Hello all! I am answering a few questions relating to this case study involving end of life care. Here is the situation:

a 62 year old female is admitted to a long-term care facility after a 10 day stay in the hosp for pneumonia and loss of appetite. Her discharge notes that she has lost 20 lbs during the last 6 months. She was also diagnosed with an aggressive form of terminal brain cancer 3 months ago. On admission to your facility she is noted to be lethargic and appears depressed. Based on the advice of the palliative care nurse, and others on the healthcare team, they decide to refuse further chemotherapy.

We had to formulate a NANDA approved nursing diagnosis using a 3-part statement. My question is...does this nursing diagnosis make sense?

Imbalanced nutrition- less than body requirements r/t inability to ingest food due to depression a/e/b a 20 pound weight loss in the past 6 months and loss of appetite.

Please let me know if this is a correct nursing diagnosis! thank you!!!

It is one ND, but think deeper. Look at her medical diagnosis- terminal cancer. Look at how that's affecting her. WHY does she have a loss of appetite, lethargy, etc.? Getting to the root of that (and the associated ND behind that) may help you help her more than only addressing the weight change and loss of appetite.

I agree with PP, look deeper into it. Also, I think your r/to doesn't work. Correct me if I'm wrong, Ive only written 3 care plans, but I don't think you can use "depression" as your r/t. Do you have a NANDA book? If so, look up the diagnosis. It'll have r/t factors listed. Do any of those fit your patient well? If not, look for another diagnosis. Nursing diagnoses are a bit abstract and difficult to figure out at first. Good luck!

I agree with PP, look deeper into it. Also, I think your r/to doesn't work. Correct me if I'm wrong, Ive only written 3 care plans, but I don't think you can use "depression" as your r/t. Do you have a NANDA book? If so, look up the diagnosis. It'll have r/t factors listed. Do any of those fit your patient well? If not, look for another diagnosis. Nursing diagnoses are a bit abstract and difficult to figure out at first. Good luck!

1) There is only one NANDA-I book. There are other nursing diagnosis handbooks that use their material, but since NANDA-I understandably doesn't give blanket permission to use all their material to other authors, many handbooks are incomplete. Also, NANDA-I is updated every three years (the last edition was 2009-2011, the next is 2015-2017)

2) The NANDA-I 2012-2014 nursing diagnosis for imbalanced nutrition does include "psychological factors" as a related/causative factor. Depression being a psychological factor which can cause loss of appetite, it's perfectly acceptable to use.

3) Nursing diagnosis are the polar opposite of abstract-- they are very, very specific, which is why you can't make them up or use them because they sound good. If you don't have the NANDA-I 2012-2014, they can be hard to "figure out," because that's the only reference that gives you all the information you need to make a nursing diagnosis.

I think this unfortunate woman's weight loss is due to more serious (as in, harder to treat) problems than depression, though, if she has cancer which is beyond treatment. So what part of your assessment makes you think that weight loss and loss of appetite is the most serious problem she has?