No: 286986

Help with Care Plans

- rn/writer

,r 06, 2008 10:51 P -

Are you scrofching your heod or ore you moybe even reody fo feor your
hoir ouf over how fo come up wifh core pIons7 Here ore some words of
wisdom from our own beIoved Doyfonife.


C,re Pl,n B,8ic8:
Every 8ingle nur8ing di,gno8i8 h,8 it8 own 8et of 8ymptom8, or defining ch,r,cteri8tic8
They ,re li8ted in the NANDA t,onomy ,nd in m,ny of the current nur8ing c,re pl,n book8
th,t ,re currently on the m,rket th,t include nur8ing di,gno8i8 inform,tion You need to
h,ve ,cce88 to the8e book8 when you ,re working on c,re pl,n8 There ,re currently 188
nur8ing di,gno8e8 th,t NANDA h,8 defined ,nd given rel,ted f,ctor8 ,nd defining
ch,r,cteri8tic8 for Wh,t you need to do i8 get thi8 inform,tion to help you in writing c,re
pl,n8 8o you di,gno8e your p,tient8 correctly

Don't focu8 your effort8 on the nur8ing di,gno8e8 when you 8hould be focu8ing on the
,88e88ment ,nd the p,tient8 ,bnorm,l d,t, th,t you collected The8e will become their
8ymptom8, or wh,t NANDA c,ll8 defining characteristics

How doe8 , doctor di,gno8e? He/8he doe8 (hopefully) , thorough medic,l hi8tory ,nd
phy8ic,l e,min,tion fir8t Surpri8e! We do th,t too! It'8 p,rt of Step #1 of the nur8ing
proce88 Only then, doe8 he u8e "medic,l deci8ion m,king" to ferret out the 8ymptom8 the
p,tient i8 h,ving ,nd determine which medic,l di,gno8i8 ,pplie8 in th,t p,rticul,r c,8e
E,ch medic,l di,gno8i8 h,8 , defined li8t of 8ymptom8 th,t the p,tient'8 illne88 mu8t
m,tch Another 8urpri8e! We do th,t too! We c,ll it "critic,l thinking ,nd it'8 p,rt of Step #2
of the nur8ing proce88 The NANDA t,onomy li8t8 the 8ymptom8 th,t go with e,ch nur8ing
di,gno8i8

Here ,re the 8tep8 of the nur8ing proce88 ,nd wh,t you 8hould be doing in e,ch 8tep when
you ,re doing , written c,re pl,n:
1 Assessment (collect d,t, from medic,l record, do , phy8ic,l ,88e88ment of the
p,tient, ,88e88 ADL'8, look up inform,tion ,bout your p,tient'8 medic,l
di8e,8e8/condition8 to le,rn ,bout the 8ign8 ,nd 8ymptom8 ,nd p,thophy8iology)
2 Determination of the patient's problem(s)/Nursing diagnosis (m,ke , li8t of
the ,bnorm,l ,88e88ment d,t,, m,tch your ,bnorm,l ,88e88ment d,t, to likely
nur8ing di,gno8e8, decide on the nur8ing di,gno8e8 to u8e)
3 Planning (write me,8ur,ble go,l8/outcome8 ,nd nur8ing intervention8)
4 Implementation (initi,te the c,re pl,n)
5 Evaluation (determine if go,l8/outcome8 h,ve been met)
Now, li8ten up, bec,u8e wh,t I ,m telling you net i8 very import,nt inform,tion ,nd i8
prob,bly going to ch,nge your whole ,ttitude ,bout c,re pl,n8 ,nd the nur8ing proce88 ,
c,re pl,n i8 nothing more th,n the written document,tion of the nur8ing proce88 you u8e to
8olve one or more of , p,tient'8 nur8ing problem8 The nur8ing proce88 it8elf IS , problem
8olving method th,t w,8 etr,pol,ted from the 8cientific method u8ed by the v,riou8
8cience di8cipline8 in proving or di8proving theorie8 One of the m,in go,l8 every nur8ing
8chool w,nt8 it8 RN8 to le,rn by gr,du,tion i8 how to u8e the nur8ing proce88 to 8olve
p,tient problem8 Why? Bec,u8e ,8 , working RN you will be u8ing th,t method m,ny time8
, d,y ,t work to re8olve ,ll kind8 of i88ue8 ,nd minor riddle8 th,t will pre8ent them8elve8
Th,t i8 wh,t you ,re going to be p,id to do o8t of the time you will do thi8 critic,l thinking
proce88 in your he,d For , c,re pl,n you h,ve to commit your thinking proce88 to p,per
And in c,8e you ,nd ,ny other8 re,ding thi8 ,re wondering why in the bl,e8 you ,re being
forced to le,rn how to do the8e c,re pl,n8, here'8 one very good ,nd re,l world re,8on:
bec,u8e there i8 , feder,l l,w th,t mandates th,t every ho8pit,l th,t ,ccept8 edic,re ,nd
edicAid p,yment8 for p,tient8 MUST include , written nur8ing c,re pl,n in every
inp,tient'8 ch,rt whether the p,tient i8 , edic,re/edicAid p,tient or not If they don't,
huge fine8 ,re ,88e88ed ,g,in8t the f,cility

