Need help with nursing diagnoses for polypharmacy case study!

  1. 0
    Hi everyone! I am at the end of my 2nd year Bachelor of Nursing and wondering why I didn't take up gardening instead!

    I am needing some help with a case management study and any help would be much appreciated. My scenario is an elderly female client admitted after a fall, with late stage PD, AF, HT and RA.

    For thes conditions she has been prescribed the following medicines:

    Levadopa (1.5 grams tds)
    Digoxin (62.5 mcg daily)
    Warfarin (4mg daily
    Enalapril (5mg bd)
    Ibuprofen (400mg tds)

    Apart from these prescription drugs which have moderate interactions, she has additional poly pharmacy issues, as she is taking a large number of naturopathic medicies (unspecified).
    Vital signs are normal apart from a BP of 153/89.


    This woman in the scenario has small< 1cm bruises over her anterior and posterior torso, is unaware of any cause or length of time they have been there and most importantly, she doesn't know when is the last time she had an INR due to difficulties making appointments.

    How do I do a nursing diagnosis for this poly pharmacy scenario?

    So far I have come up with 'Ineffective Protection r/t anticoagulant drug therapy' and

    'Therapeutic Regimen, Ineffective Management r/t knowledge deficit and social support deficits'

    Any other thoughts? I can't find any nice simple NANDA diagnosis such as 'Ineffective medication management'. I do think Nursing Lecturers have long liquid lunches and dream up these scenarios just to torture students!

    Hoping to be a regular contributor to this forum,

    Warm regards, Annie
  2. 2 Comments so far...

  3. 1
    welcome to allnurses.

    you are problem solving here. you have a tool to do that called the nursing process. it adapts extremely well to care planning:
    1. assessment (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
      • a physical assessment of the patient
      • assessment of the patient's ability and any assistance they need to accomplish their adls (activities of daily living) with the disease
      • data collected from the medical record (information in the doctor's history and physical, information in the doctor's progress notes, test result information, notes by ancillary healthcare providers such as physical therapists and dietitians
      • knowing the pathophysiology, signs/symptoms, usual tests ordered, and medical treatment for the medical disease or condition that the patient has. this includes knowing about any medical procedures that have been performed on the patient, their expected consequences during the healing phase, and potential complications. if this information is not known, then you need to research and find it.
      • http://allnurses.com/forums/f205/med...es-258109.html - medical disease information/treatment/procedures/test reference websites
    2. determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
      • it helps to have a book with nursing diagnosis reference information in it. there are a number of ways to acquire this information.
      • your instructors might have given it to you.
      • you can purchase it directly from nanda. nanda-i nursing diagnoses: definitions & classification 2007-2008 published by nanda international. cost is $24.95 http://www.nanda.org/html/nursing_diagnosis.html
      • many authors of care plan and nursing diagnosis books include the nanda nursing diagnosis information. this information will usually be found immediately below the title of a nursing diagnosis.
      • the nanda taxonomy and a medical disease cross reference is in the appendix of both taber's cyclopedic medical dictionary and mosby's medical, nursing, & allied health dictionary
      • there are also two websites that have information for about 75 of the most commonly used nursing diagnoses that you can access for free:
    3. planning (write measurable goals/outcomes and nursing interventions)
      • goals/outcomes are the predicted results of the nursing interventions you will be ordering and performing. they have the following overall effect on the problem:
        • improve the problem or remedy/cure it
        • stabilize it
        • support its deterioration
      • interventions are of four types
        • assess/monitor/evaluate/observe (to evaluate the patient's condition)
        • care/perform/provide/assist (performing actual patient care)
        • teach/educate/instruct/supervise (educating patient or caregiver)
        • manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)
    4. implementation (initiate the care plan)
    5. evaluation (determine if goals/outcomes have been met)
    a doctor doesn't diagnose without first performing a thorough physical exam and diagnostoc testing. we don't either. our assessment of the patient is a tad different, but we do assess. your scenario specifically tells you this is a poly pharmacy scenario. obviously, you are to focus on the drugs. i saw evidence there of the patient's side effects to taking two of her medications as well as complications of her medical conditions. because all diagnoses must be supported by evidence (symptoms), you have to find those symptoms first. that is done by thoroughly assessing the patient. assessment, if you read the information i posted above, includes looking up information about the patients diseases (pd, af, ht and ra) and treatments (her medications and their side effects). in addition, the scenario tells you
    • she fell (risk for falls)
    • she's bruised (impaired skin integrity)
    • she has a memory problem (acute or chronic confusion or ineffective health maintenance might be a better diagnosis to use)
    the nursing diagnoses are meant to be broad in scope and cover a general area of a problem. assessment always was meant to be the foundation supporting all diagnosing.
    anushka4 likes this.
  4. 0
    Quote from daytonite
    welcome to allnurses.

