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

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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"?

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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.

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But why's it one and not the other?

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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.

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Hmm you could try looking under the individual electrolytes....but in general a concern would be cardiac irregularities.....

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.

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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! >:(

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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.

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! >:(

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Specializes in Labor and Delivery.

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.

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But I don't see "Electrolyte imbalance" on the index of any of these textbooks...

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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

But I don't see "Electrolyte imbalance" on the index of any of these textbooks...
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Uhm, cardiac dysrhythmias? At least according to this book, hypocalcemia can cause QT wave stuff to happen and that's obviously not good.

But that's still quite a stretch to say Ulcerative Colitis is gonna lead to a heart attack which is then gonna kill you, right?

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

NANDA describes (Ackley: Nursing Diagnosis Handbook, 9th Edition)

Risk for Electrolyte imbalance

NANDA-IDefinition:

At risk for change in serum electrolyte levels that may compromise health

Risk Factors:

Diarrhea; endocrine dysfunction; fluid imbalance (e.g., dehydration, water intoxication); impaired regulatory mechanisms (e.g., diabetes insipidus, syndrome of inappropriate secretion of antidiuretic hormone); renal dysfunction; treatment-related side effects (e.g., medications, drains); vomiting

Outcomes (Nursing Outcomes Classification)Suggested NOC Outcomes:

Electrolyte & Acid Base Balance, Fluid Balance, Hydration, Nutritional Status: Biochemical Measures, Nutritional Status: Food & Fluid Intake, Nutritional Status: Nutrient Intake, Kidney Function

NOC Outcome with Indicators Electrolyte & Acid/Base Balance as evidenced by: Apical heart rate/Apical heart rhythm/Serum potassium/Serum sodium/Serum calcium (Rate the outcome and indicators of Electrolyte & Acid/Base Balance: 1 = Severe deviation from normal range, 2 = substantial deviation from normal range, 3 = Moderate deviation from normal range, 4 = mild deviation from normal range, 5 = No deviation from normal range.)

Client Outcomes Client Will (Specify Time Frame):

Maintain a normal sinus heart rhythm with a regular rate

Have a decrease in edema

Maintain an absence of muscle cramping

Maintain normal serum potassium, sodium, and calcium

Maintain normal serum pH

Interventions (Nursing Interventions Classification)Suggested NIC Interventions:

Electrolyte Monitoring, Electrolyte Management: Hypokalemia, Electrolyte Management: Hyponatremia, Fluid/Electrolyte Management, Laboratory Data Interpretation

Example NIC Activities—Electrolyte Monitoring

Identify possible causes of electrolyte imbalances; Monitor the serum level of electrolytes......I use ackly as well.

Just because it says risk of electrolyte imbalance doesn't mean you can't make it an actual risk. Actually dehydration, electrolyte imbalance.....potassium, calcium, and magnesium can kill you. One of the saddest codes I have EVER witnesses was a baby that can in so dehydrated we could not save her. Again nit having the WHOLE picture is it very difficult to help you. In your original post you never mentioned the patient had hypocalcemia.

The care plan is all about the patient and the ASSESSMENT of the PATIENT. ALl about what THE PATIENT NEEDS.

Was the calcium the only electrolyte that was abnormal? Look up hypocalcemia: Calcium regulation is critical for normal cell function, neural transmission, membrane stability, bone structure, blood coagulation, and intracellular signaling. The essential functions of this divalent cation continue to be elucidated, particularly in head injury/stroke and cardiopulmonary effects. Depending on the cause, unrecognized or poorly treated hypocalcemic emergencies can lead to significant morbidity or death. Medscape: Medscape Access again medscape is my favourite go to professional reference.....it requires registration but it is free.

Neuromuscular and cardiovascular findings predominate. Neural hyperexcitability due to acute hypocalcemia causes smooth and skeletal muscle contractions. The patient should be examined for the following:

  • Dry skin and psoriasis (if long-term hypocalcemia)
  • Perioral anesthesia, cataracts, papilledema, and laryngeal stridor
  • Scars over thyroid region
  • Recent trauma or surgery to the neck
  • Cardiopulmonary effects
    • Wheezing, dysphagia, stridor, bradycardia, rales, and S3 may be noted.[5]
    • Acute hypocalcemia causes prolongation of the QT interval, which may lead to ventricular dysrhythmias. It also causes decreased myocardial contractility, leading to CHF, hypotension, and angina. Cardiomyopathy and ventricular tachycardia may be reversible with treatment.
    • Smooth muscle contraction may lead to laryngeal stridor, dysphagia, and bronchospasm.

    [*]Smooth muscle contraction causes biliary colic, intestinal colic, and dysphagia.

    [*]Diarrhea and/or gluten intolerance (celiac sprue) may result in significant malabsorption and electrolyte abnormalities.

    [*]Preterm labor or detrusor dysfunction may result from smooth muscle contraction.

    [*]Peripheral nervous system findings include tetany, focal numbness, and muscle spasms.

    [*]Classic peripheral neurologic findings include the Chvostek sign and Trousseau sign.

    • Chvostek sign: Tap over the facial nerve about 2 cm anterior to the tragus of the ear. Depending on the calcium level, a graded response will occur: twitching first at the angle of the mouth, then by the nose, the eye, and the facial muscles.
    • Trousseau sign: Inflation of a blood pressure cuff above the systolic pressure causes local ulnar and median nerve ischemia, resulting in carpal spasm.

    [*]Irritability, confusion, hallucinations, dementia, extrapyramidal manifestations, and seizures may occur.

    • Calcification of basal ganglia, cerebellum, and cerebrum may occur.
    • Seizures often occur in individuals with preexistent epileptic foci when the excitation threshold is lowered.

So this patient with their history is...... At risk for electrolyte imbalance with documented hypocalcemia R/T.........AEB..........low calcium but........Did this patient show evidence of symptoms of electrolyte imbalance? Making more sense?

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