please help on Critical thinking question

Daytonite, BSN, RN · Mar 19, 2009

for critical thinking (problem solving) use the nursing process. it is the best tool we have to help us. the steps of the nursing process apply well to care planning.

step 1 assessment - assessment consists of:

a health history (review of systems)
performing a physical exam
assessing their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming)
reviewing the pathophysiology, signs and symptoms and complications of their medical condition
reviewing the signs, symptoms and side effects of the medications they are taking

in this case you can only work with the information that you are given. these are the items i feel are important to note:

70 years old
lives in an independent living facility
has been having diarrhea
caused her to leave the bridge game

step #2 determination of the patient's problem(s)/nursing diagnosis - diagnosis is based on abnormal data. that data becomes proof that the problem (nursing diagnosis) exists. nursing diagnosis references list the signs and symptoms that accompany the various nursing diagnoses to help in diagnosing when you are new at it. these would be my 3 nursing diagnoses in priority order.

diarrhea
risk for deficient fluid volume
risk for falls

step #3 planning (write measurable goals/outcomes and nursing interventions)

diarrhea
- goal
  - patient will have one formed stool every day
  [*]interventions
  - give clear liquids
  - avoid milk products
  - encourage small, frequent meals of brat (bananas-rice-applesauce-toast)
  - advise patient to stay near a readily available bathroom
  - place a sanitary napkin in underwear if there is a tendency to be incontinent or to avoid embarrassment
  - teach patient how to cleanse and dry perianal skin after each stool to avoid skin irritation
  - provide emotional support
  - give antidiarrheal medication as appropriate and as ordere
[*]risk for deficient fluid volume
- goal
- interventions
[*]risk for falls
- goal
- interventions

2. after you have completed your exam, anna tells you that she has been taking maalox for her diarrhea. does it going to change my plan of care?

yes, this is data of the nursing diagnosis

ineffective health maintenance

. she is not treating her diarrhea appropriately. it is not clear why at this point, but the reason needs to be determined. maalox is taken for heartburn, not diarrhea.

--------------------------------

readiness for enhanced therapeutic regimen management

this is a wellness diagnosis. these diagnoses are used when the patient has no problems at all with the stated subject, in this case, therapeutic regimen management and wants to improve and learn more about that area. that is not the case here at all. the patient is asking for help because she has diarrhea, which is an actual problem, and you eventually find out that the self-treatment she is using is inappropriate.

plan: - pt will not have diarrhea, pt will increase fluid intake, pt will get appropriate medication.

everything you list here sound like

goals

--things that will happen if nursing interventions are performed. goals should be listed in positive terms. saying "pt will

not

have diarrhea" is a negative statement. you listed no interventions.

maalox is used to treat the symptoms of too much stomach acid such as stomach upset, heartburn, and acid indigestion. one of the medication side effects is diarrhea. so that means i don't have to change the plan right?

wrong. read the scenario again. it begins by telling you about the patient having diarrhea. so, you develop a plan of care about the patient having diarrhea and possibly becoming dehydrated because of it (that is what

risk for deficient fluid volume

means). i felt she was also at a

risk for falls

because of her age and the diarrhea. you get this plan put together and she then tells you she has been taking maalox

for her diarrhea.

you know people take maalox for heartburn! she's not using the maalox correctly. i would not change the part of the care plan involving the diarrhea and risk for deficient fluid, but something is wrong with her thinking and reasoning. maybe she's developing some dementia or maybe she is just lacking information about how diarrhea is treated. in any case, the maalox has to be stopped and her cognition needs further monitoring. the scenario also stated that she had gotten

irritated

and left the bridge game. that might have something to do with her thinking and reasoning as well. maybe a little

risk for acute confusion

going on.