How to make a Nursing Care Plan? As students, this is really tiring for some of us, but we really do need to have our NCP's right in order to give quality nursing care to our patient. Well, for sure after reading this, say HI to a perfect score in your NCP. Here are some tips.
Someone else made an acronym of the points that goes like this:
S 'n' M Excites Frank! Ha ha ha ha
Safety, Nutrition, Maslow's, Mobility, Elimination and Fluids
It's more like S 'n' M(squared) Excites Frank! Frank must be a pretty kinky guy! Can you tell that the nurse who made up the acronym had been a psych nurse for many years!
Anyway, from a practical point of view with nursing, it works. It gets the patient through the shift.
Safety is always priority, because if your patient isn't safe, then you will be writing an incident report and too many of those means you won't have a job and your patients are probably walking around with a lot of bumps and bruises.
Nutrition is very related to strength and diagnosis.
In the case above, you'd see how you need good calorie intake to keep a skinny little old man from becoming more weak. Then, what do you always need for old people? - If their diagnosis doesn't contraindicate it, fiber doesn't hurt to keep the bowels rumbling around. Mushed up food is not as palatable as regular food, so give it to them if they don't have any swallowing issues. (ABC's - A&B apply to people who can't eat well because of a stroke, no teeth, etc. Speech evaluation if you notice coughing. Don't want to give anyone an aspiration pneumonia!) Water is a part of nutrition that overlaps with fluids. Cleans your palate, and your mouth, prevents nasty infections in your mouth (along with teeth and gum cleaning in the morning), prevents dehydration and keeps the bowels rumbling once again! Do they need supplements. Is their neutrophil count low, (so they can't have fresh fruits, salads, and no flowers in the room because they are on reverse isolation). Do they need free H20 or juice (depending on their sodium level, are they vomiting or having diarrhea). Can they hold the fluids and food down. Do their bowels need a rest with a liquid diet (i.e, acute colitis). Do they have the gag reflex? Do we need to get their bowels woken up from anaesthesia by starting them on a clear liquid diet. If they need potassium, can you give it to them orally. If their potassium won't come up, do they need Magnesium? If they have asthma, do they respond to magnesium supplementation. How's the Calcium level? K+, magnesium and Calcium are all absorbed well in the gut. Their levels are all related and contribute to good muscle contraction and heart rhythms. Do they need low vitamin K, because they are on Coumadin. In this case, get a dietary consultation for patient teaching, give them a hand out and teach, quiz, etc. Use your common sense and learn as much about nutrition as it applies to the particular diagnosis. You will learn a lot here and it very much relates to fluids (riders and electrolyte balance).
Maslow's always needs to be included. You need to see what level your patiet is at and then get to that level with them so you understand how you will communicate with them, give them what they need and do your teaching appropriately.
S 'n' M Excites Frank! Ha ha ha ha
Safety, Nutrition, Maslow's, Mobility, Elimination and Fluids
It's more like S 'n' M(squared) Excites Frank! Frank must be a pretty kinky guy! Can you tell that the nurse who made up the acronym had been a psych nurse for many years!
Anyway, from a practical point of view with nursing, it works. It gets the patient through the shift.
Safety is always priority, because if your patient isn't safe, then you will be writing an incident report and too many of those means you won't have a job and your patients are probably walking around with a lot of bumps and bruises.
Nutrition is very related to strength and diagnosis.
In the case above, you'd see how you need good calorie intake to keep a skinny little old man from becoming more weak. Then, what do you always need for old people? - If their diagnosis doesn't contraindicate it, fiber doesn't hurt to keep the bowels rumbling around. Mushed up food is not as palatable as regular food, so give it to them if they don't have any swallowing issues. (ABC's - A&B apply to people who can't eat well because of a stroke, no teeth, etc. Speech evaluation if you notice coughing. Don't want to give anyone an aspiration pneumonia!) Water is a part of nutrition that overlaps with fluids. Cleans your palate, and your mouth, prevents nasty infections in your mouth (along with teeth and gum cleaning in the morning), prevents dehydration and keeps the bowels rumbling once again! Do they need supplements. Is their neutrophil count low, (so they can't have fresh fruits, salads, and no flowers in the room because they are on reverse isolation). Do they need free H20 or juice (depending on their sodium level, are they vomiting or having diarrhea). Can they hold the fluids and food down. Do their bowels need a rest with a liquid diet (i.e, acute colitis). Do they have the gag reflex? Do we need to get their bowels woken up from anaesthesia by starting them on a clear liquid diet. If they need potassium, can you give it to them orally. If their potassium won't come up, do they need Magnesium? If they have asthma, do they respond to magnesium supplementation. How's the Calcium level? K+, magnesium and Calcium are all absorbed well in the gut. Their levels are all related and contribute to good muscle contraction and heart rhythms. Do they need low vitamin K, because they are on Coumadin. In this case, get a dietary consultation for patient teaching, give them a hand out and teach, quiz, etc. Use your common sense and learn as much about nutrition as it applies to the particular diagnosis. You will learn a lot here and it very much relates to fluids (riders and electrolyte balance).
