Help with nursing diagnosis!!

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    I have a pt that was admitted for renal failure. He is a diabetic and just recently had his RT great toe amputated.. Can anyone help me with prioritizing nursing diagnosis!! I am not sure what diagnosis would be the most important. Thanks!!

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  2. 9 Comments...

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    hi, nrsingrulz!

    in order to help you prioritize any nursing diagnoses, i need to know what nursing diagnoses you have chosen to use. nursing diagnoses, in general, cannot be chosen based on a patient's medical diagnoses. so, your post leads me to believe that you have not yet grasped the concept of what goes into the nursing process and formation of nursing diagnosis. this process of choosing nursing diagnoses can be very confusing to learn and understand at first. it is all based on your assessment data of the patient. so, you need to go back and look at all the information you got about this patient from the chart, physician's history and physical exam, any consults that were in the chart, lab results, any evaluations by physical therapy and dietary, x-ray results and the nursing admission assessment as well as your own physical assessment of the patient. you then need to put this assessment information in front of you and pull out all the abnormal assessment items. it is these abnormal assessment items, or what nanda calls defining characteristics, that are at the heart of every single nursing diagnosis. just like a doctor learns that to make a medical diagnosis of gout he/she must look for signs and symptoms of (1) joint pain, (2) sodium deposits in the great toe, ankle and pinna of the ear, (3) elevated skin temperature, and (4) red, swollen joints, we nurses have to learn that the symptoms of impaired skin integrity or impaired tissue integrity (two of the nursing diagnoses that you might consider using for this patient) are likely to be among the following:
    i recommend that you read the posts in the threads i'm listing below, particularly the care plan ones, to help you get an understanding of the process involved in determining nursing diagnoses for patients. then, if you are still having trouble with this care plan, ask again, but please give me more information to work with. i can give you links to online nursing diagnosis sites (as i did above for impaired skin integrity and impaired tissue integrity) where you can get information on related factors, defining characteristics, outcomes and nursing interventions for quite a number of nursing diagnoses that will help you with constructing your care plan. however, i need to know what nursing diagnoses you are going to be using. i can help you prioritize them according to maslow's hierarchy of needs as well. welcome to allnurses!
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    In our nursing program, we were required to include 3 nursing diagnoses. Then each nursing diagnosis had a minimum of 6 nursing actions. If the nursing actions were good and appropriate, I included more.

    It was suggested that we structure them in the following way:

    1. R/t the patient's most acute physical condition, as in what has happened to cause this hospitalization? Many patients have a long laundry list of diagnoses, but think about what has changed or become unmanagable. We did list and research all the diagnoses in our care plans, just not under the nursing diagnosis area, it was included in the pathophysiology area.

    2. R/t patient safety - I always lumped/included skin integrity in this category, because it is so important and there are many patients that movement and skin has become an issue.

    3. R/t patient psychological well being. I had a teen aged patient, and one of most important concerns she had was how to keep busy and connected to her friends. But with adults it may be family issues, body image, work stresses, issues with God/higher being - just depends on your patient.

    Hope this helps, it made it easier for me to pick nursing diagnoses if I knew what I was looking for.

    Lynn
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    Pain is always my number one diagnosis...have you assessed the pain level. This is great because it can be measured for the NOC outcome/goal.
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    Quote from Danish
    Pain is always my number one diagnosis...have you assessed the pain level. This is great because it can be measured for the NOC outcome/goal.

    I do not know in this case if pain would apply, simply because of poor circulation you often see in diabetics. I suspect a lack of pain sensation was the reason for the toe amputation in the first place.
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    Start with your ABC's. Airway is always tops then go down the list from there. Then think about when you began your day. What intervention did you know you had to do first for this pt? What did you spend you day doing? What you were doing tells you what problems you were addressing. Many times you are putting the nursing process to work by applying a RN DX and don't even realize it! You are also prioritizing all day long as a result of that or those DX.

    Hope that helps. I know care plans and RN Dx's were always difficult for me until I got a full grasp of what it all meant. Once I understood them, and what their purpose was, they were much MUCH easier!

    rags
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    Quote from Danish
    Pain is always my number one diagnosis...have you assessed the pain level. This is great because it can be measured for the NOC outcome/goal.
    A lot of times that is true, but dont' get caught up with it. If a pt's pain is under control than it isn't the top priority at that time. Important yes, but not necessarily the most important.

    It would seem that in the hospital setting that most all pt's have 'pain' as one of their RN Dx's though wouldn't it?

    rags
  9. 0
    Quote from nrsingrulz
    I have a pt that was admitted for renal failure. He is a diabetic and just recently had his RT great toe amputated.. Can anyone help me with prioritizing nursing diagnosis!! I am not sure what diagnosis would be the most important. Thanks!!
    It would seem I'm on a roll here... :spin:

    This pt being a diabetic with a recent R toe amputation may distract you. These are important factors in the pt's care and may end up coming into play with your RN Dx but you are treating this pt for the reason of admit: Renal Failure. Something to keep in mind. Things like this will get you on the NCLEX every time!

    You would address the toe amputation if the pt is say... having body image issues... Difficulty dealing with it? How has it affected his gait and mobility? Safety is always pretty important to think about....

    Just a few more ideas for helping you break it down and ways to think about what was top priority for this pt at the time you cared for him.

    rags
  10. 0
    That is true...thanks Rags. I actually spent some time today while doing my AM assesment trying to tie my careplan to the pt. Not that I dont always tie it to my pt, but I have found that things sound great in the nursing Dx book and when you actually specify them to the pt, they dont make sense. I think I am getting a better grasp on why we are even doing careplans now and how the seasoned nurses can do them in their heads as they go through the day.
  11. 0
    I know exactly what you mean. Good Plan!

    rags


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