- 0Apr 18, '13 by mariaberry19Was 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!!!
- 3Apr 18, '13 by cscb2003I 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!
- 3Apr 18, '13 by KelRN215, BSN, RNFirst "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.
- 2Apr 18, '13 by RubberDuckieLoveQuote from cscb2003Think 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 aboveI 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!
- 1Apr 18, '13 by EricJRNAgree 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?
- 4Apr 18, '13 by ProfRN4With 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.
- 0Apr 18, '13 by danceyrunOur 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.