first of all, you need some guidance in getting to your nursing diagnoses. the proper procedure is to list the patient's symptoms which you have done. so, have i.
- sores on feet
- 50 lb weight loss in one year
- no exercise
- no diet
- "i don't have time for this"
these symptoms, or defining characteristics, are then used to match up to nursing diagnoses. each nursing diagnosis has a definition, defining characteristics (symptoms) and related factors (causes). if you have a nursing care plan book or nursing diagnosis book
to help you out here you will find an explanation of this in the very beginning of the book.
impaired skin integrity
is indeed one of the diagnoses to attach to this patient. however, you cannot use deficient knowledge of proper foot care secondary to diabetes mellitus as the causative factor, or "related to" item in your diagnostic statement. there are a couple of reasons for this. (1) you can't use a medical diagnosis in a nursing diagnostic statement. (2) not knowing how to take care of her feet is not the cause the sores on her feet. you need to do some reading on diabetes and it's side effects. that is part of the purpose of doing these case studies anyway. the sores on this patient's feet are primarily the result of some small trauma, but we'll never know exactly what it was since that information wasn't given. the diabetes did the rest of the damage due to poor circulation. so, since you don't have definitive proof that the patient stubbed her toe or stepped on a nail, you work with what you know about diabetes, which is that it causes problems with peripheral circulation. therefore, i would revise this nursing diagnosis to read as follows: impaired skin integrity r/t altered circulation aeb sores on feet
. it's that simple, because that's all you have to work with. there should be other symptoms, but you weren't given them. outcomes for this diagnosis include healing of the skin surface and the patient describing what they are going to do to protect, care for, and promote healing of the sores on the foot. you always want to involve the patient in the final formulation of outcomes if you want to get any cooperation from them. a goal is going to be to get the patient to demonstrate to you how to perform wound care as ordered by the doctor. your nursing interventions will concern the care of these sores as well as teaching the patient how to care for them. the rationales are merely the reasoning behind choosing each intervention, or "why" that intervention is going to work.
with any newly diagnosed medical condition, there is always need for teaching the signs, symptoms and treatment for the disease. so, deficient knowledge of disease process r/t lack of information aeb apathetic behavior toward condition
[the statement "i don't have time for this" is apathy] should be your second nursing diagnosis for this patient. outcome will be for the patient to be able to explain what diabetes is, what medications he/she needs to take to keep in under control, and what treatments need to be done to heal up the sores on the feet. also, the patient needs to explain how he/she is going to work all this into their present lifestyle.
now, i want to turn to the 50-lb weight loss. the 50-lb weight loss is a good symptom of undiagnosed diabetes. other symptoms are missing, but the weight loss sticks out like a sore thumb, especially since the patient has not been following any kind of a diet. why does a person with undiagnosed diabetes loose weight? you need to find the answer to that question. it has to do with the pathophysiology of diabetes and it is a very important point that you need to know the answer to. this patient should have had other symptoms of her diabetes such as thirst, hunger and excessive urination. this all goes along with the weight loss in a diabetic who is newly diagnosed. so, another potential nursing diagnosis here would be ineffective health maintenance
. the definition of this diagnosis is: "inability to identify, manage, and/or seek out help to maintain health." (nursing diagnoses: definitions & classification 2005-2006
published by nanda international, page 90) the nursing diagnostic statement would be: ineffective health maintenance r/t knowledge deficiency in caring for disease condition aeb inability (or refusal) to recognize symptoms of illness.
your outcome with this kind of patient, hopefully would be for the patient to follow a mutually agreed upon plan for maintenance of his/her diabetes. one goal might be to have the patient discuss why they resist seeking medical help. this patient has an obvious attitude problem that needs exploring, and has to change (although you can't make them change it) if they want to survive and live a comfortable life. you can also put your patient teaching of diabetes under this diagnosis, but only if you don't use deficient knowledge of disease process as a nursing diagnoses.
a fourth nursing diagnosis is risk for noncompliance
. with statements like "i don't have time for this", it is likely that this patient is going to have a problem with controlling their disease, if they even bother to. i've seen this over the years as a practicing nurse. there are some very stubborn diabetics out there who just do not want to take any responsibility for managing their condition. consequently, they are frequent visitors to the emergency rooms and doctor's offices for all the problems that go along with diabetes. so, risk for noncompliance r/t patient's behavior
is a diagnosis i might use. there are no aeb items attached to "risk for" diagnoses because they are problems that do not yet exist. however, with this patient, i think there is a good possibility that he/she is not going to follow medical advice. outcomes would be to have the patient verbalize understanding of his/her disease and treatment, to agree to follow through with treatment plans.
there are 4 possible nursing diagnoses and outcomes to get you started. read up on diabetes! that's another reason why instructors give case studies--so you learn about the disease condition itself. diabetes is one of those medical conditions that has lots of problems connected with it. care plans
for diabetics can become quite extensive and long. the four nursing diagnoses i've suggested are only the tip of the iceberg. good luck!