[imanurse2008]

I am new to this site and have found a lot of helpful information to help me get through LPN school. I am in my 2nd quarter which is Med-Surg I. I am definitely going to use some of the helpful tips tomorrow during my clinical rotation.

[2bnuuurse]

i need help! what are some nursing diagnosis for a patient with MRSA (of the skin).. i already have

impaired skin integrity
loneliness
acute pain
anxiety

but i need a few more!!

[Daytonite]

Originally Posted by 2bnuuurse

i need help! what are some nursing diagnosis for a patient with MRSA (of the skin).. i already have

impaired skin integrity
loneliness
acute pain
anxiety

but i need a few more!!

You cannot diagnose any patient with any nursing diagnoses without knowing what their signs and symptoms (defining characteristics) are. Diagnosing is the resulting decision or opinion you make after doing an examination or investigation of the facts. This can only be done by doing a thorough assessment of the patient. This is step #1 of the nursing process which is how we problem solve. A symptom is an objective observation or a subjective perception of the patient. With that information you use a nursing diagnosis reference book that most likely has the NANDA taxonomy in it. The NANDA taxonomy is the written classification or arrangement of the nursing diagnoses into logical groupings and includes information about their definitions and specific signs, symptoms and related factors for each diagnosis. You do this so you classify and apply each nursing diagnosis correctly. Medical students do this when they are first learning to diagnose medical diseases for patients. You student nurses must do this as well when first learning to use nursing diagnoses. A nursing diagnosis becomes nothing more than a label whose definition describes the patient's nursing problem as per the NANDA taxonomy--that's all it is. You have to have done the assessment work to get to that point, however.

So, the four nursing diagnoses you listed mean nothing without the patient's accompanying signs and symptoms to support them. What is important is where are this patient's signs and symptoms? They form the basis of the patient's real underlying problems that you are going to address in your care plan, NOT the MRSA. MRSA is a medical diagnosis and may not be particularly relevant to the patient's nursing needs.

Please read some of the previous replies and posts on this thread to help you out! Then, if you are still having trouble with this, post another question on a new thread in this forum please.

[tasysop]

Originally Posted by NOIRLINCOLN

We have to do a list of nursing ques. I hated doing this 1st semester b/c it seemed ridiculous. I just turned it into a game/challenge. I try to get as many ques as I possibly can as I go thru my head to toe assessment. As I go thru each body system I them come up with some idea of the ndx. I tend to work it backwards ie starting w/ the ndx, then substantiating it w/ the ques. I found an excellent website. It is orthodox.net and it take you thru all the body systems and then at the end of each body system it ques you for a ndx. The subjective info that I garner in the into is also very helpful. This is what Stephanie in Fl is writing about. I always ask the pt. "Why are you here? They are always happy to elucidate and catch me up. Then I go to elsevier and/or Ackley's book and formulate a goal.

I tried your suggested link to orthodox.net and am certain that was not the one for this subject? Could you check and see what the correct one should have been?

Thanks,
Tasysop

[greenfaery]

I have to come up with 3 care plans for a quadriplegic pt I took care of recently. 1st choice- impaired skin integrity (he's got ulcers...) And I also did risk for dysreflexia. I just don't know what to do for the third, he has cellulitus, 3+peripheral edema, no breathing problems at the time, his main problem while I was working with him was that he had difficulty with having a BM that morning, and he's on a strict bowel program (m, w, f) so he was getting anxious because he didn't have a bm even after suppositories and enema. His abdomen felt kind of distended too.

I thought about a constipation plan, but the definition says that it's "the state in which an individual experiences stasis of the large intestine, resulting in infrequent (two or less weekly) elimination and/or hard, dry feces." So would his symptoms technically count as constipation if his last bm was 2 days earlier? I was thinking he would be an exception?

I also checked out risk for disuse syndrome, but I'm kind of confused about that one, it seems rather broad. Plus some of the defining characteristics are actualities (and this is a "risk for" diagnosis.)

