Any nurses?? Who know about care planning!

[Smurfgirl]

I have a question about a care plan I am doing for an assignment. Am using Orem but its more general advice.

fire away

I am struggeling to get my goals to be nursing based, the scenario is about someone with TB and all of his problems relate to the TB and symtoms so I am not sure how to fit that in.

Like he has reduced mobility because he is breathless - he feels breathless because of the TB - he is anxious because he has TB so getting rid of the TB would fix these but thats a medical problem not a nursing one. Does this make sense?

You could plan for dealing with night-sweats, which is a common symptom of TB.

Your care plan would state that your goal is for the patient to be comfortable and apyrexial at all times (yes, that's a biggy, I realise) but you could then talk about the use of paracetamol, fan-therapy etc to relieve the symptoms of high-temps.

Dont forget infection control..thats an important one too.

Maybe you need to think about it from a nursing shift perspective.
What would be his needs from the moment you walk into his room till the moment you leave..

Diet, would it be high protien, would he need suppliments, who would provide them.

hygiene needs, bath shower or bed bath, would this be communal or would every effort be made to place him in a solitary environment.

maybe go down that route?

Don't forget, Smurfgirl, that you are doing what it says on the tin - ie. planning care.

Forget drug therapies, unless they impact on how the patient feels.

As Donbean has said, you are planning for everytning you can do to make a patient feel as good as he/she can.

This might be something like oral care (nobody likes a cacky mouth) or any other things you can do to make him/her feel better and maintain a safe environment.

Ok so far have.

For pt to feel less 'unwell' (its a self statement which Orem says we shiuld use) and for the breathlessness to be ? (reduced, eliviated??)

I feel like this is too medical though.

plan is -
-give meds - encourage to self medicate
-moniter obs + record
-moniter sats and encourage compliance with mask - scenario says he is on 28% venturi but only 90% so i feel like I am missing something here
-mouth care - and teach pt/family how to do it
-position pt in bed upright

Also have one on hygiene because pt states he is too 'exhausted' to do his own

Is the public health issue part of the care plan? Feel like there is something I am missing in the scenario.

He has lost weight recently but BMI is still overweight so would that need planning for?

I would say that sats of 90% is ok with this disease process, he wont have 100% with TB and dyspnoea will he.
What about getting sputum specimins, and disposing of bodily fluids...again maintaining scrupulous infection control measures to avoid cross infection blah blah blah.

Ok - am not familiar with tb at all so its a bit of a challenge.

Will mention waste disposal - do you think i could involve self caring by doing teaching for the family about washing hands etc?

90% sounds good here, too. Anything above 85% is considered good enough in recovery wards.

Breathlessness should be alleviated.

Upright in bed with pillows (if they still exist in the NHS?) Might be worth suggesting family get themselves down to Argos and buy a V-shaped one. May be too political, though?

Howdy smurf girl
I'm a TB nurse specialist on maternity leave!! What info do you need??

Absolutely vital i would say.

Is there any mention in the Orem model about what order to put this in?
Its got to have been 15 years since i looked at nursing models!

Public health issue affects you in as much as observing good hygeing protocols to prevent risk of cross-infection.

Smurf girl- Is the scenario one you have been given or have you made it up? Ie care of the patient with TB?

Now you are cooking...with a TB specialist to hand girl, you will get 100% for this assignment!!!!

Don bean - i should bloody well hope she will get 100% for this or I should be sacked- lol
Come on smurf girl- hit me with it, I'm getting all excited

Heeelllllllooooooooooooooo? smurf girl

me me me !!!

HAHA snottyshoulders! Have you just started mat leave or are you nearing the end???
This cannot be a person just starting mat leave with so much excitement about TB ridden sputum...surely not!

MINGER!!!!!!!!!!!!!!!

Don bean_ been off a year...waiting to go back but moved area, so looking for new job. I am VERY passionate about TB though, been in TB for years and love it. Moved to new area and alas, no TB in east anglia...to pay for specialist nurse anyway....

Haha! am pissing myself here!
Why TB in particular?

Don bean_thanks

Its a scenario I have been given.

Newly diagnose 65 yr old man with tb just come back from australia. Did smoke - now quit, exhausted, weightloss, reduced sleep.

Has a diagnosis - sputum sample sent off

I am 2nd yr st/n BTW so be kind!!

more than halfway through now!!