Nursing Care Plans - الرئيسية

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care planning resources

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Doenges, Moorhouse & Murr

Nurse's Pocket Guide

Diagnoses, Prioritized Interventions and Rationales

The perfect portable guide for practitioners and nursing students on the go! Here's everything you need to select the appropriate diagnoses for your patients and develop safe and effective care plans.

Doenges & Moorhouse

APPLICATION OF NURSING PROCESS AND NURSING DIAGNOSIS

An Interactive Text for Diagnostic Reasoning

Master the nursing process with this step-by-step approach to the whys and hows, while you develop the diagnostic reasoning and problem-solving skills you need to `think like a nurse.'

Doenges, Moorhouse & Murr

Nursing Diagnosis Manual

Planning, Individualizing, and Documenting Client Care

Rely on this complete reference to identify interventions commonly associated with specific nursing diagnoses across the lifespan, and to help plan, individualize, and document care for more than 800 diseases and disorders.

Order your copies today!



Taber's? 22 brings meanings to life!

Taber's 22

Edited by Donald Venes, MSJ, MD Meet the needs of diverse learning styles and today's time-pressed students with FREE mobile and web access, flash-card app, audio pronunciations, interactive learning activities, and more!

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Don't miss the

nursing diagnosis and care planning resources

online at

A wealth of online tools help you learn to plan and implement safe, individualized care.

Visit DavisPlus. today!

?? Concept Care Map Generator ?? Learning Activities ?? Interactive Assessment Tool ?? Care Plan Template

?? Care Plan Case Studies ?? Gordon's Functional Health Case Studies ?? Online Disorder Lookup ?? Nursing Diagnoses Arranged by Maslow Hierarchy



INDEX OF DISEASES/DISORDERS

This is 1 of 2 indexes in the book. It should be compiled by the indexer and only needs to contain the disorder/disease and the page number in which the care plan for that disorder/disease begins.

Acid-base imbalances respiratory, 179 metabolic, 450

Acquired immunodeficiency syndrome (AIDS), 689

Acute coronary syndrome (ACS), 58 Acute kidney injury (acute renal failure), 505 Adult leukemias, 484 Alcohol: acute withdrawal, 800 Alzheimer's disease, 743 Amputation, 616 Anemia?iron deficiency, anemia of chronic

disease, pernicious, aplastic, hemolytic, 459 Angina: chronic/stable, 67 Anorexia nervosa, 340 Aplastic anemia, 459 Appendectomy, 315 Asthma, 118

Bariatric surgery, 367 Benign prostatic hyperplasia, 559 Brain infections: meningitis and encephalitis,

229 Bulimia nervosa, 340 Burns: thermal, chemical, and electrical--acute

and convalescent phases, 638

Cancer, 827 Cardiac dysrhythmias, 87 Cardiac surgery: postoperative care, 98 Cardiomyoplasty, 98 Cerebrovascular accident/stroke, 214 Chemical burns, 638 Cholecystectomy, 335 Cholecystitis with cholelithiasis, 329 Cholelithiasis, 329 Chronic obstructive pulmonary disease (COPD)

and asthma, 118 Cirrhosis of the liver, 412 Colostomy, 304 Coronary artery bypass graft, 98 Craniocerebral trauma?acute rehabilitative

phase, 197 Crohn's disease, 291

Dementia (Alzheimer's type or vascular), 743 Diabetes mellitus/diabetic ketoacidosis, 377 Diabetic ketoacidosis, 377 Disaster considerations, 858 Disc surgery, 237 Dysrthymias, 87

Eating disorders: anorexia nervosa/bulimia nervosa, 340

Eating disorders: obesity, 358 Electrical burns, 638 Encephalitis, 229 End-of-life care/hospice, 848 End stage renal disease, 517 Enteral feeding, 437 Esophageal bleeding, 281 Extended care, 781

Fecal diversions: postoperative care of ileostomy and colostomy, 304

Fluid and electrolyte imbalances, 886 Fractures, 601

Gastrectomy/gastroplasty, DavisPlus Gastric bypass, 367 Gastric partitioning, 367 Glaucoma, DavisPlus Graves' disease, 391

Heart failure: chronic, 43 Hemodialysis, 544 Hemolytic anemia, 459 Hemothorax, 150 Hepatitis, 400 Herniated nucleus pulposus, DavisPlus HIV-positive client, 677 Hospice, 848 Hypercalcemia (calcium excess), 909 Hyperkalemia (potassium excess), 903 Hypermagnesemia (magnesium excess), 915 Hypernatremia (sodium excess), 897 Hypertension: severe, 33 Hyperthyroidism (Graves' disease,

thyrotoxicosis), 391 Hypervolemia (extracellular fluid volume

excess), 886 Hypocalcemia (calcium deficit), 906 Hypokalemia (potassium deficit), 900 Hypomagnesemia (magnesium deficit), 912 Hyponatremia (sodium deficit), 893 Hypovolemia (extracellular fluid volume

deficit), 890 Hysterectomy, 581

Ileostomy, 304 Inflammatory bowel disease: ulcerative colitis,

Crohn's disease, 291 Iron deficiency anemia, 459

Laminectomy, 237 Laryngectomy, DavisPlus Lewy body disease, 743 Leukemias, 484 Lung cancer: postoperative care, 141 Lymphomas, 494

