Did I write this Nursing Diagnosis right?

  1. 0
    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)
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  4. 0
    Looks good to me. Risk Diagnosis's don't have to have the "as manefested by" or "as evidenced by" afterwards.

    Another one for a patient such as this would be Activity Intolerance

    These patients also often have knowledge deficits. About diet, daily weights, medications, etc.

    Good luck.
  5. 0
    I'm not a pro at writing these things, but I was always taught that a related to issue could not be a medical dx. (For example, Neuropathy is a medical dx.) How about this one:

    Risk for Impaired Skin Integrity related to edema secondary to CHF and decreased peripherial sensation secondary to diabetic neuropathy

    It's a little long.. lol. Don't you just love care plans and nursing diagnoses?! If you are required to write a care plan based on a priority nursing dx, i would stick to Impaired gas exchange R/T inadequate cardiac fx secondary to Left sided CHF (if left sided heart failure is the case there, Pulmonary edema often results in decreased oxygenation) or decreased cardiac output R/T reduction in stroke volume secondary to CHF, etc. These would be actual problems so they would require an AMB, but you would have to tailor these to your specific patient and your assessment findings.
  6. 0
    your related to factors need to be changed. the related to factors need to be specific risk factors that are present that would cause the tissue breakdown, that you, the nurse, have the ability to control and/or manage. edema and neuropathy are not appropriate to use because you, as the nurse, have no control of the patient's edema or neuropathy. this is a very important concept for you to grasp here. you do, however, as the nurse, have the ability to exercise control and management of some of the following related factors that would go with this nursing diagnosis, such as physical pressure on the skin (intervention: nurse simply removes the pressure), the patient being immobile in the bed (intervention: turning and repositioning), presence of secretions (keeping the patient cleaned), altered circulation (positioning, assessing skin condition), altered sensation (assessing condition of skin), alterations in skin turgor (assessing condition of skin). what kind of independent nursing interventions can you do for edema and neuropathy? nothing for the neuropathy. you might get away with elevating a dependent extremity with the edema, but it doesn't eliminate the edema because there is still an underlying cause to it. give some thought to this patient since you know her from your clinicals. what kind of physical situations might exist within her environment that would cause her to have an alteration in the epidermis or dermis of her skin (skin breakdown) that you can intercede in to break the chain of damage? i've listed some above, but you might know of others since you took care of her.
  7. 0
    yeah, I tend to agree with Tweety on this one.

    1)Activity intolerance r/t weakness, fatigue

    2)Disturbed sensory perception r/t ineffective tissue perfusion

    3)Risk for inpaired skin integrity r/t loss of pain perception in extremities

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

    Any of these would be appropriate as they don't use a med dx. Do you have the Nursing Diagnosis Handbook by Ackley and Ladwig? I got these from the handbook. I absolutely loved this book through the last 3 semesters!!

    We also needed AEB's for all nursing diagnoses, and I don't see that with yours. We had to have at least 4 interventions, and also the pathophys associated with each diagnoses, accompanied by the source.

    HTH! Good luck!
  8. 0
    Quote from leslasic
    regarding: risk for impaired skin integrity r/t loss of pain perception in extremities

    any of these would be appropriate as they don't use a med dx. do you have the nursing diagnosis handbook by ackley and ladwig? i got these from the handbook. i absolutely loved this book through the last 3 semesters!!

    we also needed aeb's for all nursing diagnoses, and i don't see that with yours. we had to have at least 4 interventions, and also the pathophys associated with each diagnoses, accompanied by the source.
    i don't know what copy of ackley and ladwig you are looking at, but i'm looking at page 1096 of the 7th edition of their ndh and "loss of pain perception in extremities" is not given as a related factor for this nursing diagnosis! aeb's are not used in diagnostic statements where the nursing diagnosis is one that is anticipated and not actually existing. and, risk for impaired skin integrity certainly qualifies as an anticipated event. go back to your ackley and ladwig handbook to the first chapter and re-read the information about the "related to" phrase or etiology in the section where they discuss step 2: nursing diagnosis (adpie) in the nursing process. it clearly states that when the etiology or cause ("related to" factor) of the nursing diagnosis can be identified as something that can be treated by the nurse then it should be used as the "related to" factor in the diagnostic statement. if this information is known it gives your nursing diagnosis specificity to that patient, something i'm sure your nursing instructors are always harping at you about. with this particular diagnosis there are no independent actions the nurse can take to treat the loss of pain perception in the extremities.

    your instructors may be giving you specific instructions that differ from nanda guidelines. ackley and ladwig follow nanda-i guidelines almost to the letter. each of you students should always follow the instructions on writing nursing diagnostic statements that you have been given by your instructors. don't assume that all nursing programs have students writing nursing diagnoses the same way as your nursing school.
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    Daytonite, that is indeed a difficult concept to grasp because in this diagnosis we aren't interested in fixing the edema or neuropathy, we are interesting in preventing skin breakdown which is where the nursing interventions come in.
    Last edit by Tweety on Jun 23, '06
  10. 0
    Quote from queenbee06
    I'm not a pro at writing these things, but I was always taught that a related to issue could not be a medical dx. (For example, Neuropathy is a medical dx.) How about this one:

    Risk for Impaired Skin Integrity related to edema secondary to CHF and decreased peripherial sensation secondary to diabetic neuropathy

    It's a little long.. lol. Don't you just love care plans and nursing diagnoses?! If you are required to write a care plan based on a priority nursing dx, i would stick to Impaired gas exchange R/T inadequate cardiac fx secondary to Left sided CHF (if left sided heart failure is the case there, Pulmonary edema often results in decreased oxygenation) or decreased cardiac output R/T reduction in stroke volume secondary to CHF, etc. These would be actual problems so they would require an AMB, but you would have to tailor these to your specific patient and your assessment findings.
    I would probably choose: Impaired tissue perfusion related to reduced cardiac output (or venous stasis secondary to reduced cardiac output) as evidenced by (describe edema). Interventions: ambulation as tol., elevation, ordered TEDs, ordered SCDs, watch for breakdown....JMHO
  11. 0
    Quote from Tweety
    Daytonite, that is indeed a difficult concept to grasp because in this diagnosis we aren't interested in fixing the edema or neuropathy, we are interesting in preventing skin breakdown which is where the nursing interventions come in.
    Tweety. . .how right you are. I have been studying this concept of nursing diagnosis and the nursing diagnostic statement for about the last two months. . .I mean really studying it. A nursing diagnosis is the patient's response to what is happening.

    With reference to the OP's diagnosis of "Risk For Impaired Skin Integrity R/T Edema and Neuropathy", it is a patient response (impaired skin integrity) that would exist if the following continues to occur _________. NANDA has been struggling to keep medical diagnoses out of the nursing diagnostic statements. In the process they have had to develop some of their own terminology such as altered sensation to go with this diagnosis rather than loss of sensation (neuropathy). It could be the patient is insisting on wearing tight shoes and her ankles are bulging over the sides (the "related to" factor would be mechanical factors), or her edema could be so bad the skin is weeping and staying wet all the time and starting to become erythemic and the threat of maceration is around the corner (the "related to" factor would be secretions). These are nursing problems that nurses can very easily abate with some independent nursing interventions. What we can't do is fix the actual cause of the edema which is most likely the CHF, CAD or Cardiomyopathy. That is strictly physician territory.

    I hope I'm not sounding mean here. I'm trying to share what I am learning myself.
  12. 0
    Yikes! You guys are confusing me lol


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