Maslow's always needs to be included. You need to see what level your patiet is at and then get to that level with them so you understand how you will communicate with them, give them what they need and do your teaching appropriately.
Mobility huge.
Even if a patient is bedridden (say a stroke patient), then you better be rolling them around to make sure they have good lung expansion on both sides. (ABC's!!) Think circulation when thinking mobility also, in regard to risk for blood clots (possibly another stroke, heart attack, DVT and PE- pulmonary embolism). Circulation again - in regard to potential bed sores. You may not see the damage to tissue, because it's happening below the surface. Next thing you know, whammo - decubs! Turn, use pillow logically and use the bed booties.
If the patient can be mobile, even up in a chair, then get them there as long as you have a doctor's order to do so. If you aren't sure because the patient just came in or they are getting weaker fast, then get that MD to order a physical therapy evaluation. Until then, have that patient turning. There are always those difficult calls, say an Alzheimer's patient who has a history of falls and is weak, but you don't want them to get weaker by keeping them in bed. The last clinical I had recently, the RN wanted the patient in a chair, so did I, the care assistant wanted a posey on that patient if they were going to be in a chair. I cringe at using restraints, but sometimes they are warranted. The doc knew the patient from the nursing home and ordered a posey while in the chair and an order for PT. Other option, get on the phone and have a family member stay with patient so they don't have to be posied. Now, you just have to see if they try to climb out of bed also and get an order for posey in bed if you have to. Ahhh! I hate restraints! It's a difficult balance, but I have to always remember that my shift is not the only shift of this patient's life. It's a collaborative effort, so do what is good for the patient now with future goals in mind. (In this case, PT).
Elimination is very related to mobility and nutrition and fluids.
How are they going to get to the bathroom? and getting there safely?, or do they need that commode or a bedpan. Think logistics and need for mobility tempered with safety and reality. They are not going to be in the hospital forever!
Are they eating enough to even make a bowel movement? (I hope so, if not, then that is the goal). Do they have enough fiber, oral fluids and mobility to keep them regular? Do they have a history of bowel obstructions? Look at their baseline, complications, patterns of output and goals.
Are they post-surgical. If so, do they have bowel sounds, gas, cramping? Have they urinated?, Is the suprapubic area hard, distended? Do they need to be straight-cathed to see if their kidneys are making urine output? Do they need fluids, are they 3rd spacing?
Even if a patient is bedridden (say a stroke patient), then you better be rolling them around to make sure they have good lung expansion on both sides. (ABC's!!) Think circulation when thinking mobility also, in regard to risk for blood clots (possibly another stroke, heart attack, DVT and PE- pulmonary embolism). Circulation again - in regard to potential bed sores. You may not see the damage to tissue, because it's happening below the surface. Next thing you know, whammo - decubs! Turn, use pillow logically and use the bed booties.
If the patient can be mobile, even up in a chair, then get them there as long as you have a doctor's order to do so. If you aren't sure because the patient just came in or they are getting weaker fast, then get that MD to order a physical therapy evaluation. Until then, have that patient turning. There are always those difficult calls, say an Alzheimer's patient who has a history of falls and is weak, but you don't want them to get weaker by keeping them in bed. The last clinical I had recently, the RN wanted the patient in a chair, so did I, the care assistant wanted a posey on that patient if they were going to be in a chair. I cringe at using restraints, but sometimes they are warranted. The doc knew the patient from the nursing home and ordered a posey while in the chair and an order for PT. Other option, get on the phone and have a family member stay with patient so they don't have to be posied. Now, you just have to see if they try to climb out of bed also and get an order for posey in bed if you have to. Ahhh! I hate restraints! It's a difficult balance, but I have to always remember that my shift is not the only shift of this patient's life. It's a collaborative effort, so do what is good for the patient now with future goals in mind. (In this case, PT).
Elimination is very related to mobility and nutrition and fluids.
How are they going to get to the bathroom? and getting there safely?, or do they need that commode or a bedpan. Think logistics and need for mobility tempered with safety and reality. They are not going to be in the hospital forever!
Are they eating enough to even make a bowel movement? (I hope so, if not, then that is the goal). Do they have enough fiber, oral fluids and mobility to keep them regular? Do they have a history of bowel obstructions? Look at their baseline, complications, patterns of output and goals.
Are they post-surgical. If so, do they have bowel sounds, gas, cramping? Have they urinated?, Is the suprapubic area hard, distended? Do they need to be straight-cathed to see if their kidneys are making urine output? Do they need fluids, are they 3rd spacing?
I hope that HELPed you! Say HI to better NCP!
Here are some links that might help you with your NCP.
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