Any help is appreciated, I've been doing this all day and keep changing my mind about my third plan. They have to be prioritized too (maslow).

[discobunni]

I see a big one you missed. Remember to prioritize by your ABC's
1. Airway
2. Breathing
3. Circulation: - Look at circulation and the peripheral edema. You've got Impaired peripheral tissue perfusion.

With the constipation you may have a risk for (abdomen distended, not soft?) or perceived.

Also, Look at Immobility and where it falls on Maslows!

Good luck on your careplan

[futurecnm]

Originally Posted by greenfaery

I have to come up with 3 care plans for a quadriplegic pt I took care of recently. 1st choice- impaired skin integrity (he's got ulcers...) And I also did risk for dysreflexia. I just don't know what to do for the third, he has cellulitus, 3+peripheral edema, no breathing problems at the time, his main problem while I was working with him was that he had difficulty with having a BM that morning, and he's on a strict bowel program (m, w, f) so he was getting anxious because he didn't have a bm even after suppositories and enema. His abdomen felt kind of distended too.

I thought about a constipation plan, but the definition says that it's "the state in which an individual experiences stasis of the large intestine, resulting in infrequent (two or less weekly) elimination and/or hard, dry feces." So would his symptoms technically count as constipation if his last bm was 2 days earlier? I was thinking he would be an exception?

I also checked out risk for disuse syndrome, but I'm kind of confused about that one, it seems rather broad. Plus some of the defining characteristics are actualities (and this is a "risk for" diagnosis.)

Any help is appreciated, I've been doing this all day and keep changing my mind about my third plan. They have to be prioritized too (maslow).

I'm not sure I'd use the risk for dysreflexia (our instructors like actual diagnoses not risk for) and I think there are higher ones that are actual diagnoses. If he has +3 edema, that would probably be #1. Fluid volume excess or something related to the edema. Then possibly the skin integrity and you could do something psychosocial like anxiety (you stated he was getting anxious, so seemed obvious) or low self esteem.

[greenfaery]

Originally Posted by futurecnm

I'm not sure I'd use the risk for dysreflexia (our instructors like actual diagnoses not risk for) and I think there are higher ones that are actual diagnoses. If he has +3 edema, that would probably be #1. Fluid volume excess or something related to the edema. Then possibly the skin integrity and you could do something psychosocial like anxiety (you stated he was getting anxious, so seemed obvious) or low self esteem.

I thought about the edema, but I don't know the real cause of it. It didn't seem pitting when I assessed it, and his home aid said it was due to gravity since he spends so much time in his wheelchair. She said he always has it. So would that qualify for poor tissue perfusion? I feel like I'm lacking a little too much info on his edema. I was thinking he should wear those TED stockings, and elevate his legs more often, but if he has arterial circulation problems that would be bad, and I just don't know...

Thanks for your help, the anxiety might be a good one.

[greenfaery]

Originally Posted by discobunni

I see a big one you missed. Remember to prioritize by your ABC's
1. Airway
2. Breathing
3. Circulation: - Look at circulation and the peripheral edema. You've got Impaired peripheral tissue perfusion.

With the constipation you may have a risk for (abdomen distended, not soft?) or perceived.

Also, Look at Immobility and where it falls on Maslows!

Good luck on your careplan

I orginially chose risk for ineffective breathing, but then I realized that "risk for" ineffective breathing wasn't on the NANDA list, and he had no actual breathing problems at the time. Are we allowed to add "risk for" to any NANDA diagnosis? I'm still confused about that.

Thanks for your input!

[greenfaery]

Hello all. I wanted to do a care plan with the diagnosis of self-care deficit for my quadriplegic patient who needs assistance for bathing, dressing, feeding, toileting, but I noticed they have a separate diagnosis for each area of deficit (hygiene, dressing, feeding, toileting) So my question is: am I allowed to combine them all into one diagnosis and one care plan?? Or do I have to do a separate diagnosis/plan for each one?