You, I ,nd ju8t ,bout everyone we know h,ve been u8ing , form of the 8cientific proce88, or
nur8ing proce88, to 8olve problem8 th,t come up in our d,ily live8 8ince we were little kid8
Let me give you , 8imple e,mple:
You ,re driving ,long ,nd 8uddenly you he,r , b,ng, you 8t,rt h,ving trouble controlling
your c,r'8 direction ,nd it'8 h,rd to keep your h,nd8 on the 8teering wheel You pull over to
the 8ide of the ro,d "Wh,t'8 wrong?" you're thinking You look over the d,8hbo,rd ,nd
none of the w,rning light8 ,re blinking You decide to get out of the c,r ,nd t,ke , look ,t
the out8ide of the vehicle You 8t,rt w,lking ,round it Then, you 8ee it A huge n,il i8
8ticking out of one of the re,r tire8 ,nd the tire i8 notice,bly defl,ted Wh,t you h,ve ju8t
done i8 STEP #1 of the nur8ing proce88--performed ,n ,88e88ment You determine th,t you
h,ve , fl,t tire You h,ve ju8t done STEP #2 of the nur8ing proce88--m,de , di,gno8i8 The
little 86uirrel 8t,rt8 running like cr,y in the wheel up in your br,in "Wh,t do I do?" you ,re
thinking You could c,ll AAA No, you c,n 8,ve the money ,nd do it your8elf You c,n
repl,ce the tire by ch,nging out the fl,t one with the 8p,re in the trunk Good thing you
took th,t cl,88 in how to do 8imple m,inten,nce ,nd rep,ir8 on , c,r! You h,ve ju8t done
STEP #3 of the nur8ing proce88--pl,nning (developed , go,l ,nd intervention) You get the
j,ck ,nd 8p,re tire out of the trunk, roll up your 8leeve8 ,nd get to work You h,ve ju8t
done STEP #4 of the nur8ing proce88--implement,tion of the pl,n After the new tire i8
in8t,lled you put the fl,t one in the trunk ,long with the j,ck, du8t your8elf off, t,ke , long
drink of th,t bottle of w,ter you h,d with you ,nd prep,re to drive off You begin 8lowly to
te8t the feel ,8 you drive Good Everything 8eem8 fine The 8p,re tire 8eem8 to be OK ,nd
off you go ,nd on your w,y You h,ve ju8t done STEP #5 of the nur8ing proce88--ev,lu,tion
(determined if your go,l w,8 met)
C,n you rel,te to th,t? Th,t'8 ,bout ,8 8imple ,8 I c,n reduce the nur8ing proce88 to But,
you h,ve the follow tho8e 5 8tep8 in th,t 8e6uence or you will get lo8t in the wood8 ,nd lo8e
your focu8 of wh,t you ,re trying to ,ccompli8h

CARE PLAN REALITY: The found,tion of ,ny c,re pl,n i8 the signs, symptoms or
responses th,t p,tient i8 h,ving to wh,t i8 h,ppening to them Wh,t i8 h,ppening to them
could be , medic,l di8e,8e, , phy8ic,l condition, , f,ilure to be ,ble to perform ADL8
(,ctivitie8 of d,ily living), or , f,ilure to be ,ble to inter,ct ,ppropri,tely or 8ucce88fully
within their environment Therefore, one of your prim,ry ,im8 ,8 , problem 8olver i8 to
collect ,8 much d,t, ,8 you c,n get your h,nd8 on The more the better You h,ve to be ,
detective ,nd ,lw,y8 be on the ,lert ,nd lookout for clue8 At ,ll time8 And th,t i8 within
the 8pirit of Step #1 of thi8 whole nur8ing proce88

A88e88ment i8 ,n import,nt 8kill It will t,ke you , long time to become proficient in
,88e88ing p,tient8 A88e88ment not only include8 doing the tr,dition,l he,d-to-toe e,m,
but ,l8o li8tening to wh,t p,tient8 h,ve to 8,y ,nd 6ue8tioning them Hi8tory c,n reve,l
import clue8 It t,ke8 time ,nd eperience to know wh,t 6ue8tion8 to ,8k to elicit good
,n8wer8 P,rt of thi8 ,88e88ment proce88 i8 knowing the p,thophy8iology of the medic,l
di8e,8e or condition th,t the p,tient h,8 But, there will be time8 th,t thi8 won't be known
Ju8t keep in mind th,t you h,ve to be like , nur8e detective ,lw,y8 8nooping ,round ,nd
looking for tho8e clue8

