SMART goal trouble and priority nursing concepts

[tmaloney90]

Hello all.

First off, I apologize if this is posted in the wrong section as I do not have very much experience with this website. I am a third semester student and am stressed out about clinical paperwork, in particular my reflection. My school asks me to come up with a SMART goal for my patient and come up with two priority nursing concepts for my patient.

I am having trouble because my clinical instructor is picky about the way the paperwork is written (apa format) which is not a problem, however, I just want to make sure that I am doing all that I can to nail down the correct concepts for my given patient. My last paperwork that was submitted, my instructor did not progress me for the week due to not listing a proper nursing diagnosis. My nursing diagnosis was "infection r/t..." when the professor said this was a medical diagnosis because it was "risk for infection"... I was taught differently last semester, but anyways that is neither here nor there, I am trying to move forward and simply progress in this clinical outcome.

A little bit of background on my patient this week. It was a older female, fully independent, admitted for asthmatic bronchitis and COPD exacerbation. The patient had a history of smoking for years and years and had no plans of quitting even after discharge. The patient indicated that they had a pre-existing foot injury after a fall, had lower back pain, and RUQ abdominal pain. The patient ranked this pain 7 out of 10. In addition, the patient was on contact plus precautions to rule out the possibility of C-Diff and had informed me that they had not eaten in over 5 days in fear of having diarrhea.

My day consisted of administering medications for the patient's pain and providing teaching in relation to the medications being administered, healthy lifestyle changes that would benefit the individual, and answering countless questions related to the care being provided and steps to get the patient discharged. My question is, would the priority concepts (2) for this patient be Pain, as the priority concept, and elimination as the second concept? And what would be an appropriate goal for this patient?

I am not just looking for answers, I would just like some guidance from those who have been in my shoes or those that have a better grasp on this. Any help or push in the right direction would be greatly appreciated. Thanks so much!

[JKL33]

I would pick at least one diagnosis that is related to the primary (admitting) diagnosis unless that is truly no longer an issue and the only reason the patient is still in the hospital is because of the other issues that have cropped up.

You have a lot of choices for this patient....

Impaired gas exchange

Altered nutrition

Risk for fluid volume deficit

Risk for infection

Acute pain

(Possible) activity intolerance

Risk for ineffective therapeutic regimen management

I realize you wrote this on Wednesday - - what did you end up doing with your care plan?