Femoral fx

  1. 0 Hi student nurses and nurses.
    Wednesday was my second week stage this week and my patient had a femoral fracture and it was her third day post op. She complains of nausea so i gave her gravol. She also reports pain 6/10 on her left hip (related to her surgery for femoral fx) and she asked me why it was so important to mobilize and do physical exercise. This is one of my dx (defficient knowledge about mobilization as evidenced by the patient doesn't want to get out of the bed) i am not really sure it is a good diagnosis. it was also the first time I was giving Lovenox subcu and i was really stressed at first but once it is done, i will never forget how to give meds. The book we are using at college is med-surg nursing in canada (cause i am from canada). So i have to write down 2 nursing diagnosis/priority for my patient. the first one would maybe be acute pain related to surgery for femoral fracture as evidenced by rating the pain 6/10. the second one would maybe be the deficient knowledge about mobilization.
    thanks for help
  2. Visit  Rosiemenard profile page

    About Rosiemenard

    From 'Montreal, QC, CA'; Joined Mar '13; Posts: 3.

    11 Comments so far...

  3. Visit  ixchel profile page
    1
    Deficient knowledge would be a great diagnosis. She needs to understand that for intestinal mobility, strength, ease of recovery, pneumonia prevention and DVT prevention, she needs to get up and move! It sucks at first, but it is better to get up and move as early as possible. Certainly the hospital isn't going to let her go home if she can't or wont even get up and move around, if that was something she could do before admission.
    Rosiemenard likes this.
  4. Visit  Rosiemenard profile page
    0
    Thank you very much for the quick comment ill take that in note!!
  5. Visit  ixchel profile page
    0
    You're welcome!
  6. Visit  GrnTea profile page
    5
    There is no such approved nursing diagnosis as "Deficient knowledge about mobilization (or anything else)," though. What you're looking for is more like "Impaired bed mobility, related to deficient knowledge and pain, as evidenced by....(what do you observe?)..."

    People will tell you I NEVER answer homework for you, but here I have just gone and done exactly that. I must be losing my touch. Now, your part of the deal is that you promise to get the book so you can do it properly yourself from here on.

    Get the NANDA-I 2012-2014 book stat, free two-day shipping from Amazon, $29 US. It is an INTERNATIONAL reference book, so no worries about you being in Canada.
  7. Visit  ixchel profile page
    1
    Quote from GrnTea
    There is no such approved nursing diagnosis as "Deficient knowledge about mobilization (or anything else)," though. What you're looking for is more like "Impaired bed mobility, related to deficient knowledge and pain, as evidenced by....(what do you observe?)..."

    People will tell you I NEVER answer homework for you, but here I have just gone and done exactly that. I must be losing my touch. Now, your part of the deal is that you promise to get the book so you can do it properly yourself from here on.

    Get the NANDA-I 2012-2014 book stat, free two-day shipping from Amazon, $29 US. It is an INTERNATIONAL reference book, so no worries about you being in Canada.
    The book I have (Ackley and Ladwig, Nursing Diagnosis Handbook) does have deficient knowledge in it. The related factors applicable here (as listed in the book) could be cognitive limitation, information misinterpretation, lack of exposure, lack of interest in learning, lack of recall, or unfamiliarity with information resources. I'm not sure if maybe the OP is using the same text as me or not, but I wanted to chime in with what I have here.

    ETA: The way we would use this would be to say "deficient knowledge" and then we would say what the deficient knowledge was referring to, then say "r/t....", "AEB...."
    Esme12 likes this.
  8. Visit  ArrowRN profile page
    1
    mine book also has "Deficient knowledge related to lack of exposure" it wont be mobilization but you can add the rest based on e.g as evidenced by pt. questions need to ambulate or pt questions need for physical therapy....anything like that would be your evidence.

    your intervention then would be to educate the pt. and your outcome would be pt. acknowledge and states understanding of need to ambulate or whatever
    Last edit by ArrowRN on Mar 30, '13
    Esme12 likes this.
  9. Visit  Esme12 profile page
    0
    GrnTea is right...you need to have a good nursing care plan book and/or NANDA-I book to make you life SO much easier! I use Ackley and Ladwig, Nursing Diagnosis Handbook as well/

    However........Deficient knowledge (specify) is a NANDA-I diagnosis......and a good one.
    NANDA-I Definition
    Absence or deficiency of cognitive information related to a specific topic
    Defining Characteristics
    Exaggerated behaviors; inaccurate follow-through of instruction; inaccurate performance of test; inappropriate behaviors (e.g., hysterical, hostile, agitated, apathetic); verbalization of the problem

    Related Factors (r/t)
    Cognitive limitation; information misinterpretation; lack of exposure; lack of interest in learning; lack of recall; unfamiliarity with information resources

    OP remember that nursing care plans are all about the assessment of the patient and what the patient needs first according to Maslows Hierachy of Needs .....or whatever theory you use


    So looking at what information you gave.....

