[DAMomma]

I was wondering if I can pick your brain? I did an assesment on a patient who's Hemog is 7.0 and Hct is 19.9. She had a c-section on the 12th of Sept. I am loking all over for a nursing diagnosis of
Iron deficiency related to c-section AEB by….. I can not believe there is nothing in my nsing diagnosis books. Am I way off base with this?

When I was at the hospital, I thought, ahhh, perfect....yeah right. I can not find a fit anywhere. Any suggestions? The doc perscribed iron supplements to help her.

I am still new at care plans (2nd semester).

TIA!

[beckinben]

Well, there isn't an "iron deficiency" nursing diagnosis, so don't try too hard to find one.

Yes, she's getting iron, but that's not really what she's lacking. Think a little more globally. What did she lose?

AEB - what are her symptoms? What's her crit? (That would be part of your evidence).

[midcom]

My teachers would tell you that Iron deficiency is a medical diagnois, not a nursing diagnosis. There are some very obvious ones, if you think hard.
Dixie

[Dolce]

When I was a new RN and getting my BSN I had the opportunity to work with an MA in a community health clinic. As she was checking women's Hemoglobin on the fingerstick machines she would query them on their diet and iron intake. To each of the women who had anemic results she would state, "This is checking your iron. Here is a pamphlet on foods that have iron in them." It was all I could do to not be totally amazed at her over generalization of all anemia being related to low iron intake. Be cautious how you categorize medical diagnoses...

[DAMomma]

Thanks guys, I am going to re-prioritize my NANDAs and see what I come up with.

Thank you so much for your input!

[Daytonite]

I wish I had seen this post a few days ago. I found it by doing a search of the forums for care plan questions. Hope it's not too late to help you out.

All nursing diagnoses are based upon your assessment data that you obtained during your physical examination and reading of the patient's medical record. From that you ferret out the abnormal items. This abnormal data is also known as signs and symptoms, or in NANDA language, defining characteristics. Without that information, you can't choose a nursing diagnosis. A doctor can't choose a medical diagnosis without knowing what the patient's symptoms are either. Nursing diagnoses have their own set of signs and symptoms called defining characteristics just as medical diagnoses have their own sets of signs and symptoms. When first doing care plans you need to have a nursing diagnosis reference to help you in choosing a diagnosis correctly.

The two defining characteristics that you have are a hemoglobin of 7.0 and hematocrit of 19.9. These are both low, both abnormal, so they qualify as symptoms, or defining characteristics. This is indicative of blood loss anemia. But that is a medical diagnosis. You're looking for a nursing diagnosis. Did your patient have any other physical symptoms such as pallor, fatigue, headache, or tachycardia? These are also symptoms of anemia and will help in determining a nursing diagnosis if any are present. In fact with fatigue and headache you can come up with two nursing diagnoses (Fatigue and Acute Pain).

Now, think of the pathophysiology behind what had to happen for a low hemoglobin and hematocrit to occur. There was most likely a loss of blood. Blood is a fluid. We have a nursing diagnosis for losses of fluid. We can come up with a nursing diagnostic statement for losses of fluid for this patient.

Deficient Fluid Volume R/T blood loss during childbirth AEB hemoglobin of 7.0 and hematocrit of 19.9 [and any other symptoms]

I write about the process of determining nursing diagnoses all the time and you can find some of this advice on these two stickys in the nursing student forums

• http://allnurses.com/forums/f205/desperately-need-help-careplans-170689.html - Desperately need help with careplans (in Nursing Student Assistance Forum)
• http://allnurses.com/forums/f50/careplans-help-please-r-t-aeb-121128-7.html - CAREPLANS HELP PLEASE! (with the R\T and AEB) (in General Nursing Student Discussion Forum)