Did I write this Nursing Diagnosis right?

[luv2shopp85]

Can someone please tell me if I wrote this nursing diagnosis right?

Risk For Impaired Skin Integrity R/T Edema and Neuropathy

Patient had CHF as primary med dx, and Cardiomyopahty secondary to diabetes as secondary diagnosis. Does this make sense to use this diagnosis for a care plan(maxi map)

[leslie :-D]

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.

i don't agree that a wrinkled sheet is the direct cause of skin breakdown.

skin breakdown would be the result of a direct pathology, i.e., pvd, dm, malnutrition, any process that impacts circulation.

i was trying to be simplistic in saying that a dr will treat the cause, and we nurses intervene with the results/outcomes of the cause.

i see it wasn't as cut and dry as i had hoped.

leslie

[Tweety, BSN, RN]

Daytonite, thanks for the inservice. I do appreciate it.

What still doesn't make sense is you say you can't use "neuropathy" because you can't do anything about it. But I say "altered sensation" there still isn't anything I can do about it, I'm just changing to terminology. I guess that's where I'm confused. I absolutely understand not using a medical diagnosis and using terminology exclusive to nursing. But does the diagnosis and the related to have to be things we can fix or intervene in?

A person has CHF, I as a nurse can't fix that. But my care plan includes, I&O's, daily weights, etc. for the "altered cardiac output".

[leslie :-D]

no, we can't do anything about ones' neuropathy, chf, etc.

what we can do is prevent relapse/exacerbation and keep them safe.

[Daytonite, BSN, RN]

Tweety. . .with NANDA the terminology that nurses use is part of what it's all about for them. I can't speak for all the nursing instructors out there. Some of them are on another page altogether--mine were, and I've had to re-learn this stuff.

The nursing diagnosis represents a group of the patient's symptoms; those non-normal things you discovered during your assessment. Think of it as putting a label on a group of symptoms that fit together. The "related to" is the etiology or cause of all the symptoms that the patient is having that make up the nursing diagnosis. Ackley and Ladwig refer to the "related to" as, ". . .the etiology, or cause, of the nursing diagnosis. . .something that can be treated by the nurse. When this is the case, the diagnosis is identified as an independent nursing diagnosis. If medical intervention is also necessary, it might be identified as a collaborative diagnosis." The nursing interventions you put in your care plan are addressing the specific symptoms the patient is experiencing. To answer your question, "does the diagnosis and the "related to" have to be things we can fix or intervene in?" My answer would be the what we can fix and intervene in are the symptoms. Sometimes by fixing the symptoms we can remove what is leading to the cause of the diagnosis (and symptoms); sometimes we can't. If you are successful in removing the cause of the diagnosis then the diagnosis can no longer exist. The nursing diagnosis and the symptoms are linked together with each other. Does that help?

[Daytonite, BSN, RN]

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

^^^ Is that written correctly?

Yes, it's looks OK to me.

[Tweety, BSN, RN]

Tweety. . .with NANDA the terminology that nurses use is part of what it's all about for them. I can't speak for all the nursing instructors out there. Some of them are on another page altogether--mine were, and I've had to re-learn this stuff.

The nursing diagnosis represents a group of the patient's symptoms; those non-normal things you discovered during your assessment. Think of it as putting a label on a group of symptoms that fit together. The "related to" is the etiology or cause of all the symptoms that the patient is having that make up the nursing diagnosis. Ackley and Ladwig refer to the "related to" as, ". . .the etiology, or cause, of the nursing diagnosis. . .something that can be treated by the nurse. When this is the case, the diagnosis is identified as an independent nursing diagnosis. If medical intervention is also necessary, it might be identified as a collaborative diagnosis." The nursing interventions you put in your care plan are addressing the specific symptoms the patient is experiencing. To answer your question, "does the diagnosis and the "related to" have to be things we can fix or intervene in?" My answer would be the what we can fix and intervene in are the symptoms. Sometimes by fixing the symptoms we can remove what is leading to the cause of the diagnosis (and symptoms); sometimes we can't. If you are successful in removing the cause of the diagnosis then the diagnosis can no longer exist. The nursing diagnosis and the symptoms are linked together with each other. Does that help?

Yes, that is making sense.

I'm still not sure that 100% it's necessary to have both a ng and the r/t part be things that we as nurses can fix because there are NG's that have r/t's that we can't fix, such as activity intolerance. There are inventions we can use to help them cope and maximize functioning, but we aren't going to ever improve their lungs. Does that mean we don't use the NG "activity intolerance" or we have to make up a r/t to make it fit?

Take the above diagnosis that you gave your blessing to. Can we really fix the impaired hearing? Or the circulatory changes for that matter? Can't we decrease the risk of infection with trying to cure the hearing problems, circulatory problems?

Take my opinion with a grain of salt because I'm not the writer or a student of this stuff. :)

[Daytonite, BSN, RN]

Can we really fix the impaired hearing? Or the circulatory changes for that matter? Can't we decrease the risk of infection with trying to cure the hearing problems, circulatory problems?

We can't fix impaired hearing, but we can affect it. The same with circulatory changes. I am trying to see this as breaking a link in a chain of events, if that makes any kind of sense.

[Tweety, BSN, RN]

We can't fix impaired hearing, but we can affect it. The same with circulatory changes. I am trying to see this as breaking a link in a chain of events, if that makes any kind of sense.

Makes perfect sense. What I'm not understanding is why is it o.k. to use "circulatory changes" and not "edema".

I'm not trying to be a brat here, but the semantics of NG frustrates me to know end.:trout:

[Daytonite, BSN, RN]

A good question too. And, probably one asked a lot. I'm willing to bet that the answer is in the NANDA publications and that I'll run across it sooner or later. When, and if, I find it I'll let you and everyone know why.