I searched for the answer to this, but i'm not quite sure how these (and other NS Dx) relate to my pt. This is the deal:
63 yr old, male, raging psoriasis all over his arms, legs, buttocks, back. Shiny taut skin, and edema in his lower legs and feet made his feet ROCK hard. (Is this worse than pitting? It's like they were cement!) Toenails were thick, crusty and too long, and they smelled awful (Not being mean, this comes into play later). He was overweight (5'8", 260lbs).
When I cared for him, he was 6 days post-CABG. However, his DMT2 was out of control and he was on a continuous Insulin infusion and O2, 2L nc (needed at rest as well). When we changed his chest bandage we also changed his Interdry AG pad, and he had skin breakdown and topical yeast under the fold of his abdominal fat. It was painful for him for us to clean him up. He said he was dying to get home and take a shower, and that the nurses didn't bathe him very well here. (He is in a great hospital with very competent nurses!) He also says he uses one of those shower heads that is attached to a hose so he can "get everything clean." However, when my co-student and I told him we were going to bathe him, he persisted and attempted to make lots of excuses of why we couldn't. But, we got it done, and I don't believe the talk about how his baths at home are better and his nurses don't care. Also, just an fyi, when he has a BM, he needs assistance from the CNA or RN with proper cleansing. We asked him how he managed at home (he has a wife but didn't mention her helping) and he said he does what he has to do. He was embarrased and my co student backed off at that point (I wasn't in there) but i don't think he gets the job done adequately. It's very sad.
He has some elevated labs (BUN, creatinine, K+, glucose, etc) and I am fine with interpreting those. Basically, your usual heart and diabetes labs. He was admitted with a K+ of 9 (yikes!) but it is dropping systematically though it's still a bit elevated.
This is my issue with care plans - yes he is a heart pt technically, but this guy doesn't take care of himself period. I don't think his biggest problem is heart related. He mentioned wanting someone just to "tell me what to eat. Just give me a menu and I will eat it." So i don't think he is overly educated on controlling his DB or if he is, he has been apathetic about being able to change his health.
So is my ns dx Ineffective health care maintenance or is it Self Care Deficit? Or both? And can these trump and more physiological Dx such as Decreased cardiac output? Our care plans only have to have 2 ns dx and they are certainly supposed to be in order of importance, but this guy is low income, low education level and I am worried that his overall issues and lack of compliance are going to cause more problems than his heart issue. Or, am I supposed to put aside what I THINK he is going to do, and believe him when he says he will eat what's on his "menu"? By the way, he eats eggs for breakfast - every morning - and that's not going to change. He said he will eat what we tell him to for Lunch and Dinner.
I know that this is kinda vague, but i think that's the important aspect of all of this. This is more than just a "labs and diagnostic test results" issue. This guy is slowly killing himself.