to write a care plan, you must follow these steps in the sequence they occur:

1. Assessment (collect data from medical record, do a physical assessment of the patient, assess ADL's, look up information 2. 3. 4. 5.
about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology) Determination of the patient's problem(s)/Nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use) Planning (write measurable goals/outcomes and nursing interventions) Implementation (initiate the care plan) Evaluation (determine if goals/outcomes have been met)

The other very major problem you have is that you are not constructing your 3-part nursing diagnostic statements properly. This is partly because you do not understand or follow the nursing process. The 3-part nursing diagnosis statement has this structural format: P-ES P = Problem E = Etiology S = Symptoms or Problem - Etiology(ies) - Symptoms these are, in NANDA language Nursing Diagnosis - Related Factor(s) - Defining Characteristic(s) in a care plan they look like this: PROBLEM [related to] ETIOLOGY(IES)[as evidenced by] SYMPTOM(S) or NURSING DIAGNOSIS [related to] RELATED FACTOR(S) [as evidenced by] DEFINING CHARACTERISTIC(S)

The RELATED FACTOR is the underlying cause of the problem or the cause of the signs and symptoms that the patient is having. To help you determine a related factor it is often helpful to know the pathophysiology of the medical disease process going on in the patient. To help you in determining a related factor you can ask yourself "is this the cause of the problem (meaning the nursing diagnosis)", or "is this what is causing the symptoms". "By taking away this factor, will the symptoms go away?" Remember this important rule: you cannot list any medical diagnosis as a related factor. You have to state a medical condition in some other scientific terms. As an example, we don't say a patient is "dehydrated" since that is a medical diagnosis, but we can say "fluid deficit". They essentially mean the same thing--the difference is in the phrasing of the words. The DEFINING CHARACTERISTICS are always the signs and symptoms that come from that list you created from your assessment activities. These will be anything from the same signs and symptoms that doctors use to statements made by patients that indicate something wrong to ADL evaluations that were not normal. The first thing you need to do in writing your care plan is to sort through the assessment information that you collected. You also need to look up information on DKA, particularly the signs and symptoms, treatment and pathophysiology. Before you can even begin to determine the patient's problems (nursing diagnoses) you have to determine which of the assessment data is abnormal. These are the patient's symptoms, or what NANDA calls defining characteristics. These symptoms, or defining characteristics, are what the nursing diagnoses, goals, and nursing interventions are based upon in the remainder of the care plan.