Did I write this Nursing Diagnosis right?

Students General Students

Published

You are reading page 2 of Did I write this Nursing Diagnosis right?

Daytonite, BSN, RN

1 Article; 14,603 Posts

Specializes in med/surg, telemetry, IV therapy, mgmt.

lostdruid. . .I hear you. I agree. I didn't understand the concept until I started taking classes in Health Information Management and Medical Coding and had do to some reading about DRGs and SNOMED. Things started making more sense. NANDA was really developed to be a computerized coding classification of what nurses did. It was so they could input nurses contribution to a patient's care into these huge computer databases that are being developed. Back in the 1970's when DRGs were just being bantered about they realized that they had no computerized way to measure what nurses did. They've had one for doctor's for years. NANDA has been working in conjunction with SNOMED which is a copyrighted work of the College of American Pathologists that will be a huge computer database which will eventually merge all kinds of computerized data into individual electronic medical records. Each of us will someday have our very own electronic medical record from which any healthcare provider will be able to retrieve information about us (with our permission, of course) at any time from any computer terminal. This is a massive undertaking that has been in the works for years and involves a dozen or so organizations and government agencies of which NANDA is only one. NANDA's job has been to classify nursing language. They need nursing information to be stored by NANDA classification so when the information is pulled out it will mean the same to a healthcare provider in New York as well as to one in San Diego. Computers, unfortunately, have to store this stuff numerically. Each one of the NANDA diagnoses has a numerical code. Each one of the related factors and defining characteristics that has been officially approved for each nursing diagnosis by NANDA also has assigned numerical codes. We nurses will most likely never see them, but we are going to be required to use this exclusive language, so it can be turned into numerical codes. It's just going to be part of our jobs. Please don't feel that nurses are being picked on. When I am working as a medical coder, the doctors get their share of ragging on by medical coders for not dictating the diagnoses and their medical procedures in proper exclusive language. They mumble about it, but payment for their services is directly tied in to the use of those codes, so they'll tow the line. I don't know that the NANDA codes were ever meant to be used for billing purposes, but I could be wrong since nurse practitioners do bill for what they do--I thought most of them billed under the doctor's codes.

So, everytime you sit at a computer terminal and are able to chose a nursing diagnosis for a patient, rest assured that somewhere in the computer system programming is already in place to convert that diagnosis to a computerized code number that will be stored with that patient's chart. If you also have the option to chose defining characteristics and related factors for each diagnosis you can also assume that those are also turned into computerized code numbers if any of them are chosen for that patient. There is another system in development for ICU nursing care called APACHE.

This stuff really turns me on which gives me away as a geek. I will just retreat back into my little geek world and not bother you about this anymore.

Daytonite, BSN, RN

1 Article; 14,603 Posts

Specializes in med/surg, telemetry, IV therapy, mgmt.

luv2shopp85. . .Unless your instructors have told you that it is OK for you to use medical diagnoses following your related to statements, what I am saying to you is that I think your diagnostic statement is half-wrong. I don't think you should use the words edema or neuropathy. I think it should say:

Risk for Impaired Skin Integrity R/T (pick one of the following)

radiation

physical immobilization

mechanical factors (shearing forces, pressure, restraints)

hypothermia or hyperthermia

humidity

chemical substance

excretions and/or secretions

moisture

extremes of age

medication

skeletal prominence

immunologic factors

developmental factors

altered sensation

altered pigmentation

altered metabolic state

altered circulation

alterations in skin turgor (changes in elasticity)

alterations in nutritional state (obesity, emaciation)

psychogenetic

This would be in adherence with NANDA guidelines.

luv2shopp85

609 Posts

Well ive used impaired skin integrity r/t excess fluid volume and neuropathy on one before so i think its okay.

Specializes in Pediatrics (Burn ICU, CVICU).
Yikes! You guys are confusing me lol

Using excess fluid volume is different than using edema. Edema is a medical dx. In my school, we were not allowed to use a med. dx in the etiology.

Risk for impaired skin integrity related to decreased tissue perfusion.

Daytonite, BSN, RN

1 Article; 14,603 Posts

Specializes in med/surg, telemetry, IV therapy, mgmt.

luv2shopp85. . .use what your nursing instructors are allowing you to use. If you have written instructions or guidelines for this project you are working on, re-check them to make sure you are doing everything correctly. Your grade depends on it. My last post was based strictly on NANDA rules and all the "related to" choices I listed came straight out of the NANDA Definitions and Classification 2005-2006 book of theirs.

