Need help with Wellness Care Plan

Daytonite, BSN, RN · Mar 24, 2009

if you are asking about using a "related to" does that mean that you did not have any instruction on how to formulate a nursing diagnostic statement? when i was in my bsn program they were very specific with us as to how they wanted each nursing diagnosis written. in general, nursing diagnostic statements follow this 3-part format:

p

(problem)

- e

(etiology)

- s

(symptoms)

problem
- this is the nursing diagnosis. a nursing diagnosis is actually a label. to be clear as to what the diagnosis means, read its definition in a nursing diagnosis reference or a care plan book that contains this information. the appendix of
taber's cyclopedic medical dictionary
has this information.
etiology
- also called the
related factor
by nanda, this is what is causing the problem and resulting in the symptoms. pathophysiologies need to be examined to find these etiologies. it is considered unprofessional to list a medical diagnosis so a medical condition must be stated in generic physiological terms. you can sneak a medical diagnosis in by listing a physiological cause and then stating "secondary to (the medical disease)" if your instructors will allow this. etiologies, if they are other than of a medical source, are often the focus of outcomes and long term goals.
symptoms
- also called
defining characteristics
by nanda, these are the abnormal data items that are discovered during the patient assessment. they could be signs and symptoms of the medical disease the patient has, their responses to their disease, problems accomplishing their adls. they are evidence that prove the existence of the problem. if you are unsure that a symptom belongs with a problem, refer to a nursing diagnosis reference. these symptoms will be the focus of your nursing interventions and goals.

wellness diagnoses are no different. it helps to have a nursing diagnosis reference book that lists the definition, related factors, and defining characteristics for each diagnosis.

with the "readiness for enhanced" (wellness) diagnoses the related factor, or cause, is pretty much the same--a desire to improve (whatever the area of health is). the reference will list the defining characteristics (symptoms). for this diagnosis it will be statements and actions by the patient to want to improve an already adequate diet that they want to make even better.

your interventions would focus on what a good, well-balanced diet should be. give them fda food guidelines, teach them how to read food labels on cans and what is most important to know and pay attention to on the labels, good carbohydrate choices to make, whole grain vs refined grains, importance of fiber, the different kinds of fats and which they should include in their diet, the best type of protein to include in their diet, vitamin and minerals to include in their diet.

debfay · Mar 24, 2009

Thanks. I do understand how to formulate a nursing diagnosis, I understand the three parts of the diagnosis (defining characteristics, problem, and related to), but I just didn't quite see how to word it for a wellness diagnosis. The term "abnormal data" takes on a whole new meaning here, as does the definition of what constitutes a "problem"--the patient is well, and the goal is health promotion and wellness, not diagnosis of an existing "problem". For a diagnosis such as Readiness for Enhanced Nutrition, the "abnormal data" is just that the patient expresses a desire to improve her nutritional status.

Stating it as related to a desire to improve is perfect. If I understand this correctly, my diagnosis would then be: Readiness for Enhanced Nutrition related to a desire to improve nutritional status. Does that sound right?

This is only one small part of the course, it is the only time all semester that we have to use nursing diagnoses, and I honestly don't have the money to buy a new NANDA nursing diagnosis book for one part of one assignment.

Daytonite, BSN, RN · Mar 24, 2009

you got it! here are the defining characteristics for this diagnosis (page 67, nanda international nursing diagnoses: definitions and classifications 2009-2011):

attitude toward drinking is congruent with health goals
attitude toward eating is congruent with health goals
consumes adequate fluid
consumes adequate food
eats regularly
expresses knowledge of healthy fluid choices
expresses knowledge of healthy food choices
expresses willingness to enhance nutrition
follows an appropriate standard for intake (e.g. food pyramid or american diabetic association guidelines)
safe preparation for fluids
safe preparation for food
safe storage for food and fluids

the suggestions for interventions came from my copy of nursing diagnosis handbook: a guide to planning care by ackley and ladwig.