    patient had a femoral fracture and it was her third day post op. She complains of nausea so i gave her gravol. She also reports pain 6/10 on her left hip (related to her surgery for femoral fx) and she asked me why it was so important to mobilize and do physical exercise. This is one of my dx (deficient knowledge about mobilization as evidenced by the patient doesn't want to get out of the bed) i am not really sure it is a good diagnosis. it was also the first time I was giving Lovenox subcu and i was really stressed at first but once it is done, i will never forget how to give meds. The book we are using at college is med-surg nursing in Canada (cause i am from Canada). So i have to write down 2 nursing diagnosis/priority for my patient. the first one would maybe be acute pain related to surgery for femoral fracture as evidenced by rating the pain 6/10. the second one would maybe be the deficient knowledge about mobilization.
    I have highlighted important information. Look at the priority of needs.....so what is most important to this patient. She has Acute Pain, complains of Nausea (yes a NAND-I diagnosis) , she has Deficient knowledge (specify) about mobility that makes her Fearful of ambulation.
  10. Visit  ixchel profile page
    1
    Esme, are you in any way in education, maybe as a preceptor, or professor? I always adore your posts in the homework help sections and, really, anywhere on AN. I could just follow you around here all day long, and I'd become a better nurse as a result of it. Love your contributions!


    (OP, I apologize for the brief hijacking!)
    Esme12 likes this.
  11. Visit  Esme12 profile page
    0
    Thanks .....I have always LOVED teaching and have been an educator and mentor, preceptor......But alas these days.....not any more....I am no longer "qualified". I don't have a high enough degree....sigh.

    I'm glad I can help...my goal is to make nursing better every day by helping the next generation become the best nurse they can be! Follow me anytime.......you can always PM me too...
  12. Visit  GrnTea profile page
    0
    I stand corrected in one way-- there is, in fact, a "Deficient knowledge" NANDA-I diagnosis.

    However, it is in Domain 5, perception/cognition, Class 4, Cognition, and its definition is, "Absence or deficiency of cognitive information related to a specific topic."

    Defining characteristics (this means, these are the symptoms I assessed):
    Exaggerated behaviors
    Inaccurate follow-through of instruction
    Inaccurate performance of test
    Inappropriate behaviors (e.g., hysterical, hostile, agitated, apathetic)
    Reports the problem

    Related factors (this means, this is the cause of the symptoms):
    Cognitive limitation
    Information misinterpretation
    Lack of exposure
    Lack of interest in learning
    Lack of recall
    Unfamiliar with information resources

    I am not seeing information in the OP's patient assessment that tells me this woman has a cognitive problem. Maybe she does, but you'd have to look for the related factor that says so, and describe the defining characteristics that support your assessment and diagnosis. As a reminder, just because a patient doesn't seem to you to know what you think she should doesn't necessarily mean she meets this diagnosis, given these definition/defining characteristics/ related factors specific to this diagnosis.

    Not getting out of bed isn't necessarily evidence that she doesn't know why she should, so it's not reasonable to give that as evidence of a cognitive deficiency. As others have pointed out, there could be a lt of other reasons. You will find many, many patients in your career who know perfectly well what they should know, but chose not to use it or act upon it. (can I hear an AMEN from other old grads?)
  13. Visit  Esme12 profile page
    2
    Quote from GrnTea
    I stand corrected in one way-- there is, in fact, a "Deficient knowledge" NANDA-I diagnosis.

    However, it is in Domain 5, perception/cognition, Class 4, Cognition, and its definition is, "Absence or deficiency of cognitive information related to a specific topic."

    Defining characteristics (this means, these are the symptoms I assessed):
    Exaggerated behaviors
    Inaccurate follow-through of instruction
    Inaccurate performance of test
    Inappropriate behaviors (e.g., hysterical, hostile, agitated, apathetic)
    Reports the problem

    Related factors (this means, this is the cause of the symptoms):
    Cognitive limitation
    Information misinterpretation
    Lack of exposure
    Lack of interest in learning
    Lack of recall
    Unfamiliar with information resources

    I am not seeing information in the OP's patient assessment that tells me this woman has a cognitive problem. Maybe she does, but you'd have to look for the related factor that says so, and describe the defining characteristics that support your assessment and diagnosis. As a reminder, just because a patient doesn't seem to you to know what you think she should doesn't necessarily mean she meets this diagnosis, given these definition/defining characteristics/ related factors specific to this diagnosis.

    Not getting out of bed isn't necessarily evidence that she doesn't know why she should, so it's not reasonable to give that as evidence of a cognitive deficiency. As others have pointed out, there could be a lt of other reasons. You will find many, many patients in your career who know perfectly well what they should know, but chose not to use it or act upon it. (can I hear an AMEN from other old grads?)
    I don't know I think it does.....
    she asked me why it was so important to mobilize and do physical exercise
    tells me that this patient has a lack of recall (if they received pre-op teaching or any post op teaching) an inaccurate follow through of instruction...won't get OOB, just by what the OP told us.

    She may not have had instruction...so she has a lack of exposure, unfamiliar with information resources given to her or lack of recall of what she has been taught.

    Cognitive deficiency doesn't necessarily mean it is an it is an absence or deficiency cognitive INFORMATION not necessarily of a pathological nature.
    CT Pixie and ixchel like this.


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