Evidence Based Paper--need help!

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    Hi. I just started nursing school 4 weeks ago! We already have papers to do in addition to all the studying and exams coming up.

    I just wanted to ask if anyone can help me out with this evidence based paper that I have to do. We are suppose to pick a nursing diagnosis and then identify subjective and objective data that is necessary to support the diagnosis. I picked myocardial infarction...but I know that is a medical diagnosis and not a nursing diagnosis. What would the nursing diagnosis for MI be?? Then we have to identify 5 nursing interventions that will lead to short and long goal achievement.

    It also said to identify the criteria that will be used to evaluate goal achievement relative to the diagnosis selected. I really have no idea what is meant by that.
  2. 19 Comments so far...

  3. 3
    If your assignment is to pick a nursing diagnosis ... I suspect you must have some sort of textbook, handout, etc. that has information on what nursing diagnoses are. I suggest you start with that. Step 1 = Pick a nursing diagnosis that interests you.

    Whatever reference you are using to identify possible nursing diagnoses probably also has some information on some of the more common diagnoses. Step 2 = Read up on your chosen nursing diagnosis. Start with your textbook and class resources ... then expand your search as necessary to include journal articles that you find in your school's library.

    Step 3 = Work with those ideas a bit and write a draft of your homework assignment.

    Step 4 = Share some of your preliminary work with us and we can comment on it to give you some help.
    VickyRN, NRSKarenRN, and dudette10 like this.
  4. 2
    Quote from llg
    If your assignment is to pick a nursing diagnosis ... I suspect you must have some sort of textbook, handout, etc. that has information on what nursing diagnoses are. I suggest you start with that. Step 1 = Pick a nursing diagnosis that interests you.

    Whatever reference you are using to identify possible nursing diagnoses probably also has some information on some of the more common diagnoses. Step 2 = Read up on your chosen nursing diagnosis. Start with your textbook and class resources ... then expand your search as necessary to include journal articles that you find in your school's library.

    Step 3 = Work with those ideas a bit and write a draft of your homework assignment.

    Step 4 = Share some of your preliminary work with us and we can comment on it to give you some help.
    This is excellent advice. There is also a Student forum on this site that has some great stickies at the top of those 2nd and 3rd forums listed that are specifically about care plans and nursing diagnoses.

    Because you are just 4 weeks in nursing school, I'm guessing you are new here too. Just FYI, we don't like to do homework for others. We do like to help people if the poster has shown some effort and has at least attempted to do her homework. We have a hard enough time doing our own homework w/o doing someone else's work.

    You've got a great medical diagnosis to build a great nursing diagnosis. Oh, and remember Maslow too.

    m
    netglow and roser13 like this.
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    I agree with everyone else, nobody likes to do poster's homework for them. But we are happy to hear what you've come up with and give feedback. I think you may just be overthinking the assignment. I remember when I was in nursing school and first learned about care plans, it was all very confusing. It took some time, but eventually I realized just how simple and easy care plans can be.

    You asked what the nursing diagnosis is for an MI. I think you are thinking of this the wrong way. The medical diagnosis doesn't translate into a nursing diagnosis. Instead, the nursing diagnosis has to deal with the patient's response to the medical problem. The response may be physical or psychosocial. So think about what the MI does to the body and develop your nursing Dx from that.
  6. 5
    Quote from Livinstrong85
    Um, why the heck isn't "Myocardial Infarction" considered a "Nursing Diagnoses" (whatever the hell "Nursing Diagnoses" means anyway...)

    What are nurses supposed to call it?
    I'm guessing you're not a nurse? A nursing Dx isn't renaming a medical problem. A nursing Dx is diagnosing the body's response to a problem. A medical Dx is naming the problem that is effects the body.

    Ex. Medical Dx: Asthma. It names a disease process of the body.
    Nursing Dx for this would be "Ineffective gas exchange." Due to what happens to the body during an asthma attack, it causes a problem with the gas exchange in the lungs, hence the "ineffective gas exchange." These diagnosis are naming two different things, but they are related.
  7. 0
    I also advise you to use any text that was assigned for your class and resources, such as the library. I know all of this can be frustrating when you are new. I've been in NS a year and I remember the feeling. That sounds like something one of my teachers would give me. But just search until you just about can't anymore and ask for some help; that way you can said you have looked. Ask for clarification from the instructor if you don't understand the assignment fully.

    Believe me...I've just spent about 7 hours looking up for specific research articles for a literature review paper. We had to form our topic as a nursing dx. I got so frustrated looking for diarrhea and IBD, since my instructor told me diarrhea and c.diff wasn't covered in class, I had to change it to activity intolerance and PVD (I know those aren't in the form of nursing dx, but I'm been on the computer too long my eyes are crossed and I'm drowsy). Anyway, I hope she approves my change since I told her I already found the information I needed for the new one. It was in minutes, literally, compared to the hours I wasted when I could have been actually working on the paper! Hopefully she doesn't cut off my head.

