Dont understand this (sigh)

MilliePieRN · Apr 20, 2013

I'm a student, too. Not an expert.

Impaired skin integrity is not a risk dx. What your friend means is that you cannot use a medical dx as your r/t (caused by), if you want it in there it has to be secondary to.

If you want to use the edema as r/t you can say something like "Impaired skin integrity r/t lower extremity swelling secondary to chronic edema AEB bilateral +3 pitting edema on ankles." *note: this is not a risk dx and has aeb.

"Risk for impaired skin integrity r/t lower extremity swelling secondary to chronic edema" would work. If pain is causing a risk for skin integrity you can't word it as c/o pain. It's just pain, the complaint of part makes it evidence, imo.

kistigirl · Apr 20, 2013

I'm a student, too. Not an expert.
Impaired skin integrity is not a risk dx. What your friend means is that you cannot use a medical dx as your r/t (caused by), if you want it in there it has to be secondary to.
If you want to use the edema as r/t you can say something like "Impaired skin integrity r/t lower extremity swelling secondary to chronic edema AEB bilateral +3 pitting edema on ankles." *note: this is not a risk dx and has aeb.
"Risk for impaired skin integrity r/t lower extremity swelling secondary to chronic edema" would work. If pain is causing a risk for skin integrity you can't word it as c/o pain. It's just pain, the complaint of part makes it evidence, imo.

What about "Risk for impaired skin integrity r/t lower extremity swelling secondary to postthrombalitoc syndrome (or hypertension)."

Not sure which to use as secondary cause bc pt has hypertension listed as her current medical dx; her admit dx was pulmonary embolism caused by deep vein thrombosis. Postthrombalitoc syndrome is not listed as a medical dx. but is this a medical dx or a symptom. (brain fried)

And Oops you're right. I forgot to insert "risk" at the beginning. Thank u so much for helping me.

Tait, MSN, RN · Apr 22, 2013

I would dump the secondary part and just run with Risk for impaired skin integrity r/t lower extremity edema. Basically what we are trying to do is prevent skin breakdown so we need to know the risk (as stated) and what is causing the risk (lower extremity swelling). Then we can go about managing that risk with interventions.

nurseprnRN, BSN, RN · Apr 23, 2013

I'm trying to come up with a "risk" NURSING diagnosis.
I've come up with "Impaired skin integrity r/t chronic edema" bc my pt has edema in her right leg and c/o pain. My classmate told me I should go w/something else because "chronic edema" is considered a medical dx. How so?
This dx is from NANDA and I don't understand why it would be in it if it's not a nursing dx. ??

It is a NANDA-I 2012-2014 nursing diagnosis. Furthermore, there is no reason whatsoever that chronic edema, a medical diagnosis, cannot be used as a related factor (cause) of a nursing diagnosis for risk as long as it appears as a risk factor for the diagnosis in the NANDA-I.

So let's go see if it does.

NANDA-I 2012-2014, page 437, risk for impaired skin integrity

Definition: At risk for alteration in epidermis and/or dermis

Risk factors: (Lots and lots, but chronic edema is not one of them)

So, your classmate is both right (you can't use chronic edema as a risk factor) and wrong (...but not because it's a medical diagnosis). There is a popular myth that medical diagnoses cannot be related factors/causative for nursing diagnoses, but that is not true, again, as long as they are listed in NANDA-I. I think a lot of faculty promulgate this myth in the vain hope that students will someday stop trying to cram nursing diagnoses into medical ones. They do this because that is not the same thing and students who think it is are completely wrong-headed, but I've talked about that a lot here and I am sure you can find rationales if you look. :)

Ahem. However, there are a number of other risk factors that you might have assessed in your patient listed. Take a look at them and see. If you don't have this book, you're cheating yourself out of the best resource you could ever have for nursing diagnosis, since it's the only one that completely defines every accepted nursing diagnoses. $29 and free 2-day delivery from Amazon, or $24 for your Kindle.