mkcrturner

Thanks Daytonite!! I just reread my post above your last reply- can you see how i am getting myself tied up? LOL as simple as it was you gave me some more ways to say the same thing- and each section now has it worded slightly different. This is our last care plan, we have a NEW instructor, was given the wrong form to fill out...so I was freaking over turning in a bare bone plan. I spent today working on a P.O.C. page to staple to this crazy form. It is more specific to the needs of my patient- and omg I was able to add interventions about her PEG tube and include the fact that I dont want her to asphyxiate. hehehe So although I have no idea when she had first menarche..... I do know a few interventions :) Thanks again

Thanks for the reply Daytonite. I got all the info from the chart (scant as it was)that I could and we are not allowed to make calls to family members. This pt has been in LTC for about 2 years so the chart does not contain info like "date of last pap smear." This care plan format is written geared toward a patient in a hospital setting, not a LTC patient, so most of the questions we need answered are not geared toward the pt's residing in LTC. For a question like "pt's expectations for this hospitalization" or "ways you deal with stress" I was seeking something to fill in that simply/professionally states that they cannot tell me- without repeating over and over thru each section "expressive aphasia" since that would be written in about 80 out of 100 boxes :) Or if you were coming in behind me and reading this material is "expressive aphasia" appropriate?

Hi, I have one last care plan to do before graduation and have run into a NEW writers block. We did our rotation in LTC facility and I learned the term "poor historian" when filling in blanks for pt's with cognitive impairment. What I did not learn is how to fill in blanks for my stroke pt who has expressive aphasia, she cannot even blink/nod etc to express anything. Soo does anyone have any tips for how to fill in the blanks for questions like "age at menopause," "age at menarche," "pt's expectations for this hospitalization," seatbelt use," etc. I'm feeling a little redundant and uncreative. TIA~Kelly

That is exactly what i meant. I am used to having some actual 'abnormals' to evaluate to lead me to the nursing diagnosis. Thanks to this board i never made the common beginning error of thinking- this patient has copd, so they must be having some air exchange issues.... I knew to assess the patient and work off their abnormals to lead me to a diagnosis. I am not used to "pretend your patient has otitis (not specified) and come up with 3 diagnoses and some interventions" there are sooo many things that could need to be addressed there is no way to address them all. Thanks for the links, I am on my way now to look further into symptoms to create a patients condition then redo the diagnosis.

Yup, I got the careplan concept mastered.... Piece of cake....review patients problems- check, Work backwards- check. I was quite proud of myself.. Now comes the wrench. I need to do nursing diagnosis and interventions on an imaginary pediatric patient with otitis and one with tonsillitis. I need 3 for each disease. I froze up and went blank, this is HARD. I have no m/b or AEB cuz there is no patient. 20 months of doing this based on what I am seeing, now I need to fake it??!! I LOVE nursing school! LOL Anyway, I tried to be thoughtful, and I did not want to pull the 2 out of the book that I know most people in the class will use. We needed 3 FULL diagnoses with the r/t and m/b. Then we needed goals and interventions... I muddled through tonsillitis, and for otitis I came up with: 1- Acute Pain R/T infectious disease process M/B patient complaints of pain in both ears (this is a gimme) 2- Anxiety, mild r/t hospitalization m/b decreased pulse and sleep disturbance. 3- Disturbed Sensory Perception: Auditory, r/t chronic otitis, m/b head tilting, pt cups ears with hands, pt cannot walk straight and states his “head is spinning”, pt states his ear hurts. Be gentle, I know I do not have exact things like "pain is 8/10" but the instructor said to be real generic and include things that COULD be a symptom. This is what is throwing me for a loop. I cannot do a pretend person! LOL Will these suffice? And if you have advice for interventions for the disturbed sensory perception I would love to hear them.

Thanks Daytonite. Your fresh eyes helped alot. This Care Plan is hard to explain. But the middle pages have the areas broken up. And if there is one thing wrong/different/unusual/abnormal we need a NANDA dx for it. It gets confusing if your patient has a huge list of symptoms. ie- generalized weakness and pain (2 different areas) could both have a dx of "activity intolerance" This pt had stuff in every section and I was finding myself repeating or getting lost. LOL about the Lasix and renal insuffiency failure....if you only knew how many times I questioned that- to myself of course...to quote my instructor "do you take Lasix? then it is not a normal thing..." She wants EVERYTHING to be highlighted so she can spot it easily. she is grading me so I do it her way. Even if Lasix was the only thing in there and all else was OK, this instructor would want a diagnosis r/t the fact this patient takes Lasix. "I love nursing school, I love nursing school..... " hehehehe THANKS VERY VERY much for giving me a fresh view and the thought process that I needed to complete this LENGTHY Care Plan without repeating a million times.

