Can you please give me your feedback? What I did was take some pts. from that I have worked with in the past and added possible interventions etc... that would be assigned for the CPNE. I sent some care plans a couple weeks ago to Dr. A but lately haven't been getting anything back. Must be busy/out of town.
You guys have always been so supportive for me so I truly take what you guys advise to heart!!
THANKS!:icon_hug:
1. Impaired tissue integrity r/t sensitivity to adhesive of ostomy appliance AEB disruption of stoma tissue
Goal: pt. will demonstrate progressive healing of tissue
a. Protect granulating wound bed from trauma
b. Apply thin coat of skin sealant to stoma site when colostomy bag changed as ordered
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
b. Apply lotion prn to relieve irritation as ordered to right arm
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
4. Activity intolerance r/t compromised 02 transport system secondary to CHF AEB dyspnea while ambulating
Goal: pt. will demonstrate increased activity during pcs
Specializes in med/surg, telemetry, IV therapy, mgmt.
i critique nursing diagnosis on the other student forums all the time. while i am not familiar with what cpne requirements are, i do know the nanda rules and the nursing process and this is what does not make logical sense about what you have posted. . .
1. impaired tissue integrity r/t sensitivity to adhesive of ostomy appliance aeb disruption of stoma tissue
goal: pt. will demonstrate progressive healing of tissue
a. protect granulating wound bed from trauma
b. apply thin coat of skin sealant to stoma site when colostomy bag changed as ordered
disruption of stoma tissue
needs to be described. wounds can be measured and described. was there drainage?
your related factor must be what causes the impaired tissue integrity.
sensitivity to adhesive of ostomy appliance
is causing skin impairment as deep as the subcutaneous layer of the skin? impaired tissue integrity is stage iii or iv wounds!
your goal sets no
time frame
when this will occur and it is not measurable. a wound is measurable, has length, width and depth. those should be a part of the original assessment. it also gives criteria by which to
measure
progressive change.
your interventions tell what will be done to achieve the goal.
protect granulating wound bed from trauma
tells me nothing if i am the person caring for this patient today. how am i supposed to protect this wound from trauma? tell me.
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
b. apply lotion prn to relieve irritation as ordered to right arm
skin tear on right forearm needs to be described better. it's dimensions can be measured and reported.
your goal sets no time frame when this will occur and it is not measurable. the skin tear is measurable, has lengthy and width. those should be a part of the original assessment. it also gives criteria by which to measure progressive change. i would not use the wording pt. will demonstrate. since the patient is scratching and opening up skin areas, why not just say, at the end of each shift patient will have no new areas of open skin areas due to scratching.
you are applying lotion to relieve the pruritis aren't you? where did irritation enter into this? it may be a subtle play on words, but it is confusing to someone who is reading this and doesn't know anything else about the patient.
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
it always drives me nuts that people fail to state
where the pain is
.
4. activity intolerance r/t compromised 02 transport system secondary to chf aeb dyspnea while ambulating
goal: pt. will demonstrate increased activity during pcs
a. assist pt. with ambulation to nurses station
b. encourage rest pauses during ambulation
the idea behind your goal is correct, but your interventions are not designed to achieve the goal. ambulation assistance must be
incrementally
increased with rest periods. you left that part out.
your goal does not have a time frame. if this is your patient, you should see and not depend on a patient report of emesis. when did
nausea
enter into this? nausea is not a loss of fluid and i think it inappropriate to be addressing nausea when fluid loss is the problem here. there is a nursing diagnosis that addresses nausea.
what interventions are you doing for the dehydration (the loss of fluids)?
goal: pt. will not experience aspiration during pcs
a. suction secretions from airway prn
b. db&c x 3
you cannot use a medical diagnosis (
pneumonia
) as a related factor (cause) of the nursing problem. the related factor (cause) of
ineffective airway clearance
is why or what is obstructing the respiratory track so a clear airway cannot be maintained.
inability to remove airway secretions
merely restates the nursing diagnosis. it is not evidence, or signs and symptoms, of this problem. there should be rales and rhonchi, sob, a productive (or non-productive) cough.
goal:
pt. will not experience aspiration during pcs.
is pretty negative sounding.
aspiration
is a problem connected with
risk for aspiration
. if one of the symptoms is rales and rhonchi, a goal might be that
after coughing and deep breathing the patients lungs will be clear to auscultation.
