integrity r/t sensitivity to adhesive of ostomy appliance aeb disruption of stoma tissue(use something like red irritated tissue. the aeb above does not discrible what the tissue looks like)

*also is this an actual diagnosis out of mosby's? i dont remember seeing it. i would just stick with impaired skin intergrity

goal: pt. will demonstrate progressive healing of tissue

a. protect granulating wound bed from trauma(assess stoma)

b. apply thin coat of skin sealant to stoma site when colostomy bag changed as ordered

(apply skin sealant to stoma)

* try not to use too many words. keep it simple

2. impaired skin integrity r/t pruritis aeb skin tear on right forearm

goal: pt. will demonstrate no further breakdown of skin integrity during pcs

a. assess skin area for any breaks in skin( assess skin)

b. apply lotion prn to relieve irritation as ordered to right arm (apply lotion to right arm)

* kee it simple

3. acute pain r/t tissue trauma aeb pain rated as ___ on pain scale of 0-10

goal: pt. will rate pain of 3 or less on pain scale 0-10 during pcs

a. reposition pt.

b. pain med. prn by primary nurse

good! i also used (assess pain level) as my primary intervention

4. activity intolerance r/t compromised 02 transport system secondary to chf(just say : r/t chf. leave the rest of that other stuff out keep it simple, stay away from the secondary stuff) aeb dyspnea while ambulating

goal: pt. will demonstrate increased activity during pcs(the goal should relate to your interventions. how about goal: pt will ambulate to the nurses station during pcs)

a. assist pt. with ambulation to nurses station(assess mobilty status)

b. encourage rest pauses during ambulation

5. fluid volume deficit r/t acute gastroenteritis aeb excessive emesis

goal: pt. will report less nausea/emesis

a. encourage patient to turn slowly after intake of fluids and food

b. provide antiemetic medication prn

(try to stay away from this nursing diagnosis. hard to prove in time given for pcs. there is alot of old post on the epn about this)

6. ineffective airway clearance r/t pneumonia aeb inability to remove airway secretions

goal: pt. will not experience aspiration during pcs(pt will have patent airway during pcs)

a. suction secretions from airway prn

b. db&c x 3

7. excess fluid volume r/t acute renal failure aeb peripheral edema

goal : pt. will exhibit decreased edema in extremities during pcs

a. assist pt. to elevate extremities on pillows

b. medicate pt. with hctz as ordered at 0900

(try to stay away from this nursing diagnosis. hard to prove in time given for pcs. there is alot of old post on the epn about this)

8. impaired physical mobility r/t right femoral head fracture aeb inability to move purposefully within the environment during ambulation.(aeb:limited range of motion. keep it simple!)

goal: pt. will adapt to using front wheel walker to increase mobility during pcs(pt will ambulate in the hallway with walker during pcs)

a. teach pt. proper technique using front wheel walker

b. encourage patient to ambulate x1 during pcs with assist of walker (assess mobilty status)

it took me a while to figure out ec's careplans. they do not have to be wordy. i used my critical elements to come up with my interventions. you have to do them anyway so why not use them in the careplans. again i am no expert but i did take the online careplan course and the instructor helped us cut down on all the wordiness with the careplans. i highly recommend it. remember that the diagnosis has to be word for word from the careplan book. r/t is what is causing the problem.you can use the diagnosis and it is not necessary to add all that other stuff if you are using the diagnosis as a r/t. the aeb are the signs and symptoms. the wording for this should paint the picture to the problem.

hope this helps. your gonna be a pro at this! keep working on them. :up:

txspadequeenRN, BSN, RN · Apr 13, 2009

most of these with the exception of the acute pain are way way to complicated for the cpne ...also the interventions must be something that can be carried out during the pcs . when doing your interventions a good guide like nc girl said is the critical elements . at the same time your interventions must be reliant to the nursing diagnosis..for example you cannot use oral care as a intervention for right lower leg pain. stay far away from things like fluid volume deficit or any nursing diagnosis that requires lab to complete cause these things cannot be measured during the pcs.

#6- you don't want to use these interventions because one you need a order to suction and during your pcs you don't want to do any task that is not assigned or ordered. deep breathing and coughing ..if itaint ordered dont make it a intervention...keep it simple

most of the ce's will look up the nursing diagnosis in the mosby's as long as it is in there and the interventions flow with the patient condidtion you will be fine...

just remember keep it simple...complications will fail you..you will get the hang of this keep practicing

bjbabs24 · Apr 13, 2009

THANK YOU!!!!! Thanks for breaking it down!!!!!!!

I am using Carpenito's so I got the impaired tissue integrity from there. I wasn't sure if I could use the skin integrity since it is a stoma so went with the one with that mentioned tissue. I am probably making it too complicated like you said.