A nursing diagnosis standing by itself means nothing. The me,t of thi8 c,re pl,n of
your8 will lie in the ,bnorm,l d,t, (8ymptom8) th,t you collected during your ,88e88ment of
thi8 p,tient In order for you to pick ,ny nur8ing di,gno8e8 for , p,tient you need to know
wh,t the p,tient'8 8ymptom8 ,re

Wh,t I would 8ugge8t you do i8 to work the nur8ing proce88 from Step #1 T,ke , look ,t
the inform,tion you collected on the p,tient during your phy8ic,l ,88e88ment ,nd review of
their medic,l record St,rt m,king , li8t of ,bnorm,l d,t, which will now become , li8t of
their 8ymptom8 Don't forget to include ,n ,88e88ment of their ,bility to perform ADL8
(bec,u8e th,t'8 wh,t we nur8e8 8hine ,t) The ADL8 ,re b,thing, dre88ing, tr,n8ferring from
bed or ch,ir, w,lking, e,ting, toilet u8e, ,nd grooming And, one more thing you 8hould do
i8 to look up inform,tion ,bout 8ymptom8 th,t 8t,nd out to you Wh,t i8 the phy8iology ,nd
wh,t ,re the 8ign8 ,nd 8ymptom8 (m,nife8t,tion8) you ,re likely to 8ee in the p,tient Did
you mi88 ,ny of the 8ign8 ,nd 8ymptom8 in the p,tient? If 8o, now i8 the time to ,dd them
to your li8t Thi8 i8 ,ll p,rt of prep,ring to move onto Step #2 of the proce88 which i8
determining your p,tient'8 problem ,nd choo8ing nur8ing di,gno8e8 But, you h,ve to h,ve
tho8e 8ign8, 8ymptom8 ,nd p,tient re8pon8e8 to b,ck it ,ll up

CARE PLAN REALITY: Wh,t you ,re c,lling , nur8ing di,gno8i8 (E: Activity Intolerance) i8
,ctu,lly , 8horth,nd l,bel for the P,tient Problem The p,tient problem i8 more ,ccur,tely
de8cribed in the definition of thi8 nur8ing di,gno8i8 (every NANDA nur8ing di,gno8i8 h,8 ,
definition)
Activity Intolerance (p,ge 3, NANDA-I Nur8ing Di,gno8e8: Definition8 & Cl,88ific,tion
2007-2008)

Definition: Insufficient phsiological or pschological energ to endure or complete
required or desired dail activities
(doe8 thi8 8ound like your p,tient'8 problem?)

Defining characteristics (symptoms): ,bnorm,l blood pre88ure re8pon8e to ,ctivity,
,bnorm,l he,rt r,te to ,ctivity, electroc,rdiogr,phic ch,nge8 reflecting ,rrhythmi,8,
electroc,rdiogr,phic ch,nge8 reflecting i8chemi,, eertion,l di8comfort, eertion,l dy8pne,,
verb,l report of f,tigue, verb,l report of we,kne88

Related Factors (etiology): bed re8t, gener,lied we,kne88, imb,l,nce between oygen
8upply ,nd dem,nd, immobility, 8edent,ry life8tyle
I've ju8t li8ted ,bove ,ll the NANDA inform,tion on the di,gno8i8 of Activity
Intolerance from the t,onomy Only you know thi8 p,tient ,nd c,n ,88e88 whether thi8
di,gno8i8 fit8 with your p,tient'8 problem 8ince you po8ted no other inform,tion

In order to choo8e nur8ing di,gno8e8, you ,l8o need to h,ve 8ome 8ort of nur8ing di,gno8i8
reference There i8 8ome free inform,tion on the Internet but it i8 limited to ,bout 75 of the
mo8t commonly u8ed nur8ing di,gno8e8 There i8 , po8t th,t h,8 the weblink8 to them (8ee
po8t #109 on the thre,d:

http://,llnur8e8com/forum8/f205/de8per,tely-need-help-c,repl,n8-170689html

One more thing CARE PLAN REALITY: Nur8ing Di,gno8e8, nur8ing intervention8 ,nd go,l8
,re ALL b,8ed upon the p,tient'8 8ymptom8, or defining ch,r,cteri8tic8 They ,re ,ll linked
together with e,ch other to form , nice rel,ted circle of c,u8e ,nd effect

You re,lly 8houldn't focu8 too much time on the nur8ing di,gno8e8 o8t of your focu8
8hould re,lly be on g,thering together the 8ymptom8 the p,tient h,8 bec,u8e the entire
c,re pl,n i8 b,8ed upon them The nur8ing di,gno8i8 i8 only one 8m,ll p,rt of the c,re pl,n
,nd to focu8 8o much time ,nd energy on it t,ke8 ,w,y from the rem,inder of the work th,t
need8 to be done on the c,re pl,n