Does this nursing diagnosis makes any sense?

  1. My patient was a 40 yes old with dka.
    So I came up with a diagnosis of knowledge deficit rt diabetes condition as evidence by DKA. I know it sounds so stupid but my instructor makes us write out three of them with 5 interventions with only a 15 min break. And he made it clear that if the diagnosis didn't make any sense we would fail clinical. I have a month left to graduate and we didn't really do care plans until now. Any advice?
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  2. 13 Comments

  3. by   Castiela
    It makes sense but it wouldn't be my priority diagnosis, especially if it is an acute dka. What other more relevant problems that dka can cause
  4. by   canoehead
    Looks ok to me.
  5. by   seaofclouds21
    When I was in nursing school, we were told to never use a medical diagnosis (Diabetes or DKA for example) in our nursing diagnosis. So, instead of it being a knowledge deficit r/t diabetes, we would say a knowledge deficit r/t management of blood glucose levels (etc) and instead of saying aeb DKA, you would want to list the s/s they have of the DKA (elevated blood glucose, etc).

    What are the other two nursing diagnoses you came up with?
  6. by   KrCmommy522
    Quote from seaofclouds21
    When I was in nursing school, we were told to never use a medical diagnosis (Diabetes or DKA for example) in our nursing diagnosis. So, instead of it being a knowledge deficit r/t diabetes, we would say a knowledge deficit r/t management of blood glucose levels (etc) and instead of saying aeb DKA, you would want to list the s/s they have of the DKA (elevated blood glucose, etc).

    What are the other two nursing diagnoses you came up with?
    My school was pretty much the same. We had nursing instructors here or there that let it pass. But for the most part, the instructor's didn't like us using medical diagnoses in our nursing diagnoses. So, I just made sure I didn't every time just to be safe.

    You have a month left to graduate and are just doing care plans now? Wow! I started doing them in my first semester and did them all the way until the end when I graduated!
  7. by   Esme12
    Quote from mzsuccess
    My patient was a 40 yes old with dka.
    So I came up with a diagnosis of knowledge deficit rt diabetes condition as evidence by DKA. I know it sounds so stupid but my instructor makes us write out three of them with 5 interventions with only a 15 min break. And he made it clear that if the diagnosis didn't make any sense we would fail clinical. I have a month left to graduate and we didn't really do care plans until now. Any advice?
    You are one month away from discharge and have not completed a care plan...that is not the norm.

    A care plan is like a recipe card on how to care for your patient so that anyone after you will know what to do and look out for on that patient. Your nursing "diagnosis" is all about the patient assessment and patient needs. You "choose" the patient needs by priority by what will make them the sickest the fastest.

    DKA that is the medical diagnosis. The patient assessment is the diagnosis.

    The biggest thing about a care plan is the assessment, of the patient. the second is knowledge about the disease process. first to write a care plan there needs to be a patient, a diagnosis, an assessment of the patient which includes tests, labs, vital signs, patient complaint and symptoms.

    The medical diagnosis is the disease itself. it is what the patient has not necessarily what the patient needs. the medical diagnosis is what the patient has and the nursing diagnosis is what are you going to do about it, what are you going to look for, and what do you need to do/look for first.

    Care plans when you are in school are teaching you what you need to do to actually look for, what you need to do to intervene and improve for the patient to be well and return to their previous level of life or to make them the best you you can be. It is trying to teach you how to think like a nurse.

    Think of them as a recipe to caring for your patient. Your plan of care.

    Every single nursing diagnosis has its own set of symptoms, or defining characteristics. they are listed in the NANDA taxonomy and in many of the current nursing care plan books that are currently on the market that include nursing diagnosis information. You need to have access to these books when you are working on care plans. there are currently 188 nursing diagnoses that nanda has defined and given related factors and defining characteristics for. what you need to do is get this information to help you in writing care plans so you diagnose your patients correctly.

    Don't focus your efforts on the nursing diagnoses when you should be focusing on the assessment and the patients abnormal data that you collected. These will become their symptoms, or what Nanda calls defining characteristics.

    Here are the steps of the nursing process and what you should be doing in each step when you are doing a written care plan:

    ADPIE

    assessment (collect data from medical record, do a physical assessment of the patient, assess adls, 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)

    a care plan is nothing more than the written documentation of the nursing process you use to solve one or more of a patient's nursing problems. the nursing process itself is a problem solving method that was extrapolated from the scientific method used by the various science disciplines in proving or disproving theories. one of the main goals every nursing school wants its rns to learn by graduation is how to use the nursing process to solve patient problems.