Another question for you both-so if you have a pt. with excessive vomiting what would you do instead of the fluid volume deficit??? Someone stated they had a pt. last weekend for a pcs that had excessive vomiting of unknown origin so how would you approach that one?

THANKS!! I knew you guys would be so helpful.

bjbabs24 · Apr 13, 2009

Another question long as I am on it.

So for intervention I can just put "assess skin"

I don't have to do any further explanation like where or for what. Assess skin of right elbow etc...

Please and thanks!

NC Girl BSN · Apr 13, 2009

thank you!!!!! thanks for breaking it down!!!!!!!
i am using carpenito's so i got the impaired tissue integrity from there. i wasn't sure if i could use the skin integrity since it is a stoma so went with the one with that mentioned tissue. i am probably making it too complicated like you said.
another question for you both-so if you have a pt. with excessive vomiting what would you do instead of the fluid volume deficit??? someone stated they had a pt. last weekend for a pcs that had excessive vomiting of unknown origin so how would you approach that one?
thanks!! i knew you guys would be so helpful.

its hard to say what i would use in this instance unless i saw the cardex and what areas of care is assigned. one that kinda comes to mind is "activity intolerace". when you get your cardex, there will be more problems other than fluid volume. i did not use carpenito's but instead i used mosbys. with mosbys, i looked up the the patients diagnosis in the front of the book and it gave several nursing diagnosis for the diagnosis. i usually used one of those. its hard to describe unless you have the mosbys book.

to piggyback of denise(texaspade) do not and i repeat do not do anything that is not assigned on the cardex. so if your not assigned cough and deep breath x3 it should not be in your interventions. also if they do not assign you to put ointment on the patients skin, then do not write it as an intervention. you will fail because your doing too much and not part of the doctors orders.

NC Girl BSN · Apr 13, 2009

Another question long as I am on it.
So for intervention I can just put "assess skin"
I don't have to do any further explanation like where or for what. Assess skin of right elbow etc...
Please and thanks!

If it makes you feel better you can say " assess (Whatever area that is assigned) for example "Assess Heels" or "Assess buttocks". Usually the CE will assign 1 of the designated areas that is listed under skin assessment section in the study guide.

I used the Mneumonic Metic(moisture, edema,temperature, intergrity,color) Shots(Sacrum,heels, occiput(back of head), trocanter(hip), sacrum) You have to assess two areas. . Usually the CE will assign one and you have to do select another one.

So lets say:

Impaired Skin intergrity r/t excess moisture AEB red excoriated buttocks

Goal: Pt will not have any further breakdown during PCS

N1: Assess Buttocks

N2: Change brief after each incontient episode

This is what Excelsior wants. I would look at my cardex under Skin Assessment and see what they have checked off and I would let that be my intervention. Do you understand?

bjbabs24 · Apr 14, 2009

Noted!! Thanks!!!

Trust me I don't want to fail for losing too much time doing things I don't need to be doing in the first place. :hdvwl:

Yes, understand all the above!!!

Thanks!

SuesquatchRN, BSN, RN · Apr 14, 2009

Do NOT use medical diagnoses such as CHF or pneumonia. That's why we have this lovely, convoluted nursing language - because we are spearate from medicine, and have our own language. :rolleyes: Anyway, we as nurses are not permitted to use them under NANDA. She can't because because of ineffctive airwya clearance or some other such annoying roundabout way of saying CHF.

:)

Keep is simple, safe, and specific.

Pull your nd's right from the Kardex, and from what you will have to do. You WILL be assigned mobility and you KNOW their mobility is impaired, either enough to need an assist to stand (impaired mobility related to insert simple thing a/e/b need for one assist) or a Hoyer (impaired mobility related to paralysis a/e/b need for mechanical positing device).

Use what is assigned. Do NOT do anything extra. You don't get extra points, all you do is not screw up what's assigned.

NC Girl BSN · Apr 14, 2009

Sue,

The studyguide states that you can use medical diagnosis for R/T. I used them in 2 out of 3 of my careplans at the CPNE and was fine. They even accepted it in my online careplan conference.

bjbabs24 · Apr 14, 2009

The staff replied to my earlier care plan and we cannot use "AEB need for one assist"

She has replied to several others recently stating the same because we can't use an intervention for AEB has to be sign or symptom. Also, she said we can use medical diagnosis for the r/t just not to use it as the diagnostic label.

Ebony_RN · Apr 14, 2009

Also, she said we can use medical diagnosis for the r/t just not to use it as the diagnostic label.

Sue,
The studyguide states that you can use medical diagnosis for R/T. I used them in 2 out of 3 of my careplans at the CPNE and was fine. They even accepted it in my online careplan conference.

Thanks for clearing this up. Sometimes I would get stuck because I really wanted to use the medical diagnosis in my r/t and was hesitant to do so. Makes things much easier for me.