hi, lhopeful, and welcome to allnurses!
first of all, you are incorrect to call "nursing diagnoses" nandas. actually, people don't know what you are talking about when you refer to them that way.
second, i can tell from the questions you have posted that you don't have the first clue of how to go about writing a care plan which includes choosing nursing diagnoses, in this case, 7 nursing diagnoses that your instructor would like you to develop for your patient. so, let me start out with the basics of care planning.
a care plan is nothing more than the written documentation of your critical thinking process. it documents your use of the nursing process. the nursing process is nothing more than the way we determine a patient's problems and solve them. you are being taught this method in nursing school because it is something you will need to use as a nurse from your days as a student until you retire from nursing. it is the single most important thing you are supposed to learn in nursing school. so, you need to know the steps of the nursing process and what goes on in each step. you will use this method to help you solve all kinds of situations in nursing. the steps of the nursing process as they relate to care plan writing are:
- assessment (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
- determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
- planning (write measurable goals/outcomes and nursing interventions)
- implementation (initiate the care plan)
- evaluation (determine if goals/outcomes have been met)
you must follow these steps in the sequence in which they occur. from what i gather from your posts you have bypassed step #1 and gone right for step #2 and you can't do that
. this is one reason why you are stuck trying to come up with nursing diagnoses.
you don't have the required background information to support any nursing diagnoses at the point you are at in writing this care plan.
you want to use the nursing diagnosis of disturbed body image.
however, did you know that nanda has provided the following information about this particular diagnosis (page 19-20, nanda-i nursing diagnoses: definitions & classification 2007-2008
(the real patient problem): confusion in mental picture of one's physical self
related factors (etiology, or cause): biophysical, cognitive, cultural, developmental changes, illness, illness treatment, injury, perceptual, psychosocial, spiritual, surgery, trauma
defining characteristics (symptoms)
[your patient must have one or more of these]:
- behaviors of acknowledgement of one's body, behaviors of avoidance of one's body, behaviors of monitoring of one's body, nonverbal response to actual change in body (e.g., appearance, structure or function), nonverbal response to perceived change in body (e.g., appearance, structure, or function), verbalization of feelings that reflect an altered view of one's body (e.g., appearance, structure, function), verbalization of perceptions that reflect an altered view of one's body in appearance
- actual change in function, actual change in structure, behaviors of acknowledging one's body, behaviors of monitoring one's body, change in ability to estimate spatial relationship, change in social involvement, extension of body boundary to incorporate environmental objects, intentional hiding of body part, missing body part, not looking at body part, not touching body part, trauma to nonfunctioning part, unintentional hiding of body part, unintentional overexposing of body part
- depersonalization of loss by impersonal pronouns, depersonalization of part by impersonal pronouns, emphasis on remaining strengths, fear of reactions by others, fear of rejection by others, focus on past appearance, focus on past strength, heightened achievement, negative feelings about body (e.g., feelings of helplessness, hopelessness or powerlessness), personalization of loss by name, personalization of part by name, preoccupation with change, preoccupation with loss, refusal to verify actual change, verbalization of change in lifestyle
every single nanda diagnosis has a definition, related factor and defining characteristics that nanda has worked out already for us. more about this later.
a diagnosis is the resulting decision or opinion that one makes after the process of examination or investigation of the facts has been completed. your post gives no evidence that you did an assessment of this patient although i'm sure you probably did. everything you discovered in assessing this patient is important in determining what their nursing problems are going to be. everything. assessment, the first step of the nursing process is the most important action(s) because everything else to follow is dependent upon what you discovered. during assessment you must:
- do a physical assessment of the patient (your basic head-to-toe or systems physical exam)
- assess the patient's ability to perform adls (activities of daily living)
- collect data from their medical record (chart)
- look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology
all of the information you learn during your assessment activity is going to be necessary to complete various parts of the written nursing care plan.
now, here is the one thing that you didn't know that is going to save you in writing care plans for the remainder of your nursing school career:
everything in the care plan (nursing diagnoses, goals and nursing interventions) is based upon the defining characteristics (symptoms, abnormal data) that you found when you assessed the patient.
tattoo that to your arm. that is the secret to successful care planning. knowing the patient's medical diagnosis or what surgery they had is helpful only so far as why it was done and what symptoms or responses the patient has had to them. the pathophysiology of these conditions yields to you the underlying causes (related factors that become the "r/t" parts of your nursing diagnostics statements) of their nursing problems (or, nursing diagnoses).