    "care plan reality: the foundation of any care plan is the signs, symptoms or responses that patient is having to what is happening to them. what is happening to them could be a medical disease, a physical condition, a failure to be able to perform adls (activities of daily living), or a failure to be able to interact appropriately or successfully within their environment. therefore, one of your primary aims as a problem solver is to collect as much data as you can get your hands on. the more the better. you have to be a detective and always be on the alert and lookout for clues. at all times. and that is within the spirit of step #1 of this whole nursing process."

    assessment is an important skill. it will take you a long time to become proficient in assessing patients. assessment not only includes doing the traditional head-to-toe exam, but also listening to what patients have to say and questioning them. history can reveal import clues. it takes time and experience to know what questions to ask to elicit good answers. part of this assessment process is knowing the pathophysiology of the medical disease or condition that the patient has. but, there will be times that this won't be known. just keep in mind that you have to be like a nurse detective always snooping around and looking for those clues.

    a nursing diagnosis standing by itself means nothing. the meat of this care plan of yours will lie in the abnormal data (symptoms) that you collected during your assessment of this patient. in order for you to pick any nursing diagnoses for a patient you need to know what the patient's symptoms are.

    "care plan reality: is actually a shorthand label for the patient problem. the patient problem is more accurately described in the definition of this nursing diagnosis (every nanda nursing diagnosis has a definition). [thanks daytonite]

    take a look at the information you collected on the patient during your physical assessment and review of their medical record. start making a list of abnormal data which will now become a list of their symptoms. don't forget to include an assessment of their ability to perform ADLS (because that's what we nurses shine at). what i would suggest you do is to work the nursing process from step #1

    The ADLS are bathing, dressing, transferring from bed or chair, walking, eating, toilet use, and grooming. and, one more thing you should do is to look up information about symptoms that stand out to you. what is the physiology and what are the signs and symptoms (manifestations) you are likely to see in the patient. did you miss any of the signs and symptoms in the patient? if so, now is the time to add them to your list.

    This is all part of preparing to move onto step #2 of the process which is determining your patient's problem and choosing nursing diagnoses. but, you have to have those signs, symptoms and patient responses to back it all up.
  8. by   mzsuccess
    So this can really fail me this term, I was so in a rush I put DKA stupidly. No none of our clinicals we did nursing diagnosis but one, long long time ago in the beginning so now it's back in our face and we're kinda stuck. This care plan determine if I go on or not
  9. by   KrCmommy522
    Quote from mzsuccess
    So this can really fail me this term, I was so in a rush I put DKA stupidly. No none of our clinicals we did nursing diagnosis but one, long long time ago in the beginning so now it's back in our face and we're kinda stuck. This care plan determine if I go on or not
    You didn't necessarily fail. Some instructors and/or schools don't mind a medical diagnosis in the nursing diagnosis. It's just not actually correct. However, as I said in my earlier post - the school I graduated from didn't like you using medical diagnoses in your nursing diagnoses, BUT some instructor's didn't mind and other's wanted it done correctly. So, you'll just have to wait and see how your instructor grades it if you've already turned it in.

    It's really unfortunate that you haven't done nursing care plans up until this point! It is really what helps you learn to think critically and see the whole picture. You are able to tie the patient's medical history, diagnosis, pathophysiology, common signs/symptoms for the diagnosis, and signs/symptoms the patient is exhibiting together to see the entire picture. Then, you are able to work through how you would care for the patient - what takes priority (important thing to learn - how to prioritize), and what you need to do to care for your patient based on those diagnoses, and how to evaluate the patient.

    It seems crazy that the instructor would be too hard on you if you've only done nursing diagnoses once in the very beginning and never again since then. But, you just never know!

    Did you do concept maps or something? It's just so crazy to me the thought of no care plans!!
  10. by   mzsuccess
    Quote from KrCmommy522
    You didn't necessarily fail. Some instructors and/or schools don't mind a medical diagnosis in the nursing diagnosis. It's just not actually correct. However, as I said in my earlier post - the school I graduated from didn't like you using medical diagnoses in your nursing diagnoses, BUT some instructor's didn't mind and other's wanted it done correctly. So, you'll just have to wait and see how your instructor grades it if you've already turned it in.