Mastectomy, 589 Meningitis, 229 Metabolic acid-base imbalances, 450 Metabolic acidosis--primary base bicarbonate

deficiency, 450 Metabolic alkalosis--primary base bicarbonate

excess, 455 Minimally invasive direct coronary artery

bypass, 98 Multiple sclerosis, 266 Myocardial infarction, 75

Obesity, 358 Obesity: bariatric surgery, 367

Pancreatitis, 426 Parenteral feeding, 437 Pediatric considerations, 872 Peritoneal dialysis, 539 Peritonitis, 320 Pernicious anemia, 459 Pneumonia, 129 Pneumothorax, 150 Primary base bicarbonate deficiency, 450 Primary base bicarbonate excess, 455 Primary carbonic acid deficit, 184 Primary carbonic acid excess, 179 Prostatectomy, 566 Psychosocial aspects of care, 729 Pulmonary emboli considerations, 109 Pulmonary tuberculosis (TB), 170

Radical neck surgery, DavisPlus Renal calculi, 573 Renal dialysis--general considerations, 529 Renal failure: acute, 505 Renal failure: chronic, 517 Respiratory acid-base imbalances, 179 Respiratory acidosis (primary carbonic acid

excess), 179 Respiratory alkalosis (primary carbonic acid

deficit), 184 Rheumatoid arthritis (RA), 709 Ruptured invertebral disc, DavisPlus

Seizure disorders, 188 Sepsis/septicemia, 665 Sickle cell crisis, 469 Spinal cord injury (acute rehabilitative phase),

248 Stroke, 214 Substance use disorders (SUDs), 815 Surgical intervention, 762

Thermal burns, 638 Thrombophlebitis: venous thromboembolism, 109 Thyroidectomy, DavisPlus Thyrotoxicosis, 391 Total joint replacement, 625 Total nutritional support: parenteral/enteral

feeding, 437 Transplantation considerations--postoperative

and lifelong, 719 Tuberculosis (TB), pulmonary, 170

Ulcerative colitis, 291 Upper gastrointestinal/esophageal bleeding, 281 Urinary diversions/urostomy (postoperative

care), 548 Urolithiasis (renal calculi), 573 Urostomy, 548

Valve replacement, 98 Vascular dementia, 743 Ventilatory assistance (mechanical), 157

Wound care: complicated or chronic, 657

Herdman, T.H. (Ed.). Nursing Diagnoses--Definitions and Classification 2012?2014. Copyright ? 2012, 1994?2012 NANDA International. Used by arrangement with John Wiley & Sons Limited. In order to make safe and effective judgments using NANDA-I nursing diagnoses it is essential that nurses refer to the definitions and defining characteristics of the diagnoses listed in this work.

KEY TO ESSENTIAL TERMINOLOGY

Client Assessment Database

Provides an overview of the more commonly occurring etiology and coexisting factors associated with a specific medical and/or surgical diagnosis or health condition as well as the signs and symptoms and corresponding diagnostic findings.

Nursing Priorities

Establishes a general ranking of needs and concerns on which the Nursing Diagnoses are ordered in constructing the plan of care. This ranking would be altered according to the individual client situation.

Discharge Goals

Identifies generalized statements that could be developed into short-term and intermediate goals to be achieved by the client before being "discharged" from nursing care. They may also provide guidance for creating long-term goals for the client to work on after discharge.

Nursing Diagnosis

The general need or problem (diagnosis) is stated without the distinct cause and signs and symptoms, which would be added to create a client diagnostic statement when specific client information is available. For example, when a client displays increased tension, apprehension, quivering voice, and focus on self, the nursing diagnosis of Anxiety might be stated: severe Anxiety related to unconscious conflict, threat to self-concept as evidenced by statements of increased tension, apprehension; observations of quivering voice, focus on self.

In addition, diagnoses identified within these guides for planning care as actual, risk, or health-promotion can be changed or deleted and new diagnoses added, depending entirely on the specific client situation or available information.

May Be Related to/Possibly Evidenced by

These lists provide the usual or common reasons (etiology) why a particular need or problem may occur with probable signs and symptoms, which would be used to create the "related to" and "evidenced by" portions of the client diagnostic statement when the specific situation is known.

When a risk diagnosis has been identified, signs and symptoms have not yet developed and therefore are not included in the nursing diagnosis statement. However, interventions are provided to prevent progression to an actual problem. Furthermore, health-promotion diagnoses (readiness for enhanced) do not contain related factors, but do have defining characteristics for the "evidenced by" segment of the client diagnostic statement.

Desired Outcomes/Evaluation Criteria--Client Will

These give direction to client care as they identify what the client or nurse hopes to achieve. They are stated in general terms to permit the practitioner to modify or individualize them by adding time lines and specific client criteria so they become "measurable." For example, "Client will appear relaxed and report anxiety is reduced to a manageable level within 24 hours."

Nursing Outcomes Classification (NOC) labels are also included. The outcome label is selected from a standardized nursing language and serves as a general header for the outcome indicators that follow.

Actions/Interventions

Nursing Interventions Classification (NIC) labels are drawn from a third standardized nursing language and serve as a general header for the nursing actions that follow.

Nursing actions are divided into independent--those actions that the nurse performs autonomously--and collaborative--those actions that the nurse performs in conjunction with others, such as implementing physician orders. The interventions in this book are generally ranked from most to least common. When creating the individual plan of care, interventions would normally be ranked to reflect the client's specific needs and situation. In addition, the division of independent and collaborative is arbitrary and is actually dependent on the individual nurse's capabilities, agency protocols, and professional standards.

Rationale

Although not commonly appearing in client plans of care, rationale has been included here to provide a pathophysiological basis to assist the nurse in deciding about the relevance of a specific intervention for an individual client situation.

Clinical Pathway

This abbreviated plan of care or care map is event- or task-oriented and provides outcome-based guidelines for goal achievement within a designated length of stay. Several samples have been included to demonstrate alternative planning formats.

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