read over those last few paragraphs until that information sinks into your brain. stop and do that now because it is important. if you don't take the time and effort to assess and collect data on a patient and then pick out what is abnormal (their symptoms), you will never be able to write a good quality care plan that will be of any benefit to a patient. worse, you won't please your instructors or get a good grade on the care plans you do come up with. wouldn't you rather know what and why you are doing something than just take pot shots in the dark and hope you did ok?
now, once you have accomplished step #1, you move on to step #2. before you go off looking for nursing diagnoses, you first make a list of all the patient's abnormal assessment data. this becomes your patient's "symptom list". the nursing diagnoses, goals and nursing interventions are all based upon the symptoms that are on this list. this list is the foundation of the remainder of the care plan.
we, like the doctors, address and treat the symptoms that our patients are having. doesn't that make sense?
with regard to choosing nursing diagnoses. . .every nanda nursing diagnosis, like disturbed body image
has a list of defining characteristics (symptoms). before you assign any nursing diagnosis to any patient, you should be consulting a nursing diagnosis reference to make sure you are diagnosing the patient correctly. do you think a medical student would just randomly assign a medical diagnosis to a patient? why would you want to carelessly do that? we have the nanda information to help us out here. the nanda information on diagnosing is reprinted in many care plan books on the market as well as in the little pocket book that i use all the time (nanda-i nursing diagnoses: definitions & classification 2007-2008
). if you don't have any of these tools, there are approximately 75 of the most commonly used nursing diagnoses with their nanda information that you can access on the internet for free along with goals and nursing interventions (as a bonus) at these two websites:
here is the link to disturbed body image
that you want to use: [color=#3366ff]disturbed body image
. until, like a medical student, you become familiar with the signs and symptoms of any particular diagnosis you need to be using a nanda reference for any nursing diagnosis you tack onto some patient's care plan. that is part of learning to be a responsible nursing practitioner. eventually, and over time with continued use, you learn the signs and symptoms of the nursing diagnoses you use most often.
now, unfortunately, i can't help you choose any nursing diagnoses for this patient because you didn't list any of your assessment information. i would recommend that you do not even consider using any of the nursing diagnoses that were suggested to you here without going through the nursing process as i have explained it to you above. you'll run into all kinds of stumbling blocks, particularly if your patient doesn't have the symptoms to qualify to be tagged with any of those diagnoses.
i urge you to go back through your assessment data. look up information about colostomy surgery (http://www.surgeryencyclopedia.com/ce-fi/colostomy.html
). what part of the colon was altered for the colostomy? this will have an impact on the aftercare. there are websites on the internet about colostomies where you can find information about the psychosocial aspects of them to see if your patient has any of these problems. you can also find good interventions for your care plan on these sites as well. this is part of the learning you must do as a nursing student. also, remember that this is a surgical patient who underwent general anesthesia so you must keep in mind the complications of general anesthesia that can occur.
- breathing problems (atelectasis, hypoxia, pneumonia, pulmonary embolism)
- hypotension (shock, hemorrhage)
- thrombophlebitis in the lower extremity
- elevated or depressed temperature
- any number of problems with the incision/wound (dehiscence, evisceration, infection)
- fluid and electrolyte imbalances
- urinary retention
- surgical pain
- nausea/vomiting (paralytic ileus)
something you didn't mention in your posts which i wanted to know off the bat was why this colostomy was done in the first place. what was the underlying disease process that led to the colostomy surgery? my mother had a colostomy (talk about body image problems--she drove me up the wall with the attention she paid to it!) and it was done for severe diverticulosis. what was this patient's colostomy done for? and i am always amazed at the people who are quick to suggest nursing diagnoses without the benefit of assessment data because no one ever suggests impaired tissue integrity
for these surgical patients. these surgery patients have been cut into and have incisions and wounds that need monitoring and sometimes need attention--everyone seems to forget about that.
if you want assistance with choosing and prioritizing this patient's nursing diagnoses you will need to post a list of the abnormal data (symptoms, defining characteristics) for me so i can show you how it's done. prioritization is done by me according to maslow's hierarchy of needs. and, if you don't post anymore, good luck with this care plan. however, i hope you do read what i have written for you and take the advice seriously. i given you a lot to think about.