    It's really unfortunate that you haven't done nursing care plans up until this point! It is really what helps you learn to think critically and see the whole picture. You are able to tie the patient's medical history, diagnosis, pathophysiology, common signs/symptoms for the diagnosis, and signs/symptoms the patient is exhibiting together to see the entire picture. Then, you are able to work through how you would care for the patient - what takes priority (important thing to learn - how to prioritize), and what you need to do to care for your patient based on those diagnoses, and how to evaluate the patient.

    It seems crazy that the instructor would be too hard on you if you've only done nursing diagnoses once in the very beginning and never again since then. But, you just never know!

    Did you do concept maps or something? It's just so crazy to me the thought of no care plans!!
    Right, but I remember not using a medical diagnosis so I think you're right. We never did nursing careplans in clinical but once, the other times we did them was projects and the instructors there said they were good. That was like 5 months ago. Now he comes out the blue telling us it could fail us for clinical
  11. by   KrCmommy522
    Quote from mzsuccess
    Right, but I remember not using a medical diagnosis so I think you're right. We never did nursing careplans in clinical but once, the other times we did them was projects and the instructors there said they were good. That was like 5 months ago. Now he comes out the blue telling us it could fail us for clinical
    Ahhh, I see. Well, again, if you guys haven't really done a lot of them. I don't see the instructor being too harsh. But you just never really know. No use stressing about it though! The diagnosis is ok. It just uses a medical diagnosis in it. Other than that its okay. So, the instructor might take into consideration that you have't done many.

    Well at least you've done them for projects before. I've just never heard of nursing students not doing care plans or doing concept maps if they don't do care plans. So, I was just curious if you did something else in place of the care plans, like concept maps. Did you do any kind of paperwork you had to turn in after clinicals?
  12. by   mzsuccess
    Quote from KrCmommy522
    Ahhh, I see. Well, again, if you guys haven't really done a lot of them. I don't see the instructor being too harsh. But you just never really know. No use stressing about it though! The diagnosis is ok. It just uses a medical diagnosis in it. Other than that its okay. So, the instructor might take into consideration that you have't done many.

    Well at least you've done them for projects before. I've just never heard of nursing students not doing care plans or doing concept maps if they don't do care plans. So, I was just curious if you did something else in place of the care plans, like concept maps. Did you do any kind of paperwork you had to turn in after clinicals?
    No we just wrote out assessments. He doesn't have a heart he's known for failing students in clinicals. The other instructors told us we have to make it pass him to graduate.
  13. by   Cindyel
    My school does not allow us to use a medical diagnosis either. My clinical instructor requires us to do a care plan each week in clinical. (Just finished first semester). Other instructors in the program did not require them and when we had to do a care plan in lecture as an activity, you would immediately see the groups who didn't have any practice doing them sweating it out. It should be required across the board as it really organizes your thinking. There are tons of resources on the web and great care plan books out there. If you need to do more in the future, look up these resources as they will help you. Good Luck!
  14. by   KrCmommy522
    Quote from Cindyel
    My school does not allow us to use a medical diagnosis either. My clinical instructor requires us to do a care plan each week in clinical. (Just finished first semester). Other instructors in the program did not require them and when we had to do a care plan in lecture as an activity, you would immediately see the groups who didn't have any practice doing them sweating it out. It should be required across the board as it really organizes your thinking. There are tons of resources on the web and great care plan books out there. If you need to do more in the future, look up these resources as they will help you. Good Luck!
    My school required them for every single clinical we did. We started off going the night before to research the patient and do the first 2 pages (what we could fill in based on our research) had to be done before clinical started. Then, after clinical (from assessing and caring for the pt all day) we had to complete the rest of the care plan. After the first 2 semesters, we started going in earlier and doing our research the hour before clinicals started - doing the same (filling in what we could on the first 2 pages based on our research) and completing the rest of it after assessing and caring for the pt for the day. We did this throughout my entire time in nursing school. At first, we had to do a care plan for each pt we had. We started off only caring for 1 pt, but by the second semester we cared for 2 pts, and we had to do a care plan on each pt and turn them in after each clinical. Once we got to the last few clinicals we only needed to complete 3 satisfactory care plans and after that we only had to do "short" care plans, which most instructors didn't have us turn in because they were basically for us to use as brain sheets unless we already had one of our own.

    I think care plans should be required for everyone. They really help you see the whole picture - what S&S are related to diagnoses, how what your pt is experiencing relates to the diagnoses, how you can care for the pt, etc.

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