need help w/nursing dx's!!!!

  1. hi. i have a pt. tomorrow who was admitted for
    declotting of dialysis graft. i could not come up w/any nursing diagnoses whatsover.. can someone
    help..please!!!!!!!!!
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  2. 12 Comments

  3. by   misti_z
    Well I can think of two right off the top of my head...
    1. If no HD until thrombectomy of graft or line placement the patient will have a problems with fluid and lytes.
    2. Knowledge deficit..how did that graft clot? Improper care?

    Good luck!!
  4. by   P_RN
    OK what needs doing FOR your patient?

    Knowledge deficit?
    Potential for injury?
    Alteration in fluid balance?

    Remember that the diagnosis has to be supported......AS EVIDENCED BY.....usually another nursing diagnosis.

    So Potential for injury as evidenced by.......

    Now look it up in your book (Mi Ja Kim's is my fave) or look it up on the web...(google.com) is my fave there.

    I typed in "NANDA nursing diagnosis hemodialysis"

    and came up with at least 34 sites.

    AS EVIDENCED BY

    And big old congrats on the upcoming graduation.
  5. by   studentnurse_02
    thanks for the help!
  6. by   BrandyBSN
    Risk for injury related to potential for clot migration
    -could cause a CVA

    Risk for injury r/t bleeding disorder secondary to overuse of anti-clotting medications.

    Fear r/t change in physical status secondary to potential organ failure.

    Risk for fluid volume deficit secondary to possible bleeding complications.

    Those are just a few that I can think of... however I had clinicals from 7-4, and 6-10, so my brain is not at the top of the food chain right now

    Hope those help!
    BrandyBSN
  7. by   Lisamulti
    What was Md's exact DX? sometimes I pull from that--To be free from pain is always one--how was PT-INR'S? can pull from that too to maintain proper clot time---hope some help---
    LE
  8. by   trishfish
    1. Altered Tissue Perfusion
    2. Potential For Infection
    3. Knowledge Deficit
    4. Body Image Disturbance (maybe )
    5. Fear
    6. Anxiety

    This is what I could come up with.
    Where in TN are you? I live in Southern Middle TN.

    Tricia
  9. by   kewlnurse
    ARRRGHHHHHHHHHHHHHH!!!!!
    i ABSOLUTLY WILL NOT USE "KNOWLEDGE DEFECIET" for nsg dx. I absolutly hate that dx. I don't care if they are dumber than a lint ball, there is always a better dx, thats an easy way out. Fluid and lyte balance are good ones. Anxiety r/t surgical procedure is another, wait, your a student, look it up, knowbody ever gave me the anwers. The floor i used to work on had students, I would help them find the answer but never gave it to them, think about what body systems are involved. report back with the answers
  10. by   frustratedRN
    and in school we were taught to always use knowledge defecit. all patients have that regardless of the medical diagnosis.

    never use it in practice tho...thats what the teaching part of the charting is for.
  11. by   Mito
    The nursing Dx also stems from the patients behaviours (ie. lab results, assessment) use these as a starting point to guide your Dx. It can be very diffucult to come up with some of them if you havn't seen the pt.

    Mito
  12. by   ADN 2002
    We're supposed to use knowledge deficit on all our pt's regardless of what they already know (I guess the instructors feel that there's always something else that can be taught...) Right now I'm working on a paper and am struggling to find something I could have taught this woman that just had her 3rd child and had no other problems (I was assigned to postpartum) - after 3 kids I think she probably knows the postpartum routine by now...ya know?
  13. by   catlady
    I have to write care plans on 49 residents, so I don't think much of *any* of the NANDA diagnoses, but I have to live with them. Knowledge deficit may sound cheesy, but it's going to get you an education care plan and that is one of the things JCAHO is looking for. I do knowledge deficits on all my new admissions.
  14. by   KC CHICK
    Does your patient have any other way, at this time, to get his dialysis treatment??? If not, then *Fluid Volume Excess and *Electrolyte imbalance might work for you. (This patient's kidneys cannot remove or retain electrolytes and/or fluids.....probly on strict, minimal fluids.)
    Does the existing clot have to be removed surgically?? Could use *Risk for infection.
    Think of the pathophysiology of what his medical dx is....what is causing the probs???.....that always made it easier for me during school.

    Do you have a nursing dx book?? Some will show what nursing dx's correspond with given medical dx's. I have one, which I have now loaned to another nsg student, that helped me immensly during school.

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