Are Nursing Dx "Malleable"?

Nursing Students Student Assist

Published

Hiya Folks,

Ok here is my problem. I am in the 2nd semester of an AAS RN Program, we were assigned a care plan and a nutrition assignment based on the same patient as our care plan. My patient's primary Dx was wound dehescence R/T nonunited trimaleolar Fx to the Left ankle. 74 year old pt coming from a LTC facility. 3 weeks post Fx debriedment and Friedman irrigation w/positive pressure placed. Pt has comorbidity of hyponatremia (122), dementia, COPD, Cerebrovascular disease, anemia, osteoporosis, seizure disorder, osteoarthritis, arthrodesis of Left ankle. His BMI is 20.48 which is within norms for a 6' 155lb male.

As I understand it, there is no "at risk" NANDA Dx, so the only Dx I could see was "Imbalanced Nutrion: less than body requirements R/T risk for deficient fluid volume AEB Hyponatremia and 1500cc Fluid restriction. I could also use R/T appetite because he is on Marinol. I just don't know if what I am doing is a "stretch" or justified? Because he is not malnourished "right now" I am having difficulty figuring this out. If any of you could point me in the right direction, I would be so grateful! Thank you in advance!

You don't have an NDX book? There are several "risk for" NDX's- including at least 2 specifically nutrition-related ones. Your program is probably just discouraging you from using "risk for" NDX's to keep you more focused on the short term. An MDX or condition is NOT an NDX.

The general format for an NDX goes like this:

1. (NDX)

2a. related to (etiology or cause)

and/or

2b. secondary to (MDX)

3. as evidenced by (prominent sign or symptom).

Note: "Risk for" NDX's don't have the as evidenced by.

You put it together like this:

NDX r/t etiology aeb sign or symptom.

Hope this helps.

Thank you, and yes I do have a NDx book and there is ZERO "at risk" in the book. The 3 options are Imbalance less, more or Adult failure to thrive R/T malnutrion :confused: My anxiety is related to the fact that the entire paper hinges on getting this Dx correct.

Specializes in Gerontological, cardiac, med-surg, peds.

http://www.amazon.com/Nursing-Diagnoses-2009-2011-Definitions-Classification/dp/1405187182#reader_1405187182

http://my.clevelandclinic.org/healthy_living/nutrition/hic_nutrition_guidelines_to_improve_wound_healing.aspx

One I might try would be:

Imbalanced Nutrition: Less Than Body Requirements r/t increased metabolic need for calories, protein, vitamins, and minerals to promote healing of wound and fracture, and insufficient intake AEB nonhealing fracture to left ankle, wound dehiscence, anemia, thinning of bones due to depletion of calcium stores and protein in bones (osteoporosis), and poor appetite

Hope this helps :)

+ Add a Comment