Diff btwn Self care deficit and Ineffective Hlth Maint.

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    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.
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  4. 1
    Quote from Kef89
    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.
    During my schooling for LPN and now during my LPN to RN bridge, we had to put the in priority order..and ABC always trumped self care deficit or health care maintenance. He's in the hospital for CABG, his edema is due to his heart issues, he's on continuous O2 and his K+ is way too high! His heart condition certainly take priority over his health care maintenance and/or his self care deficit.

    While you could use one of the two you mentioned, if I were you, I'd be sure to put a cardiac related on that care plan. However, I would go with Imbalanced nutrition, more than body requirements (he's eating too much and too much of the wrong foods, which you can use for both the cardiac AND IDDM dx) over the care deficit. You left out some info, but I'd have to assume he's got some pain which is r/t the CABG, that trumps the two you want to use. Basically, if it were my care plan..the two you want to use would be pretty far down my list.

    If you say your care plans are "certainly supposed to be in order of importance", I'd say, you already know your answer..don't put one or the other as a priority over cardiac.

    You could incorporate Ineffective Health Care Maintenance with the cardiac AND IDDM dx because the r/t factors are deficient knowledge regarding postprocedural care (his CABG), lifestyle adjustment after surgery (r/t both his CABG and his IDDM). the lifestyle adjustments would include changing his diet..not only does his bad food choices affect his DM, it for sure affects his heart and arteries.

    Hope that makes some sense.
    Esme12 likes this.
  5. 0
    I look and them as one is habit/lifestyle/social economic and the other "disease" like stroke. I agree that the CABG is first as it is the most pressing and present but the other will need to be solved/cared for before he goes home. But don't forget how hard it is to be poor and on a fixed income. Many have to choose between medicine and eating/warmth/rent.....healthy organic food is expensive. They are too proud/embarrassed to admit it and want to remain fiercely independent. It's great to point it out but realistically difficult to change.

    Ineffective Health Maintenance
    NANDA-I Definition: Inability to identify, manage, and/or seek help to maintain health
    Ineffective health maintenance reflects a change in an individual's ability to perform the functions necessary to maintain health or wellness. That individual may already manifest symptoms of existing or impending physical ailment or display behaviors that are strongly or certainly linked to disease. The nurse's role is to identify factors that contribute to an individual's inability to maintain healthy behavior and implement measures that will result in improved health maintenance activities. The nurse may encounter these patients either in the hospital or in the community; the increased presence of the nurse in the community and home health settings improves the ability to assess patients in their own environment. Patients most likely to experience more than transient alterations in their ability to maintain their health are those whose age or infirmity (either physical or emotional) absorb much of their resources or those for whom the economic challenges of daily life negate an interest in personal health. The task before the nurse is to identify measures that will be successful in empowering patients to maintain their own health within the limits of their ability.
    Common Related Factors
    Perceptual/cognitive impairment
    Presence of physical disabilities or challenges
    Presence of adverse personal habits:
    • Smoking
    • Poor diet selection
    • Morbid obesity
    • Alcohol abuse
    • Drug abuse
    • Poor hygiene
    • Lack of exercise
    Low income/lack of material resources
    Lack of access to care
    Lack of knowledge
    Poor housing conditions
    Ineffective coping
    Risk-taking behaviors
    Inability to communicate needs adequately (e.g., deafness, speech impediment)
    Dramatic change in health status
    Lack of support systems
    Denial of need to change current habits

    Self-Care Deficit
    NANDA-I Definition: Impaired ability to perform or complete activities of daily living for oneself, such as feeding, dressing, bathing, toileting
    . The deficit may be the result of transient limitations, such as those one might experience while recuperating from surgery, or the result of progressive deterioration that erodes the individual's ability or willingness to perform the activities required to care for himself or herself. Careful examination of the patient's deficit is required in order to be certain that the patient is not failing at self-care because of a lack of material resources or a problem with arranging the environment to suit the patient's physical limitations. The nurse coordinates services to maximize the independence of the patient and to ensure that the environment the patient lives in is safe and supportive of his or her special needs. This care plan combines a variety of self-care deficits into one comprehensive plan.
    Common Related Factors
    Neuromuscular impairment
    Musculoskeletal impairment
    Impaired mobility or transfer ability
    Cognitive impairment
    Perceptual impairment
    Fatigue, weakness
    Pain
    Severe anxiety
    Decreased motivation
    Environmental barriers

    Defining Characteristics
    Inability to feed self independently
    Inability to dress self independently
    Inability to bathe and groom self independently
    Inability to perform toileting tasks independently
    Inability to transfer from bed to wheelchair
    Inability to ambulate independently
    Inability to perform miscellaneous common tasks such as telephoning and writing
    Gulanick: Nursing Care Plans, 7th Edition

  6. 1
    Thanks a bunch! I appreciate both of your perspectives!
    Esme12 likes this.
  7. 1
    as for people who can't reach to clean themselves after bms, there's an app for that. well, no, not an app, but there are some nifty gadgets made for use by people with mobility or dexterity issues. honest. do the poor guy a favor and get him one. disclaimer: no financial interest in this product.

    personal hygiene wand: home | freedom wand
    the freedomwandŽ is a multi-task, multi-length tool; it holds an ointment pad, loofah or lightweight wash cloth, disposable shaver and the all-important toilet tissue. the freedomwand can be used from 7-30" and comes with a cloth carry bag. it’s specifically designed for personal cleaning and hygiene for anyone with limited mobility. the easy to use slide button releases tissue into the toilet with little effort. the freedomwandŽ is made from a polypropylene material, making it very durable and easy to clean. it is also designed with a rinse hole in the head to aid in easy cleaning.
    Esme12 likes this.
  8. 1
    Thanks GrnTea - I haven't looked at your link yet, b/c i'm afraid i'll get off track (trying to study). But i will, and i thank you in advance!

    :-)
    Esme12 likes this.


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