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
you cannot use a medical diagnosis (
acute renal failure
) as a related factor (cause) of the nursing problem. you need to look up the pathophysiology of why the patient retains fluid in arf and state it in as few words as possible.
goal: leg edema is measurable. get a tape measure and measure the circumference of the patient's legs daily. the decreased edema will be noticed by the decreased circumference in the legs. this will be an intervention and will result in decreased edema that can be measured.
8. impaired physical mobility r/t right femoral head fracture aeb inability to move purposefully within the environment during ambulation.
goal: pt. will adapt to using front wheel walker to increase mobility during pcs
a. teach pt. proper technique using front wheel walker
b. encourage patient to ambulate x1 during pcs with assist of walker
inability to move purposefully within the environment during ambulation
is a restatement of the nursing diagnosis and does not tell us what the aebs are.
if you are
teaching proper technique using front wheel walker
then why is the goal to
adapt
to using front wheel walker
?
it makes it sound like there was a problem with using a wheelchair. there is a diagnosis for
impaired wheelchair mobility
which should then be used.
i know you are trying to make you care plans sound professional, but watch your words. they have to be logical and relate back to the information that went into the formation of the diagnosis.
Thank you for your thoughtful post with advice. I know these care plans are not how I would do them for work and have had to change them according to the CPNE test. They want them wayyyyy more simple than I would ever do at work so had to adjust and readjust and as you can see from earlier critiques still need to cut them down and simplify even more. I do a ton of them on my admissions at work but this isn't work related instead it is test related so had to completely change how I do them to get through this test. For the CPNE we can actually use a medical diagnosis for the r/t and our goals have to be met within the short time frame that we are in the pt. room unlike my care plans at work which are monthly time lines and even stricter time lines when it comes to wounds. The goals don't have a time frame detailed out because the time frame is the testing time frame. We then go into further detail about wound drainage etc.... in the documentation evaluation phase of the test.
Hope that makes sense of why I wrote some of the things that I did here.
make sure that when you write your goal, that it always ends in "during pcs". daytonite is right with the careplans if this was traditional school but you need to stick to the way ec wants you to do it. make sure you review that the rules in the careplan section and practice, practice, practice. do you have chucks scenario's. also there are three more practice careplans in the back of the studyguide too. good luck and the more you practice the better you will become.
nursing diagnosis=word for word out of the careplan book
related to= what causing the problem in mosby right before the interventions, they list several. also ec
will allow you to use medical diagnosis.
aeb=signs and symptoms of the problem. in mosbys they are listed under each diagnosis.
Specializes in med/surg, telemetry, IV therapy, mgmt.
i understand you have specific guidelines and rules you have to follow. it just that in the construction of the diagnostic statement the "r/t" and "aeb" based on the rules you do use must make logical sense. i do not believe that restating the diagnosis is what your instructors will want for the "aebs". goals, if anything, need to reflect what your interventions are accomplishing. i post all the time that goals are the predicted results of your nursing interventions. from what i see about these cpne care plans that is so very true. proceed with extreme logic and rationale.
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.
i critique nursing diagnosis on the other student forums all the time. while i am not familiar with what cpne requirements are, i do know the nanda rules and the nursing process and this is what does not make logical sense about what you have posted. . .
1. impaired tissue integrity r/t sensitivity to adhesive of ostomy appliance aeb disruption of stoma tissue
goal: pt. will demonstrate progressive healing of tissue
a. protect granulating wound bed from trauma
b. apply thin coat of skin sealant to stoma site when colostomy bag changed as ordered
disruption of stoma tissue
needs to be described. wounds can be measured and described. was there drainage?
your related factor must be what causes the impaired tissue integrity.
sensitivity to adhesive of ostomy appliance
is causing skin impairment as deep as the subcutaneous layer of the skin? impaired tissue integrity is stage iii or iv wounds!
your goal sets no
time frame
when this will occur and it is not measurable. a wound is measurable, has length, width and depth. those should be a part of the original assessment. it also gives criteria by which to
measure
progressive change.
your interventions tell what will be done to achieve the goal.
protect granulating wound bed from trauma
tells me nothing if i am the person caring for this patient today. how am i supposed to protect this wound from trauma? tell me.
