i am finding it very difficult to understand what you are talking about. you have listed nursing diagnoses that were corrected by your instructor for a ncp 1
and ncp 2
but said originally that you were working on your second care plan
. wouldn't that mean you are working on your third care plan?
please understand that when i spend a few hours working on a care plan for someone it is based on the information you post. i assume you have posted the pertinent information. when you come back with a whole bunch of other information you need to add it to what i've done. there are other students who post on these forums who are also looking for help.
prioritizing of diagnoses should be done by maslow's hierarchy of needs. i don't think that your instructors asking you to assess patients using maslow's terminology is a mistake. did you miss something in the lectures about assessing patients and how your nursing program expects patients to be assessed? the coincidence is just too uncanny for it not to be noticed. to assess a patient's self-actualization was like being hit in the face by maslow himself.
i would recommend that you get a book that includes the nanda taxonomy information in it. you needto see the definitions, related factors and defining characteristics that go along with each of these diagnoses that you are using.
alteration in tissue perfusion-peripheral related to decrease hemoglobin concentration in blood as evidenced by left leg edema, she crossed out "by left leg edema" and wrote "cool, pale". i chose edema b/c it was listed in the nursing diagnosis book by doenges. i thought this applies to the client.
the aeb stuff is proof--evidence. it is a symptom of this problem and must be present if you list it. if you list edema, then you are saying the patient has edema in the left leg. they would have edema if that was a symptom of the disease they had. if cool and pale was the manifestation, or symptom, of their disease then that was the better and correct answer.
other diagnoses are not from the care plan, but they are diagnoses from different assessments that we were assigned for the week and got red marks:
>>impaired tissue integrity related to impaired physical mobility manifested by damaged tissue (pressure ulcer stage ii and stage iv on the right foot)
risk for unstable blood glucose related to physical immobility/ limited activity level
>>activity intolerance related to immobility as evidenced by left side weakness and not able to get out of bed without assistance.
the symptoms on this have to be related to hypoxia or intolerance of activity because of not enough oxygen. "left side weakness" is too broad and does not apply to this diagnosis and "not able to get out of bed without assistance" belongs with impaired bed mobility.
>>impaired physical mobility related to neuromuscular impairment as evidenced by left side weakness for this one she crossed "left side weakness" and wrote "unable to start or transfer into w/c by self"
i would tend to agree. what is left side weakness? it is very vague and not descriptive at all of how the patient's movement is damaged (impaired). the information following "as evidenced by" is always the proof of the problem. impaired physical mobility is limited movement of one or more extremities. "left side weakness' just doesn't describe that very well.
>>self care deficit: bathing/hygiene, dressing/grooming, and toileting related to neuromuscular impairment as evidenced by left side weakness "evidenced by left side weakness" was crossed out.
same problem as above. this diagnosis is the impaired ability to perform bathing and hygiene for oneself. "left side weakness" is not proof of how the patient fails to wash their face or brush their teeth.
>>alteration in comfort: pain related to immobility evidenced by left side weakness "immobility evidenced" was crossed out
i ring my call light. you come in the room. i say, "nurse, i have left side weakness." and from that you know to give me pain medication? you must tell me where you got your crystal ball. evidence of pain is the patient telling you they are in pain or the patient limiting their movement to avoid pain and other such symptoms. alteration in comfort: pain r/t immobility aeb protective gestures and positioning to avoid pain.
>>deficient diversional activity deficit related to physical limitations as evidenced by left side weakness
this is a diagnosis about boredom and the patient who is bored because of having to be confined because of their illness so they can't do the things they normally do. again, "left side weakness" is not a symptom of boredom. deficient diversional activity related to physical limitations as evidenced by patient's statement that he wished there was something he could do.
assessment for the 2 diagnosis on the bottom:
nail bed on feet- hard, yellow; exposed to respiratory irritant- air from ventilation (smells unpleasant), cleaning chemical used on the floor; feels pain, sometimes, on the left leg-left side hemiplegia due to cva (resident described as severe); irregular apical rhythm. history of htn, chf, cva, diabetes. takes furosemide 40mg tab-1 tab by mouth every day (diuretic); metoprol 25mg tab-1/2 tab (12.5 mg) by mouth twice daily (antihypertensive and cardiac medication). low co2 level: 19meq/l (normal:20-37meq/l)
>> activity intolerance related to immobility as evidenced by left side hemiplegia "left side hemiplegia" was crossed out
this is a diagnosis about hypoxia and oxygenation. you have to recognize the s/s of hypoxia as a result of activity. "left side hemiplegia" was just way off base. activity intolerance related to immobility as evidenced by irregular apical rhythm and low co2 level of 19meq/l
>>alteration in comfort-pain to immobility as evidenced by left side hemiplegia "to immobility as evidenced by" was crossed out
the scenario states: alteration in comfort-pain to immobility as evidenced by resident description of severe pain in left leg.
she just included another diagnosis:
risk for altered tissue perfusion
risk for altered tissue perfusion r/t interrupted blood flow (patient has hard yellow nails on feet indicating compromised circulation to the lower extremities)
risk for decreased cardiac out put
risk for decreased cardiac output r/t altered heart rhythm (patient has an irregular apical rhythm)