[earle58]

how are his bowel sounds?
and a rectal tube will help pass the flatus.
if he's on constipating meds, combined w/the known effects of anesthesia and immobility, he should be on a bowel regimen until he's off some of these meds, up and about w/pt....

[bandas]

I have a question about sleep that I need answered for class. Can anyone help?

Pt. complains of difficulty falling asleep, awakening earlier than desired, and not feeling rested. She attributes these problems to leg pain that is secondary to her arthritis. What would be the appropriate nursing diagnosis for her?

a. sleep pattern disturbances related to arthritis
b. fatigue related to leg pain
c. knowledge deficit related to sleep hygiene measures
d. sleep pattern disturbances related to chronic leg pain

I am pretty sure it is between a and c, but we have hardly talked about nursing diagnoses at all yet. I don't quite get how to pick the "related to" portion. Thanks for any help in advance.

[Daytonite]

The answer is "D". The "related to" factors are those things that are the etiology or cause of the nursing diagnosis. As a nurse, it is not within the scope of your practice to say that the cause of the person's sleep disturbances is arthritis. That would be in a physician's realm to state that a patient had arthritis. You can, however, use the terminology "chronic leg pain". It is not a medical diagnosis and is, per the patient, the reason she is not able to sleep.

In NANDA's world, the cause, or "related to" factor should be something that the nurse can do something about through his/her own independent actions. Now, I know people are going to say that there are independent actions a nurse can take for a patient with arthritis. And, that is true, but arthritis is still a medical diagnosis and also requires medical intervention. A rule of thumb when working with or developing nursing diagnostic statements is not to use medical diagnosis or medical disease terms as "related to" items. Arthritis would be considered a medical diagnosis; chronic leg pain would not--it is a symptom and a vague one at that. There are very few exceptions to using medical diagnoses as "related to" items, but they are rare.

Just to throw a monkey wrench in here, there could also be a case for answer "B", fatigue related to leg pain. The only reason I would not choose it is because the patient is not complaining of exhaustion and inability to perform normal activities of daily living at her regular level of functioning which is the definition of that diagnoses. Had that been the case, fatigue would have been the diagnosis of choice.

If you have a care plan or a nursing diagnosis handbook, read the very early chapter(s) where it talks about the nursing process and forming the nursing diagnosis. One reading is not enough. It needs to be read and mulled over several times before getting a grasp on these concepts.

To skip ahead of your instructor a bit, the complete nursing diagnostic statement for this particular patient would be: Sleep pattern disturbances related to chronic leg pain as evidenced by difficulty falling asleep, awakening earlier than desired, and not feeling rested.

[beatot]

I am clueless on what diagnosis is suitable for this particular problem of a patient of mine.

She's 42. She tells me that she has a lump on her urethra and she doesnt want to seek medical help because of financial problems.. She also says that if she'll undergo an operation of her lump, there will be no one to work for the family because of the recovery time needed (she's the only one working in the family..)

She also says that everytime she experiences fatigue (where she experiences it during work.), the lump grows bigger..

i was thinking of these 3: ineffective coping, non-compliance and ineffective health maintenance. but it does not seem right.. and i do not have a clue on what will be my "related to"..

any suggestions..??

thanks..

[JentheRN05]

risk for decreased urinary output would be another (if indeed she has a 'lump' on her urethra OR there's another

Health Maintainance Alteration r/t lack of financial resources

Risk for Role performance alterations r/t primary provider

Nursing Diagnosis Reference Manual

[Daytonite]

Listing the abnormal findings in the data you presented in your post you have the following:

patient's statement of a lump on her urethra
failure to seek medical help
financial problems
worry over time away from work
fatigue related to enlargement of the lump

I would group these into any one of the following nursing diagnoses:

• Decisional Conflict R/T support system deficit and perceived threat to value system AEB failure to seek medical help because of financial problems, worry over time away from work and fatigue.
• Ineffective Health Maintenance R/T lack of material resources AEB failure to seek medical help due to statements of financial problems
• Deficient Knowledge R/T misinterpretation of information AEB belief that fatigue results in the enlargement of the lump on her urethra.

Just out of curiosity, did you do a review of systems with this patient about her genitourinary system? Is she having any pain, discharge or trouble with urinating?

[Daytonite]

Originally Posted by alexan18

Need help with care plan for MRSA..
Any help would be appreciated...

MRSA is methicillin-resistant Staphylococcus aureus. Can't give you any specific help without knowing what you need. Is this a real patient or a case study? Did you do an assessment of the patient? Is the infection in a wound or an organ system? Do you have a listing of the non-normal symptoms you developed from your assessment? What working nursing diagnoses have you come up with so far?

