So ridiculous. | allnurses

So ridiculous.

  1. 0 Was almost done with my nursing care plan until my instructor tells me it's wrong and I should choose another nursing diagnosis! (sigh). Don't. Understand. General info on patient: Patient overweight. Consumes 4 oz liquid /day. No breakfast &snacks throughout the day. Eats 44% of meals but is overweight/ has HTN. Admit reason: pulmonary embolism as a result of deep vein thrombosis caused by bacterial knee surgery. Patient has contractures of upper extremities. Pain and edema in right leg (where thrombosis occurred). Patient refuses physical therapy. Immobile and gets up only to use restroom & bathe--both w/assistance. My dx taken from NANDA: Risk for skin integrity r/t chronic edema secondary to postthrombalitoc syndrome & immobility AEB pitting edema (1+). Subjective: Patient states she discontinued physical therapy. Objective: Patient immobile. Mobility occurs only to bathe and use restroom What is wrong with my DX?? Confused& stressed!!!
  2. 30 Comments so far...

  3. Visit  Katie71275 profile page
    0
    Well what were your other ones? For our care plans we choose our top 3. I wouldn't have skin be the top one.
  4. Visit  cscb2003 profile page
    3
    I would focus more on the PE. Maybe something like, Impaired gas exchanged related to decrease pulmonary perfusion associated with obstruction of pulmonary arterial blood flow by the embolus as evidence by dyspnea, positive for Pulmonary Embolism, and abnormal pulse oximetry. Best of luck!
    Jennybrie, loriangel14, and babsy28 like this.
  5. Visit  KelRN215 profile page
    3
    First "risk for skin integrity" is not a nursing diagnosis. I assume you mean risk for IMPAIRED skin integrity. With everything going on with this patient, I think I agree with your instructor and you need to focus on something else as your priority diagnosis.
  6. Visit  RubberDuckieLove profile page
    2
    Quote from cscb2003
    I would focus more on the PE. Maybe something like, Impaired gas exchanged related to decrease pulmonary perfusion associated with obstruction of pulmonary arterial blood flow by the embolus as evidence by dyspnea, positive for Pulmonary Embolism, and abnormal pulse oximetry. Best of luck!
    Think of your priorities. Yes, skin breakdown is a concern for immobilized patients, but is it your top priority? I would think along of ABCs with this one, as stated above
    OB-nurse2013 and loriangel14 like this.
  7. Visit  EricJRN profile page
    1
    Agree with the above. We need more about the other possibilities you considered. Also, you usually won't have an AEB with a risk-for diagnosis. If there's evidence, that's more than a risk. To clarify, was this a bacterial infection after knee surgery?
    loriangel14 likes this.
  8. Visit  ProfRN4 profile page
    4
    With all due respect, its Not so ridiculous.

    I call these diagnoses the "cheap" ones; add risk for falls, impaired mobility and risk for infection to the list.

    Are they important? Sure. Are they critical? Every patient is at risk for infection, and most are at risk for falls. Don't look for the easy ones, look for the ones that are the most important. And for extra brownie points, look for the ones that show your ability to think and prioritize. Your patient with impaired skin integrity would not be your most important patient. But your S/P PE who is morbidly obese might be.
    RunnerRN2015, psu_213, loriangel14, and 1 other like this.
  9. Visit  Stephalump profile page
    2
    I don't think it's ridiculous, either. Risk for impaired skin integrity is pretty low on the importance list when it comes to someone with something as serious as a PE.
    psu_213 and loriangel14 like this.
  10. Visit  danceyrun profile page
    0
    Our instructors taught us to look at actual problems before risk for problems. I think the only risk for diagnosis they really let us use is risk for aspiration. I agree that there are other (read: more appropriate/higher priority) nursing diagnoses than risk for impaired skin integrity.
  11. Visit  FineAgain profile page
    0
    I agree with everyone here. I never use "risk for" dx unless I have to...and your patient has more important things going on.
  12. Visit  mariaberry19 profile page
    0
    The first one I was going to go with was one for PE. My teacher said it must be a physiologic dx and that you can't use a medical dx (ex:hypertension). PE is the medical dx. The other was something focused on her food/fluid intake and nutrition but I'm lost at which of these to choose (below) bc my patient only drink a total of 12 oz fluid each day, doesn't eat breakfast, hates the food provided by the Nursing home, and eat unhealthy snack throughout the day for meals. BUT get this: shes overweight and has hypertension. You see why I'm confused on which of the two below to use?

    Nutrition Imbalance:Less Than Body Requirements
    Or
    Nutrition Imbalance: MoreThan Body Requirements
  13. Visit  RescueNinjaKy profile page
    1
    I think your priority nursing dx would probably be something like decreased cardiac output r/t htn, or dehydration. find out what your pt's diet is supposed to be. if theyre consuming more than what it is supposed to be then less than body reqs. and maybe risk for impaired gas exchange r/t pe or something. but your priority would definitely be the respiration, htn, then diet/skin
    loriangel14 likes this.
  14. Visit  lwhitten profile page
    0
    We are discouraged to use"risks" when patients could actually have so much more.

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