16: Problem Intervention Goals (PIGS)
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1 Section 16: Problem Intervention Goals (PIGS) Section Author(s): skolman
2 Section 16: Problem Intervention Goals (PIG) 2 Section 16: Problem Intervention Goals (PIGS) Field Guide
3 Section Contents Expectations for Care Plans... 5 All Disciplines... 5 RN Specific... 5 Chaplain and MSW Specific... 5 Common Nursing Care Plans for Common Diseases... 6 Cardiovascular Disease... 6 Pulmonary Disease... 6 Dementia... 6 Cancer... 6 Impending Death... 6 Liver Disease... 7 Field Guide Section 16: Problem Intervention Goals (PIGS) 3
4 4 Section 16: Problem Intervention Goals (PIGS) Field Guide
5 Expectations for Care Plans Based on Common Mistakes in the Field All Disciplines Care plans are a vital component of documentation. Clinical documentation compliments and supports the care plan (not the other way around) Care plans must be patient specific and individualized. Updating/maintaining care plans is part of documenting a visit and should be done same day. On-going care plan maintenance is required: Update plan of care whenever pt care changes. Care plans and documentation must parallel. Every patient POC should have RN45 Medication Administration, Z99 INFO ONLY, TM03 Adjustment to Disease, Prognosis, and Hospice Care (TMO4 for Home Health), RN99 The Denver Hospice Basic Orders. o Admissions nurse will add those 4 problems plus 1 symptom management problem to initiate care plan. Primary care team is responsible for on-going updates of those POCs If it s yellow don t be mellow all care plans are expected to be completed upon initiation; with all yellow highlighted areas addressed and completed. Care Plans should be updated at least 2 hrs before IDT RN Specific Pt POC should be thoroughly developed at initial RN visit. Initiating GI level of care or Care Plus o add Place on GI level of care or Place on Care Plus intervention in problem pertaining to GI/Care Plus status. o Start RN68 Patient Care: Complex Removing GI level of care or Care Plus o Stop Place on GI level of care or Place on Care Plus intervention in problem pertaining to GI/Care Plus status o D/C RN68 Patient Care: Complex o If pt is coming home from ICC D/C NP03 Admission to Care Center If Pain (RN 01, 02 or 03) POC is initiated also start Constipation, Actual or Risk (RN16) POC. RN35 Parenteral meds or fluids is required for any pt with parenteral lines (sq, IV, central line, including unaccessed port) NA2 Self-care deficit POC is required at the initiation of CNA and should be updated on-going based on changes in pt condition and/or personal needs. o NA2 needs to be specific o Do not choose all interventions when initiating NA2 care plan. It is difficult/time consuming to delete what is not needed. Chaplain and MSW Specific MSW and Chaplain are required to start POC 5 days within hospice admission. If pt/family declines services CH712 Chaplaincy Services Currently Declined or SW01 MSW Support Declined must be initiated. Field Guide Section 16: Problem Intervention Goals (PIGS) 5
6 Common Nursing Care Plans for Common Diseases (Please note: these are commonly used care plans for particular diseases only and by no means represent a comprehensive care plan based on individual patient needs.) Cardiovascular Disease CAD: RN06 Angina, RN22 Nutritional Intake Decreased, RN29 Seizures, RN39 Skin Integrity, RN48 Fatigue CVA: RN14 Dysphagia, RN16 Constipation, RN22 Nutritional Intake Decreased, RN23 Urinary Incontinence, RN29 Seizures, RN39 Skin Integrity, RN49 Mobility Impaired, RN51 Safety, RN59 Decreased Level of Consciousness CHF: RN07 Dyspnea, RN22 Nutritional Intake Decreased, RN26 Anxiety, RN37 Ascites, RN38 Edema, RN39 Skin Integrity, RN48 Fatigue, RN49 Mobility Impaired Pulmonary Disease COPD: RN07 Dyspnea, RN08 Cough, RN22 Nutritional Intake Decreased, RN26 Anxiety, RN28 Confusion, RN39 Skin Integrity, RN48 Fatigue, RN49 Mobility Impaired, RN50 Fall Risk, RN51 Safety,RN58 Depression Pulmonary Fibrosis: RN07 Dyspnea, RN22 Nutritional Intake Decreased, RN26 Anxiety, RN39 Skin Integrity, RN48 Fatigue, RN49 Mobility Impaired Lung Cancer: RN 07 Dyspnea, 01, 02, and/or 03, RN16 Constipation (b/c Pain POC started), RN26 Anxiety, RN39 Skin Integrity, RN48 Fatigue, RN49 Mobility Impaired Dementia Debility/Failure to Thrive: RN16 Constipation, RN19 Bowel Incontinence, RN22 Nutritional Intake Decreased, RN23 Urinary Incontinence, RN27 Agitation, RN28 Confusion, RN39 Skin Integrity, RN39 Skin Integrity, RN41a,b,c Wound, RN48 Fatigue, RN49 Mobility Impaired, RN50 Fall Risk, RN51 Safety, RN65 Foley Catheter Cancer Brain: RN 01, 02, and/or 03 (usually HA), RN16 Constipation (b/c Pain POC started), RN15 Nausea/Vomiting, RN22 Nutritional Intake Decreased, RN26 Anxiety, RN27 Agitation/Delirium, RN28 Confusion, RN29 Seizures, RN39 Skin Integrity, RN49 Mobility Impaired, RN58 Depression Bone: RN 01, 02 and/or 03, RN16 (because Pain POC started), RN22 Nutritional Intake Decreased, RN26 Anxiety, RN39 Skin Integrity, RN49 Mobility Impaired General Cancer: RN 01, 02 and/or 03, RN16 (because Pain POC started), RN22 Nutritional Intake Decreased, RN26 Anxiety, RN35 Parenteral meds or fluids (if sq, iv, central line placed), RN38 Edema, RN39 Skin Integrity, RN48 Fatigue, RN49 Mobility Impaired, RN58 Depression, RN59 Decreased Level of Consciousness, RN65 Foley Catheter Impending Death RN13 Oral Mucosa, RN14 Dysphagia, RN15 Nausea/Vomiting, RN19 Bowel Incontinence, RN22 Nutritional Intake Decreased, RN23 Urinary Incontinence, RN26 Anxiety, RN27 Agitation/Hallucinations, RN28 Confusion, RN39 Skin Integrity, RN41a,b,c Wound, RN43 Body 6 Section 16: Problem Intervention Goals (PIGS) Field Guide
7 Temperature Altered, RN47 Caregiver Breakdown, RN49 Mobility Impaired, RN57 Actively Dying, RN65 Foley Catheter Liver Disease RN07 Dyspnea, RN27 Agitation/Hallucinations, RN28 Confusion, RN32 Hemorrhage, RN37 Ascites, RN38 Edema, RN40 Puritis, RN48 Fatigue, RN49 Mobility Impaired, RN59 Decreased Level of Consciousness Expectations for Care Plans Revised: 2011 Author: skolman Field Guide Section 16: Problem Intervention Goals (PIGS) 7
8 8 Section 16: Problem Intervention Goals (PIGS) Field Guide
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