    I need sleep. :zzzzz
  8. 0
    I remember my first month of nursing school very well, probably because it wasn't too long ago! Take a deep breath and try to relax. You have a lot of resources available. Ask your instructor for clarification and help. Refer to your textbooks. You can also ask other classmates for help.

    I'm sure one (if not all) of your nursing textbooks has a list of NANDA nursing diagnoses. Start going through that list and pick out two or three that would apply to an MI. Which nursing diagnoses would be your top three and why?

    Also, if you don't already have a textbook for care plans, you should get one. It will come in handy for all your classes, for care plans as well as papers. I used the "All-in-One Care Planning Resource" by Swearingen. I'm sure you can find it on half.com for a reasonable price.

    Also, the format for a nursing diagnosis is "Acute pain (for example) related to.......... as evidenced by..........." Ask your professor for further clarification, and ask your clinical instructor as well. My first clinical instructor was a wonderful resource for those first few care plans. Best of luck to you!!!
  9. 1
    Found among my old books a book called "Nurses Pocket Guide". Publisher FA Davis company in philidelphia. My copy is really old, but good resource, I'm sure there are other books out there on nursing diagnoses.
    Back to your question. When you chose Myocardial Infarction, you chose a diagnosis, which can only be made by a physician. For your nursing diagnosis, think about how MI affects the body. The nurses concern when caring for a patient is maintaining/ restoring homeostasis, so how does MI disrupt homeostasis? In an MI you are going to have a disruption in the bodies ability to perfuse itself with oxygen which results in all kinds of nasty symptoms. Possible nursing dx's could include. Impaired gas exchange, altered tissue perfusion, Acute pain, fear anxiety, and knowledge deficit related to that dx. These are all from the books list of accepted nursing dx's. Take your pick. Dont forget the part about : Nursing dx RELATED TO (MI) as evidenced by(list yyour symptoms).When your instructor told you to identify criteria to evaluate whether or not you've achieved your goal......well, just think about it. If you choose impaired gas exchange, what shows that your pt is not getting enough oxygen? They get short of breat, they turn cyanotic, get anxious, o2 sats drop. Criteria that might show improvement in that situation might be improvement in any of those symptoms. In other words, How are you going to show that they are doing better.

    Hope this helps. Fellow nurses, she is only 4 weeks in, cut her some slack. It is easy to forget how hard it is to start thinking like a nurse when you have been doing it for years, but it is very difficult at first. Coolpeachmoy, you will probably get a better response in future if you bring your question AND more of your completed assignment so we can help you correct it rather than walk you through completing the actual assignment.
    sunkissed75 likes this.
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    Quote from misschiatia
    Possible nursing dx's could include. Impaired gas exchange, altered tissue perfusion, Acute pain, fear anxiety, and knowledge deficit related to that dx. These are all from the books list of accepted nursing dx's. Take your pick. Dont forget the part about : Nursing dx RELATED TO (MI) as evidenced by(list yyour symptoms).
    I just wanted to say that Impaired gas exchange may not always be correct for an MI unless the damage is so severe that it is causing a problem with the actual gas exchange that takes place in the lungs. The MI isn't impairing the gas exchange that happens in the capillary bed of the lungs, unless there is enough left sided heart damage which decreases the cardiac output and causes pulmonary edema. If they are having shortness of breath due to the pain or anxiety, then the correct nursing Dx would be "Ineffective Breathing Pattern."

    And you wouldn't want to say "related to MI." because that is the medical Dx. An example would be Decreased cardiac output related to ventricular ischemia/damage AEB and then list your physical assessment findings that support the Dx. Or my example above: Impaired gas exchange r/t pulmonary edema secondary to decreased cardiac output, AEB fill in the blank here (ex. adventitious breath sounds, SpO2 = xx%, pt complaint of SOB, etc.).

    Or another unrelated example. This is one I used for a newborn that was hypoglycemic after birth, because the mother was diabetic.
    Risk for unstable blood glucose R/T increased glucose metabolism secondary to hyperinsulinemia AEB blood glucose levels < 45mg/dL.

    Hope some of this helps the OP.
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    NickRN/EMT-

    The "impaired gas exchange" was in regards to an example of medical vs. nursing dx, as indicated in her post---NOT related to the OP's MI question.

    [QUOTE=NickRN/EMT;4551959]I'm guessing you're not a nurse? A nursing Dx isn't renaming a medical problem. A nursing Dx is diagnosing the body's response to a problem. A medical Dx is naming the problem that is effects the body.

    Ex. Medical Dx: Asthma. It names a disease process of the body.
    Nursing Dx for this would be "Ineffective gas exchange." Due to what happens to the body during an asthma attack, it causes a problem with the gas exchange in the lungs, hence the "ineffective gas exchange." These diagnosis are naming two different things, but they are related.[/QUOTE


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