Did I write this Nursing Diagnosis right?

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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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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

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.

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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.

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

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.

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Specializes in ICU/PCU/Infusion.

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!

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

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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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

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.

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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

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

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Yikes! You guys are confusing me lol

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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.

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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.

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