R/C nursing care plan??

[ashaw720]

Hey all,

I am doing a care plan for school and have questions about the "Risk for Complications" collaborative nursing diagnoses.

I have the goal written out, "The nurse will monitor the patient for signs and symptoms of hypokalemia and will collaboratively intervene when necessary to restore physiologic stability."

My questions are as follows,

1. With the goal, do I need to include a specific target date like when doing actual nursing diagnoses? Or should I add "until the patient's serum potassium level reaches 3.5 mEq/L" to make it measurable in some sort of way?

2. As far as evaluating this goes, how would an example of that look? I can't really say the goal was met, partially met, or not met...can I? I know I could provide supporting information such as the patient has not experienced any symptoms of hypokalemia, the patient's serum potassium level is now at 3.2 mEq/L, etc. but I am just unsure of how the evaluation should look.

[NICUismylife, ADN, BSN, RN]

You need "indications" that the goal is being met. So for hypokalemia, it would be something like. Indications: maintain K+ between 3.5-5.0

If the patient's level is 3.2, did you cover that? If so, what is it after coverage? If it's still not within normal range, then goal is not met. If you did bring it back into normal range, then the goal was met with your intervention.

[NICUismylife, ADN, BSN, RN]

I also think you should be using a different goal statement for that particular RC. Probably: "The nurse will manage and minimize complications of the problem." Mostly because there aren't really "early" symptoms of hypokalemia that you can monitor for, and the big issue with hypokalemia is dysrhythmias, and you want to intervene before those occur. If that makes sense. So I'd go with the "manage and minimize complications" goal.

[ashaw720]

Hey thanks! Could you write an example for me? I am unsure what you mean by indications. The patient's serum potassium was 2.8 upon admission, no follow up labs have been drawn yet. They are currently asymptomatic (as far as hypokalemia goes)?

So like: The nurse will monitor the patient for signs and symptoms of hypokalemia such as paralytic ileus, nausea, vomiting, decreased or absent deep tendon reflexes, and EKG changes and will collaboratively intervene when necessary to restore physiologic stability as indicated by serum potassium levels of less than 3.5 mEq/L

?

[NICUismylife, ADN, BSN, RN]

I guess my critical thinking question to you is: why would you monitor for signs/symptoms of hypokalemia such as paralytic ileus and EKG changes before intervening? Why risk that the pt will have a lethal dysrhythmia and die, or end up with paralytic ileus that turns necrotic and need emergency surgery? All it takes is a simple blood draw and an IVPB of K to prevent all of that.

Does that make sense?

As far as formatting. I'll see if I can link my RC study guide here. It gives a properly formatted example.

[NICUismylife, ADN, BSN, RN]

http://www2.bakersfieldcollege.edu/cgard/NURS%20B28/STUDY%20GUIDE%201.1%20NCP%20REVISED.pdf

[ashaw720]

Yes, it makes sense. I am not saying that the patient's hypokalemia will go left untreated. Since the patient presented with hypokalemia, they should be monitored for any adverse s/s of the disorder while receiving treatment. And since it is not in my nor any floor nurse's scope of practice to prescribe the patient potassium IVPB, I think this has to be a collaborative diagnosis (Risk for Complications of Hypokalemia). Yes, I could maybe use a nursing diagnosis instead. But there are no nursing interventions besides encouraging the patient to eat foods high in potassium to resolve the issue. The best way to resolve hypokalemia is with the aid of a physician who would prescribe an IVPB solution containing potassium and probably some oral potassium pills.

I apologize if my question was a little out of context.

Thank you for all the help

[NICUismylife, ADN, BSN, RN]

Yes, it makes sense. I am not saying that the patient's hypokalemia will go left untreated. Since the patient presented with hypokalemia, they should be monitored for any adverse s/s of the disorder while receiving treatment. And since it is not in my nor any floor nurse's scope of practice to prescribe the patient potassium IVPB, I think this has to be a collaborative diagnosis (Risk for Complications of Hypokalemia). Yes, I could maybe use a nursing diagnosis instead. But there are no nursing interventions besides encouraging the patient to eat foods high in potassium to resolve the issue. The best way to resolve hypokalemia is with the aid of a physician who would prescribe an IVPB solution containing potassium and probably some oral potassium pills.

I apologize if my question was a little out of context.

Thank you for all the help

Most facilities have a potassium protocol (and Mg and Phos too) in place so that you don't have to get a direct physician order to cover a low K. Does your facility have one? Just out of curiosity, how long ago was the 2.8 admission lab obtained? If it's been more than a couple of hours, and there isn't an order for a re-draw, I'd be on the phone with the dr. requesting one to make sure this was resolved ASAP. Low K is not something that should be left untreated.

I, personally, LOVE RC dx, and don't use anything else! It's definitely appropriate to use in this, and really any scenario, just be sure to use the appropriate goal and indications. :)

[NICUismylife, ADN, BSN, RN]

In fact, RC dysrhythmias would be completely applicable too. :)

[ashaw720]

I'm currently a LPN in school for my RN, so the care plan is based on a made up patient in a made up scenario. And I am actually not familiar with my hospital's policies regarding electrolyte imbalances since LPNs can't hang the first dose of anything...I don't work on an acute floor per say. But I completely agree with you though, hypokalemia is a priority and should be treated asap. Thanks again for your help!

[NewEnglandRN16]

If I were to write the goal I would state (in loose terms) Pts potassium level will be (improved/within range) in X amount of days. Your interventions would focus on monitor signs and symptoms of hypokalemia, encouraging K+ rich foods, PO K+ supplements, finding other reasons for low K+ (are they on digixon?)

If that makes sense.

[NICUismylife, ADN, BSN, RN]

If I were to write the goal I would state (in loose terms) Pts potassium level will be (improved/within range) in X amount of days. Your interventions would focus on monitor signs and symptoms of hypokalemia, encouraging K+ rich foods, PO K+ supplements, finding other reasons for low K+ (are they on digixon?)

If that makes sense.

With the RC format, there are only 3 specific Nanda-approved goals that you must choose from. RCs are a bit different than standard Nanda diagnoses. I don't know how strict OPs instructors are, but ours knock off a good amount of points if you don't use the properly formatted RC goal.