RNNS12

Thanks for the input!! He cannot follow commands from staff which makes it hard for education.. that's why I was stuck. I guess there is really nothing you can do to teach a pt that cannot respond to staff. Thanks again!

my pt is an 86 yom who is in for bil aspiration pna, resp failure, cad with pos troponin, acute renal insuff. iv vol depletion. he is demented ox3 does not respond to verbal or tactile stimuli has hx of htn, dm 2, s/p peg tube placement, copd, anemia, debility. o2 sats remain btwn 94-98 with 2l continuous o2 per nasal cannula. he is bed rest as well.. ineffective airway clearance r/t excessive mucus and inability to cough effectively s/t bilateral aspiration pneumonia and copd aeb pt has crackles in rul, wheezing in lul and lll and diminished breath sounds throughout lung fields i need help with goals as i cannot teach incentive spirometer use, effective coughing techniques because he is demented and ox3 and he is not cyanotic at the moment so i cannot use cyanotic free skin these are the only goals i have.. 1. pt will maintain patent airway throughout shift ending at 6 pm 9/30/10 a.e.b respiratory rate in expected range (12-20) moves sputum out of airway free of adventitious breath sounds or patient's secretions are mobilized and airway is maintained free of secretions, as evidenced by clear lung sounds, eupnea, and ability to effectively cough up secretions after treatments and deep breaths 2. pt will demonstrate effective coughing and clear breath sounds by interventions: auscultate the lungs for diminished, absent and adventitious breath sounds throughout shift--pt has crackles in rul, wheezing in lul and lll and diminished breath sounds throughout lung fields give oxygen, bronchodilators, mucolytics, expectorants and antibiotics as ordered and as needed--pt has scheduled albuterol sulfate q and zosyn reposition the pt at least once every two hours to optimize respirations. position the pt with the hob upright at least 45 degrees at all times- ensure pt is getting adequate fluid intake so that he is staying hydrated and liquefying secretions- pt has hx of intravenous volume depletion and is tube fed suction as needed- pt is demented, 0x3 and has depressed cough reflex so suction is necessary when needed monitor blood gas values and pulse oxygen saturation levels-pt has pulse oximeter taped to finger for continuous monitoring

OK, makes sense... THanks for the help! :)

I have Hopelessness r/t inadequate support system and lack of positive feedback AEB pt states " I have never been able to do anything right and ther is no reason to continue on when I have nothing or no one to live for" Relevant Hx: Lost job 5 days ago Lost Home 3 days ago He has no family support, they do not accept that he is gay He has no friends His partner of 6 years died 4 years ago and was never able to talk about feelings with anyone Pt states "love is pain, I don't want to find love because I cannot go throught what I went through again" Hx of physical and emotional abuse Says father was just a "sperm donor, he never talked to me or cared about me" Pt states " I can't find the desire to want to deal with everyday tasks anymore" Goals (THIS IS WHAT I"M HAVING PROBLEMS WITH)!!! SHort term: Pt will express feelings of sadness and anger towards lack of family support and loss of partner and will want to move forward with hope for the future in 1 week Intervention: Allow pt to express feelings of sadness and anger while providing positive feedback Long term: By discharge pt will experience an increase in self-worth and hope AEB setting positive goals for self and interaction in therapeutic communication ( Provide positive feedback and support of goals set for patient OR By d/c pt will demonstrate sense of hope and drive to continue living AEB interactions and willingness to participate in therapeutic communication I ALSO need help with dysfunctional grieving r/t loss of partner and lack of family support AEB pt states "I have never been able to express my feelings to anyone, they have been built up inside of me for so long and I have finally hit the bottom" I don't think my r/t is right??? It is the same hx as above---father never was there for him, could never talk about feelings when lost partner because he was gay and family didn't approve anyway, physically and emotionally abused, "love is pain" All help is greatly appreciated!! Thanks! :)

OK, I have my 7 dx but I can't figure out which order they need to be in by most important and if they make sense or if my AEB data is correct. Also which one out of these 7 would be good for a care plan? PLEASE HELP. THanks!!! :) 1. R/F self-directed violence r/t dysfunctional family system AEB pt states " I cut my flesh for attention and to feel the pain from all the hurt my parents gave me" 2. Spiritual distress r/t situational losses and loss of partner AEB pt states "I am angry at God and don't understand why he has done this to me" 3. Ineffective coping r/t inadequate support systems and coping strategies AEB ? 4. Impaired social interaction r/t absence of available significant others or peers AEB expression of feelings of aloness and not being able to trust anyone 5. Powerlessness r/t lack of positive feedback AEB feelings of hopelessness and expressions of never being able to do anything right or being good enough for his mother 6. Dysfunctional grieving r/t loss of partner AEB expression of never having chance to grieve when partner died 4 years ago and never having anyone there to talk about it 7. Post-trauma syndrome r/t physical and psychosocial abuse AEB anger towards mother and father and statements of what it would be like if he had different parents