ESRD Concept Map/Care Plan Nursing Diagnosis Help

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    I am doing a concept map on a patient with ESRD I have 4 collaberative problems of DM, Hypokalemia, Arial Fib, and anemia. I have 4 nursing diagnosis of
    1.) Excess Fluid Volume R/T advanced disease process AEB JVD, dyspnea, crackles. Pt reports being, “tired all the time”.
    2.) Nutrition imbalanced, less than body requirements R/T Dietary Restrictions AEB Albumin 2.4, BGL 47, states, “This food has no taste and there isn’t enough of it to feed a bird.
    3.) Fatigue R/T ineffective O2 transport, secondary to anemia AEB c/o s.ob. with movement and inability to carry out basic ADL’st, HR increases more than 20 bpm with ambulation, HCt -low, HGB-low ,...
    4.) Anxiety R/T severity/chronicity of her illness and uncertanty of her illness course AEB “I take care of my spouse….. I am usually the only one caring for him. Now how am I gonna take care of him?”

    There was no skin breakdown, and the pt's wbc count was good so there is not much room for risk of infection

    But, I need one more. It ought to be easy with all the collaborative problems listed, but I am stumped. Anyone else have any idea's?
    Help is always greatly appreciated!!
    Last edit by singingstudentnita on Sep 21, '07
  2. 4 Comments so far...

  3. 0
    Do you have a careplan book? Easiest way to write careplans...... they list possible NANDA dx based on the medical dx. Kinda need more info on the pt. to think of another one.... anyone can have any of those dx but what unit are they in? ivs? brittle diabetic? able to ambulate? meds? Here are some straight outta Ackley Nursing Diagnosis Handbook.....

    Ineffective Health maintenance r/t deficient knowledge regarding care of diabetic condition
    Ineffective Tissue perfusion: peripheral r/t impaired arterial circulation
    Decreased Cardiac output r/t possible dysrhythmia from electrolyte imbalance
    Activity intolerance r/t muscle weakness
    Decreased Cardiac output r/t altered electrical conduction
    Ineffective Tissue perfusion: cerebral r/t interruption of cerebral arterial flow secondary to decreased cardiac output


    Obviously you will need to update the etiology. Here's a tip for careplans.. prioritize nursing dx by what the patient will die from first. Think of your ABCs. You're off to a good start
  4. 0
    hi, singingstudentnita and welcome to allnurses!

    i'm looking over your list of nursing diagnoses and you have a few problems with the wording in your diagnostic statements.
    excess fluid volume r/t advanced disease process aeb jvd, dyspnea, crackles. pt reports being, “tired all the time”.
    the second section that i bolded is actually a defining characteristic that belongs with your diagnosis of fatigue. what is the disease process that is causing the patient to retain fluid? i think you could be a little more specific with your related factor here. what's the underlying cause of the jvd?

    fatigue r/t ineffective o2 transport, secondary to anemia aeb c/o s.ob. with movement and inability to carry out basic adl’st, hr increases more than 20 bpm with ambulation, hct -low, hgb-low. anemia is a related factor for fatigue. ineffective oxygen transport doesn't belong with the diagnosis of fatigue. you've set up and worded this diagnosis incorrectly. ineffective oxygen transport comes under another nursing diagnosis. you need to look at the definition and defining characteristics of activity intolerance since your defining characteristics match with the symptoms of that nursing diagnosis.

    anxiety r/t severity/chronicity of her illness and uncertanty of her illness course aeb “i take care of my spouse….. i am usually the only one caring for him. now how am i gonna take care of him?” the symptoms you list are about the patient talking about taking care of her husband. that has no relationship with "severity/chronicity of her illness and uncertainty of her illness course". you need to change the wording of your "related to" etiology since her anxiety seems to be about her concern for her husband and not for herself.
    if you reconfigure your nursing diagnosis for fatigue and add a diagnosis of activity intolerance, you will have one more nursing diagnosis to add to your list.

    you will find these threads on the nursing student forums to help you with writing care plans and care maps:
  5. 0
    Thank You everyone for you responses, gave me some things to correct and some places to go!! Thanks for all the input. Daytonite, it might look so much better when I put in your corrections that my instructors will wonder if I really did it ! Thanks everyone.

    Singingstudentnita :spin:
  6. 0
    you're kidding, right? why would you chance taking a lower grade? if asked tell them you re-read the first chapter of your care plan book that discusses the nursing process and how to determine a nursing diagnosis and you had an epiphany. then, really go and read that chapter. and, use that activity intolerance diagnosis. here's information on it from the online ackely/ladwig ([color=#3366ff]activity intolerance) and gulanick/myers (http://www1.us.elsevierhealth.com/me...ex.cfm?plan=01) care plan constructor websites so you can verify the defining characteristics and definition just in case you don't have a nursing diagnosis book of your own to use for reference.

    none of this is guesswork. it is all rational and logical decision making that follows defined rules. we have to learn to stop thinking that we are going down the medical diagnosis pathway and learn to use our own nursing diagnosis pathways. when you get that, you'll see that this process will go much easier. your care plan is only going to be as good as your assessment data. missing clues = a diagnosis that may not be completely correct.


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