Need help with Wellness Care Plan

  1. I just started back to school to get my BSN. I have been out of school for 18 years and never in all that time have I worked in a hospital that had us actually use the care plan information that I learned in school. Needless to say, I have forgotten a lot, and a lot has changed. I am taking a health promotion course and have an assignment due that requires us to pick a wellness diagnosis for our client. I have chosen Readiness for Enhanced Nutrition, but am not really sure how to use this diagnosis. Do we still have to have a related to and an as evidenced by? What would be some good interventions other than nutrition counseling? How would you use this diagnosis? Can anyone help?
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    About debfay

    Joined: Mar '09; Posts: 7; Likes: 2


  3. by   Daytonite
    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.
  4. by   debfay
    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.
  5. by   Daytonite
    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.