SMART goal for ascites

[peppermintytea]

I am trying to come up with a SMART goal (specific, measurable, achievable, realistic, timely) for my nursing care plan. The patient has fluid overload as evidenced by ascites, edema, etc but low blood pressure (92/50). We're supposed to have 1 smart goal and 3 evidence based nursing interventions.

The interventions I found from papers are 1. positioning 2. monitor ins and outs 3. daily weights.

For the SMART goal I am thinking the patient has a negative ins-and-outs (more liquid out than in since she has fluid overload), no increase in edema, or no increase in discomfort from fluid overload at the end of my shift vs. the beginning but I'm not sure if these are all related to the interventions I found also I can only choose one goal. Suggestions?

[bgxyrnf, MSN, RN]

I am trying to come up with a SMART goal (specific, measurable, achievable, realistic, timely) for my nursing care plan. The patient has fluid overload as evidenced by ascites, edema, etc but low blood pressure (92/50). We're supposed to have 1 smart goal and 3 evidence based nursing interventions.

The interventions I found from papers are 1. positioning 2. monitor ins and outs 3. daily weights.

For the SMART goal I am thinking the patient has a negative ins-and-outs (more liquid out than in since she has fluid overload), no increase in edema, or no increase in discomfort from fluid overload at the end of my shift vs. the beginning but I'm not sure if these are all related to the interventions I found also I can only choose one goal. Suggestions?

Well for one, you've got three goals, not one... net output, no increase in edema (which is kind of a lame goal... how 'bout improvement?), and no worsening discomfort (again, how 'bout a goal of improvmeent rather than what brought 'em in to begin with?).

I would pick a goal that directly correlates to each of your three interventions... or pick three interventions that directly help achieve your goal. For example, none of your interventions directly support a goal of net negative fluid balance but strict fluid restriction and low sodium diet would.

Discomfort is a pretty nebulous thing. Many is the patient who can't really decide if they feel better or not, or can't communicate it effectively. I don't consider "discomfort" to be a measurable goal, nor is it specific. Abdominal pain never more than 4/10 is specific and, probably measurable... though I find the pain scale to border on useless.

BTW, patients with ascites are not necessarily fluid overloaded... quite often just the contrary... and a diastolic of 50 doesn't scream fluid overload. Ascites doesn't derive from fluid overload, right? It comes from funky liver function (or severe malnutrition). Now dependent edema, wet lungs, JVD, orthopnea are all indicators of fluid overload.