you have very serious problems here that i suspect are going to take more than just a post from me to fix. back in october when you asked for care plan help (http://allnurses.com/forums/f50/stru...lp-255737.html
) i gave you the steps of the nursing process. i'm posting them again because i don't think you're following them and in order to write a care plan, you must follow these steps in the sequence they occur
- assessment (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
- determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
- planning (write measurable goals/outcomes and nursing interventions)
- implementation (initiate the care plan)
- evaluation (determine if goals/outcomes have been met)
the other very major problem you have is that you are not constructing your 3-part nursing diagnostic statements properly. this is partly because you do not understand or follow the nursing process.
the 3-part nursing diagnosis statement has this structural format:
p - e - s
p = problem
e = etiology
s = symptoms
problem - etiology(ies) - symptoms
these are, in nanda language
nursing diagnosis - related factor(s) - defining characteristic(s)
in a care plan they look like this:
problem [related to] etiology(ies)[as evidenced by] symptom(s)
nursing diagnosis [related to] related factor(s) [as evidenced by] defining characteristic(s)
the related factor
is the underlying cause of the problem or the cause of the signs and symptoms that the patient is having. to help you determine a related factor it is often helpful to know the pathophysiology of the medical disease process going on in the patient. to help you in determining a related factor you can ask yourself "is this the cause of the problem (meaning the nursing diagnosis)", or "is this what is causing the symptoms". "by taking away this factor, will the symptoms go away?" remember this important rule
: you cannot list any medical diagnosis as a related factor
. you have to state a medical condition in some other scientific terms. as an example, we don't say a patient is "dehydrated" since that is a medical diagnosis, but we can say "fluid deficit". they essentially mean the same thing--the difference is in the phrasing of the words.
the defining characteristics
are always the signs and symptoms that come from that list you created from your assessment activities. these will be anything from the same signs and symptoms that doctors use to statements made by patients that indicate something wrong to adl evaluations that were not normal.
the first thing you needed to do in writing your care plan was to sort through the assessment information that you collected on this patient. you also needed to look up information on dka, particularly the signs and symptoms, treatment and pathophysiology. before you can even begin to determine the patient's problems (nursing diagnoses) you have to determine which of the assessment data is abnormal. these are the patient's symptoms, or what nanda calls defining characteristics. these symptoms, or defining characteristics, are what the nursing diagnoses, goals, and nursing interventions are based upon in the remainder of the care plan.
let's dissect your nursing diagnoses. . .
imbalanced nutrition: less than body requirements r/t catabolism of protein and fat for fuel as evidenced by dka and high blood sugar levels
can't use dka as a related factor. it is a medical diagnosis. only symptoms, or defining characteristics, can be listed as aeb items. deficient knowledge r/t prevention of diabetic ketoacidosis as evidenced by verbal confusion on how the body produces energy
first of all, you must specify a subject when you use deficient knowledge. in this case the subject you are wanting to teach the patient is "diabetes". secondly, deficient knowledge is the "absence or deficiency of cognitive information related to a specific topic"
(page 130, nanda-i nursing diagnoses: definitions & classification 2007-2008
). does "prevention of diabetic ketoacidosis" sound like an etiology, or cause, of a deficiency of cognitive knowledge to you? it is because the patient just hasn't had the facts (information) that they have inadequate knowledge of diabetes. diabetic ketoacidosis is a medical diagnosis and shouldn't be part of the nursing diagnosis anyway. to see a list of related factors for this diagnosis, see this website: [color=#3366ff]deficient knowledge (specify)
. your aeb information is ok. the diagnosis should be written as: deficient knowledge (diabetes) r/t lack of information aeb verbal statement by patient of confusion on how the body produces energy.
risk for ineffective breathing pattern r/t hyperglycemia as evidenced by dka risk for infection r/t hyperglycemia and suppressed inflammatory response as evidence by dka
first, "risk for" diagnoses are for anticipated problems--problems you are expecting might
occur, but are not actually present. therefore, they are listed last and after the actual problems that the patient has. since they are non-existent problems, they cannot have any actual symptoms, so there can be no aeb items in the diagnostic statements unless you have a crystal ball. the diagnostic statements for these diagnoses only contain the nursing diagnosis label and the risk factor. you can see the information for the nursing diagnosis [color=#3366ff]ineffective breathing pattern
. the risk factors you would use for risk for ineffective breathing pattern
would be the same as the related factors for ineffective breathing pattern.
the bad news is that hyperglycemia cannot be a related factor (etiology) of this nursing problem. this nursing problem is inspiration and/or expiration that does not provide adequate ventilation
(page 26, nanda-i nursing diagnoses: definitions & classification 2007-2008). hyperglycemia is not the direct cause of this. the most likely cause would be respiratory muscle fatigue. when you plan the nursing care for this, you must have a specific problem in mind that you expect will occur. why? because your nursing interventions are going to be to monitor for the signs and symptoms of it and prevent it, so you and anyone else reading the care plan need to know what you're looking for!
i'll buy the suppressed inflammatory response, but how are you tying the hyperglycemia to infection? i know how, but do you? again, no aeb evidence and dka is a medical diagnosis anyway and not a symptom. what infection did you have in mind here that fits these etiologies? this statement should read risk for infection r/t hyperglycemia and suppressed inflammatory response.
you need to go back and re-write these nursing diagnostic statements. actually, i would suggest that you start from scratch with step #1 of the nursing process and work the first three steps. everything in the care plan has to relate to the symptoms that the patient has and those symptoms come from the assessment information.