Please someone help me proofread...

[Janinern84]

I finished the care plan (small portion of the whole paper), but just was wondering if someone can proofread. Also, I need a deadline...I'm never good at that part. Please help

Care plan

Problem statement: Ineffective Tissue Perfusion (peripheral)

related to interrupted venous flow resulting from statis dermatitis.

Manifested by:

a. errythematous, scaly, and roughness to integument bilaterally to lower legs.

b. +1 pulses posterior tibialis and doralis pedis pulses.

c. Decreased capillary refill to bilateral lower extremities.

Desired goal:

1. The client will demonstrates adequate tissue perfusion.

As evidenced by:

a. The client will have palpable peripheral pulses.

b. The client will have warm and dry skin.

c. The client will have increase capillary refill

Deadline:

Nursing orders:

1. Check dorsalis pedis and posterior tibial pulses bilaterally q shift. Use Doppler is unable to find and notify doctor if unable to find.

2. Elevate edematous legs and ensure no pressure under knee q shift.

3. Observe for signs of deep vein thrombosis, including pain, tenderness, swelling in the calf and thigh, and redness in the involved extremity q8h.

Rationales:

1. Diminished or absent peripheral pulses indicate arterial insufficiency (Harris, Brown-Etris, Troyer-Caudle, 1996).

2. Elevation increases venous return and helps decrease edema. Pressure under the knee decreases venous circulation. Client will obey this once put in the position via the wheelchair.

3. Thrombosis with clot formation is usually first detected as swelling of the involved leg and then as pain. Leg measurement discrepancies >2 cm warrant further investigation. Homans' sign is not reliable (Herzog, 1992; Launius, Graham, 1998). Unfortunately, symptoms of already-developed DVT will not be found in 25% to 50% of clients' exams, even though the thrombus is present (Eftychiou, 1996; Launius, Graham, 1998).

Any help is well appreciated!!!

Thanks!!

~Janine

[TexasPediRN]

just a few recommendations on grammer & such:

desired goal:

1. the client will demonstrates(no s) adequate tissue perfusion.

as evidenced by:

a. the client will have palpable peripheral pulses.

b. the client will have warm and dry skin. (how about..skin will remain warm and dry)

c. the client will have increased capillary refill

1. check dorsalis pedis and posterior tibial pulses bilaterally q shift. use doppler is unable to find and notify doctor if unable to find.

check dorsalis pedis and posterior tibial pulses bilaterally q shift. use doppler if unable to manually palpate pulse, and notify physician of such findings .

(just think you can state those better)

2. elevate edematous legs and ensure no pressure under knee q shift.

2. elevate legs with... pillow!

2. elevation increases venous return and helps decrease edema. pressure under the knee decreases venous circulation. client will obey this once put in the position via the wheelchair.

2. i would never say client will obey, cause its def. not going to happen.

how about, "client will verbalize understanding regarding need to elevate bilateral extremities due to impaired blood flow resulting from stasis dermititis?"

ah the joy of care planning, i always hated it and here i am looking at yours! please just take what write as a suggestion- your care plan was good, i just wanted to tweak it a little bit. good job!

for deadlines, im not quite sure how you're doing that-

i would always use something along the lines of 'q shift' - or 'tid'

ie: client will ambulate in halls tid before discharge.

good luck!

[Janinern84]

Thank you soooo much! I can't wait to be done with school lol. I really love allnurses.com you guys have been such a help to me throughout this year :) Thanks again!!

~Janine