OK, I am truly stuck. I am doing a huge care plan. pt is 38 y.o. f with aids, hep c, mrsa in a wound from an ind to a cyst that has gone from anterior hip to the iliac crest with osteomyelitis (fun dressing change..) she was admitted with lady partsl bleed and green frothy discharge. medical dx = trichomonas lady partslis. for the life of me I am stuck on a nanda diagnosis. our care plan is broken into each system, under elimination I have the following elimination intake for shift = 2254 output for shift = voids x5, bm x1 urine characteristics/problems voiding; foley (y or n)= amber, cloudy, sediment, strong odor hx of kidney or bladder disease = renal insuffiency bm/stool pattern/last bm= daily, 4/12 @ 11:30 hx of hemorrhoids or bleeding= admitted with lady partsl bleeding, green frothy discharge. diuretics= 40 mg lasix daily bun= 7 creatinine= 0.6 we are supposed to highlight anything that is abnormal, then if there is any abnormality we need to include a nursing diagnosis for that section. I am stuck on this area. please help...... tia~ kelly

THANKS VERY much!! The websites/links were helpful as was your time to help me!

oh and... after the undermining clears up- the perfect dressing that is permeable and promotes healing by sealing in fibrin, plasma etc is called? and two examples. I am looking all over the place. This is for sure not in our book, we only have one paragraph that gives the definitions of the 4 different stages, and that is all.... hmmm

I have a question I need some help with please. Our books are sorely lacking in pressure ulcer info. scenario= A pt with a stage 3 pressure ulcer....sacral coccyx area...7.5 cm x 5 cm and 5/8" deep with undermining (tunnels) at 2 o'clock and 9 o'clock. ?= To which layer of skin does this wound extend the deepest? All I can find is "Involves full thickness of dermis--into subcutaneous tissue; may see tunneling below skin surface" So if there is tunneling, I know it is 'below the skin surface' but not sure of the layer of skin the wound extends the deepest to. I WISH they would teach us in order..chapter 1-12. Not 3, 8,11, etc. LOLOLOLOL TIA for any help

I am F and prefer my M ob-gyn. As a matter of fact, I moved to FL and still schedule my annual exam during a trip back home to MI to see him. I had a F once and was uncomfortable with HER doing my breast exam, etc. Just my comfort level-When I am healthy and have the choice. However, if I am sick, I do not care who treats me as long as they are doing their job well. I discriminate against attitude, not gender. Although... my own gender is losing alot of points since I have yet, to date, run across a rude male nurse. I lost count of the number of female nurses that treated my family and myself like slabs of meat.

Thanks to all who replied. This board is (and has been) a gift to me. From trying to get into school, and now to survive school. I am off to work on my care plan and study for test on 2 systems tomorrow- lymph and digestive. I truly appreciate the experioence you shared to help me get out of my rut.

sorry I left that out- she had another problem and was in an infusion center for 54 days receiving antibiotics to treat a leg infection. While there she didn't get up much, became weak...... and so on. oh, and if i use the Urinary Retention dx, where can I fit in the elevated WBC ?? I actually really do know how to formulate the care plan..just for some reason this one is stumping me in having to change UTI to something not a medical DX. The book the school required lists medical dx for almost every r/t for nursing dx- ie; impaired gas exchange r/t COPD. We cannot use COPD. We cannot even say r/t femur fracture, r/t hysterectomy, etc.

please help me with some wording.... our instructors will nto allow us to use medical dx for our r/t. my pt has a uti, was retaining 1000ml of urine so they put in a foley. i cannot use: "impaired urinary elimination r/t uti aeb....... " i am drawing a complete blank with how to rephrase uti the pt was otherwise ok healthwise, she is weak and i plan to use a "risk for" dx as my second (w/instructor approval cuz there really was nothing else) this pt will be discharged soon. tia for any help!