Help! Instructor wants diagnosis that aren't related to Fundamentals!

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    Hello all!
    I'm new here to the site, I'm in the last 6 weeks of my LPN program and in need of some serious help! I have a paper due, not exactly a care plan but close. I need 3 diagnosis and 3 interventions except my instructor wants us to move away from Fundamentals. My patient was in for Cellulitis and was then diagnosed with superficial thrombophlebitis the day I was leaving. The patient was in extreme pain and could not get up, besides sitting on the side of the bed for a few minutes. The patient had edema and redness of right calf and feet. Her RBC, Hgb, Hct and Ca are low. She has a hx of renal insufficiency, hypertension, obesity, and Type 2 diabetes. I wanted to go with Impaired skin integrity but my instructor says thats fundamentals! Now I have ineffective tissue perfusion, Acute pain and I'm not sure if I should use activity intolerance. I've never had this much of a problem but not being able to use diagnosis that fit my patient is really not helping! I'm also having trouble finding interventions for ineffective tissue perfusion R/T inflammatory process damaging skin, any help would be extremely appreciated
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    Ineffective tissue perfusion definition is 'decrease in O2 resulting in failure to nourish the skin at capillary level'. In saying that, it would be more of a cause to skin damage. If the skin is deprived of oxygen it could become necrotic. Ineff. tissure perfusion would be r/t things such as low hgb & hct, rbc and interruptions in blood flow, etc....this is what carries the oxygen thru the system. If the proper O2 is not getting where it needs to go it would cause the BP to increase because it is trying to compensate for the lack of oxygen and solve the problem. You should rethink that one and look it up in your nursing care plan book and I'm sure you can come up with interventions once it's straightened out.
    Other Nsg Dx that pop in my mind are:
    Altered nutrition.....
    Risk for falls/ injury....
    Impaired physical mobility...
    Pain....
    Risk for constipation....
    Fear/ Anxiety....
    as well as many that would be listed under immobility & hypertension. Hope that helps some. Good luck
  6. 0
    How about inadequate nutrition? knowledge deficit? Ineffective coping? Altered body image?
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    Thank you, I apparently read into tissue perfusion wrong! I would like to use risk for falls or impaired mobility but they too are on our "do not use list" I understand they want us to look at the pathophys, but I don't like not having all the NANDA diagnosis available. They don't want us to use any anxiety, fear, etc. I'm so stuck!!!!!
  8. 0
    I was looking at Tissue Perfusion because she does not have sufficient circulation, the hgb, hct, rbc are very low. Maybe I do not understand??
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    Imbalanced Nutrition: Less than body Requirements
    Risk for infection
    Acute Pain
    Risk for Fall
    Impaired mobility
    Self-care defecit
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    Ineffective tissue perfusion is definately a good one but the low lab values would be more of an AEB. WHY doesn't she have effective tissue perfusion. If it's due to hypertension it may be r/t changes in blood pressure assoc with effects of prolonged/excessive elevation of blood pressure, possible decrease in cardiac output assoc. with increased workload as a result of elevated BP, excessive lowering of BP by antihypertensive meds. If it's due to DM it could be r/t vascular abnormalities that commonly develop with DM. There's a few examples for inadequeat tissue perfusion. The r/t factors should be more of signs & symptoms of the problem, then lab values and assessment data would be the AEB part of the diagnosis.
    How about her vitals? Does she show signs of worsening infection? Maybe Hyperthermia R/T infectious process AEB temperatures of. . .
    Altered Comfort.....
    Constipation r/t immobility....
    Potential acute metabolic complications
    (DKA, hypoglycemia, hyperglycemic hyperosmolar nonketotic coma...r/t can be any of the s&s of these)
    Risk for constipation r/t immobility....
    Risk for loneliness.....
    Risk for infection: superinfection r/t
    a. decreased resistance to infection assoc. with depletion of immune mechanisms resulting from current infection & treatment with antimicrobial agents. b. stasis of resp. secretions and/ or urinary stasis if mobility is decreased.

    Do you have a nursing careplan book? They help me a great deal! Also the website evolve.elsevier.com is very helpful also. Well I hope that helped, I need to get back to my work.


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