Diagnosis for Refusal of Therapy

Daytonite, BSN, RN · Dec 6, 2009

so, think about how this information

reliant on staff to perform her adls (self-care deficits)
has full use of her arms but refuses to do her own hair, showers and oral care (bathing/hygiene self-care deficit)
history of choking (risk for aspiration)
has a colostomy and the staff does the colostomy care (risk for impaired skin integrity or ineffective health maintenance)
refuses all therapies (speech, ot & pt) (impaired verbal communication, impaired physical mobility, ineffective health maintenance)
erickson stage of development...integrity vs. despair - what does she show more symptoms of? integrity or despair? how? what are her symptoms? (ineffective coping, chronic sorrow, hopelessness, social isolation)

translates into nursing diagnoses? every one of the above can be turned into nursing diagnoses depending on her symptoms. don't let her attitude be too influencing on you when diagnosing--look at facts. you need to look at a nanda list that includes the taxonomy and look at the definitions of the diagnoses to help you decide what applies here. the appendix of taber's cyclopedic medical dictionary includes the nanda taxonomy. there is also evidence you would have collected that supports using these diagnoses. you don't just diagnose a bathing/hygiene self-care deficit for no reason. the etiology may simply be her lack of motivation or that she is stubborn. it doesn't matter. the problem is that she won't do it herself and she has to be assisted because she won't do anything to initiate a bath, remove her clothes or wash her body. because she won't otherwise bathe, her problem is an impaired ability to perform or complete bathing/hygiene activities for self (page 153, nanda international nursing diagnoses: definitions and classifications 2009-2011) and that is what a bathing/hygiene self-care deficit is.

OCD_Mom · Dec 7, 2009

Thank you so much...the book we have for NANDA really does not break it down that well and I have spent the last 12 hours trying to decipher the meanings of everything. Sometimes the line is so gray as to what would be the most fitting diagnosis. Especially with a patient with so many chronic and interlated health issues. Diabetes Mellitus, Renal Failure, HTN, Osteoporosis....I guess I am getting a good breaking in right away.

Thanks again!

Daytonite, BSN, RN · Dec 7, 2009

it takes working with the diagnoses to learn them. read the definitions as you use them. the related factors are common causes, or reasons, why that particular problem would happen. the defining characteristics are the common signs and symptoms a patient may have of the problem. when you read through the lists you will find that they are very broad in some cases. in others, particularly for the physiologic problems, they are physical signs and symptoms (ex: excess fluid volume lists the signs and symptoms of overhydration; acute pain gives a long list of the signs and symptoms of pain).

the taxonomy is printed and sold by nanda and can be purchased from them. it is also published in a number of commercial printings by other publishers and in some current care plan books.

nanda international nursing diagnoses: definitions and classifications 2009-2011 published by nanda international for $34.99 contains the complete taxonomy. i have a copy of this and refer to it all the time. 2009-2011 diagnoses summary list reference card has all 206 current diagnoses on it costs $7. see this website: http://www.nanda.org/marketplace/nandaipublications.aspx

OCD_Mom · Dec 7, 2009

thanks so much I think I will be requesting a book for Christmas