Urgent Care Plan Help!

[lookingabove313]

I am about to finish my first semester of nursing school but I have to complete a care plan evaluation before I do and I haven't gotten a "satisfactory" yet! I have a question about the actual format of the care plan. Do the outcomes have to come out of the book? I have been using outcomes from the book and making them measurable/specific, etc, to my patient but then she said that I did not mention how I was going to lower the HgB/HCT levels. (patient had anemia/renal failure) I'm not sure where that should go or how to implement it. I also have a hard time with priorities. I know that ABC's come first and then pain but beyond that, I need help. This is really stressing me out. My instructor gave up a brief lecture on how to construct CP's back in early september and I still feel like I'm just now starting to get the hang of it. I have 48 hrs to complete this one and it's my last shot. Please help! btw, the book I use to get my outcomes/interventions/rationales is a nursing diagnosis handbook, authored by Ackley.

[Bug Out, BSN]

Your outcomes or goals are whatever the patient wants...not what the book wants.

Also remember that you are not paid to treat the disease...thats what MDs are for, you treat the person. Focus on the person. What is important to them and think through the steps, you can't run until you can stand.

[Daytonite, BSN, RN]

look at the posts on https://allnurses.com/general-nursing-student/help-care-plans-286986.html - help with care plans.

look at outcomes a different way. outcomes are what you predict will happen as a result of your nursing interventions being done. you, as a nurse, really cannot lower hgb and hct levels, can you? not without doctor's orders. be careful what you write as nursing interventions and what you expect them to do for your patient. make sure that your nursing interventions are addressing the evidence that is proving the existence of the nursing problem for which you have given it the nursing diagnostic name or the cause of the problem.

goal (outcome) statements have four components:

1. a behavior
   
   • this is the desired patient response/action you expect to see/hear as a direct result of your nursing interventions.
     
   • you must be able to observe the behavior
     

[*]it is measurable

• criteria that identifies exactly what you are measuring in terms of
  
  • how much
    
  • how long
    
  • how far
    
  • on what scale you are using
    

[*]sets the conditions under which the behavior should occur

• such conditions as
  
  • when
    
  • how frequently
    

  [*]take into account the patient's overall state of health (this requires knowing the pathophysiology of their disease process)

  [*]take into account the patient's ability to meet the goals you are recommending

  [*]it is a good idea to get the patient's agreement to meet the intended goal so both the nurse and the patient are working toward the same goal

[*]have a realistic time frame for completing the goal

• long-term goals usually take weeks or months
  
• short-term goals can take as little time as a day
  
• it all depends on knowing what your nursing interventions are designed to do and what you believe your patient is capable of doing.
  

prioritizing is better done according to maslow's hierarchy of needs. you can read about them here: http://en.wikipedia.org/wiki/maslow's_hierarchy_of_needs

but this is the listing:

1. physiological needs (in the following order)
   
   • the need for oxygen and to breathe [the brain gets top priority for oxygen, then the oxgenation of the heart followed by oxygenation of the lung tissue itself, breathing problems come next, then heart and circulation problems--this is based upon how fast these organs die or fail based upon the lack of oxygen and their function.]
     
   • the need for food and water
     
   • the need to eliminate and dispose of bodily wastes
     
   • the need to control body temperature
     
   • the need to move
     
   • the need for rest
     
   • the need for comfort
     

[*]safety and security needs (in the following order)

• safety from physiological threat
  
• safety from psychological threat
  
• protection
  
• continuity
  
• stability
  
• lack of danger
  

[*]love and belonging needs

• affiliation
  
• affection
  
• intimacy
  
• support
  
• reassurance
  

[*]self-esteem needs

• sense of self-worth
  
• self-respect
  
• independence
  
• dignity
  
• privacy
  
• self-reliance
  

[*]self-actualization

• recognition and realization of potential
  
• growth
  
• health
  
• autonomy