    you are problem solving here. you have a tool to do that called the nursing process. it adapts extremely well to care planning:
    1. assessment (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
      • a physical assessment of the patient
      • assessment of the patient's ability and any assistance they need to accomplish their adls (activities of daily living) with the disease
      • data collected from the medical record (information in the doctor's history and physical, information in the doctor's progress notes, test result information, notes by ancillary healthcare providers such as physical therapists and dietitians
      • knowing the pathophysiology, signs/symptoms, usual tests ordered, and medical treatment for the medical disease or condition that the patient has. this includes knowing about any medical procedures that have been performed on the patient, their expected consequences during the healing phase, and potential complications. if this information is not known, then you need to research and find it.
      • http://allnurses.com/forums/f205/med...es-258109.html - medical disease information/treatment/procedures/test reference websites
    2. determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
      • it helps to have a book with nursing diagnosis reference information in it. there are a number of ways to acquire this information.
      • your instructors might have given it to you.
      • you can purchase it directly from nanda. nanda-i nursing diagnoses: definitions & classification 2007-2008 published by nanda international. cost is $24.95 http://www.nanda.org/html/nursing_diagnosis.html
      • many authors of care plan and nursing diagnosis books include the nanda nursing diagnosis information. this information will usually be found immediately below the title of a nursing diagnosis.
      • the nanda taxonomy and a medical disease cross reference is in the appendix of both taber's cyclopedic medical dictionary and mosby's medical, nursing, & allied health dictionary
      • there are also two websites that have information for about 75 of the most commonly used nursing diagnoses that you can access for free:
    3. planning (write measurable goals/outcomes and nursing interventions)
      • goals/outcomes are the predicted results of the nursing interventions you will be ordering and performing. they have the following overall effect on the problem:
        • improve the problem or remedy/cure it
        • stabilize it
        • support its deterioration
      • interventions are of four types
        • assess/monitor/evaluate/observe (to evaluate the patient's condition)
        • care/perform/provide/assist (performing actual patient care)
        • teach/educate/instruct/supervise (educating patient or caregiver)
        • manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)
    4. implementation (initiate the care plan)
    5. evaluation (determine if goals/outcomes have been met)
    a doctor doesn't diagnose without first performing a thorough physical exam and diagnostoc testing. we don't either. our assessment of the patient is a tad different, but we do assess. your scenario specifically tells you this is a poly pharmacy scenario. obviously, you are to focus on the drugs. i saw evidence there of the patient's side effects to taking two of her medications as well as complications of her medical conditions. because all diagnoses must be supported by evidence (symptoms), you have to find those symptoms first. that is done by thoroughly assessing the patient. assessment, if you read the information i posted above, includes looking up information about the patients diseases (pd, af, ht and ra) and treatments (her medications and their side effects). in addition, the scenario tells you
    • she fell (risk for falls)
    • she's bruised (impaired skin integrity)
    • she has a memory problem (acute or chronic confusion or ineffective health maintenance might be a better diagnosis to use)
    the nursing diagnoses are meant to be broad in scope and cover a general area of a problem. assessment always was meant to be the foundation supporting all diagnosing.
    dear daytonite,
    wow! fantastic answer, i am going back to the drawing board with all my assessment in this scenario now. i am an external student and none of my online lecturers have ever explained the nursing process as well to me. thank you so much, this has been really helpful, warm regards, annie


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