When doing nursing care plans you have to get away from thinking so much about the medical diagnosis. It's OK to use the same symptoms that also determine the medical diagnosis. Symptoms are not for the sole property and use of the physician. However, nurses are going to turn those symptoms into nursing diagnoses. Your care plan is going to ultimately end up having nursing interventions that address these symptoms the patient has--not the medical diagnosis per se. We will have some collaborative responsibility in reporting progressive or developing symptoms of a medical condition.

Here are links to information about MRSA:
http://www.emedicine.com/med/topic2166.htm - Staphylococcal Infections. From eMedicine. Includes listing of antibiotics used to treat as well as complications of the infection itself.

http://www.nlm.nih.gov/cgi/medlinepl...lthcareFS.html - Information about MRSA for Healthcare Personnel. From the CDC.

http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_public.html - information for the public about MRSA from the CDC

http://www.nlm.nih.gov/medlineplus/s...nfections.html - a page of links to more specific information about MRSA conditions on the Medline Plus site

http://www.symptoms101.com/med/archi...05/05/msra.php - symptoms of MRSA

http://mrsa-survivors.org/_wsn/page4.html - symptoms of MRSA. From MRSA Survivors Network. There is also a fact sheet on MRSA at this site you can link in to.

[Daytonite]

The following 7 links to case scenarios show you, in steps, how to develop a nursing care plan using NANDA languages. They are learning activities for the nurses working for a facility owned by the University of Michigan. In these scenarios the nurses are directed to choose nursing diagnoses, NOC outcomes and NIC interventions (this is all terminology that NANDA uses). Unfortunately, no answers are provided. However, you can see how the process is supposed to flow from one step to the next and some of the critical thinking that goes into the making of the care plan.
http://www.med.umich.edu/nursing/snl/cs2.pdf - this is a adult surgical care planning case study activity
http://www.med.umich.edu/nursing/snl/cs3.pdf - this is an adult ICU care planning case study activity
http://www.med.umich.edu/nursing/snl/cs4.pdf - this is a pediatric care planning case study activity
http://www.med.umich.edu/nursing/snl/cs5.pdf - this is a pediatric ICU care planning case study activity
http://www.med.umich.edu/nursing/snl/cs6.pdf - this is a prenatal care planning case study activity
http://www.med.umich.edu/nursing/snl/cs7.pdf - this is a psychiatric care planning case study activity
http://www.med.umich.edu/nursing/snl/cs8.pdf - this is an ambulatory patient care planning case study activity

Other links to case scenarios you can look at:
http://learn.sdstate.edu/craigg/ERCases.html - examples of student case studies. Click on the link of a case study that interests you.

http://learn.sdstate.edu/craigg/ERSp01.html - examples of student case studies. Click on the link of a case study that interests you.

[Candice31]

I was wondering if someone can tell me a better explanation of the nursing process. I get that the process has 5 steps and they are Assement, Nursing Diagnosis, Planning, Implentation, and Evaluation. But i need to know how to use them in critical thinking.

And

I am really lost in the nursing diagnosis. I cant tell the difference between nursing diagnosis and medical diagnosis. Any ideas for me to get this

[FutureNurse35]

Nursing Process::NURSING DIAGNOSIS

The nursing diagnosis is derived from data gatered during the assessment. Health problems or potential health problems are identified and formulated into nursing diagnosis. Nursing Diagnosis is the basis for planning nurisng interventions that help prevent, minimize or aleviate specific health issues.
A Medical Diagnosis is much different than nursing diagnosis, it is used to define etiology of the disease. It only focuses is on the function and malfunction of a specific organ system.
The two are very different.
A Nursing Diagnosis is written in a format called "PES ", devloped by NANDA(1).

• "P" stands for PROBLEM
• "E "satnds for ETIOLOGY or cause of problem
• "S "stands SIGNS and SYMPTOMS of problem

By usimg all of the components of the nursing diagnosis, the problem is clearly communicated to everyone involved in the clients care.
Measurement Criteria:(2)

1. Diagnosis are derived from the assessment data
2. Diagnosis is validated with the client.
3. Diagnosis is documented to aid in the expected outcomes and plan of care.

NOTE: For the purpose of examples of Nursing Process , I will be using the following Case Study through out this report.

Case Study:

Client with Liver Disease - Cirrhosis

Mr.K is a 45 year old polish male. Married with three children. He is currently unemployed. He has worked in the service industry for his entire life. He has been socially drinking since he was 13 yrs. He has a family history of acholism an diabetes. He has been admitted to ICU on three previous occassions for liver disease.
Sample Nursing Care Pla

Nursing Diagnosis Imbalance Nutrition:Less than Body Requirements related to anorexia, metabolic imbalanceActivity Intolerance related to fatigueRisk for Impaired Skin Integrity related to edema, immobility, pruritis, hypoproteinemia Ineffective Breathing Patterns related to ascites Risk for Injury related to impaired coagulationDisturbed Thought Processes related to elevated blood ammonia