Quote from maryk99
imbalanced nutrition: less than body requirements r/t copd, cocaine use aeb pt's report of poor appetite, wt loss, not buying food, appears malnourished (skin/hair), low albumin, .....
pt's with copd are recommended to eat 6 small meals w/high protein d/t disease process - weight loss very common in end-stage, small meals b/c they tire easily when eating, consider dietary consult, recommend supplement
pts with drug abuse often forego buying food in order to buy the drug
while what you are saying about copders and long term drug abusers is true i want to point out that that your language in the nursing diagnostic statement [imbalanced nutrition: less than body requirements r/t copd, cocaine use aeb pt's report of poor appetite, wt loss, not buying food, appears malnourished (skin/hair), low albumin] would be found incorrect by many nursing instructors for these reasons: (1) the etiology section of this diagnostic statement is indicating two medical determinations as the cause of the inadequate food intake, and (2) there are etiologies mixed in with assessment data items in the aeb items.
this particular nursing diagnosis pertains to "intake of nutrients insufficient to meet metabolic needs." (nursing diagnoses: definitions & classification 2005-2006
published by nanda international, page 126) appropriate related factors (r/t) that fit this descriptor: "inability to ingest or digest food or absorb nutrients due to biological, psychological, or economic factors." to say "copd, cocaine use" tells nothing of the cause behind the inadequate nutrient intake. more appropriate "r/t"s would be such things as inability or failure to eat due to loss of appetite, lack of financial means to purchase food, or failure to purchase food. these are things included in the aeb items that need to pulled out and placed in their correct place in the diagnostic statement.
i want to look at the aebs (defining characteristics or symptoms) you attach to this nursing diagnosis:
- patient's report of poor appetite
- weight loss
- not buying food
- appears malnourished (skin/hair)
- low albumin
i have to ask myself, how do each of these help to explain more fully, or effect, the cause of the problem. copd and cocaine use. the answer is, they don't. some of them are symptoms and some of them are causes of the nutrition problem. however, if you rewrite this nursing diagnosis and say: imbalanced nutrition: less than body requirements r/t failure to eat due to loss of appetite and failure to purchase food aeb weight loss, appears malnourished (skin/hair), and low albumin
, you now have supported your aeb items with some specific logical reasoning. the weight loss, malnourished appearance and low albumin all describe a result, or effect, of (1) failure to eat due to loss of appetite, and (2) failure to purchase food. [note: some schools will permit students to include medical diagnoses and write their nursing diagnostic statements this way: imbalanced nutrition: less than body requirements r/t failure to eat due to loss of appetite and failure to purchase food secondary to copd and cocaine abuse aeb weight loss, appears malnourished (skin/hair), and low albumin
another way to break this down is to think of the diagnostic statement as representing the following:
: not eating enough
: no appetite, doesn't buy food
: weight loss, malnourished appearance, low albumin (abnormal data assessment items)
problem becomes the nursing diagnosis.
etiology becomes the r/t, or related factors, part of the diagnostic statement.
symptoms become the aeb, or defining characteristics, part of the diagnostic statement.
when you are first learning to work with nursing diagnoses, it is important that you have a nursing diagnosis reference book to help you understand the definitions, etiologies and symptoms of each one of the diagnoses so you can formulate these diagnostic statements correctly. one very important thing that makes nursing diagnoses different from medical diagnoses is that nursing diagnoses are based on a person's response and behavior to what is happening to them. in writing nursing diagnosis statements we are trying to stay with basic facts and not move too far into the realm of decision making with determining these patient problems because that takes us into the domain of medicine and the doctor's world. our decision-making expertise comes in the next step of the nursing care process: independent nursing interventions. and that is where we shine!