How do I write up a ''risk for'' diagnosis for my Med-Surg class's NPR?

  1. 0
    So two weeks back I had this patient with an exacerbation of ulcerative colitis. And for my concept map for this patient I'd made three very lovely nursing diagnoses:

    "Diarrhea r/t bowel inflammation and intestinal hyperactivity AEB frequent loose, liquid stools (> 10 per day)"; "Imbalanced nutrition: less than body requirements r/t decreased intake, decreased absorption, and increased nutrient loss through diarrhea AEB weakness, lethargy"; "Acute pain r/t hyperperistalsis, prolonged diarrhea, skin and tissue irritation, perirectal excoriation, fissures, fistulas AEB cramping abdominal pain".

    Nice, eh?

    My nursing professor looked at my concept map and noted that my patient had abnormally low calcium levels. She said, "I can think of a more important nursing diagnosis". Since hypocalcemia can affect the cardiac system, which is obviously going to be a priority, I have to do it on 'fluid and electrolyte imbalance'.

    So anyway, I'm looking through my nursing care plan textbook and I don't know what I'd use.

    I don't see "Electrolyte imbalance" in here, but I DO see "Risk for electrolyte imbalance".

    So would my nursing diagnosis be "Risk for electrolyte imbalance r/t diarrhea", or “risk for electrolyte imbalance r/t hypocalcemia”? Or would it just be “Risk for electrolyte imbalance”?
    Last edit by delrepublica1776 on Oct 20, '12 : Reason: The thingy wouldn't scroll down when I kept on typing

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  2. 22 Comments...

  3. 0
    So would my nursing diagnosis be "Risk for electrolyte imbalance r/t diarrhea", or “risk for electrolyte imbalance r/t hypocalcemia”? Or would it just be “Risk for electrolyte imbalance”?
    I am not much for care plans, but i am thinking the highlighted part would be wrong.
  4. 0
    But why's it one and not the other?
  5. 0
    Okay, now I'm on this part of the care plan:

    "Signs and Symptoms - These refer to specific DEFINING CHARACTERISTICS (as evidenced by) or observable signs and symptoms demonstrated or described by the patient. At least 70% of the major defining characteristics must be present for the diagnosis to be present. When writing this aspect of the diagnosis, write the defining characteristic and then write the data for that defining characteristic underneath it. The data referred to here is that which comes from this patient regarding a particular defining characteristic. For example, if a defining characteristic is “fever” the data would be THIS patient’s temperature: T 102.6. Data, in this context, refers to what you saw, felt, read, heard or smelled that makes real this defining characteristic for THIS patient."


    I looked through the Ackley/Ladewig book and I simply cannot find "Risk for electrolyte imbalance", much less where the Defining Characteristics of such a diagnosis would be.
  6. 0
    Hmm you could try looking under the individual electrolytes....but in general a concern would be cardiac irregularities.....
    Quote from samianquazi
    Okay, now I'm on this part of the care plan:

    "Signs and Symptoms - These refer to specific DEFINING CHARACTERISTICS (as evidenced by) or observable signs and symptoms demonstrated or described by the patient. At least 70% of the major defining characteristics must be present for the diagnosis to be present. When writing this aspect of the diagnosis, write the defining characteristic and then write the data for that defining characteristic underneath it. The data referred to here is that which comes from this patient regarding a particular defining characteristic. For example, if a defining characteristic is “fever” the data would be THIS patient’s temperature: T 102.6. Data, in this context, refers to what you saw, felt, read, heard or smelled that makes real this defining characteristic for THIS patient."


    I looked through the Ackley/Ladewig book and I simply cannot find "Risk for electrolyte imbalance", much less where the Defining Characteristics of such a diagnosis would be.
  7. 0
    I have a copy of Ackley's "Nursing Diagnosis Handbook" with me. I looked up "Hypocalcemia" for suggested nursing diagnoses. Here's what I get:

    1) Activity intolerance r/t neuromuscular irritability
    2) Imbalanced nutrition: Less than body requirements r/t effects of vitamin D deficiency, renal failure, malabsorption, laxative use
    3) Ineffective breathing pattern r/t laryngospasm

    ARGH! Exactly NOT what I was looking for! >
  8. 0
    yeah, those are sx of rather severe def. as i said i am not really good at these. hopefully Esme will come along. Maybe ashley....? can you go with "risk of r/t diarrhea, AEB hypokalcemia? or is that last not usable because it is ordered by the doc? been a looong time... Is the patient on IV hydration? If so, perhaps what she has is excess fluid volume and the hypokalcemia via dilution? How low was the Ca++?good luck.
    Quote from samianquazi
    I have a copy of Ackley's "Nursing Diagnosis Handbook" with me. I looked up "Hypocalcemia" for suggested nursing diagnoses. Here's what I get:

    1) Activity intolerance r/t neuromuscular irritability
    2) Imbalanced nutrition: Less than body requirements r/t effects of vitamin D deficiency, renal failure, malabsorption, laxative use
    3) Ineffective breathing pattern r/t laryngospasm

    ARGH! Exactly NOT what I was looking for! >
  9. 1
    I would from what i remember is if they have an electrolyte imbalance then they can't be at risk for something they already have. So I would look at what risk they are at for having the electrolyte imbalance and you could write your careplan for that.
    KelRN215 likes this.
  10. 0
    But I don't see "Electrolyte imbalance" on the index of any of these textbooks...
  11. 0
    and it is not on the NANDA list...but what iluvpatho is saying is what is the patient "at risk for" because of the electrolyte imbalance....so we are back to cardiac and neuro stuff
    Quote from samianquazi
    But I don't see "Electrolyte imbalance" on the index of any of these textbooks...


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