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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  3. Visit  luv2shopp85 profile page

    About luv2shopp85

    Joined Dec '05; Posts: 606; Likes: 10.

    32 Comments so far...

  4. Visit  Tweety profile page
    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. Visit  queenbee06 profile page
    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. Visit  Daytonite profile page
    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. Visit  GeminiTwinRN profile page
    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. Visit  Daytonite profile page
    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.
  9. Visit  Tweety profile page
    0
    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. Visit  Roseyposey profile page
    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. Visit  Daytonite profile page
    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. Visit  luv2shopp85 profile page
    0
    Yikes! You guys are confusing me lol
  13. Visit  DaFreak71 profile page
    0
    Quote from leslasic
    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!
    #2 would not be appropriate because your r/2 is another nursing diagnosis. #4 would not be appropriate because the r/2 is a medical diagnosis--hyperglycemia. This is what we are taught in my ADN program anyhow.
  14. Visit  DaFreak71 profile page
    1
    Speaking of NANDA, I really dislike the entire concept of developing a language that is exclusive to nursing. I understand that nursing has a vested interest in creating nursing specific language, and this is what I disagree with. The idea that nursing HAS to create its own language in order for nursing to be viewed as more legitimate or scientific is, in my opinion, making a mockery of our already substantial knowledge base. NANDA has turned nursing lingo into a word game that seems to alienate other health care professionals. Take for example the following situation:

    Patient has a sprained ankle. Instead of assuming that a competent nurse would automatically be able to deduce that this patient won't be able to walk, we have to give it a unecessarily verbose definition: Impaired walking.

    Who are we serving by labeling a sprained ankle "impaired walking"? Other nurses? Do we really need to spell out to other nurses that this patient can't walk comfortably? Considering that nurses have their own section in the patient chart that is seldom read by most physicians, it seems like we are just taking common everyday language and making it more verbose in order to have our own language.

    I don't buy into the idea that medical language belongs to doctors. I know what diarrhea is and I should not have to come up with an alternate term just so I can avoid using "their language". It is cumbersome and I really don't think that it serves nursing very well. The whole concept of language is a way of communicating ideas and messages to a other people, concocting a special language only for nurses undermines that.

    Nursing diagnoses are like playing a word game that prevents the nurse from using her medical terminology in absurd deference to physicians. It's like a crossword puzzle where you can't come right out and say what it is, you have to elude to it and find ways to redefine what has already been defined. It seems defensive, like we have to legitimize our own profession by creating our own language. I submit that nursing does not need to be legitimized, it has been throughout the ages.

    Just my 2 cents.
    Panthyr likes this.
  15. Visit  Daytonite profile page
    0
    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.


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