Help w/ goal/outcome
- 0Jun 24, '07 by k.lvn.momfluid volume excess r/t generalized edema AEB +1 bilateral tibia pitting edema.
24 y/o F post op- c-section
- 3Jun 24, '07 by Daytonitehi, k.lvn2b. . .you've got a problem with your nursing diagnostic statement here. your r/t part of the statement is supposed to be the etiology of the problem. generalized edema is actually a symptom. it is something that you would notice on assessment of the patient. so, it really doesn't belong as a related item in your nursing diagnostic statement.
do you have a care plan book or a book of nursing diagnoses that you can refer to in order to help you with this? with excess fluid volume the related factors that nanda lists are:
- compromised regulatory mechanism
- excess fluid intake
- excess sodium intake
goals and outcomes are the predicted results of our nursing actions that we perform for the symptoms that the patient is having. so, what are the interventions that you are performing for this patient's pitting edema in her legs? the desired result of those actions is _______. that is your patient goal. goals/outcomes describe patient states that follow and are influenced by your interventions.
- http://allnurses.com/forums/f205/des...ns-170689.html - desperately need help with careplans (in nursing student assistance forum)
- http://allnurses.com/forums/f50/care...-121128-7.html - careplans help please! (with the r\t and aeb) (in general nursing student discussion forum)
- 0Jun 24, '07 by k.lvn.momOk Daytonite, this is prob the stupids question you are going to hear from a student about to graduate LVN school in 7 weeks. But since i go to clown school for nurses, i obviously don't know the answer, and none of my instr. have bothered to correct me.
When writing a nrsg dx, you have to use the r/t that NANDA says goes with that dx? ex: Fluid volume excess has to use one of the following for a r/t Compromised regulatory mechanism
Excess fluid intake
Excess sodium intake
Or can i make up my own?
- 1Jun 25, '07 by DaytoniteNo, you don't have to use what NANDA says goes with a diagnosis, HOWEVER, you do have to keep whatever you do write with your diagnosis within the meaning of what the diagnosis is about. In their publication NANDA-I Nursing Diagnoses: Definitions & Classification 2007-2008, which is a pocket sized book, they publish all current 188 nursing diagnoses, the definition of each, related factors (you know them as the R/T part of a nursing diagnostic statement) and the defining characteristics (the AEB part of a nursing diagnostic statement but these are actually the signs and symptoms of each particular diagnosis). These are all based on hundreds of nurses who have done research and study of them, put their information together and developed these guidelines. They published them so that we nurses don't have to sit there scratching our heads trying to come up with something to put in the R/T or AEB part of a nursing diagnostic statement and so it helps us to better understand what underlies the problem in the patients who have that particular nursing diagnosis. Choosing an etiology, or related factor, involves some critical thinking and an understanding of the pathophysiology of what is going on with the patient's disease process.
The overall main idea in writing nursing diagnostic statements as students and as new nurses is to help see the relationship between the nursing diagnosis, related factors and defining characteristics and help to learn and develop an understanding of the critical thinking that goes into it. The R/T part of the nursing diagnostic statement is the cause of the problem (in this case Excess Fluid Volume). The actual definition of this is "Increased isotonic fluid retention" (page 91). The word, isotonic, refers to "having equal pressure" (page 1028, Taber's Cyclopedic Medical Dictionary, 18th edition, published in 1997 by F.A. Davis Company.) This nursing diagnosis is specifically referring to osmotic pressure. We know, however, that blood pressure and changes in the vascular system can also be responsible for fluid retention. There are lots of people who have swollen feet and legs due to cardiovascular problems rather than electrolyte problems. There are other nursing diagnoses that are appropriate to use for patients with those underlying etiologies of their edema. It is important when choosing a nursing diagnosis that you understand the underlying pathophysiology of what is going on with the patient. That is why I asked: why do you suppose she has this edema in her legs? I was trying to stimulate your thinking on this.
As I said previously, NANDA lists the following as related factors for this diagnosis:
- Compromised regulatory mechanism
- Excess fluid intake
- Excess sodium intake
- renal dysfunction
- loss of plasma proteins
as R/T items for this diagnosis of Excess fluid Volume. The loss of plasma proteins would cause fluid to be pulled into the patient's intracellular spaces in order for osmotic fluid pressures to become equalized and result in the edema. This is very definitely a valid related factor that can go along with this nursing diagnosis (and I've written it into my NANDA book). That meets the definition of this nursing diagnosis (increased isotonic fluid retention). When someone looses a lot of plasma proteins they develop anasarca, a condition where there is severe generalized edema throughout the entire body. You might see this in patients who have the medical conditions of nephrotic syndrome, pre-eclampsia or eclampsia. You would write a nursing diagnosis for something like this as:Excess Fluid Volume R/T loss of plasma proteins AEB generalized body edema
The reason I wouldn't just use the +1 bilateral tibia pitting edema is because there should be edema in other areas of the body as well, not just the legs. Instead of using "generalized body edema" as the AEB item you could start to specifically list out all the areas of the body that you noticed the edema in. Some instructors might not want you to use the term anasarca saying that it is medical diagnosis. You might want to check with your instructors on that before using it.
Hope that helps clear things up for you a little bit. Your question was far from stupid. This business of nursing diagnosis is incredibly complex and takes persistence, time and a lot of working with it to master. Even I am always learning something new about it. I commend your courage to have posted on this. A good many others would have just skipped over it rather than tried to gain an understanding of it. I call that the old "sweep the dirt under the carpet" solution! You may manage to make it disappear for the moment, but it is, in reality, still there and eventually has to be dealt with.
- 0Jun 25, '07 by anonymurseSimple test: substitute the words "because of" for your R/T and see if it makes sense. Now in the case of a medical diagnosis, you'd say "secondary to" instead of "related to," but it's the same thing.
You might be looking at the "defining characteristics" lists in your nursing Dx book. Those are just conditions that must be present (major) or may be present (minor), but they are NOT the R/Ts. For those, you'll want to look at the items listed under "related factors."
Both Doenges and Carpenito are useful and usable. Townsend's "Nursing Diagnoses in Psychiatric Nursing" is pure magic for getting a firm handle on so many psychosocial things seen on the floor.