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
b. apply lotion prn to relieve irritation as ordered to right arm
skin tear on right forearm needs to be described better. it's dimensions can be measured and reported.
your goal sets no time frame when this will occur and it is not measurable. the skin tear is measurable, has lengthy and width. those should be a part of the original assessment. it also gives criteria by which to measure progressive change. i would not use the wording pt. will demonstrate. since the patient is scratching and opening up skin areas, why not just say, at the end of each shift patient will have no new areas of open skin areas due to scratching.
you are applying lotion to relieve the pruritis aren't you? where did irritation enter into this? it may be a subtle play on words, but it is confusing to someone who is reading this and doesn't know anything else about the patient.
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
it always drives me nuts that people fail to state
where the pain is
.
4. activity intolerance r/t compromised 02 transport system secondary to chf aeb dyspnea while ambulating
goal: pt. will demonstrate increased activity during pcs
a. assist pt. with ambulation to nurses station
b. encourage rest pauses during ambulation
the idea behind your goal is correct, but your interventions are not designed to achieve the goal. ambulation assistance must be
incrementally
increased with rest periods. you left that part out.
your goal does not have a time frame. if this is your patient, you should see and not depend on a patient report of emesis. when did
nausea
enter into this? nausea is not a loss of fluid and i think it inappropriate to be addressing nausea when fluid loss is the problem here. there is a nursing diagnosis that addresses nausea.
what interventions are you doing for the dehydration (the loss of fluids)?
goal: pt. will not experience aspiration during pcs
a. suction secretions from airway prn
b. db&c x 3
you cannot use a medical diagnosis (
pneumonia
) as a related factor (cause) of the nursing problem. the related factor (cause) of
ineffective airway clearance
is why or what is obstructing the respiratory track so a clear airway cannot be maintained.
inability to remove airway secretions
merely restates the nursing diagnosis. it is not evidence, or signs and symptoms, of this problem. there should be rales and rhonchi, sob, a productive (or non-productive) cough.
goal:
pt. will not experience aspiration during pcs.
is pretty negative sounding.
aspiration
is a problem connected with
risk for aspiration
. if one of the symptoms is rales and rhonchi, a goal might be that
after coughing and deep breathing the patients lungs will be clear to auscultation.
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
you cannot use a medical diagnosis (
acute renal failure
) as a related factor (cause) of the nursing problem. you need to look up the pathophysiology of why the patient retains fluid in arf and state it in as few words as possible.
goal: leg edema is measurable. get a tape measure and measure the circumference of the patient's legs daily. the decreased edema will be noticed by the decreased circumference in the legs. this will be an intervention and will result in decreased edema that can be measured.
8. impaired physical mobility r/t right femoral head fracture aeb inability to move purposefully within the environment during ambulation.
goal: pt. will adapt to using front wheel walker to increase mobility during pcs
a. teach pt. proper technique using front wheel walker
b. encourage patient to ambulate x1 during pcs with assist of walker
inability to move purposefully within the environment during ambulation
is a restatement of the nursing diagnosis and does not tell us what the aebs are.
if you are
teaching proper technique using front wheel walker
then why is the goal to
adapt
to using front wheel walker
?
it makes it sound like there was a problem with using a wheelchair. there is a diagnosis for
impaired wheelchair mobility
which should then be used.
i know you are trying to make you care plans sound professional, but watch your words. they have to be logical and relate back to the information that went into the formation of the diagnosis.
Daytonite, BSN, RN
1 Article; 14,604 Posts
i critique nursing diagnosis on the other student forums all the time. while i am not familiar with what cpne requirements are, i do know the nanda rules and the nursing process and this is what does not make logical sense about what you have posted. . .
i know you are trying to make you care plans sound professional, but watch your words. they have to be logical and relate back to the information that went into the formation of the diagnosis.