By the way, I sent you an e-mail a few minutes ago. If you sent me an e-mail the other day, I never got it or it went to my SPAM folder and I didn't recognize it as coming from you.

all4schwa

524 Posts

Specializes in Neuro ICU, Neuro/Trauma stepdown.
Risk for Impaired Skin Integrity R/T (pick one of the following)

radiation

physical immobilization

mechanical factors (shearing forces, pressure, restraints)

hypothermia or hyperthermia

humidity

chemical substance

excretions and/or secretions

moisture

extremes of age

medication

skeletal prominence

immunologic factors

developmental factors

altered sensation

altered pigmentation

altered metabolic state

altered circulation

alterations in skin turgor (changes in elasticity)

alterations in nutritional state (obesity, emaciation)

psychogenetic

but all of these things are not able to be controlled by you, the nurse...isn't that what you said in your first statement, or did i not understand that correctly?

Daytonite, BSN, RN

1 Article; 14,603 Posts

Specializes in med/surg, telemetry, IV therapy, mgmt.
but all of these things are not able to be controlled by you, the nurse...isn't that what you said in your first statement, or did i not understand that correctly?

These things are the cause of the patient's response (nursing diagnosis). If you remove/disable/block the cause, you prevent the response. The control is in what you can do to prevent the patient's response. Think about it. There are independent nursing interventions you can take to interrupt these processes so that impairment of skin integrity doesn't occur. You can't necessarily remove the cause of impaired skin integrity, but you can intercede to affect the patient's response to it. Take "skeletal prominence", for instance. We know that if the patient lies on a bony prominence for a lengthy time the skin will turn red and eventually break down and become a decubitus ulcer. Through independent nursing action of regular, frequent turning and massaging of a bony prominence we can remove the risk of impaired skin integrity.

leslie :-D

11,191 Posts

cause and effect.

the doctor treats the cause.

the nurse treats the effect.

also, when able, i used to try and incorporate 'knowledge deficit' into my ncp.

how much does the pt know about their disease process(es)?

leslie

Specializes in ICU/PCU/Infusion.

OK. I am looking at the Sixth Edition of Ackley and Ladwig, my quotes have come from Section II, and for those of you who are correcting "my" NANDA's, they are not "mine", they are direct quotes.

I appreciate the information given, but if you have issues with the actual quoted NANDA's, they need to be addressed to the professionals who wrote the book.

For example, the "Risk for impaired skin integrity r/t loss of pain perception in extremities" is from page 49, under Diabetes Mellitus, which I believe the OP gave as one of the medical diagnoses her patient had.

#2 of the ones I listed came from the same page, same heading.

#1 came from page 37, under the heading CHF.

Thanks for the information. I thought the OP was looking for input, I didn't expect to be torn apart, but thanks anyway.

Specializes in Corrections, neurology, dialysis.

I was given a project for my pharmacology class. We have to create drug cards with different information about a particular drug. One of the pieces of information we have to provide is a nursing diagnosis. I am not in nursing school yet and don't know how to write a nursing diagnosis. I went to the NANDA web site and, well, that made my confusion even worse.

Is there a place I can find a list of nursing diagnoses and then choose one that most fits my drug?

For example - Tenormin (metoprolol). The diagnoses given in the drug book are mild to moderate hypertension, acute MI to reduce cardiovascular mortality, angina pectoris and heart failure. How do I rewrite these as nursing diagnoses?

You may not be able to explain it all to me in a short time, but please give it your best shot.

Thanks.

luv2shopp85

609 Posts

Risk for infection r/t hyperglycemia, impaired healing, circulatory changes

^^^ Is that written correctly?

Daytonite, BSN, RN

1 Article; 14,603 Posts

Specializes in med/surg, telemetry, IV therapy, mgmt.
cause and effect.

the doctor treats the cause.

the nurse treats the effect. . .leslie

i don't know that i agree with you there, leslie. a wrinkled sheet is the direct cause of skin breakdown. the nurse treats this cause by keeping the sheets smoothed and straight. the nurse can also intervene with the causes of patient's responses to things within their environment. these concepts are not all that easy to grasp. it takes some thinking on them.

is there a place i can find a list of nursing diagnoses and then choose one that most fits my drug?

you can find a list of the 172 nursing diagnoses here

http://www.nursingstudio.net/2005/03/20/nanda-nursing-diagnoses/ at least i think it's a complete list. nanda owns the copyright to them, so they will only sell them to you. you can try to find nursing diagnoses that will match up with drugs by looking for the condition that the drug is treating at this care plan constructor site

http://www1.us.elsevierhealth.com/evolve/ackley/ndh6e/constructor/

for hypertension (and most drugs) you could use ineffective health maintenance related to deficient knowledge regarding treatment and control of disease process. that is actually a diagnostic statement. the actual nursing diagnosis is "ineffective health maintenance".

+ Add a Comment