Hi I'm stumped. I have to do my first Diagnosis an a goal on a patient admitted to the hosp following a stroke, which has left him paralyzed on the right side. He is unable to bathe himself or participate in ADLs Our teacher said to use the NANDA reference guide. I just have no clue.
Quote from cleo777
okay i have cva patient in rehabillation, and i am looking at the pathophysiology, of the stroke.
as of yesterday, assessing him he cannot stand or at all on his own, he is a two person assist, he can pivot with his legs. he cannot feed himself, but he can move his arms, he has dysphagia, aphasia(speaks very little), dypraxia. so my question as i am looking at different nursing diagnosis, the related to factor
in his immobility...is it really due to muscle weakness, or is it due to neuromuscular involvement. he does have sensation in all four extrememties.
so as i look at my nursing diagnosis the related to factors, how do i determine whether is it muscle weakness, neuromuscular involvement, i can't talk with the client, because of his speech inability. this stroke happen approx 2 weeks ago, this is a big healthy guy, would his muscles start to become that weak that he cannot stand?
you say you were "looking" at the pathophysiology of a stroke. what did you learn? is the reason he cannot move his arms, has dysphagia, aphasia and dypraxia because of muscle weakness or neuromuscular impairment as a result of the stroke? taber's cyclopedic medical dictionary
defines "weakness" as a subjective term used by a patient to indicate a lack of strength compared with what he or she feels in normal.
does "weakness" sound like a scientific term we should be using to base the cause (related factor) of a diagnosis upon? if this patient can't talk how do you know he even has muscle weakness? who determined he had muscle weakness? he certainly didn't (reference: the definition of the term "weakness"). i wouldn't use the term "muscular weakness" as a related factor in a diagnostic statement for the basic reason that (1) the patient didn't determine it and (2) it is subjective.
Last edit by Daytonite on Jun 15, '09