End renal failure Nursing Diagnosis Help!!!

  1. Ok, I am trying to come up with NDs but the only ones that I have found are those, which are mostly risk for and not actual:

    Run down: The patient is 42, Male, has end stage renal failure on dyalisis, cortisol and ACTH deficiency because of total protidectomy a few months ago, hypothyroidism, chronic constipation, htx of pancreatitis, chronic N&V, chronic constipation, and htx of hypocalcemia.

    -Risk for fluid volume excess R/T compromised regulatory mechanism secondary to renal failure. (No edema, no ascites, 5 10 and 160 lbs)
    -Ineffective health maintenance R/T spiritual distress secondary to illness (came to hosp. with K of 5.5 b/c missed dyalisis.
    -Risk for decreased cardiac output R/T altered contractility secondary to hyperkalemia and hypocalcemia.
    -Ineffective copin R/T chronic illness.

    I don't know why but I feel I am missing something and also, my defining characteristics are like 1 or 2. Any ideas? Thanks a bunch!
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    About CSNS

    Joined: Aug '06; Posts: 46; Likes: 4


  3. by   SFDRN
    How about "impaired urinary elimination r/t chronic renal disease process"?
  4. by   Daytonite
    all nursing diagnoses, goals and nursing interventions in a care plan are based upon a patient's defining characteristics (symptoms). i don't believe that a patient who has end stage renal failure who is on dialysis, has hypothyroidism, chronic constipation, chronic nausea and vomiting and hypocalcemia only has 1 or 2 symptoms. if you look up these conditions and look at their signs and symptoms i'm betting you'll find that you missed a few that this patient had. did you review the doctor's history and physical exam in the chart? did you assess his ability to perform adls? you can't even begin to choose any nursing diagnoses until you develop as complete a list as possible of this man's symptoms.

    when you are writing a care plan you must follow the steps of the nursing process in their sequence with a major focus on step #1:
    1. assessment (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions)
    2. 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 diagnosis to use)
    3. planning (write measurable goals/outcomes and nursing interventions)
    4. implementation (initiate the care plan)
    5. evaluation (determine if goals/outcomes have been met)
    then when choosing nursing diagnoses, every nursing diagnosis has a set of signs and symptoms (defining characteristics). you cannot say a patient has a specific nursing diagnosis if the patient does not have the signs/symptoms (defining characteristics) of it.

    so, my question to you is. . .how did you come up with 5 nursing diagnoses if you only have 1 or 2 defining characteristics? me thinks that at least 3 of these diagnoses then have no symptoms to support the use of them.

    please read these two threads on how to write a care plan:
  5. by   CSNS
    Well, I did not do an assessment yet because we haven't had clinicals yet. Our teacher asked us to find nursing diagnoses and interventions to work on prior to clinicals. I did read the doctor's notes. I meant 1-2 characteristics per diagnoses. I forgot to mention he came in (and still has) hyperkalemia because he missed his dialysis. His BMI is WNL, he has no dysrthymias, BP under control thanks to meds, he also has some weakness in L leg (neuropathy) but is not diabetic. I came up with a few more diagnoses, hopefully that will be enough and I can get more data when I actually see the patient.
  6. by   Daytonite
    When you have to cold diagnose patients that you haven't had a chance to assess the day before clinicals what you need to do is take each of their medical diagnoses and look them up, make a list of the signs and symptoms of each disease and choose nursing diagnoses based on those signs and symptoms. If you have a chance to get into the patient's medical record you can also look at the doctor's history and physical and any physician consultations for their assessment of the patient's signs and symptoms. A compilation of those, or any, signs and symptoms are what you need to make any diagnoses. After you've seen the patient in clinical, then you will have much more accurate information for your own care plan and can revise your initial diagnoses.
  7. by   CSNS
    Thank you very much. I really appreciate all of your help!
  8. by   Mish7470
    See, that's where my trouble was when I had to do a care plan on a dialysis patient, because it was in an outpatient dialysis center and we didn't care for the patient, mostly talked to the nurses to find out what their roles are and what dialysis is all about and then we were to talk to one patient and find out what they know about their disease and then come up with a complete care plan using 2 nursing diagnosis. I didn't quite get how it was that I was going to be able to "evaluate" my nursing actions if I didn't actually "do" anything. Care plans are hard enough, I wish they didn't make us fake it.
  9. by   KeshaW
    This may help with the nursing diagnosis
  10. by   GoldenFire5
    I peeked in this thread because I had a patient yesterday who is similar to yours. I find the non-compliant dialysis patients to be some of the most challenging on our floor.

    A couple things you may want to ask yourself:

    -what's going on with their skin? Why?
    -you have the fluid volume excess ND above. Is it a dialysis day? What's going on with their BP before and after dialysis? Does it make sense?
    -how is their diet managed in the hospital? Any supplements with meals? Why?

    Hope this helps.
  11. by   irkedoneSN
    If he has a permanent dialysis port that would be risk for infection I think.